EGFR TKI (1st generation) · small molecule

erlotinib

10 active trials across 10 of our biomarkers, targeting EGFR. 6 active approvals for a biomarker on marked.bio.

Also known as OSI-774, Tarceva.

Counts only trials that select patients by one of the biomarkers on marked.bio, not every trial of this drug.

Approvals and pivotal results

Biomarker-selected approvals in the United States and the European Union, with the pivotal trial's results and side effects where we have them. Results from different trials are not directly comparable.

TherapyBiomarkerTumourUnited StatesEuropean Union
erlotinib
FDA, 2013
metastatic, EGFR exon 19 deletion or exon 21 L858R, first line Current label (10/2016) covers EGFR ex19del/L858R NSCLC in first-line, maintenance, or second or later line (see own row for the 2016 maintenance/later-line change). Year 2013 for first line not checked against an FDA announcement. Year confirmed: FDA approval announced 14/05/2013. Source
FDA, 2016
metastatic, EGFR exon 19 deletion or exon 21 L858R, maintenance or second/later line after >=1 chemotherapy Label Recent Major Changes show Indications and Usage 1.1 changed 10/2016, restricting maintenance and later-line use (previously approved for unselected NSCLC) to ex19del/L858R. Date is from the label, not an FDA announcement. Source
EU (EMA), 2011
first line, locally advanced or metastatic with EGFR activating mutations Tarceva authorised in the EU 2005 for unselected NSCLC; first-line EGFR-mutation indication added by II/0020, EC decision 24/08/2011. Source
EU (EMA), 2016
switch maintenance, locally advanced or metastatic with EGFR activating mutations and stable disease after first-line chemotherapy Maintenance indication first authorised 27/04/2010 for unselected patients (II/0017); restricted to EGFR-activating mutations by II/0043, EC decision 25/01/2016. Source
Tarceva
EGFR exon 19 deletion / L858R NSCLC Approved 2013 Approved 2011

In the US label

EURTAC vs platinum-based chemotherapy, 86 vs 88 patients
PFS 10.4 months vs 5.2 months, HR 0.34 (0.23-0.49)Response 65% vs 16%OS 22.9 months vs 19.5 months, HR 0.93 (0.64-1.35), not significant

Stopped for side effects 14%

Trial details and side effects
Patients
first-line EGFR exon 19 deletion or L858R NSCLC (NCT00446225)
Most common side effects
rash 85%, diarrhoea 62%, cough 48%, dyspnoea 45%, dry skin 21% (84 patients)
Notes
US label rev. 10/2016, sections 6 and 14 (trial called Study 1 in the label).
Source
US label

In the EU product information

EURTAC vs platinum-based chemotherapy, 86 vs 87 patients
PFS 10.4 months vs 5.1 months, HR 0.34 (0.23-0.49)Response 58% vs 15%OS 22.9 months vs 20.8 months, HR 0.93 (0.64-1.36), not significant

Trial details and side effects
Patients
first-line EGFR exon 19 deletion or L858R NSCLC (NCT00446225)
Most common side effects
rash 85%, diarrhoea 62%, cough 48%, dyspnoea 45%, dry skin 21% (84 patients)
Notes
EU SmPC section 5.1 (EURTAC, updated 2012 analysis; ORR from the 2011 analysis). 82% of chemotherapy patients later received an EGFR TKI. Side effects from the US label.
Source
EU product information

In the EU product information

SATURN vs placebo, 49 (EGFR-mutated subgroup of 889)
PFS HR 0.10 (0.04-0.25) in EGFR-mutated; 0.71 overallOS HR 0.83 (0.34-2.02) in EGFR-mutated; 0.81 overall

