03311nam a2200325   4500001000800000005001700008007000300025008004100028040000800069041000800077100002500085245007600110300002300186520235500209650002502564650001702589650003202606650003202638700002402670700001902694700001802713700001802731700002402749700002302773700001902796700001702815700002302832700002802855773010202883ESSALUD20260821122750.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aZhou, Caicun eAutor  aFirst-line sunvozertinib in NSCLC with EGFR exon 20 insertion mutations  apáginas: 765-775  aBackground: Sunvozertinib received accelerated approval for use in later lines of therapy for patients with advanced non–small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations. Data are needed on the efficacy and safety of sunvozertinib as a first-line treatment for NSCLC. Methods: In this phase 3, international trial, we randomly assigned, in a 1:1 ratio, patients with advanced nonsquamous NSCLC with EGFR exon 20 insertions to receive sunvozertinib or chemotherapy (carboplatin–pemetrexed). The primary end point was progression-free survival as assessed by blinded independent central review. Crossover to the sunvozertinib group was allowed after disease progression was confirmed. Secondary end points included overall survival, investigator-assessed progression-free survival, objective response (complete or partial response), change in tumor size, and duration of response. Results: A total of 324 patients were randomly assigned to receive sunvozertinib (163 patients) or chemotherapy (161 patients). Treatment with sunvozertinib led to significantly longer median progression-free survival than chemotherapy (10.3 vs. 7.5 months; hazard ratio for disease progression or death, 0.65; 95% confidence interval, 0.50 to 0.85; P<0.001). At 12 months, progression-free survival was reported in 46.1% of the patients in the sunvozertinib group and in 26.7% of those in the chemotherapy group; the data for overall survival were immature (38.9% maturity). The percentage of patients with an objective response was 58.9% in the sunvozertinib group and 31.1% in the chemotherapy group; the median best percentage change in tumor size was −42.1% and −24.7% respectively, and the median duration of response was 11.2 and 7.1 months. Grade 3 or higher adverse events were reported in 75.5% of the patients in the sunvozertinib group and in 56.7% of those in the chemotherapy group. In the sunvozertinib group, the most common adverse events of grade 3 or higher included increased serum creatine kinase levels, diarrhea, and anemia. No deaths were attributed to adverse events considered by the investigators to be related to sunvozertinib. Conclusions: The efficacy of sunvozertinib was superior to that of chemotherapy as first-line treatment for advanced NSCLC with EGFR exon 20 insertions.  aCÁNCER DE PULMÓN  aNEUMOLOGÍA  aCUIDADOS INTENSIVOS GENERAL  aTRATAMIENTOS EN ONCOLOGÍA  aGreillier, Laurent   aLiu, Geoffrey   aJohn, Thomas   aXing, Ligang   aKowalski, Dariusz    aMemmott, Regan M.   aYazici, Ozan    aSun, Meili    aShu, Catherine A.   aPons-Tostivint, Elvire 0 022717dMassachusetts NEJM GroupoNEJM12tThe New England Journal of Medicine wESSALUDx0028-4793