EVOKE-01 Study Results in Metastatic NSCLC to Be Presented at an Oral Session at ASCO 2024

Rhea-AI Summary

Gilead Sciences announced results from the Phase 3 EVOKE-01 study, evaluating Trodelvy in metastatic non-small cell lung cancer (NSCLC). The study did not meet its primary endpoint of overall survival (OS), but showed a 16% reduction in the risk of death compared to docetaxel (median OS: 11.1 vs. 9.8 months). A subgroup analysis revealed a meaningful OS improvement of 3.5 months in patients whose tumors did not respond to anti-PD-(L)1 therapy (mOS: 11.8 vs. 8.3 months). Adverse events were lower with Trodelvy (66.6%) compared to docetaxel (75.7%). Notably, more patients treated with Trodelvy were alive at 12 months (46.6% vs. 36.7%). These findings were presented at the 2024 ASCO Annual Meeting and published in the Journal of Clinical Oncology.

Positive

• Trodelvy showed a 16% reduction in risk of death compared to docetaxel.
• Median overall survival was 11.1 months for Trodelvy vs. 9.8 months for docetaxel.
• A 3.5-month OS improvement in a key subgroup (11.8 vs. 8.3 months).
• Lower Grade ≥3 adverse events with Trodelvy (66.6% vs. 75.7%).
• More patients alive at 12 months with Trodelvy (46.6% vs. 36.7%).

Negative

• The study did not meet the primary endpoint of overall survival (OS).
• Subgroup analysis was not alpha-controlled for formal statistical testing.
• Median OS in responsive subgroup was worse for Trodelvy (9.6 vs. 10.6 months).
• Higher incidence of diarrhea with Trodelvy (53% vs. 34%).

Insights

Financial Analyst

The Phase 3 EVOKE-01 study results for Gilead Sciences' Trodelvy® in metastatic NSCLC provide a mixed financial outlook. On one hand, the study did not meet its primary endpoint of overall survival (OS), which is a significant drawback. Such results can negatively impact market confidence, potentially leading to a decline in stock value due to perceived inefficacy in a highly competitive oncology market.

However, the study did show a 16% reduction in the risk of death and some meaningful OS improvements in certain subgroups. Investors might see this as a positive sign for future developments and potential indications, particularly given the lower incidence of severe adverse events with Trodelvy compared to docetaxel. The drug's better safety profile could make it a more attractive option in specific patient populations, offering a potential market niche.

In the long term, Gilead’s ongoing initiatives in the broader lung cancer clinical development program, including combinations with KEYTRUDA®, suggest a commitment to enhancing their oncology pipeline. This could translate into future revenue growth if these combinations prove successful in later-stage trials.

Oncology Doctor

From a clinical perspective, the EVOKE-01 results present a nuanced picture. The primary endpoint of overall survival was not met, which underscores the challenge in treating metastatic NSCLC after progression on standard treatments. However, the subgroup analysis revealing a 3.5-month improvement in OS for a specific patient group (those who did not respond to the last anti-PD-(L)1-containing treatment) is notable. This subgroup represents a significant portion of the study population and suggests that Trodelvy may offer substantial benefits in particular contexts.

Moreover, the improved safety profile of Trodelvy, with fewer Grade ≥3 adverse events compared to docetaxel, supports its potential as a less toxic alternative. This is particularly important in oncology, where treatment tolerability can significantly impact patient quality of life and adherence.

Overall, while the primary endpoint miss is a setback, the data indicate potential areas where Trodelvy could be further investigated and possibly integrated into treatment protocols, especially for patients with high unmet medical needs.

– Simultaneously Published by the Journal of Clinical Oncology –

FOSTER CITY, Calif.--(BUSINESS WIRE)-- Gilead Sciences, Inc. (Nasdaq: GILD) today announced detailed results from the Phase 3 EVOKE-01 study that will be presented during an oral session (Abstract #LBA8500) today (2:45-5:45pm CT) at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. The results were also published simultaneously in the Journal of Clinical Oncology. The company previously announced that the study did not meet the primary endpoint of overall survival (OS) in previously treated metastatic non-small cell lung cancer (NSCLC).

