Sutetinib for Patients with Non-Small Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Multicenter, Open-Label, Phase IIb Trial.

Purpose

Uncommon epidermal growth factor receptor (EGFR) mutations account for ∼10% of EGFR-altered non-small cell lung cancer (NSCLC) and show heterogeneous sensitivity to EGFR-tyrosine kinase inhibitors (TKIs), with limited prospective evidence to inform first-line therapy. Sutetinib is an irreversible EGFR-TKI. We assessed the safety and antitumor efficacy of sutetinib in patients with locally advanced or metastatic NSCLC with uncommon EGFR mutations.

Methods

In this multicenter, open-label, single-arm phase IIb trial, adults with locally advanced or metastatic NSCLC harboring EGFR G719X, S768I, L861Q, or predefined compound mutations and no prior EGFR-TKI therapy were enrolled. Patients received sutetinib 80 mg orally once daily in 28-day cycles until radiographic progression or unacceptable toxicity. Patients who received at least one dose of treatment and evaluable for efficacy analysis were included in the primary analysis, and all patients who received at least one dose of treatment were included in the safety analysis. The primary endpoint was objective response rate (ORR), as assessed by the independent review committee (IRC). Secondary endpoints included duration of response (DoR), disease control rate (DCR), time to response (TTR), progression-free survival (PFS), overall survival (OS), and safety.

Results

From December 9, 2021, to May 5, 2024, 99 patients were enrolled (efficacy-evaluable, n=96; safety, n=99). As of data cut-off in October, 2024, the median follow-up was 16.6 months. The IRC-confirmed ORR was 70.8% (95% confidence interval [CI], 60.7-79.7) and the DCR was 90.6% (95% CI, 82.9-95.6). Median DoR was 12.0 months (95% CI, 9.3-15.7) and median PFS was 13.7 months (95% CI, 10.9-16.4). Median OS was not reached (95% CI, 22.2-not reached). ORR was numerically higher in patients with compound versus solitary uncommon EGFR mutations (84.4% vs 64.1%), with median PFS of 13.8 versus 11.0 months, respectively. Treatment-related adverse events (TRAEs) of any grade occurred in 97.0% (96/99) of patients, and grade ≥3 TRAEs occurred in 42.4% (42/99). The most common grade ≥3 TRAEs were diarrhea (28.3% [28/99]), hypokalemia (8.1% [8/99]), and increased gamma-glutamyl transferase (5.1% [5/99]). TRAEs led to dose reduction in 34.3% (34/99) and treatment discontinuation in 4.0% (4/99). No treatment-related deaths occurred.

Conclusions

Sutetinib met the prespecified primary endpoint and demonstrated clinically meaningful antitumor activity with a manageable safety profile in advanced NSCLC harboring uncommon EGFR mutations (G719X, S768I, and L861Q). These findings support sutetinib as a potential treatment option for this molecularly heterogeneous population. TRIAL REGISTRATION NCT05168566.