A Prospective, Single-arm, Multi-center Clinical Trial of Furmonertinib Combined With Anlotinib as First-line Treatment for Advanced NSCLC With EGFR-sensitive Mutations and Brain Metastasis.
EGFR mutation-positive NSCLC patients have a higher risk of developing brain metastases. The prognosis is poor for patients presenting with brain or leptomeningeal metastases at any stage, particularly those with such metastases at initial diagnosis, who have the worst prognosis. Furmonertinib, as a novel EGFR-TKI, enhances its lipophilicity by incorporating a trifluoroethoxy pyridine group. Preclinical animal studies further confirm that both Furmonertinib (AST2818) and its metabolite (AST5902) exhibit excellent intracranial distribution. This provides strong theoretical support for the effective treatment of lung cancer brain metastasis patients with Furmonertinib. EGFR TKI-based combination therapies, as a strategy to delay disease progression, have consistently been a focal point in medical research. Among these, antiangiogenic agents are increasingly recognized for their synergistic effects when combined with TKIs, jointly inhibiting tumor growth, proliferation, and metastasis.Such combinations have demonstrated clear efficacy and manageable safety profiles. Based on this, the current study aims to explore the efficacy and safety of first-line treatment with 160 mg Furmonertinib combined with anlotinib for advanced NSCLC patients with EGFR-sensitive mutations and brain metastases.
• Patient must meet all of the following inclusion criteria to be enrolled in this study:
‣ Patients must voluntarily agree to participate in the study and sign a written informed consent form.
⁃ Patients must be ≥18 years old, regardless of gender.
⁃ Patients must have histologically or cytologically confirmed advanced NSCLC, staged as AJCC TNM 9th edition Stage IV.
⁃ Histological or cytological report issued by a hospital or a third-party testing institution recognized by the national assessment confirmed the presence of EGFR 19Del or L858R mutations, with or without other EGFR mutations.
⁃ Patients must have an ECOG performance status score of 0-2 and be expected to survive for at least 12 weeks, as determined by the investigator.
⁃ Patients must have brain parenchymal metastases confirmed by CT or MRI scans, with or without symptoms (as judged by the investigator).
⁃ Patients must have at least one measurable lesion based on RECIST 1.1 criteria.
⁃ Patients must not have received prior systemic anticancer therapy for advanced/metastatic NSCLC, including standard chemotherapy, biological therapy, targeted therapy, immunotherapy, or investigational drug therapy. Patients who received adjuvant or neoadjuvant therapy (chemotherapy and/or radiotherapy) are eligible if there has been no disease progression within 6 months of treatment completion. Patients who received local therapy (radiotherapy or pleural perfusion therapy) are also eligible if the treated lesion is not a target lesion.
⁃ Patients must meet the following organ function criteria:
‣ Absolute neutrophil count (ANC) ≥1.5 × 10⁹/L. Platelet count ≥75 × 10⁹/L. Hemoglobin (HGB) ≥80 g/L. Serum total bilirubin (TBIL) ≤1.5 times the upper limit of normal (ULN). For patients with liver metastases, TBIL may be up to 3 times ULN. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 times ULN.
‣ For patients with liver metastases, AST and ALT may be up to 5 times ULN. Serum creatinine (SCr) ≤1.5 times ULN, or creatinine clearance rate ≥50 mL/min (calculated using the Cockcroft-Gault formula).
‣ Male patients with reproductive potential and female patients with a possibility of pregnancy must use highly effective contraceptive methods (e.g., oral contraceptives, intrauterine devices, abstinence, or barrier contraception combined with spermicide) during the study and for 12 months after treatment discontinuation.