EVOKE-01, evaluating Trodelvy^® (sacituzumab govitecan-hziy; SG) vs. docetaxel, showed a 16% reduction in the risk of death (median OS: 11.1 vs. 9.8 months; HR: 0.84; 95% CI: 0.68-1.04; 1-sided p=0.0534) in patients with metastatic or advanced NSCLC that had progressed on or after platinum-based chemotherapy and anti-PD-(L)1-therapy. This numerical improvement in OS was observed consistently across both squamous and non-squamous histology. In patients with high unmet medical need whose tumors did not respond to last anti-PD-(L)1-containing treatment, a meaningful OS improvement of 3.5 months was seen when treated with Trodelvy vs. docetaxel (mOS: 11.8 vs. 8.3 months; HR: 0.75; 95% CI: 0.58-0.97). This subgroup represents approximately 2/3 of the study population. This pre-specified subgroup analysis was not alpha-controlled for formal statistical testing.

For the subgroup of patients whose mNSCLC was responsive to last anti-PD-(L)1-containing treatment, median OS was 9.6 vs. 10.6 months when treated with Trodelvy vs. docetaxel (HR: 1.09; 95% CI: 0.76-1.56). In the overall study population numerically more patients were alive at 12-months when treated with Trodelvy compared to docetaxel (46.6% vs. 36.7%).

In the study, Grade ≥3 adverse events (AEs) were lower among patients receiving Trodelvy (66.6%) vs. docetaxel (75.7%), and AEs leading to discontinuation were lower with Trodelvy (9.8%) vs. docetaxel (16.7%). The most common AEs of any grade for Trodelvy were fatigue (57%), diarrhea (53%), and alopecia (43%) and for docetaxel were fatigue (56%), neutropenia (43%) and diarrhea (34%). Patients treated with docetaxel had a greater incidence of neutropenia of any grade compared with Trodelvy (43% vs. 38%, respectively), while patients treated with Trodelvy experienced more diarrhea of any grade vs. docetaxel (53% vs. 34%, respectively). The safety profile for Trodelvy was consistent with prior studies, with no new safety signals identified in this patient population.

“Treating patients with metastatic NSCLC who have progressed on available treatments continues to be a challenge. After progression, standard of care for most patients is limited to single-agent chemotherapy, which offers modest benefit,” said Dr. Luis Paz-Ares, PhD, Head of the Medical Oncology Service at the Hospital Universitario 12 de Octubre, Madrid. “These data, including the meaningful benefit observed in the sub-group of patients, are encouraging and warrants further investigation as these patients have a great unmet need.”

“Our data in metastatic NSCLC demonstrating Trodelvy’s activity continue to advance our understanding of the potential to build on our impact for patients,” said Merdad Parsey, MD, PhD, Chief Medical Officer, Gilead Sciences. “We look forward to further investigating how these data may positively impact patients in the second-line setting. We would also like to thank the patients, families, investigators and advocates who contributed to this important research.”

In addition to the EVOKE-01 presentation at the 2024 ASCO Annual Meeting, Gilead will present data from its broader lung cancer clinical development program. Longer-term results from Cohort A of the Phase 2 EVOKE-02 study of Trodelvy in combination with KEYTRUDA^® (pembrolizumab) in first-line metastatic PD-L1 ≥50% NSCLC will also be presented in a poster session (Abstract #8592) on June 3, 2024. These data show a median progression-free survival (PFS) of 13.1 months and support promising activity in this patient population in both squamous and non-squamous histologies. These data continue to support our ongoing Phase 3 EVOKE-03 study in PD-L1-high mNSCLC. In addition, Gilead has a broad clinical development program in lung cancer with domvanalimab, the first Fc-silent investigational anti-TIGIT antibody, and the investigational anti-PD-L1, zimberelimab.

