Afatinib for Advanced Cancers Carrying an EGFR, HER2, or HER3 Mutation: An Open-Label, Phase II, Belgian Precision Study

Abstract

PURPOSE The Belgian Precision initiative aims to implement tumor-agnostic next-generation sequencing (NGS) in patients with advanced cancer and expand genotype-matching drug availability. The present investigator-driven trial aimed to study the efficacy of afatinib in patients with advanced solid tumors harboring an activating HER2, EGFR, or HER3 mutation. PATIENTS AND METHODS This open-label phase II trial has three cohorts: HER2-, EGFR-, and HER3-mutated previously treated solid tumors. The primary end point was objective response rate (ORR). For each cohort, a Simon two-stage design was used. Observation of >= 2 responses in the first 10 patients prompted a further 19 to be included. Secondary end points were disease control rate (DCR), duration of response (DOR), progression-free survival, overall survival, and safety. RESULTS A total of 45 patients were included, with a median age of 62 years. For the HER2 cohort (n = 30), ORR was 3.3% (one partial response) and DCR was 23.3%. In the EGFR cohort, a total of seven patients were included, resulting in an ORR in 2/7 (28.6%) patients, with a DOR of 6.6 and 15.4 months. In the HER3 cohort, a total of eight patients were included, but none demonstrated an objective response. Safety data were consistent with the known safety profile of afatinib. CONCLUSION The present phase II study, investigating afatinib in HER2-, EGFR-, or HER3-mutant pretreated solid tumors did not reach its primary end point in the HER2 cohort. Neither the EGFR nor the HER3 cohort reached full accrual, but clinically meaningful responses were observed in two EGFR-mutated patients. Further exploration of HER targeting in solid tumors is warranted.