RELAY: Final Overall Survival for Erlotinib Plus Ramucirumab or Placebo in Untreated, EGFR-Mutated Metastatic NSCLC.
Journal
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
Journal Volume
20
Journal Issue
4
Start Page
487
End Page
499
ISSN
1556-1380
Date Issued
2025-04
Author(s)
Nakagawa, Kazuhiko
Garon, Edward B
Seto, Takashi
Nishio, Makoto
Aix, Santiago Ponce
Paz-Ares, Luis
Chiu, Chao-Hua
Park, Keunchil
Novello, Silvia
Nadal, Ernest
Nishino, Kazumi
Yoh, Kiyotaka
Chik, Jeannie Y K
Moro-Sibilot, Denis
Puri, Tarun
Chacko Varughese, Sunoj
Frimodt-Moller, Bente
Visseren-Grul, Carla
Reck, Martin
Abstract
Introduction: RELAY, a global double-blind, placebo-controlled phase 3 study (NCT02411448) found statistically significant improvement in progression-free survival (primary end point) for ramucirumab (RAM) plus erlotinib (ERL) (RAM + ERL) in patients with untreated EGFR-mutated metastatic NSCLC (hazard ratio [HR] = 0.59, 95% confidence interval [CI]: 0.46-0.76, p < 0.0001; median progression-free survival: 19.4 versus 12.4 mo). Here, we report the final overall survival (OS; secondary end point) outcomes for the intention-to-treat population.
Methods: Between January 2016 and February 2018, 449 eligible patients with an EGFR exon 19del or L858R mutation and no central nervous system metastases were randomized (1:1) to ERL (150 mg/day) with RAM (10 mg/kg every two weeks, N = 224) or placebo (N = 225).
Results: At data cutoff, 297 deaths were reported (overall event rate = 66%), with a median follow-up of 45.1 months (interquartile range: 26.7-71.2), an OS HR of 0.98 (95% CI: 0.78-1.24, p = 0.864), and median OS of 51.1 months (RAM + ERL) and 46.0 months (placebo + ERL). Outcomes in subsets of patients with poor prognosis (L858R or TP53 co-mutation) suggest a directional improvement in OS (L858R: HR = 0.87, 95% CI: 0.62-1.22; exon 19del: HR = 1.13, 95% CI: 0.83-1.55; TP53 co-mutation: HR = 0.83, 95% CI: 0.58-1.19; TP53-wild-type: HR = 1.22, 95% CI: 0.87-1.72). Treatment-emergent T790M rates were similar between arms. Over 80% of patients received post-study discontinuation therapy (>50% received osimertinib in comparable numbers between arms). The safety profile for RAM + ERL was consistent with previous reports with no increased toxicity over time or new safety signals observed.
Conclusion: In RELAY, OS was not significantly improved with similar long OS durations in both treatment arms.
Subjects
EGFR mutation
Erlotinib
NSCLC
Overall survival
Ramucirumab
Type
journal article