Adjuvant Osimertinib for Lung Cancer

(TARGET Trial)

Not currently recruiting at 67 trial locations

Overseen By AstraZeneca Clinical Study Information Center

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: AstraZeneca

Must not be taking: CYP3A4 inducers, QT prolongers

Disqualifiers: Other malignancies, Cardiac issues, ILD, others

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 5 years

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial evaluates the effectiveness and safety of osimertinib, a targeted therapy drug, for individuals with EGFRm positive stage II-IIIB non-small cell lung cancer (NSCLC). Participants who have had their tumors completely removed by surgery, with or without additional chemotherapy, may qualify. The trial aims to determine if this treatment can prevent cancer recurrence or spread. Individuals who have undergone surgery to remove non-squamous NSCLC and whose tumors have specific EGFR gene changes may find this trial suitable. As a Phase 2 trial, the research focuses on assessing the treatment's effectiveness in an initial, smaller group of participants.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot take medications or supplements that strongly affect the enzyme CYP3A4 at least 3 weeks before starting the study.

Is there any evidence suggesting that osimertinib is likely to be safe for humans?

Research shows that osimertinib is generally well-tolerated by people with non-small cell lung cancer (NSCLC). In past studies, patients taking osimertinib experienced a good balance between extended survival and manageable side effects. Reports indicate that side effects are often mild, such as skin rash or diarrhea, and can usually be managed with standard care.

Osimertinib is already approved for treating certain types of NSCLC, indicating thorough safety testing in humans. This approval also suggests confidence in its safety for similar conditions. While all treatments can have side effects, existing data supports osimertinib as a generally safe option for people with this type of lung cancer. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising?

Osimertinib is unique because it specifically targets a mutation in the epidermal growth factor receptor (EGFR) that is often found in certain types of lung cancer. Unlike traditional chemotherapy, which can affect both cancerous and healthy cells, osimertinib is a targeted therapy that aims to attack cancer cells more precisely, potentially leading to fewer side effects. Researchers are excited about osimertinib because it has shown promise in overcoming resistance to earlier EGFR inhibitors, offering new hope for patients whose cancers have become resistant to standard treatments.

What evidence suggests that osimertinib might be an effective treatment for lung cancer?

Studies have shown that osimertinib greatly improves survival rates for patients with a specific type of lung cancer that has been surgically removed and has a certain genetic mutation (EGFR). In one study, 88% of people treated with osimertinib were still alive five years after starting treatment. Another study found that osimertinib resulted in the longest survival benefit ever reported for this type of cancer, with a median survival of nearly four years. Research also shows that osimertinib offers a significant survival benefit for patients with cancer stages similar to those in this trial. Due to its proven effectiveness, this treatment has been approved for certain stages of this lung cancer. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

Adults with a confirmed diagnosis of non-squamous NSCLC, who have had complete surgical removal of the tumor and are in stage II-IIIB. They must have specific EGFR mutations, be fully recovered from surgery, not pregnant or breastfeeding, using effective contraception if applicable, and without a history of certain heart conditions or other cancers.

Inclusion Criteria

I can carry out all my usual activities without help.

You have had a scan of your brain using MRI or contrast CT.

I have fully recovered from any surgery and its follow-up treatments.

Exclusion Criteria

I do not have any major heart issues or a family history of sudden heart-related deaths.

I am not taking strong CYP3A4 inducers for the last 3 weeks.

I have only had minor lung surgery.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive osimertinib for 5 years following complete tumor resection with or without adjuvant chemotherapy

5 years

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 years

What Are the Treatments Tested in This Trial?

Interventions

• Osimertinib

Trial Overview

The trial is testing the effectiveness and safety of osimertinib for patients with EGFRm positive stage II-IIIB NSCLC after full tumor resection. It may include those who've had adjuvant chemotherapy. The focus is on long-term outcomes over five years.

How Is the Trial Designed?

Group I: Osimertinib Experimental Treatment 1 Intervention

Participants will receive osimertinib (AZD9291).

Who Is Running the Clinical Trial?

AstraZeneca

Lead Sponsor

Trials

4,491

Recruited

290,540,000+

Sir Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Dr. Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Medical Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Published Research Related to This Trial

In a phase 2 study involving 210 patients with EGFR Thr790Met-positive non-small-cell lung cancer (NSCLC), osimertinib demonstrated significant efficacy, with 70% of patients achieving an objective response, including 3% with complete responses.

Osimertinib was found to have manageable side effects, although serious adverse events occurred in 25% of patients, with interstitial lung disease being the only fatal event possibly related to the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Osimertinib for pretreated EGFR Thr790Met-positive advanced non-small-cell lung cancer (AURA2): a multicentre, open-label, single-arm, phase 2 study. Goss, G., Tsai, CM., Shepherd, FA., et al.[2022]

In a retrospective analysis of 32 patients with EGFR T790M-mutant non-small-cell lung cancer, osimertinib showed a 50% objective response rate and a median progression-free survival of 11.3 months, indicating its efficacy in clinical practice.

The median overall survival was 18.3 months, with better outcomes observed in patients without cerebral metastases and those with better performance status, highlighting the importance of these factors in treatment response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of osimertinib in patients with lung adenocarcinoma in clinical practice - the Expanded Drug Access Program in Poland. Knetki-Wróblewska, M., Kowalski, DM., Czyżewicz, G., et al.[2022]

Osimertinib (TAGRISSO) received accelerated FDA approval for treating metastatic non-small cell lung cancer with the EGFR T790M mutation, showing significant tumor response rates of 57% and 61% in two major trials involving 411 patients.

