Interstitial Lung Disease (ILD)/Pneumonitis. ILD/pneumonitis, which can be fatal, occurred in patients treated with TABRECTA™ (capmatinib) tablets. ILD/pneumonitis occurred in 4.5% of patients trea...
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Efficacy
Major efficacy outcome
- Overall response rate*
Additional efficacy outcome
- Duration of response
Other efficacy outcomes
- Time to response
- Disease control rate
- Progression-free survival
- Safety
Patients were enrolled in trial cohorts 4 and 5b after central confirmation of METex14 by an RNA-based clinical trial assay using RT-PCR.1,2
ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor; NSCLC, non-small cell lung cancer; RT-PCR, reverse transcription-polymerase chain reaction.
*Evaluated by a blinded independent review committee (BIRC).
Evaluable patients were defined as those who completed at least 6 cycles of treatment (18 weeks).
Patient Characteristics
TABRECTA™ (capmatinib) tablets was studied in patients with METex14 in mNSCLC with a clinically diverse profile
Characteristics of study population with METex14 (n=97)1-3
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DEMOGRAPHICS |
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Median age (range), years |
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71 (49-90) |
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Sex, n (%) |
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Female |
58 (60) |
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Male |
39 (40) |
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Race, n (%) |
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White |
73 (75) |
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Asian |
23 (24) |
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Other |
1 (1) |
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PATIENT CHARACTERISTICS |
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|
Smoking history, n (%) |
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|
Never smoked |
58 (60) |
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Former smoker |
36 (37) |
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Current smoker |
3 (3) |
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|
ECOG status, n (%) |
|||
|
0 |
23 (24) |
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|
1 |
73 (75) |
||
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≥2 |
1 (1) |
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Treatment history, n (%) |
|||
|
Treatment naive |
28 (29) |
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Previously treated |
69 (71) |
||
|
19 (28) |
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|
65 (94) |
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|
16 (23) |
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DISEASE CHARACTERISTICS |
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Histology, n(%) |
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Adenocarcinoma |
78 (80) |
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Squamous |
8 (8) |
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Othera |
11 (11) |
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Metastatic site of cancer, n (%) |
|||
|
Bone |
57 (59) |
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|
Liver |
20 (21) |
||
|
Adrenala |
17 (18) |
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|
Brainb |
13 (12) |
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|
DEMOGRAPHICS |
PATIENT CHARACTERISTICS |
DISEASE CHARACTERISTICS |
|||
|
Median age (range), years |
Smoking history, n (%) |
Histology, n (%) |
|||
|
71 years (49-90) |
Never smoked |
58 (60) |
Adenocarcinoma |
78 (80) |
|
|
Former smoker |
36 (37) |
Squamous |
8 (8) |
||
|
Current smoker |
3 (3) |
Othera |
11 (11) |
||
|
Sex, n (%) |
ECOG status, n (%) |
Metastatic site of cancer, n (%) |
|||
|
Female |
58 (60) |
0 |
23 (24) |
Bone |
57 (59) |
|
Male |
39 (40) |
1 |
73 (75) |
Liver |
20 (21) |
|
≥2 |
1 (1) |
Adrenal |
17 (18) |
||
|
|
|
Brainb |
13 (12) |
||
|
Race, n (%) |
Treatment history, n (%) |
||||
|
White |
73 (75) |
Treatment naive |
28 (29) |
||
|
Asian |
23 (24) |
Previously treated |
69 (71) |
||
|
Other |
1 (1) |
|
19 (28) |
||
|
65 (94) |
||||
|
16 (23) |
||||
ECOG, Eastern Cooperative Oncology Group; mNSCLC, metastatic non-small cell lung cancer.
aAll other histologies, including 5 sarcomatoid/carcinosarcoma.
bTwelve identified in medical history and 2 identified during baseline computed tomography (CT) scan.
Treatment-Naive Patients
Powerful and sustained overall responses with TABRECTA in treatment-naive patients (n=28)
Other efficacy outcomes
- The majority of patients taking TABRECTA responded within 7 weeks2
DCR was an exploratory efficacy outcome that accounted for CR + PR + SD, which may reflect the natural history of disease in an individual patient rather than the therapeutic effect of the treatment.
Highlights of Important Safety Information
TABRECTA™ (capmatinib) tablets has Warnings and Precautions for interstitial lung disease (ILD/pneumonitis), hepatotoxicity, risk of photosensitivity and embryo-fetal toxicity.
The most common adverse reactions (≥20%) are peripheral edema, nausea, fatigue, vomiting, dyspnea, and decreased appetite.
Please see additional Important Safety Information below.
Previously Treated Patients
Efficacious and sustained overall responses with TABRECTA in previously treated patients (n=69)
Other efficacy outcomes2
- Previous treatments included immunotherapy (28%) and chemotherapy (94%), and 23% of patients received 2 prior lines of therapy
DCR was an exploratory efficacy outcome that accounted for CR + PR + SD, which may reflect the natural history of disease in an individual patient rather than the therapeutic effect of the treatment.
CR, complete response; DCR, disease control rate; NE, not estimable; PR, partial response; SD, stable disease.
