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

Abstract

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. This open-label phase II trial has three cohorts: <i>HER2-</i>, <i>EGFR-</i>, and <i>HER3-</i>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. A total of 45 patients were included, with a median age of 62 years. For the <i>HER2</i> cohort (n = 30), ORR was 3.3% (one partial response) and DCR was 23.3%. In the <i>EGFR</i> 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 <i>HER3</i> 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. The present phase II study, investigating afatinib in <i>HER2-, EGFR-,</i> or<i>HER3</i>-mutant pretreated solid tumors did not reach its primary end point in the <i>HER2</i> cohort. Neither the <i>EGFR</i> nor the <i>HER3</i> cohort reached full accrual, but clinically meaningful responses were observed in two <i>EGFR</i>-mutated patients. Further exploration of <i>HER</i> targeting in solid tumors is warranted.