Trodelvy is the first approved Trop-2-directed antibody-drug conjugate (ADC) that has demonstrated meaningful survival advantages in two different types of metastatic breast cancers and shown improved clinical outcomes for certain people with 2L advanced or metastatic urothelial cancer.

Trodelvy has not been approved by any regulatory agency for the treatment of metastatic NSCLC. Its safety and efficacy have not been established for this indication. Trodelvy has a Boxed Warning for severe or life-threatening neutropenia and severe diarrhea; please see below for the approved U.S. Indication and additional Important Safety Information.

KEYTRUDA® is a registered trademark of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.

About Metastatic Non-Small Cell Lung Cancer

Worldwide, more than two million people were diagnosed with lung cancer in 2020. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for up to 85% of diagnoses. About half of NSCLC cases are diagnosed at the metastatic stage (57%), when treatment is especially difficult. Even in patients whose disease is caught early, half will eventually progress to the metastatic stage within five years. Newly diagnosed patients have several treatment options including platinum-based therapy, checkpoint inhibitors and targeted therapies. However, there are limited treatment options once patients with metastatic NSCLC progress on or after platinum-based chemotherapy and checkpoint inhibitors.

About the EVOKE-01 Study

The EVOKE-01 study is a global, multi-center, open-label Phase 3 study randomized 1:1 to evaluate Trodelvy vs. docetaxel in patients with advanced or metastatic NSCLC that has progressed on or after platinum-based chemotherapy and checkpoint inhibitor therapy. The study enrolled 603 participants. The primary endpoint is overall survival (OS). Key secondary endpoints include progression-free survival (PFS), objective response rate (ORR), duration of response (DoR) and disease control rate (DCR) as assessed by investigator per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and safety. Additional efficacy measures include time to first deterioration in shortness of breath domain as measured by NSCLC Symptom Assessment Questionnaire (NSCLC-SAQ) Score and time to first deterioration NSCLC-SAQ Total Score. Further study details are available on clinicaltrials.gov (NCT05089734).

About Trodelvy

Trodelvy^® (sacituzumab govitecan-hziy) is a first-in-class Trop-2-directed antibody-drug conjugate. Trop-2 is a cell surface antigen highly expressed in multiple tumor types, including in more than 90% of breast, bladder and lung cancers. Trodelvy is intentionally designed with a proprietary hydrolyzable linker attached to SN-38, a topoisomerase I inhibitor payload. This unique combination delivers potent activity to both Trop-2 expressing cells and the tumor microenvironment through a bystander effect.

Trodelvy is approved in almost 50 countries, with multiple additional regulatory reviews underway worldwide, for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) who have received two or more prior systemic therapies, at least one of them for metastatic disease.

Trodelvy is also approved in multiple countries globally to treat certain patients with pre-treated HR+/HER2- metastatic breast cancer in Australia, Brazil, Canada, the European Union, Israel, United Arab Emirates and the United States. In the U.S., Trodelvy has an accelerated approval for treatment of certain patients with second-line or later advanced or metastatic urothelial cancer; see below for full indication statements and please see yesterday’s announcement of topline results from Gilead’s Phase 3 TROPiCS-04 study in locally advanced or metastatic urothelial cancer.

Trodelvy is being explored for potential investigational use in other TNBC, HR+/HER2- and metastatic UC populations, as well as a range of tumor types where Trop-2 is highly expressed, including metastatic non-small cell lung cancer (NSCLC), head and neck cancer, gynecological cancer, and gastrointestinal cancers.