Additional Analysis
In a post hoc analysis, intracranial responses were observed with TABRECTA in patients with brain lesions at baseline (n=13)
Thirteen evaluable patients in the cohorts with METex14 (n=97) had brain metastases at baseline, as assessed by a BIRC.3
Intracranial response with TABRECTA: 54% (n=7 of 13)3
• Complete resolution: 31% (n=4 of 13)
• Partial resolution: 23% (n=3 of 13)
Intracranial disease control rate: 92% (n=12 of 13)3
Intracranial disease control rate was an exploratory efficacy outcome that accounted for CR + PR + SD, and may reflect the natural history of disease in an individual patient rather than the therapeutic effect of the treatment.
This analysis of overall intracranial response rate included patients with measurable brain disease at baseline and at least one postbaseline assessment but omits brain imaging in patients with premature discontinuations, which may lead to bias favoring a treatment effect.
If brain lesions were documented at baseline, CT with intravenous contrast or a magnetic resonance imaging scan was mandated every 6 weeks, or otherwise, only if clinically indicated.2
Results are based on a noncomparative post hoc analysis and are observational in nature; as such, they should be interpreted with caution.
References: 1. Tabrecta [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2020. 2. Data on file. Study CINC280A2201. Novartis Pharmaceuticals Corp; 2019. 3. Wolf J, Seto T, Han J, et al. Capmatinib in METex14-mutated advanced non-small cell lung cancer (NSCLC): Efficacy data from the phase II GEOMETRY mono-1 study. Abstract 9004. Presented at: 2019 ASCO Annual Meeting; May 31-June 4, 2019; Chicago, IL.
Indication
TABRECTA™ (capmatinib) tablets is indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have a mutation that leads to mesenchymal-epithelial transition (MET) exon 14 skipping as detected by an FDA-approved test.
This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.
Important Safety Information
Interstitial Lung Disease (ILD)/Pneumonitis. ILD/pneumonitis, which can be fatal, occurred in patients treated with TABRECTA. ILD/pneumonitis occurred in 4.5% of patients treated with TABRECTA in the GEOMETRY mono-1 study, with 1.8% of patients experiencing grade 3 ILD/pneumonitis and 1 patient experiencing death (0.3%). Eight patients (2.4%) discontinued TABRECTA due to ILD/pneumonitis.
Monitor for new or worsening pulmonary symptoms indicative of ILD/pneumonitis (eg, dyspnea, cough, fever). Immediately withhold TABRECTA in patients with suspected ILD/pneumonitis and permanently discontinue if no other potential causes of ILD/pneumonitis are identified.
Hepatotoxicity. Hepatotoxicity occurred in patients treated with TABRECTA. Increased alanine aminotransferase (ALT)/aspartate aminotransferase (AST) occurred in 13% of patients treated with TABRECTA in GEOMETRY mono-1. Grade 3 or 4 increased ALT/AST occurred in 6% of patients. Three patients (0.9%) discontinued TABRECTA due to increased ALT/AST.
Monitor liver function tests (including ALT, AST, and total bilirubin) prior to the start of TABRECTA, every 2 weeks during the first 3 months of treatment, then once a month or as clinically indicated, with more frequent testing in patients who develop increased transaminases or bilirubin. Based on the severity of the adverse reaction, withhold, reduce dose, or permanently discontinue TABRECTA.
Risk of Photosensitivity. Based on findings from animal studies, there is a potential risk of photosensitivity reactions with TABRECTA. In GEOMETRY mono-1, it was recommended that patients use precautionary measures against ultraviolet exposure, such as use of sunscreen or protective clothing, during treatment with TABRECTA. Advise patients to limit direct ultraviolet exposure during treatment with TABRECTA.
Embryo-Fetal Toxicity. Based on findings from animal studies and its mechanism of action, TABRECTA can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TABRECTA and for 1 week after the last dose. Advise males with female partners of reproductive potential to use effective contraception during treatment with TABRECTA and for 1 week after the last dose.
Most Common Adverse Reactions. The most common adverse reactions (≥20%) were peripheral edema (52%), nausea (44%), fatigue (32%), vomiting (28%), dyspnea (24%), and decreased appetite (21%). The most common grade 3 adverse reactions (≥2%) were peripheral edema (9%), fatigue (8%), dyspnea (7%), nausea (2.7%), vomiting (2.4%), and noncardiac chest pain (2.1%).
Clinically Relevant Adverse Reactions. Clinically relevant adverse reactions observed in <10% of patients were pruritus (allergic and generalized), ILD/pneumonitis, cellulitis, acute kidney injury (including renal failure), urticaria, and acute pancreatitis.
Laboratory Abnormalities. Select laboratory abnormalities (≥20%) worsening from baseline in patients who received TABRECTA were decreased albumin (68%), increased creatinine (62%), decreased lymphocytes (44%), increased ALT (37%), increased alkaline phosphatase (32%), increased amylase (31%), increased gamma-glutamyltransferase (29%), increased lipase (26%), increased AST (25%), decreased hemoglobin (24%), decreased leukocytes (23%), decreased sodium (23%), decreased phosphate (23%), increased potassium (23%), and decreased glucose (21%).
Please see full Prescribing Information for TABRECTA.
