SCI

31 July 2024

Entrectinib in ROS1-positive advanced non-small cell lung cancer: the phase 2/3 BFAST trial

(IF: Nat Med., 58.7)

  • Peters S, Gadgeel SM, Mok T, Nadal E, Kilickap S, Swalduz A, Cadranel J, Sugawara S, Chiu CH, Yu CJ, Moskovitz M, Tanaka T, Nersesian R, Shagan SM, Maclennan M, Mathisen M, Bhagawati-Prasad V, Diarra C, Assaf ZJ, Archer V, Dziadziuszko R. Entrectinib in ROS1-positive advanced non-small cell lung cancer: the phase 2/3 BFAST trial. Nat Med. 2024 Jul;30(7):1923-1932. 

  • Correspondence: solange.peters@chuv.ch

Although comprehensive biomarker testing is recommended for all patients with advanced/metastatic non-small cell lung cancer (NSCLC) before initiation of first-line treatment, tissue availability can limit testing. Genomic testing in liquid biopsies can be utilized to overcome the inherent limitations of tissue sampling and identify the most appropriate biomarker-informed treatment option for patients. The Blood First Assay Screening Trial is a global, open-label, multicohort trial that evaluates the efficacy and safety of multiple therapies in patients with advanced/ metastatic NSCLC and targetable alterations identified by liquid biopsy. We present data from Cohort D (ROS1-positive). Patients ≥18 years of age with stage IIIB/IV, ROS1-positive NSCLC detected by liquid biopsies received entrectinib 600 mg daily. At data cutoff (November 2021), 55 patients were enrolled and 54 had measurable disease. Cohort D met its primary endpoint: the confirmed objective response rate (ORR) by investigator was 81.5%, which was consistent with the ORR from the integrated analysis of entrectinib (investigator-assessed ORR, 73.4%; data cutoff May 2019, ≥12 months of follow-up). The safety profile of entrectinib was consistent with previous reports. These results demonstrate consistency with those from the integrated analysis of entrectinib in patients with ROS1-positive NSCLC identified by tissue-based testing, and support the clinical value of liquid biopsies to inform clinical decision-making. The integration of liquid biopsies into clinical practice provides patients with a less invasive diagnostic method than tissue-based testing and has faster turnaround times that may expedite the reaching of clinical decisions in the advanced/ metastatic NSCLC setting.

尽管在开始一线治疗之前,建议对所有晚期/转移性癌症(NSCLC)患者进行全面的生物标志物检测,但组织样本的可获得性可能会限制检测。液体活检中的基因组检测可用于克服组织取样的固有局限性,并为患者确定最合适的基于生物标志物的知情治疗选项。血液优先检测筛查试验(BFAST)是一项全球性的开放标签多队列试验,旨在评估通过液体活检确定有靶向变异的晚期/转移性NSCLC患者中,多种疗法的疗效和安全性。我们展示了队列D(ROS1阳性)的数据。年龄≥18岁、液体活检检测为 IIIB/IV 期、ROS1 阳性 NSCLC 的患者每天接受 600 mg 恩曲替尼治疗。截至数据截止日期(2021年11月),共有55名患者被纳入研究,其中54名患者有可测量疾病。队列D达到了其主要终点:研究者确认的客观缓解率(ORR)为81.5%,这与恩曲替尼的综合分析中的ORR一致(研究者评估的ORR为73.4%;数据截止日期为2019年5月,随访时间≥12个月)。恩曲替尼的安全性与之前的报告相符。这些结果与基于组织检测确定的ROS1阳性NSCLC患者中恩曲替尼的综合分析的结果一致,并支持液体活检在临床决策方面的临床价值。将液体活检整合到临床实践中,可为患者提供一种比基于组织的检测侵入性更小的诊断方法,并且具有更快的周转时间,可能加快晚期/转移性 NSCLC 环境中的临床决策。