U.S. Indications for Trodelvy

In the United States, Trodelvy is indicated for the treatment of adult patients with:

• Unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC) who have received two or more prior systemic therapies, at least one of them for metastatic disease.
• Unresectable locally advanced or metastatic hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (IHC 0, IHC 1+ or IHC 2+/ISH–) breast cancer who have received endocrine-based therapy and at least two additional systemic therapies in the metastatic setting.
• Locally advanced or metastatic urothelial cancer (mUC) who have previously received a platinum-containing chemotherapy and either programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor. This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

U.S. Important Safety Information for Trodelvy

BOXED WARNING: NEUTROPENIA AND DIARRHEA

• Severe or life-threatening neutropenia may occur. Withhold Trodelvy for absolute neutrophil count below 1500/mm³ or neutropenic fever. Monitor blood cell counts periodically during treatment. Consider G-CSF for secondary prophylaxis. Initiate anti-infective treatment in patients with febrile neutropenia without delay.
• Severe diarrhea may occur. Monitor patients with diarrhea and give fluid and electrolytes as needed. At the onset of diarrhea, evaluate for infectious causes and, if negative, promptly initiate loperamide. If severe diarrhea occurs, withhold Trodelvy until resolved to ≤Grade 1 and reduce subsequent doses.

CONTRAINDICATIONS

• Severe hypersensitivity reaction to Trodelvy.

WARNINGS AND PRECAUTIONS

Neutropenia: Severe, life-threatening, or fatal neutropenia can occur and may require dose modification. Neutropenia occurred in 64% of patients treated with Trodelvy. Grade 3-4 neutropenia occurred in 49% of patients. Febrile neutropenia occurred in 6%. Neutropenic colitis occurred in 1.4%. Withhold Trodelvy for absolute neutrophil count below 1500/mm³ on Day 1 of any cycle or neutrophil count below 1000/mm³ on Day 8 of any cycle. Withhold Trodelvy for neutropenic fever. Administer G-CSF as clinically indicated or indicated in Table 1 of USPI.

Diarrhea: Diarrhea occurred in 64% of all patients treated with Trodelvy. Grade 3-4 diarrhea occurred in 11% of patients. One patient had intestinal perforation following diarrhea. Diarrhea that led to dehydration and subsequent acute kidney injury occurred in 0.7% of all patients. Withhold Trodelvy for Grade 3-4 diarrhea and resume when resolved to ≤Grade 1. At onset, evaluate for infectious causes and if negative, promptly initiate loperamide, 4 mg initially followed by 2 mg with every episode of diarrhea for a maximum of 16 mg daily. Discontinue loperamide 12 hours after diarrhea resolves. Additional supportive measures (e.g., fluid and electrolyte substitution) may also be employed as clinically indicated. Patients who exhibit an excessive cholinergic response to treatment can receive appropriate premedication (e.g., atropine) for subsequent treatments.

Hypersensitivity and Infusion-Related Reactions: Serious hypersensitivity reactions including life-threatening anaphylactic reactions have occurred with Trodelvy. Severe signs and symptoms included cardiac arrest, hypotension, wheezing, angioedema, swelling, pneumonitis, and skin reactions. Hypersensitivity reactions within 24 hours of dosing occurred in 35% of patients. Grade 3-4 hypersensitivity occurred in 2% of patients. The incidence of hypersensitivity reactions leading to permanent discontinuation of Trodelvy was 0.2%. The incidence of anaphylactic reactions was 0.2%. Pre-infusion medication is recommended. Have medications and emergency equipment to treat such reactions available for immediate use. Observe patients closely for hypersensitivity and infusion-related reactions during each infusion and for at least 30 minutes after completion of each infusion. Permanently discontinue Trodelvy for Grade 4 infusion-related reactions.

Nausea and Vomiting: Nausea occurred in 64% of all patients treated with Trodelvy and Grade 3-4 nausea occurred in 3% of these patients. Vomiting occurred in 35% of patients and Grade 3-4 vomiting occurred in 2% of these patients. Premedicate with a two or three drug combination regimen (e.g., dexamethasone with either a 5-HT3 receptor antagonist or an NK₁ receptor antagonist as well as other drugs as indicated) for prevention of chemotherapy-induced nausea and vomiting (CINV). Withhold Trodelvy doses for Grade 3 nausea or Grade 3-4 vomiting and resume with additional supportive measures when resolved to Grade ≤1. Additional antiemetics and other supportive measures may also be employed as clinically indicated. All patients should be given take-home medications with clear instructions for prevention and treatment of nausea and vomiting.

