Montag, 26. Juli 2021
Navigation öffnen

AFAMOSI: Efficacy and Safety of Afatinib Followed by Osimertinib Compared to Osimertinib in Patients With EGFRmutated/T790M Mutation Negative Nonsquamous NSCLC



September 2020

Letztes Update:

Afatinib, Osimertinib

Indikation (Clinical Trials):
Carcinoma, Non-Small-Cell Lung


Erwachsene (18+)

Phase 4

Michael Hopp

Boehringer Ingelheim


Thomas Wehler, Prof Dr med
Principal Investigator
Evangelisches Krankenhaus Hamm


(3 von 8)

Evangelisches Krankenhaus Hamm
59063 Hamm
GermanyRekrutierend» Google-Maps
Thomas Wehler, Prof Dr med
Phone: +49 2381 589
Phone (ext.): 1864
» Ansprechpartner anzeigen
Klinikverbund Allgäug gGmbH, Klinik für Pneumologie, c/o Klinik
87509 Immenstadt
GermanyRekrutierend» Google-Maps
Christian Schumann, Prof. Dr. med.

Robert Kaiser, Dr. med
» Ansprechpartner anzeigen
Pankreaskarzinomzentrum Universitätsklinikum Regensburg
Franz-Josef-Strauß-Allee 11
93053 Regensburg
DeutschlandRekrutierend» Google-Maps
Christian Schulz, Professor

Maximilian V Malfertheiner, PhD
» Ansprechpartner anzeigen
Alle anzeigen


Brief Summary:

This randomized, open label Phase IV trial will be performed in patients with a diagnosis of

advanced NSCLC (non-squamous cell histology), harboring EGFR mutation positive but T790M

Mutation negative, who have no previous chemotherapy for metastatic NSCLC. Neoadjuvant or

adjuvant systemic treatments had to be finished at least (≥) 6 months before study inclusion.

In conclusion, this study is investigating the important clinical question whether tumor

growth and long term overall survival for a patient is better controlled in a specific

treatment sequence of different EGFR-inhibitors. Patients will be treated with registered

compounds according to their label in both treatment arms. Thus, all patients will get an

effective treatment regimen and patients who progressed on afatinib, and who developed a

T790M mutation will be treated subsequently with osimertinib. Those who progressed under

osimertinib or under afatinib without T790M mutation will be treated according to the current

treatment guidelines with Investigator´s choice of active therapy (ICT) including but not

limited to platin doublet chemotherapy.


Inclusion Criteria:

- Histologically confirmed non-squamous NSCLC harboring EGFR mutation positive but T790M

mutation negative by local testing

- Unresectable stage UICC ≥ IIIb or metastatic stage UICC IV disease

- TKI naïve for metastatic NSCLC, neoadjuvant or adjuvant chemotherapy allowed

- At least one evaluable lesion according to RECIST v1.1

- Age ≥ 18 years

- ECOG performance status 0 - 2

- Adequate organ function, defined as all of the following:

1. Absolute neutrophil count (ANC) ≥ 1500/mm3. (ANC > 1000/mm3 may be considered in

special circumstances such as benign cyclical neutropenia as judged by the

investigator and in discussion with the coordinating investigator)

2. Platelet count ≥ 75,000/mm3

3. Estimated glomerular filtration rate (eGFR) > 45 ml/min/1.73 m2 according to the

Cockcroft-Gault formula d. If history of cardiac comorbidity: Left ventricular

function with resting ejection fraction ≥ 50% or above the institutional lower

limit of normal (LLN)

e. Total Bilirubin ≤ 1.5 times upper limit of normal (ULN), (if related to liver

metastases ≤ 3 times ULN). (Patients with Gilbert's syndrome total Bilirubin must be ≤

4 times institutional upper limit of normal) f. Aspartate amino transferase (AST) or

alanine amino transferase (ALT) ≤ 3 times the upper limit of normal (ULN) (if related

to liver metastases ≤ 5 times ULN)

