Real World Treatment Study of AZD9291 for Advanced/Metastatic EGFR T790M Mutation NSCLC

NCT ID: NCT02474355

Last Updated: 2021-11-11

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

3017 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-18

Study Completion Date

2019-04-18

Brief Summary

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The aim of this study is to assess the efficacy and safety of single agent AZD9291 in a real world setting in adult patients with advanced or metastatic, epidermal growth factor receptor (EGFR) T790M mutation-positive Non-Small Cell Lung Cancer (NSCLC), who have received prior EGFR-tyrosine kinase inhibitor (TKI) therapy.

Detailed Description

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Objective: The primary objective of this study is to assess the efficacy and safety of single agent AZD9291 in a real world setting in adult patients with advanced or metastatic, epidermal growth factor receptor (EGFR) T790M mutation-positive Non-Small Cell Lung Cancer (NSCLC), who have received prior EGFR-tyrosine kinase inhibitor (TKI) therapy.

Study site(s) and number of patients planned: Approximately 1500 patients will be recruited in Europe. The recruitment will be increased beyond that as the study will expand in other regions of the world (America, Asia).

Study Design This will be an open-label, single-arm, multinational, multicenter, real world treatment study.

Target patient population: Adult patients (fulfilling the definition of "age of majority" per local regulations) with locally advanced (stage IIIB) or metastatic (stage IV) NSCLC with confirmed T790M mutation, who have received prior EGFR-TKI therapy.

Investigational product (IP), dosage, and mode of administration: AZD9291 is an oral, potent, selective, irreversible inhibitor of both EGFR-TKI sensitising and resistance mutations in NSCLC with a significant selectivity margin over wild-type EGFR. AZD9291 will be administered orally as one 80 mg tablet once a day.

Duration of IP administration: Patients may continue to receive AZD9291 as long as they continue to show clinical benefit, as judged by the investigator, and in the absence of discontinuation criteria). The study will be closed in each participating country as soon as possible following national reimbursement of AZD9291 in that country (up to a max of 90 days post reimbursement). Enrolment will be closed within 6 months after market license approval in that country or at national reimbursement, whichever is sooner. Patients withdrawing from the treatment prior to national reimbursement will be followed up as part of this study. Patients on treatment will receive commercial supply until documented disease progression as per investigator assessment.

In the event that national reimbursement should not be granted following a reasonable time after market license approval in the country, the study will be closed in a maximum period of 18 months after the last patient is enrolled in that country. If applicable, timelines for conversion to commercial drug will be agreed with local bodies which may include regulatory agencies, ethics committees, and institutions. Patient will be followed until death or lost to follow-up.

Study measures: Data collected will include patient demographics, information needed to determine patient eligibility (including medical history, past and current disease characteristics, and tumor EGFR mutational status), AZD9291 exposure, investigator-reported efficacy (including tumor response and disease progression), overall survival (OS), and safety (including serious adverse events \[SAEs\], adverse events leading to dose modification, and adverse events of special interest \[interstitial lung disease/pneumonitis-like events, and QTc prolongation events\]).

Statistical methods: All data will be presented for the overall full analysis/evaluable set, and also by cohorts defined by number and type of previous treatment lines for the advanced disease. Descriptive statistics will be used for all variables, as appropriate. Continuous variables will be summarised by the number of observations, mean, standard deviation, median, minimum, and maximum. Categorical variables will be summarised by frequency counts and percentages for each category. OS and PFS will be summarized using Kaplan-Meier estimates of the median time to death or censoring and quartiles together with their 95% confidence intervals.

Conditions

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Lung Cancer

Keywords

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NSCLC EGFRm T790M

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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AZD9291

Single arm of AZD9291, starting dose of 80mg

Group Type EXPERIMENTAL

T790M+ Testing

Intervention Type PROCEDURE

If a previous lab report is unavailable, the patient will need to have T790M+ testing.

Baseline Visit Blood & Urine Testing

Intervention Type PROCEDURE

Blood count and standard chemistry testing to ensure patient meets inclusion/exclusion criteria

Baseline ECG

Intervention Type PROCEDURE

ECG to ensure absence of any cardiac abnormality

Visual Slit-Lamp Testing

Intervention Type PROCEDURE

Slit-lamp testing performed to ensure patients do not have any eye abnormalities or symptoms

AZD9291 Dosing

Intervention Type DRUG

Patients to be provided with AZD9291 every 6 weeks (+/- 7 days)

Interventions

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T790M+ Testing

If a previous lab report is unavailable, the patient will need to have T790M+ testing.