Increased Risk of Adverse Reactions in Patients with Reduced UGT1A1 Activity: Patients homozygous for the uridine diphosphate-glucuronosyl transferase 1A1 (UGT1A1)*28 allele are at increased risk for neutropenia, febrile neutropenia, and anemia and may be at increased risk for other adverse reactions with Trodelvy. The incidence of Grade 3-4 neutropenia was 58% in patients homozygous for the UGT1A1*28, 49% in patients heterozygous for the UGT1A1*28 allele, and 43% in patients homozygous for the wild-type allele. The incidence of Grade 3-4 anemia was 21% in patients homozygous for the UGT1A1*28 allele, 10% in patients heterozygous for the UGT1A1*28 allele, and 9% in patients homozygous for the wild-type allele. Closely monitor patients with known reduced UGT1A1 activity for adverse reactions. Withhold or permanently discontinue Trodelvy based on clinical assessment of the onset, duration and severity of the observed adverse reactions in patients with evidence of acute early-onset or unusually severe adverse reactions, which may indicate reduced UGT1A1 function.

Embryo-Fetal Toxicity: Based on its mechanism of action, Trodelvy can cause teratogenicity and/or embryo-fetal lethality when administered to a pregnant woman. Trodelvy contains a genotoxic component, SN-38, and targets rapidly dividing cells. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with Trodelvy and for 6 months after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with Trodelvy and for 3 months after the last dose.

ADVERSE REACTIONS

In the pooled safety population, the most common (≥ 25%) adverse reactions including laboratory abnormalities were decreased leukocyte count (84%), decreased neutrophil count (75%), decreased hemoglobin (69%), diarrhea (64%), nausea (64%), decreased lymphocyte count (63%), fatigue (51%), alopecia (45%), constipation (37%), increased glucose (37%), decreased albumin (35%), vomiting (35%), decreased appetite (30%), decreased creatinine clearance (28%), increased alkaline phosphatase (28%), decreased magnesium (27%), decreased potassium (26%), and decreased sodium (26%).

In the ASCENT study (locally advanced or metastatic triple-negative breast cancer), the most common adverse reactions (incidence ≥25%) were fatigue, diarrhea, nausea, alopecia, constipation, vomiting, abdominal pain, and decreased appetite. The most frequent serious adverse reactions (SAR) (>1%) were neutropenia (7%), diarrhea (4%), and pneumonia (3%). SAR were reported in 27% of patients, and 5% discontinued therapy due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence ≥25%) in the ASCENT study were reduced neutrophils, leukocytes, and lymphocytes.

In the TROPiCS-02 study (locally advanced or metastatic HR-positive, HER2-negative breast cancer), the most common adverse reactions (incidence ≥25%) were diarrhea, fatigue, nausea, alopecia, and constipation. The most frequent serious adverse reactions (SAR) (>1%) were diarrhea (5%), febrile neutropenia (4%), neutropenia (3%), abdominal pain, colitis, neutropenic colitis, pneumonia, and vomiting (each 2%). SAR were reported in 28% of patients, and 6% discontinued therapy due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence ≥25%) in the TROPiCS-02 study were reduced neutrophils and leukocytes.

In the TROPHY study (locally advanced or metastatic urothelial cancer), the most common adverse reactions (incidence ≥25%) were diarrhea, fatigue, nausea, any infection, alopecia, decreased appetite, constipation, vomiting, rash, and abdominal pain. The most frequent serious adverse reactions (SAR) (≥5%) were infection (18%), neutropenia (12%, including febrile neutropenia in 10%), acute kidney injury (6%), urinary tract infection (6%), and sepsis or bacteremia (5%). SAR were reported in 44% of patients, and 10% discontinued due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence ≥25%) in the TROPHY study were reduced neutrophils, leukocytes, and lymphocytes.