- Recovered from any previous therapy related toxicity to ≤ Grade 1 at before

randomization (except for stable sensory neuropathy ≤ Grade 2 and alopecia)

- Written informed consen

Exclusion Criteria:

- Any investigational drug within 30 days or hormonal anticancer treatment within 2

weeks prior to randomization (continued use of anti-androgens and/or gonadorelin

analogues for treatment of prostate cancer permitted)

- T790M mutation positive tumors (by local testing)

- Radiotherapy within 2 weeks prior to randomization, except as follows:

1. Palliative radiation to target organs other than chest may be allowed up to 1

week prior to randomization

2. Single dose palliative treatment for symptomatic metastasis outside above

allowance to be discussed with coordinating investigator prior to enrolling

- Major surgery within 2 weeks before starting study treatment or scheduled for surgery

during the projected course of the study

- Known hypersensitivity to afatinib or osimertinib or the excipients of any of the

trial drugs

- History or presence of clinically relevant cardiovascular abnormalities such as

1. uncontrolled hypertension

2. congestive heart failure NYHA classification of ≥ 3

3. unstable angina or poorly controlled arrhythmia as determined by the investigator

4. Myocardial infarction within 6 months prior to randomization

5. Clinically important abnormalities in rhythm and conduction as measured by

resting electrocardiogram (ECG) (e.g. QTc interval greater than 470 ms) or QTc

interval prolongation with signs/symptoms of serious arrhythmia

6. Congenital long QT syndrome, congestive heart failure, electrolyte abnormalities,

or intake of medicinal products that are known to prolong the QTc interval

- Patients with a past or present medical history of

1. Interstitial lung disease (ILD), drug-induced ILD, radiation pneumonitis that

required steroid treatment, or any evidence of clinically active ILD

2. Any history of or concomitant condition that, in the opinion of the Investigator,

would compromise the patient's ability to comply with the study or interfere with

the evaluation of the efficacy and safety of the test drug

3. Any history or presence of poorly controlled gastrointestinal disorders that

could affect the absorption of the study drug (e.g. Crohn's disease, ulcerative

colitis, chronic diarrhoea, malabsorption)

4. Known active hepatitis B infection (defined as presence of HepB sAg and/ or Hep B

DNA), active hepatitis C infection (defined as presence of Hep C RNA) and/or

known HIV carrier

5. Previous or concomitant malignancies at other sites, except effectively treated

non-melanoma skin cancers, carcinoma in situ of the cervix, ductal carcinoma in

situ or effectively treated malignancy that has been in remission for more than 5

years and is considered to be cured

- Pregnancy and contraception:

1. Women who are pregnant, nursing, or who plan to become pregnant while in the


2. Women of child-bearing potential (WOCBP) and men who are able to father a child,

unwilling to be abstinent or use highly effective methods of birth control that

result in a low failure rate of less than 1% per year when used consistently and

correctly beginning at informed consent, for the duration of study participation

and for at least 2 months for females and 4 months for males after last dose

- Requiring treatment with any of the prohibited concomitant medications protein

Inhibitors/Inductors CYP3A4/5 Inhibitors/Inductors that cannot be stopped for the

duration of trial participation or concomitant St. John's Wort

- Uncontrolled brain metastases (Patients with brain or subdural metastases are not

eligible, unless they have completed local therapy (≤ 2 weeks apart from last

radiotherapy or radiosurgery) and have discontinued the use of corticosteroids,

anticonvulsants or have been on stable dose of corticosteroids (i.e. Dexamethasone ≤ 8

mg) for at least 4 weeks before starting study treatment. Any symptoms attributed to

brain metastases must be stable for at least 4 weeks before starting study treatment)

or Leptomeningeal carcinomatosis 11. Other contraindications to study treatment

(Investigators opinion) or legal incapacity or limited legal capacity


Primary outcome:

1. Time to EGFR-TKI failure within 24 months for afatinib followed by osimertinib in T790Mpositive group vs osimertinib (Time Frame - 24 months):
The main objective is to investigate whether the time to EGFR-TKI failure at 24 months is better for the treatment sequence of afatinib followed by osimertinib in the T790M positive group compared to osimertinib.