While osimertinib demonstrated promising efficacy, common side effects included diarrhea (42%) and rash (41%), with 28% of patients experiencing severe adverse events, highlighting the need for careful monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Osimertinib for the Treatment of Metastatic EGFR T790M Mutation-Positive Non-Small Cell Lung Cancer. Khozin, S., Weinstock, C., Blumenthal, GM., et al.[2022]

Osimertinib (Tagrisso) is an approved adjuvant treatment for non-small cell lung cancer patients with specific tumor mutations, highlighting its targeted therapeutic approach.

Common side effects of osimertinib include blood-related issues like leukopenia and thrombocytopenia, as well as gastrointestinal and skin reactions, indicating the need for careful monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New Adjuvant Drug for Lung Cancer. Aschenbrenner, DS.[2023]

In a study of 240 advanced non-small-cell lung cancer (NSCLC) patients with acquired resistance to EGFR TKIs, 52.9% had the T790M mutation after rebiopsy, highlighting the mutation's prevalence in treatment resistance.

Patients with the T790M mutation who had previously used osimertinib experienced significantly longer post-progression survival (42.6 months) compared to those without osimertinib (18.0 months) or without the mutation (18.8 months), suggesting osimertinib's effectiveness as a standard treatment for T790M-positive NSCLC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Post-Progression Survival in Secondary EGFR T790M-Mutated Non-Small-Cell Lung Cancer Patients With and Without Osimertinib After Failure of a Previous EGFR TKI. Chiang, CL., Huang, HC., Shen, CI., et al.[2022]

Osimertinib significantly improves disease-free survival (DFS) in adults with completely resected, early-stage EGFR mutation-positive non-small cell lung cancer (NSCLC), as shown in the pivotal ADAURA trial, regardless of prior adjuvant chemotherapy.

The treatment is well tolerated with a manageable safety profile, and it does not negatively impact health-related quality of life, making it a suitable option for adjuvant therapy in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Osimertinib: A Review in Completely Resected, Early-Stage, EGFR Mutation-Positive NSCLC. Frampton, JE.[2022]

The study established an osimertinib-resistant cell line (HCC827/OSIR) from EGFR-sensitive HCC827 cells, demonstrating that these resistant cells have higher resistance to multiple EGFR tyrosine kinase inhibitors compared to the original cells.

Increased expression of IRE1α was identified as a potential mechanism for resistance to osimertinib, and targeting IRE1α with an inhibitor showed promise in reducing the number of viable resistant cells.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increased Expression of IRE1α Associates with the Resistant Mechanism of Osimertinib (AZD9291)-resistant non-small Cell Lung Cancer HCC827/OSIR Cells. Tang, ZH., Su, MX., Guo, X., et al.[2022]

In a study of 94 patients with advanced non-small-cell lung cancer (NSCLC) who had previously been treated, osimertinib showed a 47.3% overall objective response rate and a 90.1% disease control rate, indicating its effectiveness in this population.

Patients with the T790M mutation experienced significantly longer progression-free survival (PFS) compared to those without the mutation, highlighting osimertinib's targeted efficacy, especially in those with specific genetic profiles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Real-World Data Of Osimertinib In Patients With Pretreated Non-Small Cell Lung Cancer: A Retrospective Study. Mu, Y., Xing, P., Hao, X., et al.[2022]

Osimertinib is an oral medication specifically designed to target the EGFR T790M mutation in advanced non-small cell lung cancer (NSCLC), which helps overcome resistance to previous EGFR TKI therapies.

It received accelerated approval in the USA in November 2015 for patients with metastatic EGFR T790M mutation-positive NSCLC who have progressed after EGFR TKI treatment, and is currently undergoing further development for broader treatment applications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Osimertinib: First Global Approval. Greig, SL.[2022]

Citations

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Evaluation of Cost-Effectiveness of Adjuvant Osimertinib in ...

Based on positive results from ADAURA (NCT02511106), adjuvant osimertinib was approved for treatment of resected stage IB‒IIIA EGFRm NSCLC.

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Osimertinib Improves Survival in Lung Cancer - NCI

At 5 years after starting adjuvant treatment, 88% of people treated with osimertinib were still alive, compared with 78% of those treated with a ...

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thelancet.com

thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00367-0/fulltext

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The safety and efficacy of osimertinib for the ... - PubMed Central

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appliedclinicaltrialsonline.com

appliedclinicaltrialsonline.com/view/astrazeneca-s-tagrisso-landmark-overall-survival-benefit-in-non-small-cell-lung-cancer

AstraZeneca's Tagrisso Shows Landmark Overall Survival ...

Tagrisso plus chemotherapy survival benefit: Median overall survival (OS) of nearly four years in first-line EGFR-mutated non-small cell lung ...

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sciencedirect.com

sciencedirect.com/science/article/abs/pii/S1525730425001299

Osimertinib as First-Line Treatment for Patients With ...

This study supports the long-term efficacy of OSI, with PFS and OS comparable to those in the FLAURA trial in a Japanese real-world setting.