DRUG INTERACTIONS

UGT1A1 Inhibitors: Concomitant administration of Trodelvy with inhibitors of UGT1A1 may increase the incidence of adverse reactions due to potential increase in systemic exposure to SN-38. Avoid administering UGT1A1 inhibitors with Trodelvy.

UGT1A1 Inducers: Exposure to SN-38 may be reduced in patients concomitantly receiving UGT1A1 enzyme inducers. Avoid administering UGT1A1 inducers with Trodelvy.

Please see full Prescribing Information, including BOXED WARNING.

About Gilead Sciences

Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis, COVID-19, and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California.

Forward-Looking Statements

This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including Gilead’s ability to initiate, progress or complete clinical trials within currently anticipated timelines or at all, and the possibility of unfavorable results from ongoing or additional clinical trials, including the EVOKE-01 study and those involving Trodelvy and domvanalimab; uncertainties relating to regulatory applications and related filing and approval timelines, including pending or potential applications for Trodelvy for the treatment of metastatic and other TNBC, HR+/HER2- metastatic breast cancer, metastatic UC, metastatic NSCLC, head and neck cancer, gynecological cancer and gastrointestinal cancer, and for domvanalimab; Gilead’s ability to receive regulatory approvals for programs and/or indications that are currently under evaluation in a timely manner or at all, and the risk that any such approvals may be subject to significant limitations on use; the possibility that Gilead may make a strategic decision to discontinue development of programs for indications that are currently under evaluation, including Trodelvy for treatment of metastatic NSCLC and domvanalimab, and as a result, these programs may never be commercialized for such indications; and any assumptions underlying any of the foregoing. These and other risks, uncertainties and other factors are described in detail in Gilead’s Quarterly Report on Form 10-Q for the quarter ended March 31, 2024, as filed with the U.S. Securities and Exchange Commission. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. All statements other than statements of historical fact are statements that could be deemed forward-looking statements. The reader is cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, and is cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation and disclaims any intent to update any such forward-looking statements.

U.S. Prescribing Information for Trodelvy including BOXED WARNING, is available at www.gilead.com.

Trodelvy, Gilead and the Gilead logo are trademarks of Gilead Sciences, Inc., or its related companies.

For more information about Gilead, please visit the company’s website at www.gilead.com or call Gilead Public Affairs at 1-800-GILEAD-5 or 1-650-574-3000.

View source version on businesswire.com: https://www.businesswire.com/news/home/20240530725767/en/

Jacquie Ross, Investors

investor_relations@gilead.com



Ashleigh Koss, Media

public_affairs@gilead.com

Source: Gilead Sciences, Inc.

FAQ

What were the results of the EVOKE-01 study in metastatic NSCLC?

The EVOKE-01 study showed a 16% reduction in the risk of death with Trodelvy compared to docetaxel, though it did not meet the primary endpoint of overall survival.

How did Trodelvy perform in terms of overall survival in the EVOKE-01 study?

Trodelvy had a median overall survival of 11.1 months compared to 9.8 months for docetaxel.

What were the adverse events reported in the EVOKE-01 study?

Adverse events were lower with Trodelvy (66.6%) compared to docetaxel (75.7%). Common AEs included fatigue, diarrhea, and alopecia for Trodelvy.

Was there a significant improvement in a specific subgroup in the EVOKE-01 study?

Yes, patients whose tumors did not respond to anti-PD-(L)1 therapy saw an OS improvement of 3.5 months with Trodelvy (11.8 vs. 8.3 months).

What was the 12-month survival rate for Trodelvy in the EVOKE-01 study?

More patients treated with Trodelvy were alive at 12 months (46.6%) compared to those treated with docetaxel (36.7%).