Preliminary results of TATTON, a multi-arm phase Ib trial of AZD9291 combined with MEDI4736, AZD6094 or selumetinib in EGFR-mutant lung cancer.

Developmental Therapeutics—Clinical Pharmacology and Experimental Therapeutics
Session Type and Session Title: 
Poster Discussion Session, Developmental Therapeutics—Clinical Pharmacology and Experimental Therapeutics
Abstract Number: 


Poster Board Number: 
Board #225
J Clin Oncol 33, 2015 (suppl; abstr 2509)
Geoffrey R. Oxnard, Suresh S. Ramalingam, Myung-Ju Ahn, Sang-We Kim, Helena Alexandra Yu, Hideo Saka, Leora Horn, Koichi Goto, Yuichiro Ohe, Mireille Cantarini, Paul Frewer, Michael Lahn, James Chih-Hsin Yang; Dana-Farber Cancer Institute, Boston, MA; The Winship Cancer Institute of Emory University, Atlanta, GA; Samsung Medical Center, Seoul, South Korea; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Memorial Sloan Kettering Cancer Center, New York, NY; Nagoya Medical Center, Nagoya, Japan; Vanderbilt-Ingram Cancer Center, Nashville, TN; Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; National Cancer Center Hospital East, Kashiwa, Japan; AstraZeneca, Macclesfield, United Kingdom; Department of Oncology, National Taiwan University Hospital; Graduate Institute of Oncology & Cancer Research Center, National Taiwan University, Taipei, Taiwan

Abstract Disclosures


Background: AZD9291 is an irreversible, mutant-selective EGFR tyrosine kinase inhibitor (TKI) developed to have potency against EGFR mutations, including T790M, while sparing wildtype EGFR. In the previous phase I study of AZD9291, EGFR-mediated toxicity was reduced compared to available EGFR-TKIs. We hypothesized that the safety profile of AZD9291 would permit combinations with other targeted therapies in a tolerable fashion. Methods: TATTON (NCT02143466) is a multi-arm phase Ib trial studying AZD9291 in combination with MEDI4736 (anti-PD-L1 mAb), AZD6094 (MET inhibitor) or selumetinib (MEK1/2 inhibitor; AZD6244, ARRY-142886). Eligibility required advanced EGFR-mutant lung cancer, progression on any prior EGFR-TKI, measurable disease, adequate PS (0-1) and organ function, and tissue for correlatives. In each combination, AZD9291 was dosed at 80 mg daily and the 2nd agent was escalated from a dose below the phase II monotherapy dose. Using a rolling 6 design, patients (pts) were randomly allocated to a combination arm. Data included here are preliminary and will be updated for presentation. Results: As of 8 January 2015, 42 pts have been enrolled on combination therapy (MEDI4736 = 14 pts; AZD6094 = 7 pts, selumetinib = 21 pts). All 3 combination agents were escalated to their phase II monotherapy doses; an additional arm continues to explore intermittent dosing of selumetinib. Adverse event (AE) data is currently available for 20 pts from all arms and cycles and includes mild/moderate AEs in 16 pts (6 skin, 5 laboratory, 2 gastrointestinal, 3 other) and severe AEs in 4 pts (1 skin, 1 laboratory, 1 gastrointestinal and 1 metabolism); 2 DLTs were reported (fatigue – AZD6094 arm; transaminase elevation – selumetinib arm). To date, 3 partial responses (PR) have been seen with AZD9291/MEDI4736, 2 PR with AZD9291/AZD6094, and 2 PR with AZD9291/selumetinib. Combination dose finding is expected to complete by May 2015. Conclusions: The toxicity profile of AZD9291 makes rational combinations with potentially synergistic targeted therapies feasible at biologically active doses. Expansion cohorts are planned for pts with acquired resistance to third-generation EGFR-TKI. Clinical trial information: NCT02143466