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Trodelvy (sacituzumab govitecan) led to a 51% reduction in the risk of progression or death compared with chemotherapy in patients with nonsquamous epidermal growth factor receptor–mutated non–small cell lung cancer that developed epidermal growth factor receptor tyrosine kinase inhibitor resistance, according to phase 3 results of the OptiTROP-Lung04 study presented during the European Society of Medical Oncology Congress 2025.

Results showed that, at a median follow-up of 18.9 months, the median progression-free survival assessed by blinded independent central review was 8.3 months with Trodelvy and 4.3 months with chemotherapy. The 12-month progression-free survival rates were 32% and 8%, respectively. The benefit with Trodelvy was observed across all prespecified subgroups.

The investigator-assessed median progression-free survival was 8.4 months with Trodelvy and 4.8 months with chemotherapy. The 12-month rates were 35% and 11%, respectively.

“Trodelvy demonstrated statistically significant and clinically meaningful improvements in progression-free and overall survival compared to platinum-based chemotherapy,” lead study author Dr. Li Zhang, professor of medical oncology at Sun Yat-sen University Cancer Center in Guangzhou, China, said in an oral presentation of the data. “The results of the OptiTROP-Lung04 study support Trodelvy as a promising new treatment option for patients with EGFR-mutated non–small cell lung cancer with epidermal growth factor receptor tyrosine kinase inhibitor resistance.”

Trodelvy is a TROP2 antibody-drug conjugate with a unique biofunctional linker that maximizes delivery of a belotecan-derivative topoisomerase I inhibitor payload to tumor cells. TROP2 is highly expressed in patients with EGFR-mutated non–small cell lung cancer, and preclinical data have shown that Trodelvy internalization and uptake are enhanced by EGFR mutations.

Current standard options for patients who relapse on third-generation EGFR tyrosine kinase inhibitors remain platinum-based chemotherapy, but more options are needed.

In the multicenter, open-label, phase 3 OptiTROP-Lung04 trial, 376 patients with nonsquamous stage 3B/3C or 4 non–small cell lung cancer with EGFR-sensitive mutations were randomly assigned 1:1 to receive Trodelvy at five milligrams per kilogram intravenously every two weeks or Alimta at 500 milligrams per square meter plus carboplatin area under the curve 5 or cisplatin at 75 milligrams per square meter every three weeks for up to four cycles, followed by Alimta maintenance at 500 milligrams per square meter every three weeks. Treatment was given until disease progression, intolerable toxicity, or patient request to discontinue therapy.

To be eligible for enrollment, patients needed to have an Eastern Cooperative Oncology Group performance status of zero or one and progression after third-generation tyrosine kinase inhibitor therapy or progression after first- or second-generation tyrosine kinase inhibitors with T790M-negative mutations.

Stratification factors included prior EGFR tyrosine kinase inhibitor therapy (third-generation in frontline versus second line versus no third-generation) or brain metastases (yes versus no).

The primary end point was progression-free survival assessed by blinded independent central review; secondary end points were overall survival, investigator-assessed progression-free survival, objective response rate, disease control rate, duration of response, and safety.

A total 148 patients on Trodelvy discontinued treatment due to disease progression (125 patients), patient or guardian withdrawal (12 patients), death (6 patients), side effects (2 patients), or other (3 patients). In the chemotherapy arm, 179 patients discontinued treatment due to disease progression (140 patients), patient/guardian withdrawal (16 patients), death (9 patients), side effects (5 patients), protocol deviation (2 patients), or other (7 patients). A total 69 and 102 patients in each arm, respectively, discontinued from the study due to death (67 and 101 patients) or were lost to follow-up (2 and 1 patients).

Patient baseline characteristics were generally well balanced between the Trodelvy (188 patients) and chemotherapy arms (188 patients). The median age was 60 years and 59 years, and 31% and 27% were at least 65 years. Most had a performance status of 1 (81% and 77%), had no smoking history (77% and 72%), had stage 4 disease (97% and 98%), and at least three metastatic sites (68% and 67%). A total 18% and 19% had brain metastases, and 13% and 18% had liver metastases. The majority in each arm had exon 19 deletions (56% and 63%), had unknown T790M mutation status (59% and 60%), and received a prior third-generation EGFR tyrosine kinase inhibitor in the frontline setting (63% and 62%).

The interim analysis showed that for Trodelvy, the median overall survival was not reached compared with 17.4 months with chemotherapy, leading to a 40% reduction in the risk of death. The 18-month overall survival rates were 66% and 48%, respectively. Overall survival was improved with Trodelvy across all prespecified subgroups.

Dr. Zhang also reported on subsequent anticancer treatment from the trial; 72% of patients on Trodelvy and 86% of those on chemotherapy received at least one subsequent treatment. In the Trodelvy and chemotherapy groups, respectively, these included chemotherapy (42%; 54%), specifically Alimta-based chemotherapy (37%; 13%), an EGFR tyrosine kinase inhibitor (43%; 40%), an anti-angiogenic agent (35%; 48%), immunotherapy (17%; 25%), or an antibody-drug conjugate (1%; 20%).

