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Fulzerasib plus cetuximab shows 69% response in first-line KRAS-mutated NSCLCCan a new drug combination shrink lung tumors in people with a specific KRAS mutation?

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Key Takeaway
Consider these phase 1b/2 fulzerasib-cetuximab results preliminary pending randomized trial confirmation.

This single-arm phase 1b/2 trial evaluated oral fulzerasib (600 mg twice daily) plus intravenous cetuximab (500 mg/m² every 2 weeks) in 47 treatment-naive patients with KRAS-mutated non-small-cell lung cancer across 30 centers in Spain, Italy, and Greece. The primary endpoint was investigator-assessed objective response rate per RECIST 1.1, with a median follow-up of 12.8 months.

The confirmed objective response rate was 69% (90% CI 56-80). Treatment-related adverse events occurred in 87% of patients, with grade 3 events in 15%. No grade 4 or 5 treatment-related adverse events were observed, and treatment-related adverse events led to drug discontinuation in 6% of patients, with only cetuximab being discontinued in those cases.

Key limitations include the single-arm design without a comparator group, preventing direct efficacy comparisons. The phase 1b/2 nature and relatively small sample size (47 treated patients) mean these findings are preliminary. The study was funded by Zhejiang GenFleet Therapeutics. For practice, these results suggest a potential signal of activity for this combination in first-line KRAS-mutated NSCLC, but randomized controlled trials are needed to establish efficacy and safety relative to standard therapies.

When you're diagnosed with a type of lung cancer driven by a specific genetic glitch called a KRAS mutation, your treatment options have been limited. A new, early-stage trial tested a two-drug combination—fulzerasib pills plus an IV drug called cetuximab—in people who hadn't yet received any treatment for their advanced cancer. The goal was to see if it could shrink tumors.

In 47 patients across Europe, the results were promising: about 69% of people saw their tumors shrink significantly, which doctors call an 'objective response.' The treatment was also manageable for most. While most patients had some side effects, severe ones were less common, and no life-threatening side effects were directly tied to the drugs. A small number of people had to stop one of the drugs because of these effects.

It's important to remember this is very early data. The study was small and didn't compare this combination to the current standard of care. We don't know yet if it helps people live longer or feel better. The results are a positive signal that warrants larger, more definitive studies to see if this could become a real option for patients.

What this means for you:
Early trial shows a new combo can shrink KRAS-mutant lung tumors, but more research is needed.

Study Details

Study typePhase1
Sample sizen = 60
EvidenceLevel 4
Follow-up216.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Fulzerasib, a KRAS inhibitor, has shown clinical activity in previously treated non-small-cell lung cancer (NSCLC). Clinical studies indicate that combining a KRAS inhibitor with an anti-EGFR antibody is effective in colorectal cancer; however, its benefit in NSCLC remains to be explored. METHODS: This single-arm, phase 1b/2 trial enrolled patients at 30 medical centres in Spain, Italy, and Greece. Eligible patients had KRAS-mutated NSCLC with no previous systemic anti-tumour therapy for advanced or metastatic disease and were aged 18 years and older; had at least one measurable lesion according to the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1; had an Eastern Cooperative Oncology Group performance status of 0 or 1; and had a life expectancy of 3 months or more. Enrolled patients received 600 mg oral fulzerasib twice daily plus 500 mg/m intravenous cetuximab every 2 weeks. The primary endpoint was investigator-assessed objective response rate per RECIST 1.1 assessed in the full response analysis set. The study was registered with ClinicalTrials.gov (NCT05756153) and is complete. FINDINGS: Between April 23, 2023, and April 15, 2024, a total of 60 patients were screened, and 47 patients (78%) received treatment. The median age was 68 years (IQR 59-72); 25 patients (53%) were male and 22 (47%) were female. 45 (95%) patients were current or former smokers. As of Jan 14, 2025, the median follow-up time and treatment duration were 12·8 months (90% CI 11·6-14·6) and 10·1 months (IQR 6·3-13·0) months, respectively. The confirmed objective response rate was 69% (90% CI 56-80). Treatment-related adverse events (TRAEs) occurred in 41 (87%) of the 47 patients (grade 3 in seven [15%]). No grade 4 or 5 TRAEs were observed. TRAEs led to drug discontinuation in three (6%) patients, with only cetuximab being discontinued. INTERPRETATION: In treatment-naive KRAS-mutated NSCLC, fulzerasib plus cetuximab showed encouraging activity with a favourable safety profile. The combination is currently being planned for investigation in a phase 3 study. FUNDING: Zhejiang GenFleet Therapeutics.
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