TAGRISSO® (osimertinib) granted Priority Review in the US for patients with unresectable, Stage III EGFR-mutated lung cancer

Rhea-AI Summary

AstraZeneca's supplemental New Drug Application (sNDA) for TAGRISSO® (osimertinib) has received Priority Review from the FDA for treating adult patients with unresectable, Stage III EGFR-mutated non-small cell lung cancer (NSCLC) post-chemoradiotherapy. The decision is based on the LAURA Phase III trial, which indicated a significant extension in median progression-free survival (PFS) of more than three years. TAGRISSO was also granted Breakthrough Therapy Designation for this setting. The FDA action date is anticipated in Q4 2024. TAGRISSO showed an 84% reduction in the risk of disease progression or death compared to placebo, with a PFS of 39.1 months versus 5.6 months with placebo. Safety profiles were consistent with no new concerns identified. Additionally, TAGRISSO is approved in over 100 countries for various indications in treating EGFR-mutated NSCLC.

Positive

• TAGRISSO granted Priority Review by FDA for unresectable, Stage III EGFR-mutated NSCLC.
• Breakthrough Therapy Designation received, accelerating development and review.
• LAURA Phase III trial showed a median progression-free survival (PFS) extension of over three years.
• FDA action date anticipated in Q4 2024, indicating a faster regulatory path.
• Data indicated a significant 84% reduction in the risk of disease progression or death compared to placebo.
• Safety profile consistent with no new safety concerns identified.
• TAGRISSO is already approved in over 100 countries for various EGFR-mutated NSCLC indications.

Negative

• Serious adverse events reported include interstitial lung disease, QTc interval prolongation, and cardiomyopathy.
• Heart rate-corrected QT (QTc) interval prolongation observed in 4.3% of patients from baseline.
• Cardiomyopathy occurred in 3.8% of TAGRISSO-treated patients, with 0.1% fatal cases.
• Aplastic anemia cases reported, some with fatal outcomes.

Insights

Oncology Doctor

This news is significant for patients with unresectable, Stage III EGFR-mutated non-small cell lung cancer (NSCLC). The LAURA Phase III trial showed that Tagrisso extended median progression-free survival (PFS) by more than three years, which is a substantial improvement. This can provide hope for patients with few treatment options.

The fact that Tagrisso was granted Priority Review and Breakthrough Therapy Designation by the FDA highlights its potential as a game-changer in this space. These designations are given to treatments that are expected to offer substantial improvements over existing therapies. For patients, this could mean earlier access to a potentially life-saving treatment.

However, it's essential to consider the side effects and safety profile of Tagrisso. The trial noted some severe adverse effects like interstitial lung disease and cardiomyopathy, which need to be closely monitored. Despite these concerns, the overall benefit-risk profile appears favorable for patients with this specific type of lung cancer.

Financial Analyst

From a financial perspective, this development is a positive for AstraZeneca. The Priority Review status implies a faster approval process, which can lead to earlier market entry and revenue generation. Given the sizeable market for lung cancer treatments, this could significantly boost the company's oncology sales.

Tagrisso is already approved in multiple indications and markets, but this new application broadens its potential use, which can drive further revenue growth. Investors should note that the Phase III trial results were highly favorable, with an 84% reduction in the risk of disease progression or death compared to placebo, which is impressive.

However, the competition in the oncology market is fierce and other companies are also developing treatments for EGFR-mutated NSCLC. While Tagrisso's results are promising, continuous monitoring of its market performance and competition is essential. The safety profile, although consistent with previous data, could still impact long-term adoption rates.

Medical Research Analyst

The clinical data from the LAURA Phase III trial presenting a median PFS of 39.1 months compared to 5.6 months for the placebo is quite remarkable. This outcome supports the drug’s efficacy in significantly delaying disease progression, making it a potential new standard of care for this patient group.

Importantly, the benefits were consistent across various subgroups, demonstrating the treatment's broad applicability. The ongoing assessment of overall survival (OS) is another critical aspect to watch, as it could further solidify Tagrisso’s therapeutic value.

Moreover, the drug’s breakthrough therapy designation underscores the significant unmet medical need it addresses. Typically, therapies that receive this designation show promise in preliminary clinical evidence, suggesting substantial improvement over existing options. This could influence the FDA's willingness to expedite the review process.