Trial details and side effects
Patients
maintenance after first-line platinum chemotherapy; EGFR-mutation subgroup (NCT00556712)
Notes
EU SmPC section 5.1 (SATURN). The EGFR-mutation subgroup analysis was exploratory.
Source
EU product information
ramucirumab with erlotinib
FDA, 2020
first line, metastatic, EGFR exon 19 deletion or exon 21 L858R Label 1.2: with erlotinib, first-line metastatic NSCLC with ex19del or L858R. Year confirmed: FDA approval announced 29/05/2020. Source
EU (EMA), 2020
first line, metastatic with activating EGFR mutations II/0033, EC decision 23/01/2020. The EPAR web page indication list omits this NSCLC bullet; date and wording taken from the procedural-steps document. Source
Cyramzaramucirumab page
EGFR exon 19 deletion / L858R NSCLC Approved 2020 Approved 2020

RELAY vs placebo + erlotinib, 224 vs 225 patients
PFS 19.4 months vs 12.4 months, HR 0.59 (0.46-0.76)Response 76% vs 75%OS 51.1 months vs 46.0 months, HR 0.98 (0.78-1.24), not significant

Stopped for side effects 13% (all study drugs)

Trial details and side effects
Patients
first-line EGFR exon 19 deletion or L858R NSCLC (NCT02411448)
Most common side effects
infections 81%, diarrhoea 70%, hypertension 45%, stomatitis 42%, proteinuria 34%, alopecia 34%, epistaxis 34% (221 patients)
Notes
Ramucirumab with erlotinib. US label rev. 08/2025.
Source
US approval report

Biomarkers

BiomarkerActive trialsAll trialsFurthest active phase
EGFR exon 19 deletion / L858R 7 112 Phase 3
KRAS G12C 3 9 Phase 3
ALK fusion 2 8 Phase 3
KRAS G12D 2 7 Phase 3
BRAF V600E 1 3 Phase 2
HER2 (ERBB2) activating mutation 1 1 Phase 2
RET fusion or mutation 1 1 Phase 2
EGFR exon 20 insertion 0 2 –
PIK3CA activating mutation 0 1 –
ROS1 fusion 0 1 –

Sponsors

Industry sponsors leading active biomarker-selected trials of erlotinib.

  1. Eli Lilly 2
  2. OBI Pharma 1
  3. AbbVie 1
  4. Roche 1

Trials

Status

10 of 121 trials shown

  1. A Study of Ramucirumab (LY3009806) in Combination With Erlotinib in Previously Untreated Participants With EGFR Mutation-Positive Metastatic NSCLC (RELAY)

    Active, not recruiting Phase 3 Eli Lilly Started 2015Primary completion 2019-01 NCT02411448

    ramucirumab FDA EUerlotinib FDA EUgefitinib FDA EUosimertinib FDA EU

    …h erlotinib based on documented evidence of tumor harboring an activating EGFR mutation \[exon 19 deletion or exon 21 (L858R) substitution mutation\].

    EGFR exon 19 deletion / L858RMetastatic Non-Small Cell Lung Cancer

  2. Erlotinib Hydrochloride in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Completely Removed by Surgery (An ALCHEMIST Treatment Trial)

    Active, not recruiting Phase 3 National Cancer Institute (NCI) Started 2015Primary completion 2025-12 NCT02193282

    erlotinib FDA EU

    Previously registered to A151216, with the result of lung cancer harboring an EGFR exon 19 deletion or L858R mutation

    EGFR exon 19 deletion / L858RALK fusionLung Non-Squamous Non-Small Cell Carcinoma, Stage IB Lung Non-Small Cell Carcinoma AJCC v7, Stage II Lung Non-Small Cell Cancer AJCC v7, Stage IIA Lung Non-Small Cell Carcinoma AJCC v7

  3. A Study of Abemaciclib (LY2835219) in Participants With Previously Treated KRAS Mutated Lung Cancer

    Active, not recruiting Phase 3 Eli Lilly Started 2014Primary completion 2017-09 NCT02152631

    abemacicliberlotinib

    A Study of Abemaciclib (LY2835219) in Participants With Previously Treated KRAS Mutated Lung Cancer

    KRAS G12CKRAS G12DNon Small Cell Lung Cancer

  4. Nintedanib Plus EGFR TKI In EGFR-mutated Non-small Cell Lung Cancer Patients

    Recruiting Phase 1/2 China Medical University Hospital Started 2024Primary completion 2026-08 NCT06071013

    gefitinib FDA EUerlotinib FDA EUafatinib FDA EUosimertinib FDA EU

    Positive EGFR mutations are diagenesis.

