KEY TAKEAWAYS
- The interventional study aimed to evaluate the efficacy of furmonertinib, bevacizumab, and intrathecal chemo for EGFR+ NSCLC with leptomeningeal metastasis after TKI failure.
- The study determined ORR, DCR, PFS, and toxicity.
- Rechallenging with furmonertinib, bevacizumab, and intrathecal chemo showed promise, warranting further study.
Leptomeningeal metastasis (LM) poses a significant challenge in non-small cell lung cancer (NSCLC) and is consistently associated with a dismal prognosis. The most effective treatment for EGFR-mutated NSCLC patients with LM following EGFR-TKI therapy failure is uncertain. Furmonertinib, a novel third-generation EGFR-TKI, demonstrated promising antitumor activity and a broad therapeutic range with minimal toxicity in a phase I-II dose-expansion study.
Shencun Fang and other team members aimed to assess the real-world efficacy and safety of combining furmonertinib 160mg with bevacizumab and intrathecal chemotherapy in EGFR-mutated NSCLC patients with leptomeningeal metastasis following initial TKI failure.
The study was conducted on 19 NSCLC patients with LM who underwent treatment with furmonertinib, bevacizumab, and intrathecal chemotherapy at Nanjing Chest Hospital between February 2021 and April 2023. All participants had previously received third-generation EGFR TKIs. The study assessed objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and toxicity.
The median age was 57 years (range: 31-77), with 31.6% males and 68.4% females. ECOG performance statuses were 21.1% ECOG 2, 36.8% ECOG 3, and 42.1% ECOG 4. 84.2% achieved partial remission (PR) of LM, with 15.8% having stable disease (SD). Intracranial ORR (iORR) was 84.2%, and intracranial DCR (iDCR) was 100%.
Overall, 26.3% had PR, and 100% had SD in the entire lesion, yielding an ORR of 26.3% and DCR of 100%. Median PFS was 11.9 months (95% CI 2.8–21.0). Overall survival data were immature (overall maturity: 26%). Treatment-related adverse events (TRAEs) ≥ grade 3 occurred in only 5.3% of patients, aligning with the safety profile of previous furmonertinib studies.
The study showed that furmonertinib rechallenges, combined with bevacizumab and intrathecal chemotherapy, demonstrate notable efficacy and a well-tolerated safety profile in EGFR-mutated NSCLC patients following third-generation EGFR-TKI treatment failure, with ongoing exploration. Research was sponsored by Allist Pharmaceuticals, Inc.
Source: https://cslide.ctimeetingtech.com/asia2023/attendee/confcal/show/session/78
Clinical Trial: https://clinicaltrials.gov/study/NCT03127449
Fang SC, Zhao M, Wang X, Xu T, et al.(2023) ‘’- Furmonertinib in combination with bevacizumab and intrathecal chemotherapy as later-line re-challenge treatment in EGFR –mutated NSCLC patients with leptomeningeal metastasis after third-generation EGFR-TKIs treatment failure.’’ Presented at ESMO ASIA 2023 (567P).