However, while the efficacy data is compelling, it’s important to weigh it against the drug’s safety profile. Issues like QT interval prolongation and cardiomyopathy are serious and need to be carefully managed in clinical practice. These factors could influence physician prescribing patterns and patient adherence.

Decision based on LAURA Phase III trial results which extended median progression-free survival by more than three years

TAGRISSO also granted Breakthrough Therapy Designation in US in this setting

WILMINGTON, Del.--(BUSINESS WIRE)-- AstraZeneca’s supplemental New Drug Application (sNDA) for TAGRISSO^® (osimertinib) has been accepted and granted Priority Review in the US for the treatment of adult patients with unresectable, Stage III epidermal growth factor receptor-mutated (EGFRm) non-small cell lung cancer (NSCLC) after chemoradiotherapy (CRT). If approved, TAGRISSO will be indicated for EGFRm patients whose tumors have exon 19 deletions or exon 21 (L858R) mutations.

The Food and Drug Administration (FDA) grants Priority Review to applications for medicines that, if approved, would offer significant improvements over available options by demonstrating safety or efficacy improvements, preventing serious conditions or enhancing patient compliance.¹ The Prescription Drug User Fee Act date, the FDA action date for their regulatory decision, is anticipated during the fourth quarter of 2024.

TAGRISSO was also recently granted Breakthrough Therapy Designation (BTD) by the FDA in this setting. BTD accelerates the development and regulatory review of potential new medicines intended to treat a serious condition and address a significant unmet medical need.²

Each year in the US, there are nearly 200,000 people diagnosed with lung cancer, and 80-85% of these patients are diagnosed with NSCLC, the most common form of lung cancer.^3-5 Approximately 15% of NSCLC patients in the US have EGFR mutations.⁶ Nearly one in five newly diagnosed individuals with NSCLC are unresectable.⁷

Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said: “Priority Review of TAGRISSO in this early-stage curative setting is important for patients who currently have no targeted treatments available. We look forward to close collaboration with the FDA on an accelerated path to bring TAGRISSO to patients as a potential new standard of care as quickly as possible. TAGRISSO continues to serve patients as a backbone therapy in EGFR-mutated lung cancer, extending progression-free survival in the LAURA trial by more than three years and reinforcing the importance of testing for EGFR mutations at the time of diagnosis.”

The sNDA is based on data from the LAURA Phase III trial recently presented during the Plenary Session at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting and simultaneously published in The New England Journal of Medicine.

In the trial, TAGRISSO reduced the risk of disease progression or death by 84% compared to placebo (hazard ratio [HR] 0.16; 95% confidence interval [CI] 0.10-0.24; p<0.001) as assessed by blinded independent central review (BICR). Median progression-free survival (PFS) was 39.1 months in patients treated with TAGRISSO versus 5.6 months for placebo. Importantly, a clinically meaningful PFS benefit was observed across all prespecified subgroups including sex, race, type of EGFR mutation, age, smoking history, and prior CRT.

Overall survival (OS) data showed a favorable trend for TAGRISSO, although data were not mature at the time of this analysis. The trial will continue to assess OS as a secondary endpoint.

Safety results and discontinuation rates due to adverse events were consistent with its known profile and no new safety concerns were identified.

TAGRISSO is approved as monotherapy in more than 100 countries including in the US, EU, China, and Japan. Approved indications include for 1st-line treatment of patients with locally advanced or metastatic EGFRm NSCLC, locally advanced or metastatic EGFR T790M mutation-positive NSCLC, and adjuvant treatment of early-stage EGFRm NSCLC. TAGRISSO with the addition of chemotherapy is also approved in the US and several other countries for 1st-line treatment of patients with locally advanced or metastatic EGFRm NSCLC.