Secondary outcome:

1. Time to EGFR-TKI failure (afatinib versus osimertinib) (Time Frame - 24 months):
Time from randomization until ICT is indicated

2. Progression-free survival (PFS: afatinib followed by osimertinib or ICT vs osimertinib followed by ICT) (Time Frame - 24 months):
Time from randomization until disease progression according to RECIST or death

3. Overall Survival (OS) (Time Frame - 24 months):
Survival Status

4. Response Rate (RR) (Time Frame - 12 months):
CR+PR according to RECIST

5. Response Rate (RR) (Time Frame - 24 months):
CR+PR according to RECIST

6. Disease Control Rate (DCR) (Time Frame - 12 months):
CR+PR+SD according to RECIST

7. Disease Control Rate (DCR) (Time Frame - 24 months):
CR+PR+SD according to RECIST

8. Adverse Events (Time Frame - 24 months):
Adverse Events as assessed by intensity of the of the adverse events and the causal relation to trial medication Intensity/Severity: investigator will use the following definitions of severity in accordance with National Cancer Institute common terminology criteria for adverse events, CTCAE, version 5.0; assessment of the relationship of an adverse event to the administration of study drug is a clinical decision by the investigator Institute common terminology criteria for adverse events, CTCAE, version 5.0

9. Symptom control assessed by patient-reported quality of life (QoL): EQ-5D (Time Frame - 24 months):
patient-reported quality of life assessed by European Quality of Life 5 Dimensions Questionnaire (EQ-5D)

10. Symptom control assessed by patient-reported quality of life (QoL): EORTC QLQ-C30 (Time Frame - 24 months):
patient-reported quality of life assessed by Questionnaire of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)

11. Symptom control assessed by patient-reported quality of life (QoL): EORTC QLQ-LC29 (Time Frame - 24 months):


  • Experimental: Afatinib
    Afatinib followed by osimertinib or ICT depending on T790M status
  • Active Comparator: Osimertinib
    Osimertinib followed by ICT

Geprüfte Regime

  • Afatinib (Osimertinib):
    Afatinib followed by osimertinib or ICT
  • Osimertinib:
    Osimertinib followed by ICT


Das könnte Sie auch interessieren
EHA 2021
  • SCD: Häufigere und längere VOC-bedingte Krankenhausaufenthalte nach Vorgeschichte von VOC-Hospitalisierungen – Ergebnisse einer Beobachtungsstudie
  • Real-World-Daten des ERNEST-Registers untermauern Überlebensvorteil unter Ruxolitinib bei primärer und sekundärer Myelofibrose
  • I-WISh-Studie: Ärzte sehen TPO-RAs als beste Option, um anhaltende Remissionen bei ITP-Patienten zu erzielen
  • Phase-III-Studie REACH2 bei steroidrefraktärer akuter GvHD: Hohes Ansprechen auf Ruxolitinib auch nach Crossover
  • SCD: Neues digitales Schmerztagebuch zur tagesaktuellen Erfassung von VOCs wird in Beobachtungsstudie geprüft
  • Französische Real-World-Studie: Eltrombopag meist frühzeitig nach ITP-Diagnose im Rahmen eines Off-label-Use eingesetzt
  • Fortgeschrittene systemische Mastozytose: Französische Real-World-Studie bestätigt klinische Studiendaten zur Wirksamkeit von Midostaurin
  • CML-Management weitgehend leitliniengerecht, aber verbesserungsfähig – Ergebnisse einer Querschnittsbefragung bei britischen Hämatologen
  • Britische Real-World-Studie: Kardiovaskuläres Risikomanagement bei MPN-Patienten in der Primärversorgung nicht optimal
  • Myelofibrose: Früher Einsatz von Ruxolitinib unabhängig vom Ausmaß der Knochenmarkfibrose