16, 95% CI: 0.10–0.26, p < 0.0001; EURTAC: 9.7 vs. 5.2 months, respectively, HR = 0.37, 95% CI: 0.25–0.54, p < 0.0001). Until now, erlotinib has not been prospectively evaluated in Japanese

patients with EGFR mutation-positive NSCLC. This prospective, phase II, open-label study (JO22903) was initiated to obtain confirmatory efficacy and safety data in the first-line setting for Japanese patients with EGFR mutation-positive NSCLC, in order to corroborate data from Chinese and Caucasian populations. JO22903 was a phase II, multicenter, open-label, non-randomized study conducted at 25 centers in Japan. Eligible patients were aged ≥20 years with advanced, untreated, metastatic (stage IIIB/IV), E7080 or relapsed NSCLC, with an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1 and tumors harboring confirmed activating mutations of EGFR (exon 19 deletion or L858R point mutation in exon 21), with at least 1 measurable lesion according

to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0. Staging was assessed by TNM classification (7th edition). The study was carried out in accordance with the Declaration of Helsinki and Japanese Good Clinical Practice guidelines. The protocol was approved by ethics committees and all patients gave informed consent for study participation. Eligible patients received oral erlotinib 150 mg/day until disease progression (PD) or unacceptable toxicity (Fig. 1). Dose reductions (in 50-mg decrements) and/or interruptions Gefitinib order (of up to 2 weeks) were permitted to manage adverse events (AEs) related to erlotinib treatment. Treatment was interrupted if interstitial lung disease (ILD) was suspected; for patients with confirmed ILD diagnosis, erlotinib was discontinued immediately. In cases of gastrointestinal perforation or any grade 4 AE, erlotinib was discontinued. Patients were screened for EGFR mutations in a local or central laboratory. In the central laboratory, EGFR mutation status was determined using Scorpion ARMS [5].

For exploratory analyses, tumor samples were obtained from hospital archives for patients who were screened in their local laboratory to confirm the concordance between several local methods and Scorpion ARMS. In addition, serum samples were collected at screening from all patients who provided informed consent to participate Pazopanib order in the exploratory research (n = 95). DNA was isolated from serum with the QIAmp MinElute Virus Spin kit (Qiagen, Hilden, Germany). Scorpion ARMS was used for EGFR mutation testing for circulating DNA in the serum. Tumor response was assessed by an independent review committee (IRC) using RECIST version 1.0. Tumor response evaluation was scheduled every 6 weeks. AEs were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTC AE) version 4.0. At baseline mandatory lung and abdominal scans (CT/MRI), brain scans (CT/MRI) and bone scans (bone scintigraphy, PET, CT and MRI) were performed.