The phase II APPLE trial gives the opportunity to prospectively validate liquid biopsies as a new standard for testing tumor progression compared with conventional radiological procedure in EGFR mutant advanced NSCLC patients. Moreover based on the sequential T790M test during treatment the investigators will assess the predictive value of liquid biopsies. APPLE trial will examine the best strategy for delivering osimertinib (upfront versus sequential treatment after 1st generation EGFR TKI) in EGFR mutant NSCLC patients. Finally, the trial will also explore the mechanisms of acquired resistance to Osimertinib based on the results of an optional biopsy upon progression.
Name: Osimertinib
Description: Osimertinib 60 or 40 mg daily until progressionType: DrugGefitinib till + blood test/progression than Osimertinib Gefitinib till progression than Osimertinib Osimertinib till progression
Name: Gefitinib
Description: Gefitinib 250mg daily until progressionType: DrugGefitinib till + blood test/progression than Osimertinib Gefitinib till progression than Osimertinib
Description: Number of participants with treatment-related adverse events by CTCAE version 4.0. Adverse events, serious adverse events and adverse reactions will be monitored.
Measure: Safety Time: 24 months after first patient inAllocation: Randomized
Parallel Assignment
There are 2 SNPs
Adverse events, serious adverse events and adverse reactions will be monitored.. Inclusion: Registration: - Pathological diagnosis of adenocarcinoma of the lung carrying common EGFR activating mutations associated with EGFR-TKI sensitivity (Del19 or L858R); performed locally; no other EGFR mutations will be allowed. --- L858R ---
Inclusion: Registration: - Pathological diagnosis of adenocarcinoma of the lung carrying common EGFR activating mutations associated with EGFR-TKI sensitivity (Del19 or L858R); performed locally; no other EGFR mutations will be allowed. --- L858R ---
APPLE Trial: Feasibility and Activity of AZD9291 (Osimertinib) Treatment on Positive PLasma T790M in EGFR Mutant NSCLC Patients. --- T790M ---
Osimertinib Treatment on EGFR T790M Plasma Positive NSCLC Patients (APPLE) The phase II APPLE trial gives the opportunity to prospectively validate liquid biopsies as a new standard for testing tumor progression compared with conventional radiological procedure in EGFR mutant advanced NSCLC patients. --- T790M ---
Moreover based on the sequential T790M test during treatment the investigators will assess the predictive value of liquid biopsies. --- T790M ---
Proportion of patients receiving Osimertinib based on the determination of cfDNA T790M mutation positive. --- T790M ---
In case of other (than EGFR) concomitant mutations, discussion with EORTC Headquarters is mandatory; - Stage IV NSCLC; - Blood sample available for cfDNA EGFR T790M central testing; - Age ≥18 years; - EGFR TKI treatment-naïve eligible to receive first-line treatment with EGFR TKI; - Prior adjuvant and neo-adjuvant therapy is permitted (chemotherapy, radiotherapy, investigational agents) if performed more than 12 months before registration; - Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations Randomization: - Report of adequacy sample for cfDNA EGFR T790M test by central laboratory; - Prior palliative radiotherapy or surgery are allowed if completed at least 4 weeks before the randomization; - Patients with brain metastases are allowed provided they are stable (i.e. --- T790M ---
In case of other (than EGFR) concomitant mutations, discussion with EORTC Headquarters is mandatory; - Stage IV NSCLC; - Blood sample available for cfDNA EGFR T790M central testing; - Age ≥18 years; - EGFR TKI treatment-naïve eligible to receive first-line treatment with EGFR TKI; - Prior adjuvant and neo-adjuvant therapy is permitted (chemotherapy, radiotherapy, investigational agents) if performed more than 12 months before registration; - Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations Randomization: - Report of adequacy sample for cfDNA EGFR T790M test by central laboratory; - Prior palliative radiotherapy or surgery are allowed if completed at least 4 weeks before the randomization; - Patients with brain metastases are allowed provided they are stable (i.e. --- T790M --- --- T790M ---
- To determine the proportion of patients receiving Osimertinib based on the determination of cfDNA T790M mutation positive. --- T790M ---