EGFR TKI (1st generation) · small molecule

gefitinib

6 active trials across 2 of our biomarkers, targeting EGFR. 2 active approvals for a biomarker on marked.bio.

Also known as ZD1839, Iressa.

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
gefitinib
FDA, 2015
first line, metastatic, EGFR exon 19 deletion or exon 21 L858R Current label: first-line metastatic NSCLC with exon 19 deletions or exon 21 L858R (label 'Initial U.S. Approval: 2015'). Year confirmed: FDA approval announced 13/07/2015. Source
EU (EMA), 2009
locally advanced or metastatic with activating EGFR-TK mutations EU label: 'activating mutations of EGFR-TK'; restriction present since initial MA 24/06/2009. Source
Iressa
EGFR exon 19 deletion / L858R NSCLC Approved 2015 Approved 2009

In the US label

IFUM single-arm, 106 patients
Response 50% (41-59)Lasting 6.0 months

Stopped for side effects about 5%

Trial details and side effects
Patients
first-line EGFR-mutation-positive NSCLC (NCT01203917)
Most common side effects
skin reactions 47%, diarrhoea 29%, decreased appetite 17%, vomiting 14% (2,462 (pooled) patients)
Later trial
IPASS EGFR-mutation subgroup vs carboplatin + paclitaxel (88 vs 98 patients): median PFS 10.9 vs 7.4 months, HR 0.54 (95% CI 0.38-0.79); ORR 67% vs 41%. In the US label (Study 2).
Notes
US label rev. 02/2023 (Study 1). Side effects are pooled from three randomised trials.
Source
US label

In the EU product information

IPASS (EGFR-mutation-positive subgroup) vs carboplatin + paclitaxel, 261 (subgroup)
PFS 9.5 months vs 6.3 months, HR 0.48 (0.36-0.64)Response 71% vs 47%OS 21.6 months vs 21.9 months, HR 1.00 (0.76-1.33)

Trial details and side effects
Patients
first-line EGFR-mutation-positive NSCLC (NCT00322452)
Most common side effects
skin reactions 47%, diarrhoea 29%, decreased appetite 17%, vomiting 14% (2,462 (pooled) patients)
Later trial
IFUM single-arm study (106 patients): ORR 70% (investigator), median PFS 9.7 months.
Notes
EU SmPC section 5.1. Side effects from the US label.
Source
EU product information

Biomarkers

BiomarkerActive trialsAll trialsFurthest active phase
EGFR exon 19 deletion / L858R 6 87 Phase 3
EGFR exon 20 insertion 0 1 –

Sponsors

Industry sponsors leading active biomarker-selected trials of gefitinib.

  1. Allist Pharmaceuticals 1
  2. Eli Lilly 1
  3. Novartis 1

Trials

Status

6 of 87 trials shown

  1. Alflutinib Mesylate Versus Gefitinib in Patients With Locally Advanced or Metastatic Non-small Cell Lung Cancer (FLAG)

    Active, not recruiting Phase 3 Allist Pharmaceuticals Started 2019Primary completion 2021-09 NCT03787992

    furmonertinibgefitinib FDA EU

    …ours one of the 2 common EGFR mutations known to be associated with EGFR-TKI sensitivity (Ex19del, L858R).

    EGFR exon 19 deletion / L858RLocally Advanced or Metastatic EGFR Sensitising Mutation Positive Non-small Cell Lung Cancer

  2. 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

  3. 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

  4. Osimertinib and Gefitinib in EGFR Inhibitor naïve Advanced EGFR Mutant Lung Cancer

    Active, not recruiting Phase 1/2 Dana-Farber Cancer Institute Started 2017Primary completion 2026-10 NCT03122717

    gefitinib FDA EUosimertinib FDA EU

    …e histologically confirmed stage IV NSCLC (per AJCC 7th edition) with either the L858R or exon 19 deletion activating EGFR mutation as identified in a CLIA-approved laboratory.

    EGFR exon 19 deletion / L858RNon-Small Cell Lung Cancer

  5. Study of EGF816 in Combination With Selected Targeted Agents in EGFR-mutant NSCLC

    Active, not recruiting Phase 1 Novartis Started 2018Primary completion 2026-10 NCT03333343

    nazartinibtrametinibribociclibnaporafenibcapmatinibgefitinib FDA EU

    …tologically confirmed locally advanced (stage IIIB) or metastatic (stage IV) EGFR mutant (ex19del, L858R) NSCLC.

    EGFR exon 19 deletion / L858REGFR-mutant Non-small Cell Lung Cancer

  6. Therapy for Advanced NSCLC With EGFR 19delins Mutation

    Not yet recruiting Early Phase 1 Fuzhou General Hospital Started 2026Primary completion 2030-10 NCT07458919

    icotinibgefitinib FDA EUbefotertinibosimertinib FDA EUfurmonertinib

    Epidermal growth factor receptor (EGFR) exon 19 deletion-insertion mutation (19delins) documented by testing of tumor tissue or plasma samples usi…

    EGFR exon 19 deletion / L858RLung Cancer