When assessed via blinded independent central review, the objective response rate with Trodelvy was 61% compared with 43% with chemotherapy; the disease control rate was 87% and 80%, respectively. The median duration of response was 8.3 months with Trodelvy and 4.2 months with chemotherapy; the 12-month rates were 36% versus 8%, respectively.

Regarding safety, treatment-related side effects occurred in 100% and 98% of Trodelvy– and chemotherapy-treated patients, respectively. Grade 3 or higher side effects occurred in 58% and 54% of patients, and serious side effects occurred in 9% and 18% of patients, respectively. Side effects that led to dose reductions and interruptions occurred in 30% and 37% of patients on Trodelvy; there were no side effects that led to discontinuation or death. In the chemotherapy arm, these rates were 23% and 33%; one patient each experienced side effects leading to discontinuation or death.

The median duration of exposure was 9.6 months with Trodelvy and 4.9 months with chemotherapy. The most common side effects in both arms were hematologic; Trodelvy had higher incidence of stomatitis that were mostly grade 1 or 2 (any-grade 62%; grade ≥3 5%). Ocular surface toxicities also occurred in 10% of patients on Trodelvy, all grade 1 or 2. No cases of interstitial lung disease or pneumonitis were reported on the Trodelvy arm.

Phase 3 trials are currently exploring Trodelvy alone and in combination with Tagrisso in patients with EGFR-mutant non–small cell lung cancer.

References

1. “Sacituzumab tirumotecan versus platinum-based chemotherapy in EGFR-mutated non-small cell lung cancer following progression on EGFR-TKIs” by Dr. Zhang, et al., presented at the 2025 ESMO Congress.
2. “Sacituzumab tirumotecan in advanced non-small-cell lung cancer with or without EGFR mutations” by Dr. Zhao, et al., Nat Med.

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Tiragolumab (MTIG7192A) plus atezolizumab (Tecentriq) and bevacizumab (Avastin) did not provide a statistically significant progression-free survival (PFS) benefit vs placebo plus atezolizumab and bevacizumab in patients with untreated locally advanced or metastatic hepatocellular carcinoma (HCC), according to findings from the phase 3 IMbrave152/SKYSCRAPER-14 study (NCT05904886) that were presented during the 2025 ESMO Congress.

In turn, the coprimary end point of investigator-assessed PFS was missed. Patients treated with placebo plus atezolizumab and bevacizumab (n = 338) had an investigator-assessed median PFS of 8.2 months (95% CI, 7.0-9.7) vs 8.3 months (95% CI, 7.1-9.8) in patients treated with tiragolumab plus atezolizumab plus bevacizumab (HR, 0.97; 95% CI, 0.8-1.2; stratified log-rank P =.7464).

Overall survival (OS) data remain immature and are not anticipated to reach statistical significance, according to study authors.

“These data, now from a double-blind, placebo-controlled study of over 600 patients, confirm the activity of atezolizumab plus bevacizumab in the management of this population, as well as the safety, and moving forward, we will hopefully learn a lot from the study on how to best decide to move forward in advancing care for our patients with HCC,” study author and presenter, Richard S. Finn, MD, stated.

Finn is a professor of medicine at the David Geffen School of Medicine, UCLA, and director of the UCLA Liver Cancer Program.

Design and Baseline Characteristics of the IMbrave152/SKYSCRAPER-14 Study

The IMbrave152/SKYSCRAPER-14 study is a double-blind, placebo-controlled, randomized, global trial that enrolled 669 patients between September 14, 2023, and September 23, 2024. Eligible patients were 18 years of age or older with unresectable locally advanced or metastatic HCC, an ECOG performance status of 0 or 1, and Child-Pugh A liver function.

Patients were excluded from the study if they had received prior systemic therapy for advanced disease or experienced recurrence within 26 months of completing adjuvant treatment. Patients were randomly assigned 1:1 to receive either tiragolumab at 600 mg plus atezolizumab at 1200 mg plus bevacizumab at 15 mg/kg intravenously (IV) every 3 weeks, or placebo plus atezolizumab at 1200 mg and bevacizumab at 15 mg/kg IV every 3 weeks.

Treatment continued until loss of clinical benefit or unacceptable toxicity, and crossover was not allowed. Imaging assessments were performed every 6 weeks, with a 1-week margin. Stratification factors included geographic region (Asia and Africa vs the rest of the world, including Japan), macroscopic vascular invasion (MVI) and/or extrahepatic spread (EHS; presence versus absence), baseline AFP level (≥ 400 ng/mL vs < 400 ng/mL), and HCC etiology (viral vs non-viral).

The study’s primary end points were investigator-assessed PFS per RECIST 1.1 criteria and OS. Key secondary end points included objective response rate (ORR), duration of response (DOR), PFS and OS rates at select time points, safety, and patient-reported outcomes (PROs).

The baseline characteristics were generally well balanced between the tiragolumab and the placebo arms. The median age for all patients was 44.5 years, with 82.2% of patients aged 65 years or older. The majority of patients were male (87.6% in both arms).