IMPORTANT SAFETY INFORMATION

• There are no contraindications for TAGRISSO
• Interstitial lung disease (ILD)/pneumonitis occurred in 4% of the 1813 TAGRISSO-treated patients; 0.4% of cases were fatal. In the FLAURA2 study, ILD/pneumonitis occurred in 3.3% of the 276 patients who received TAGRISSO in combination with pemetrexed and platinum-based chemotherapy; 0.4% of cases were fatal. Withhold TAGRISSO and promptly investigate for ILD in patients who present with worsening of respiratory symptoms which may be indicative of ILD (eg, dyspnea, cough and fever). Permanently discontinue TAGRISSO if ILD/pneumonitis is confirmed
• Heart rate-corrected QT (QTc) interval prolongation occurs in TAGRISSO-treated patients. Of the 1813 TAGRISSO monotherapy-treated patients in clinical trials, 1.1% were found to have a QTc >500 msec, and 4.3% of patients had an increase from baseline QTc >60 msec. Of the 276 patients treated with TAGRISSO in combination with pemetrexed and platinum-based chemotherapy in the FLAURA2 study, 1.8% were found to have a QTc >500 msec, and 10.5% of patients had an increase from baseline QTc >60 msec. No QTc-related arrhythmias were reported. Conduct periodic monitoring with ECGs and electrolytes in patients with congenital long QTc syndrome, congestive heart failure, electrolyte abnormalities, or those who are taking medications known to prolong the QTc interval. Permanently discontinue TAGRISSO in patients who develop QTc interval prolongation with signs/symptoms of life-threatening arrhythmia
• Cardiomyopathy occurred in 3.8% of the 1813 TAGRISSO-treated patients; 0.1% of cardiomyopathy cases were fatal. In the FLAURA2 study, cardiomyopathy occurred in 9% of the 276 patients who received TAGRISSO in combination with pemetrexed and platinum-based chemotherapy; 1.1% of cardiomyopathy cases were fatal. A decline in left ventricular ejection fraction (LVEF) ≥10% from baseline and to <50% LVEF occurred in 4.2% of 1557 patients who had baseline and at least one follow-up LVEF assessment. In the ADAURA study, 1.5% (5/325) of TAGRISSO-treated patients experienced LVEF decreases ≥10% from baseline and a drop to <50%. In the FLAURA2 study, 8% (21/262) of patients treated with TAGRISSO in combination with pemetrexed and platinum-based chemotherapy, who had baseline and at least one follow-up LVEF assessment, experienced LVEF decreases ≥10% and a drop to less than 50%. For patients receiving TAGRISSO monotherapy, conduct cardiac monitoring in patients with cardiac risk factors, including assessment of LVEF at baseline and during treatment. For patients receiving TAGRISSO in combination with pemetrexed and platinum-based chemotherapy, conduct cardiac monitoring in all patients, including assessment of LVEF at baseline and during treatment. Assess LVEF in patients who develop relevant cardiac signs or symptoms during treatment. For symptomatic congestive heart failure, permanently discontinue TAGRISSO
• Keratitis was reported in 0.6% of 1813 patients treated with TAGRISSO monotherapy in clinical trials. Promptly refer patients with signs and symptoms suggestive of keratitis (such as eye inflammation, lacrimation, light sensitivity, blurred vision, eye pain and/or red eye) to an ophthalmologist
• Postmarketing cases consistent with erythema multiforme major (EMM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients receiving TAGRISSO. Withhold TAGRISSO if EMM, SJS, or TEN is suspected and permanently discontinue if confirmed
• Postmarketing cases of cutaneous vasculitis including leukocytoclastic vasculitis, urticarial vasculitis, and IgA vasculitis have been reported in patients receiving TAGRISSO. Withhold TAGRISSO if cutaneous vasculitis is suspected, evaluate for systemic involvement, and consider dermatology consultation. If no other etiology can be identified, consider permanent discontinuation of TAGRISSO based on severity
• Aplastic anemia has been reported in patients treated with TAGRISSO in clinical trials (0.06% of 1813) and postmarketing. Some cases had a fatal outcome. Inform patients of the signs and symptoms of aplastic anemia including but not limited to, new or persistent fevers, bruising, bleeding, and pallor. If aplastic anemia is suspected, withhold TAGRISSO and obtain a hematology consultation. If aplastic anemia is confirmed, permanently discontinue TAGRISSO. Perform complete blood count with differential before starting TAGRISSO, periodically throughout treatment, and more frequently if indicated
• Verify pregnancy status of females of reproductive potential prior to initiating TAGRISSO. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TAGRISSO and for 6 weeks after the final dose. Advise males with female partners of reproductive potential to use effective contraception for 4 months after the final dose
• Because of the potential for serious adverse reactions in breastfed infants from TAGRISSO, women should not breastfeed during treatment with TAGRISSO and for 2 weeks after the final dose
• Most common (≥20%) adverse reactions, including laboratory abnormalities, were:
  • TAGRISSO monotherapy: leukopenia, lymphopenia, thrombocytopenia, anemia, diarrhea, rash, musculoskeletal pain, neutropenia, nail toxicity, dry skin, stomatitis, and fatigue
  • TAGRISSO in combination with pemetrexed and platinum-based chemotherapy: leukopenia, thrombocytopenia, neutropenia, lymphopenia, rash, diarrhea, stomatitis, nail toxicity, dry skin, and increased blood creatinine