Intervention Type PROCEDURE

Baseline Visit Blood & Urine Testing

Blood count and standard chemistry testing to ensure patient meets inclusion/exclusion criteria

Intervention Type PROCEDURE

Baseline ECG

ECG to ensure absence of any cardiac abnormality

Intervention Type PROCEDURE

Visual Slit-Lamp Testing

Slit-lamp testing performed to ensure patients do not have any eye abnormalities or symptoms

Intervention Type PROCEDURE

AZD9291 Dosing

Patients to be provided with AZD9291 every 6 weeks (+/- 7 days)

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Provision of signed and dated written informed consent by the patient or legally acceptable representative prior to any study-specific procedures
2. Adults (according to each country regulations for age of majority)
3. Locally advanced (stage IIIB) or metastatic (stage IV) EGFRm NSCLC, not amenable to curative surgery or radiotherapy, with confirmation of the presence of the T790M mutation
4. Prior therapy with an EGFR-TKI. Patients may have also received additional lines of treatment
5. World Health Organization (WHO) performance status 0-2
6. Adequate bone marrow reserve and organ function as demonstrated by complete blood count, biochemistry in blood and urine at baseline (please refer to IB for guidance)
7. ECG recording at baseline showing absence of any cardiac abnormality as per exclusion criterion #6
8. Female patients of childbearing potential must be using adequate contraceptive measures, must not be breast feeding, and must have a negative pregnancy test prior to start of dosing. Otherwise, they must have evidence of nonchildbearing potential
9. Male patients must be willing to use barrier contraception, i.e., condoms

Exclusion Criteria

1. Previous (within 6 months) or current treatment with AZD9291
2. Patients currently receiving (or unable to stop use at least 1 week prior to receiving the first dose of AZD9291) any treatment known to be potent inhibitors or inducers of cytochrome P450 (CYP) 3A4
3. Any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, active bleeding diatheses, active infection including hepatitis B, hepatitis C, and human immunodeficiency virus, or significantly impaired bone marrow reserve or organ function, including hepatic and renal impairment, which in the investigator's opinion would significantly alter the risk/benefit balance.
4. Patient with symptomatic central nervous system (CNS) metastases who is neurologically unstable or has required increasing doses of steroids to manage CNS symptoms within the 2 weeks prior to start AZD9291 administration;
5. Past medical history of ILD, drug-induced ILD, radiation pneumonitis requiring steroid treatment, or any evidence of clinically active ILD
6. Any of the following cardiac criteria:

1. Mean resting corrected QT interval (QTcF) \> 470 ms using Fredericia's formula :
2. Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG (e.g., complete left bundle branch block, third degree heart block, second degree heart block)
3. Any factors that increase the risk of QTc prolongation or risk of arrhythmic events
7. Any unresolved toxicity from prior therapy CTCAE \> grade 3 at the time of starting treatment
8. History of hypersensitivity to excipients of AZD9291 or to drugs with a similar chemical structure or class to AZD9291
Minimum Eligible Age

18 Years

Maximum Eligible Age

130 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Parexel

INDUSTRY

Sponsor Role collaborator

AstraZeneca

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Research Site

Buenos Aires, , Argentina

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Buenos Aires, , Argentina

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CABA, , Argentina

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Bedford Park, , Australia

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East Melbourne, , Australia

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Kurralta Park, , Australia

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Randwick, , Australia

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Waratah, , Australia

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Innsbruck, , Austria

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Linz, , Austria

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Salzburg, , Austria

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Vienna, , Austria

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Charleroi, , Belgium

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Edegem, , Belgium

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Leuven, , Belgium

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Barretos, , Brazil

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Belo Horizonte, , Brazil

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Florianópolis, , Brazil

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Ijuí, , Brazil

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Itajaí, , Brazil

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Porto Alegre, , Brazil

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Porto Alegre, , Brazil

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Rio de Janeiro, , Brazil

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Rio de Janeiro, , Brazil

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Salvador, , Brazil

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Salvador, , Brazil

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São Paulo, , Brazil

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São Paulo, , Brazil

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São Paulo, , Brazil

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Calgary, Alberta, Canada

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Burnaby, British Columbia, Canada

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Vancouver, British Columbia, Canada

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Hamilton, Ontario, Canada

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North York, Ontario, Canada

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Oshawa, Ontario, Canada

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Toronto, Ontario, Canada

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Toronto, Ontario, Canada

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Toronto, Ontario, Canada

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Montreal, Quebec, Canada

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Québec, Quebec, Canada

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Regina, Saskatchewan, , Canada

