1
New targets: ROS1, NTRK, MEK
Angelo Delmonte
Responsabile SSD Oncologia Toracica Responsabile Unità Clinica di Studi di Fase 1
IRST-IRCCS
Driver Mutations
NTRK 1%
ROS1 FUSION PROTEIN INTRACELLULAR PATHWAYS
Crizotinib in ROS1+ NSCLC: PFS data
First line drugs under development
• Lorlatinib: ALK ROS1
• Repotrectinib: ROS1, ALK, TRK
• Entrectinib: ALK, ROS1, TRK
Repotrectinib (Phase 1) Lorlatinib (Phase 2 EXP 6)
Novel 1
stline ROS1 inhibitors
(44-97)
Entrectinib in ROS1+ NSCLC 1
stline: Integrated Analysis
Doebele RC, et al. WCLC 2018. Abstract OA02.01. ClinicalTrials.gov. NCT02568267.
Drilon A, et al. Cancer Discov. 2017;7:400-409.
• Primary endpoints: ORR, DoR
• Secondary endpoints: PFS, OS, intracranial ORR and DoR, safety/tolerability
Efficacy population:
ROS1+ NSCLC with no prior ROS1
inhibitor (n = 53)
Safety population:
Entrectinib-treated ROS1+, all tumor
types and gene rearrangements
(n = 355)
STARTRK-2
Multicenter, global basket phase II study; 600 mg QD, 28-day cycle (n = 37 with NSCLC)
ALKA-372-001
Phase I dose escalation (n = 9 with NSCLC)
STARTRK-1
Phase I dose escalation
(n = 7 with NSCLC)
Doebele RC, et al. WCLC 2018. Abstract OA02.01
Entrectinib in ROS1+ NSCLC: Integrated Analysis
Median DOR 24.6 mo (11.4-34.8)
Acquired Resistance Mechanisms
On target Off target
Available data with ROS1 inhibitors in crizotinib refractory ROS1 NSCLC
Repotrectinib (Phase 1) Lorlatinib (Phase 2 EXP 6)
Novel ROS1 inhibitors after TKI treament
TRK signaling pathway
TRK Inhibitors Under Development
ORR 75% (95% CI, 61 to 85) Grade 3-4 AE 5%
Entrectinib Safety Profile
MEK IN THE RAF INTRACELLULAR PATHWAYS
Leonetti, Cancer Treat Rev 2018
EGFR, MET, Other
PFS in KRASm population OS in KRASm poulation
mORR 33% mDOR 9.9 mo
SAE 42%; most frequent G3: asthenia 5%, cutaneous squamous cell carcinoma 12%, basal-cell carcinoma 5%
Study Results D in 2° line D+T in 2° line D+T in 1° line ORR 33% (23-45%) 63.2% (49.3-75.6%) 64% (46-79%) PFS (mo) 5.5 (3.4-7.3) 9.7 (6.9-19.6) 10.9 (7.0-16.6) DoR (mo) 9.6 (5.4-15.2) 9.0 (6.9-18.3) 10.4 (8.3-17.9) OS (mo) 12.7 (7.3-16.3) 18.2 (14.3- NE) 24.6 (12.3-NE)
Addition of Trametinib (T) to Dabrafenib (D) in V600E positive NSCLC
Planchard et al. Lancet Oncol 2016; 17: 642 Planchard et al. Lancet Oncol 2016; 17: 984 Planchard et al. Lancet Oncol 2017; 18: 1307 Khunger et al. Ther Adv in Resp Dis 2018; 12: 1