INDICATIONS

• TAGRISSO is indicated as adjuvant therapy after tumor resection in adult patients with non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test
• TAGRISSO is indicated for the first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test
• TAGRISSO is indicated in combination with pemetrexed and platinum-based chemotherapy, for the first-line treatment of adult patients with locally advanced or metastatic NSCLC whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test
• TAGRISSO is indicated for the treatment of adult patients with metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive NSCLC, as detected by an FDA-approved test, whose disease has progressed on or after EGFR tyrosine kinase inhibitor (TKI) therapy

Please see complete Prescription Information, including Patient Information for TAGRISSO.

You may report side effects related to AstraZeneca products by clicking here.

Notes

Lung cancer

Lung cancer is the leading cause of cancer death among both men and women, accounting for about one-fifth of all cancer deaths.⁸ Lung cancer is broadly split into NSCLC and small cell lung cancer.⁴ The majority of all NSCLC patients are diagnosed with advanced disease.⁹

Patients with EGFRm NSCLC are particularly sensitive to treatment with an EGFR-tyrosine kinase inhibitor (EGFR-TKI) which blocks the cell-signaling pathways that drive the growth of tumor cells.¹⁰

LAURA

LAURA is a randomized, double-blind, placebo-controlled, multi-center, global Phase III trial in patients with unresectable, Stage III EGFRm NSCLC whose disease has not progressed following definitive platinum‑based CRT. Patients were treated with TAGRISSO 80 mg once daily oral tablets until disease progression, unacceptable toxicity or other discontinuation criteria were met. Upon progression, patients in the placebo arm were permitted to be treated with TAGRISSO.

The trial enrolled 216 patients in more than 145 centers across more than 15 countries, including in the US, Europe, South America and Asia. This is the analysis of the primary endpoint of PFS. The trial is ongoing and will continue to assess the secondary endpoint of OS.

TAGRISSO^® (osimertinib)

TAGRISSO^® (osimertinib) is a third-generation, irreversible EGFR-TKI with proven clinical activity in NSCLC, including against central nervous system (CNS) metastases. TAGRISSO (40 mg and 80 mg once-daily oral tablets) has been used to treat nearly 800,000 patients across its indications worldwide and AstraZeneca continues to explore TAGRISSO as a treatment for patients across multiple stages of EGFRm NSCLC.

There is an extensive body of evidence supporting the use of TAGRISSO in EGFRm NSCLC. TAGRISSO is the only targeted therapy to improve patient outcomes in early-stage disease in the ADAURA Phase III trial, locally advanced stages in the LAURA Phase III trial and late-stage disease in the FLAURA Phase III trial and FLAURA2 Phase III trial.

As part of AstraZeneca’s ongoing commitment to treating patients as early as possible in lung cancer, TAGRISSO is also being investigated in the neoadjuvant setting in the NeoADAURA Phase III trial with results expected later this year and in the early-stage adjuvant resectable setting in the ADAURA2 Phase III trial.

The Company is also researching ways to address tumors mechanisms of resistance through the SAVANNAH and ORCHARD Phase II trials, and the SAFFRON Phase III trial, which test TAGRISSO plus savolitinib, an oral, potent and highly selective MET TKI, as well as other potential new medicines.