The most common geographic region was Asia/Asian Pacific/Australia (tiragolumab, 52.0%; placebo, 48.1%), followed by Europe and Middle East/North America (18.7%; 17.5%). Hepatitis B was the most frequent HCC etiology (65.6%; 59.8%), whereas 76.1% of all patients had an ECOG performance status of 0 or 1. Most patients had Barcelona Clinic Liver Cancer (BCLC) stage B or C disease (75.9% overall) and a Child-Pugh score of A5 or A6 (63.5% overall).

Other key characteristics were similar: macrovascular invasion and/or extrahepatic spread was present in 36.7% of all patients, AFP levels of 400 ng/mL or higher were seen in 25.9% of all patients, and 38.9% of the overall population had received prior local cancer therapy.

Exploratory Subgroup Analysis

An exploratory subgroup analysis of 909 patients showed that adding tiragolumab to atezolizumab plus bevacizumab was numerically associated with an improvement in median investigator-assessed PFS of 8.3 months vs 8.2 months (HR, 0.98; 95% CI, 0.8-1.2) compared with the atezolizumab plus bevacizumab arm.

Treatment benefit varied across prespecified baseline characteristics. Patients with baseline AFP levels less than 400 ng/mL appeared to derive the greatest benefit (HR, 0.74; 95% CI, 0.6-1.0), with a median investigator-assessed PFS of 9.8 months vs 5.5 months in the control arm. Conversely, patients with an ECOG performance score of 1, those in the Americas excluding Japan, those with high MVI and/or EHS (HR, 1.18; 95% CI, 0.9-1.5), and those with a Child-Pugh score A8 (HR, 1.18; 95% CI, 0.8-1.7) appeared to have a diminished or unfavorable treatment effect.

The median investigator-assessed PFS was longer in the experimental arm for nearly all subgroups, with notable exceptions including HCC etiology of hepatitis C (7.7 months vs 12.8 months) and the Child-Pugh A8 subgroup (4.7 months vs 5.7 months).

Understanding Additional Outcomes of the IMbrave152/SKYSCRAPER-14 Study

The ORR was 29.9% for the tiragolumab group with a complete response (CR) rate of 2.1% and a partial response (PR) rate of 27.8%. In the placebo group, the ORR was 26.0%, the CR rate was 1.8%, and the PR rate was 24.3%.

Among patients receiving the tiragolumab combination, there were 99 responders. Of these, 33.3% of patients experienced a subsequent event. The median DOR was 15.0 months (range,13.9-not estimable [NE]).

Among those receiving placebo, there were 88 responders. Of these, 38.6% experienced a subsequent event. The median DOR was 13.2 months (range, 10.1-NE).

Stable disease was reported in 48.0% of patients in the tiragolumab group vs 48.8% of those in the placebo group; progressive disease was reported in 16.3% vs 18.9% of patients, respectively, and the disease control rates were 77.9% vs 74.9%, respectively.

How Safe Is Tiragolumab Plus Atezolizumab and Bevacizumab?

The safety profile of the tiragolumab plus atezolizumab and bevacizumab combination (n = 332) was similar to that of the placebo plus atezolizumab and bevacizumab regimen (n = 333), though patients in the tiragolumab arm experienced slightly higher rates of adverse effects (AEs).

Nearly all patients in both arms reported AEs of any cause (tiragolumab arm, 98.8%; placebo arm, 97.6%). Grade 3/4 AEs were observed in 53.6% of patients in the tiragolumab-treated group, and grade 5 AEs were seen in 8.4% of patients in this arm. The rates of grade 3/4 and grade 5 AEs in the placebo arm were 47.7% and 7.2%, respectively.

Serious AEs occurred in 45.8% of patients in the tiragolumab arm and 38.4% of those in the placebo arm. Drug-related AEs were reported in 92.8% and 87.1% of patients, respectively. AEs led to withdrawal of tiragolumab in 73.8% of patients receiving it, with 18.4% of those patients requiring systemic corticosteroids. AEs resulted in bevacizumab withdrawal in 64.5% of patients in the tiragolumab group and 60.7% of those in the placebo group.

Disclosures: Finn reported serving as a Principal Investigator for Merck/Eisai and Roche. He has received research funding from Bristol-Myers Squibb, Merck/Eisai, Pfizer, and Roche/Genentech. His roles as a speaker, consultant, or advisor involve relationships with AstraZeneca, Bristol-Myers Squibb, Chugai, Guerbet, Merck/Eisai, Novartis, Pfizer, Roche/Genentech, and Zai Labs. He is also a steering committee member for Bristol-Myers Squibb, Merck/Eisai, and Roche.

Reference

Finn RS, Singal AG, Cheng A, et al. IMbrave152/SKYSCRAPER-14: a phase III study of first-line tiragolumab + atezolizumab + bevacizumab vs placebo + atezolizumab + bevacizumab for patients with untreated locally advanced or metastatic hepatocellular carcinoma. Presented at: 2025 ESMO Congress; October 19, 2025; Berlin, Germany. Abstract LBA50.