    EGFR exon 19 deletion / L858RNon-small Cell Lung Cancer, EGFR Gene Mutation, EGFR-TKI Resistant Mutation

  5. To Evaluate OBI-833/OBI-821 in Combination With First-Line Erlotinib in Patients With EGFR-Mutated, Globo H-Positive, Locally Advanced or Metastatic Non-Small Cell Lung Cancer

    Recruiting Phase 2 OBI Pharma Started 2022Primary completion 2025-12 NCT05442060

    30 μg OBI-833/100 μg OBI-821erlotinib FDA EU

    The tumor harbors an exon 19 deletion or exon 21 L858R mutation in EGFR, confirmed locally.

    EGFR exon 19 deletion / L858RNon-small Cell Lung Cancer

  6. Erlotinib Hydrochloride and Cabozantinib-s-Malate Alone or in Combination as Second or Third Line Therapy in Treating Patients With Stage IV Non-small Cell Lung Cancer

    Active, not recruiting Phase 2 National Cancer Institute (NCI) Started 2013Primary completion 2015-08 NCT01708954

    cabozantiniberlotinib FDA EU

    Tumor with a sensitizing mutation in epidermal growth factor receptor (EGFR), defined as follows:

    EGFR exon 19 deletion / L858RKRAS G12CKRAS G12DBRAF V600EHER2 (ERBB2) activating mutationRET fusion or mutationRecurrent Lung Non-Small Cell Carcinoma, Stage IV Lung Non-Small Cell Cancer AJCC v7

  7. Erlotinib With or Without Hydroxychloroquine in Chemo-Naive Advanced NSCLC and (EGFR) Mutations

    Active, not recruiting Phase 2 Massachusetts General Hospital Started 2009Primary completion 2015-05 NCT00977470

    erlotinib FDA EUhydroxychloroquine

    An EGFR sensitizing mutation must be detected in tumor tissue.

    EGFR exon 19 deletion / L858RNon-small Cell Lung Cancer

  8. A Study to Evaluate the Safety, Pharmacokinetics, and Activity of GDC-6036 Alone or in Combination in Participants With Advanced or Metastatic Solid Tumors With a KRAS G12C Mutation

    Active, not recruiting Phase 1 Roche Started 2020Primary completion 2027-12 NCT04449874

    divarasibatezolizumabcetuximabbevacizumaberlotinibGDC-1971inavolisib

    Histologically documented advanced or metastatic solid tumor with KRAS G12C mutation.

    KRAS G12CNon-Small Cell Lung Cancer, Colorectal Cancer, Advanced Solid Tumors

  9. A Study Evaluating the Safety, Pharmacokinetics (PK), and Preliminary Efficacy of ABBV-399 in Participants With Advanced Solid Tumors

    Active, not recruiting Phase 1 AbbVie Started 2014Primary completion 2026-08 NCT02099058

    osimertinib FDA EUnivolumabtelisotuzumab vedotinerlotinib FDA EU

    …ced nonsquamous NSCLC with documented Epidermal Growth Factor Receptor (EGFR) mutation(s) del19 or L858R, with or without T790M mutation, and none of the EGFR mutations known to be resi…

    EGFR exon 19 deletion / L858RAdvanced Solid Tumors Cancer

  10. Genetic Testing in Screening Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been or Will Be Removed by Surgery (The ALCHEMIST Screening Trial)

    Active, not recruiting No phase National Cancer Institute (NCI) Started 2014Primary completion 2025-12 NCT02194738

    carboplatincisplatincrizotinib FDA EUerlotinibgemcitabinenivolumabpaclitaxelpembrolizumabpemetrexed

    No prior treatment with agents targeting EGFR mutation, ALK rearrangement, and PD-1/PD-L1/CTLA-4

    ALK fusionStage IB Lung Non-Small Cell Carcinoma AJCC v7, Stage II Lung Non-Small Cell Cancer AJCC v7, Stage IIA Lung Cancer AJCC v8, Stage IIB Lung Cancer AJCC v8