AstraZeneca in lung cancer

AstraZeneca is working to bring patients with lung cancer closer to cure through the detection and treatment of early-stage disease, while also pushing the boundaries of science to improve outcomes in the resistant and advanced settings. By defining new therapeutic targets and investigating innovative approaches, the Company aims to match medicines to the patients who can benefit most.

The Company’s comprehensive portfolio includes leading lung cancer medicines and the next wave of innovations, including TAGRISSO and gefitinib; durvalumab and tremelimumab-actl; fam-trastuzumab deruxtecan-nxki and datopotamab deruxtecan in collaboration with Daiichi Sankyo; savolitinib in collaboration with HUTCHMED; as well as a pipeline of potential new medicines and combinations across diverse mechanisms of action.

AstraZeneca is a founding member of the Lung Ambition Alliance, a global coalition working to accelerate innovation and deliver meaningful improvements for people with lung cancer, including and beyond treatment.

AstraZeneca in oncology

AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients.

The Company’s focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyze changes in the practice of medicine and transform the patient experience.

AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death.

About AstraZeneca

AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines in Oncology, Rare Diseases and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit www.astrazeneca-us.com and follow us on social media @AstraZeneca.

References

1. FDA. Priority Review. Available at: https://www.fda.gov/patients/fast-track-breakthrough-therapy-accelerated-approval-priority-review/priority-review. Accessed June 2024.
2. FDA. Frequently Asked Questions: Breakthrough Therapies. Available at: https://www.fda.gov/regulatory-information/food-and-drug-administration-safety-and-innovation-act-fdasia/frequently-asked-questions-breakthrough-therapies. Accessed June 2024.
3. National Cancer Institute. Cancer Stat Facts: Lung and Bronchus Cancer. Available at: https://seer.cancer.gov/statfacts/html/lungb.html. Accessed June 2024.
4. LUNGevity Foundation. Types of Lung Cancer. Available at: https://www.lungevity.org/lung-cancer-basics/types-of-lung-cancer. Accessed June 2024.
5. American Cancer Society. What Is Lung Cancer? Available at: https://www.cancer.org/cancer/types/lung-cancer/about/what-is.html. Accessed June 2024.
6. Keedy VL, et al. American Society of Clinical Oncology Provisional Clinical Opinion: Epidermal Growth Factor Receptor (EGFR) Mutation Testing for Patients with Advanced Non-Small-Cell Lung Cancer Considering First-Line EGFR Tyrosine Kinase Inhibitor Therapy. J Clin Oncol. 2011;29:2121-27.
7. Quint LE. Lung cancer: assessing resectability. Cancer Imaging. 2003;4(1):15-8.
8. World Health Organisation. International Agency for Research on Cancer. Lung Fact Sheet. Available at https://gco.iarc.who.int/media/globocan/factsheets/cancers/15-trachea-bronchus-and-lung-fact-sheet.pdf. Accessed June 2024.
9. Cagle P, et al. Lung Cancer Biomarkers: Present Status and Future Developments. Archives Pathology Lab Med. 2013;137:1191-1198.
10. Cross DA, et al. AZD9291, an Irreversible EGFR TKI, Overcomes T790M-Mediated Resistance to EGFR Inhibitors in Lung Cancer. Cancer Discov. 2014;4(9):1046-1061.

 US-90388 Last Updated 06/24

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FAQ

What is TAGRISSO's current status for treating unresectable, Stage III EGFR-mutated lung cancer?

As of now, TAGRISSO has received Priority Review by the FDA for this indication, with a decision anticipated in Q4 2024.

What were the results of the LAURA Phase III trial for TAGRISSO?

The LAURA Phase III trial indicated that TAGRISSO extended median progression-free survival by more than three years, reducing the risk of disease progression or death by 84% compared to placebo.

Has TAGRISSO received any special designations from the FDA?

Yes, TAGRISSO has been granted Breakthrough Therapy Designation by the FDA for treating unresectable, Stage III EGFR-mutated NSCLC.

What are the major safety concerns associated with TAGRISSO?

Major safety concerns include interstitial lung disease, QTc interval prolongation, cardiomyopathy, and aplastic anemia, some with fatal outcomes.

How widely is TAGRISSO approved for EGFR-mutated NSCLC?

TAGRISSO is approved in more than 100 countries for various indications in treating EGFR-mutated NSCLC.