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Beijing, , China

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Changchun, , China

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Changchun, , China

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Changsha, , China

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Chengdu, , China

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Chongqing, , China

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Chongqing, , China

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Chongqing, , China

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Dalian, , China

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Fuzhou, , China

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Fuzhou, , China

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Fuzhou, , China

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Guangzhou, , China

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Guangzhou, , China

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Guangzhou, , China

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Haikou, , China

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Hangzhou, , China

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Hangzhou, , China

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Hangzhou, , China

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Hangzhou, , China

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Harbin, , China

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Hefei, , China

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Hohhot, , China

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Jinan, , China

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Kunming, , China

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Linhai, , China

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Nanchang, , China

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Nanjing, , China

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Nanjing, , China

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Nanjing, , China

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Nanjing, , China

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Nanjing, , China

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Nanning, , China

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Nantong, , China

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Qingdao, , China

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Shanghai, , China

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Shanghai, , China

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Shanghai, , China

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Shanghai, , China

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Shenyang, , China

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Shenyang, , China

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Shenzhen, , China

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Shijiahzhuang, , China

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Tianjin, , China

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Ürümqi, , China

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Ürümqi, , China

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Ürümqi, , China

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Wuhan, , China

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Wuhan, , China

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Wuhan, , China

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Wuhan, , China

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Wuxi, , China

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Xi'an, , China

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Xi'an, , China

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Yancheng, , China

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Yangzhou, , China

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Yantai, , China

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Zhengzhou, , China

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Vejle, , Denmark

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Dublin, , Ireland

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Ancona, , Italy

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Avellino, , Italy

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Bari, , Italy

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Bologna, , Italy

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Brescia, , Italy

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Cagliari, , Italy

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Catania, , Italy

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Florence, , Italy

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Genova, , Italy

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Lecce, , Italy

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Livorno, , Italy

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Milan, , Italy

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Novara, , Italy

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Palermo, , Italy

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Parma, , Italy

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Perugia, , Italy

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Pisa, , Italy

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Reggio Emilia, , Italy

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Roma, , Italy

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Roma, , Italy

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Roma, , Italy

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Udine, , Italy

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Verona, , Italy

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Dammam, , Saudi Arabia

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Riyadh, , Saudi Arabia

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Anyang, , South Korea

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Busan, , South Korea

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Busan, , South Korea

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Busan, , South Korea

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Cheongju-si, , South Korea

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Daegu, , South Korea

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Daegu, , South Korea

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Daejeon, , South Korea

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Gangneung-si, , South Korea

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Goyang-si, , South Korea

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Incheon, , South Korea

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Jeonju, , South Korea

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Jeonnam, , South Korea

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JinJoo, , South Korea

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Seogu, , South Korea

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Seongnam-si, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Suwon, , South Korea

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Ulsan, , South Korea

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A Coruña, , Spain

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Alicante, , Spain

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Badalona, , Spain

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Barcelona, , Spain

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Castellon, , Spain

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Donostia / San Sebastian, , Spain

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Jaén, , Spain

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Las Palmas de Gran Canaria, , Spain

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León, , Spain

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Madrid, , Spain

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Madrid, , Spain

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Majadahonda, , Spain

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Oviedo, , Spain

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Palma de Mallorca, , Spain

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Seville, , Spain

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Valencia, , Spain

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Valencia, , Spain

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Zaragoza, , Spain

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Örebro, , Sweden

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Uppsala, , Sweden

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Kaohsiung City, , Taiwan

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Kaohsiung City, , Taiwan

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Taichung, , Taiwan

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Tainan City, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taoyuan District, , Taiwan

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Antrim, , United Kingdom

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London, , United Kingdom

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London, , United Kingdom

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Norwich, , United Kingdom

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Poole, , United Kingdom

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Wolverhampton, , United Kingdom

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Countries

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Finland Mexico Netherlands Norway Switzerland United Arab Emirates Argentina Australia Austria Belgium Brazil Canada China Denmark Ireland Italy Saudi Arabia South Korea Spain Sweden Taiwan United Kingdom

References

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Zhou Q, Zhang HL, Jiang LY, Shi YK, Chen Y, Yu JM, Zhou CC, He Y, Hu YP, Liang ZA, Pan YY, Zhuo WL, Song Y, Wu G, Chen GY, Lu Y, Zhang CY, Zhang YP, Cheng Y, Lu S, Wang CL, Zhou JY, Liu YP, He JX, Wang J, Wu YL. Real-world evidence of osimertinib in Chinese patients with EGFR T790M-positive non-small cell lung cancer: a subgroup analysis from ASTRIS study. J Cancer Res Clin Oncol. 2023 Sep;149(12):10771-10780. doi: 10.1007/s00432-023-04923-8. Epub 2023 Jun 14.

Reference Type DERIVED
PMID: 37316692 (View on PubMed)

Cheema P, Cho BC, Freitas H, Provencio M, Chen YM, Kim SW, Wu YL, Passaro A, Martin C, Tiseo M, Chang GC, Park K, Solomon B, Burghuber O, Laskin J, Wang Z, Lee SY, Hu Y, Vansteenkiste J, Zhang HL, Hanrahan E, Geldart T, Taylor R, Servidio L, Li J, Marinis F. A real-world study of second or later-line osimertinib in patients with EGFR T790M-positive NSCLC: the final ASTRIS data. Future Oncol. 2023 Jan;19(1):61-75. doi: 10.2217/fon-2022-0919. Epub 2023 Jan 19.

Reference Type DERIVED
PMID: 36656302 (View on PubMed)

Leighl NB, Kamel-Reid S, Cheema PK, Laskin J, Karsan A, Zhang T, Stockley T, Barnes TA, Tudor RA, Liu G, Owen S, Rothenstein J, Burkes RL, Iqbal M, Spatz A, van Kempen LC, Izevbaye I, Laurence D, Le LW, Tsao MS. Multicenter Validation Study to Implement Plasma Epidermal Growth Factor Receptor T790M Testing in Clinical Laboratories. JCO Precis Oncol. 2020 Nov;4:520-533. doi: 10.1200/PO.19.00335.

Reference Type DERIVED
PMID: 35050743 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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D5160C00022

Identifier Type: -

Identifier Source: org_study_id