ctDNA Monitoring Guides the Treatment of NSCLC With Befotertinib Combined With Radiotherapy

Dynamic ctDNA Monitoring Guides a Single-Arm, Multicenter, Exploratory Study of Befotertinib Combined With Radiotherapy for EGFR-Mutated Oligometastatic NSCLC

Befotertinib is a third-generation EGFR-TKI independently developed in China. In first-line treatment of advanced non-small cell lung cancer (NSCLC) with EGFR mutations, it has demonstrated a median progression-free survival (PFS) of 22.1 months, representing the longest reported PFS data among currently available third-generation EGFR-TKIs. Building on the clinical advantages of this agent and addressing the unmet therapeutic needs in oligometastatic NSCLC, this study aims to conduct a prospective exploration by dynamically monitoring circulating tumor DNA (ctDNA) to guide the application of befotertinib combined with radiotherapy in patients with EGFR mutation-positive oligometastatic NSCLC.

Study Overview

• Status: Not yet recruiting
• Conditions: Patients With Advanced Oligometastatic Non-small Cell Lung Cancer (NSCLC) Who Have Tested Positive for EGFR Mutations Confirmed by Histopathological Examination
• Intervention / Treatment: Drug: Befotertinib

• Study Type: Interventional
• Enrollment (Estimated): 84
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Zhou Zhiguo Zhou; Phone Number: 0086-0311-86095628; Email: chenk777@126.com

Study Locations

• China
  • Hebei
    • Shijiazhuang, Hebei, China, 050000
      • The Fourth Hospital of Hebei Medical University
      • Contact: ZHOU; Phone Number: 0086-0311-86095588; Email: chenk777@126.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age 18-75 years at the time of signing the informed consent form, both males and females are eligible;
2. Histologically confirmed newly diagnosed or treatment-naïve oligometastatic stage IV NSCLC (AJCC 9th edition) with ≤3 involved organs and ≤5 metastatic lesions. Regional lymph node involvement (regardless of number) is not counted as metastatic sites; non-regional lymph node involvement is classified as a metastatic lesion;
3. Presence of an EGFR sensitizing mutation (19Del or 21L858R);
4. At least one measurable lesion according to RECIST v1.1;
5. ECOG performance status 0-1;
6. Life expectancy ≥12 weeks;
7. No prior systemic anti-tumor therapy for advanced NSCLC, including standard chemotherapy, biologic therapy, targeted therapy, immunotherapy, or investigational drug treatment before starting the study drug. Patients who have received adjuvant or neoadjuvant therapy (chemotherapy and/or radiotherapy) are eligible if there has been no progression within 6 months after completion of such therapy;

8. Adequate organ function (no transfusion, growth factor support, or medical correction within 14 days before screening):

   Hematology:

   1. Hemoglobin (HB) ≥90 g/L;
   2. Absolute neutrophil count (ANC) ≥1.5 × 10⁹/L;
   3. Platelet count (PLT) ≥100 × 10⁹/L;
   4. White blood cell count (WBC) ≥4.0 × 10⁹/L and ≤15 × 10⁹/L.

   Blood biochemistry (no transfusion or albumin infusion within 14 days before screening):

   1. AST and ALT ≤1.5 × ULN (≤5 × ULN if liver metastases are present);
   2. Alkaline phosphatase (ALP) ≤2.5 × ULN;
   3. Total bilirubin (TBiL) ≤1.5 × ULN;
   4. Albumin (ALB) ≥30 g/L;
   5. Serum creatinine (Cr) ≤1.5 × ULN and creatinine clearance (CrCL) ≥60 mL/min (Cockcroft-Gault formula);
   6. Activated partial thromboplastin time (APTT) ≤1.5 × ULN, and INR or PT ≤1.5 × ULN.
9. Women of childbearing potential must agree to use effective contraception (e.g., intrauterine device, oral contraceptives, or condoms) during the study and for 6 months after study completion; a negative serum or urine pregnancy test within 7 days before enrollment is required, and the patient must not be breastfeeding. Male participants must agree to use contraception during the study and for 6 months afterward;
10. Voluntary participation in the study, provision of written informed consent, good compliance, and willingness to provide blood samples.

Exclusion Criteria:

1. Small cell lung cancer or non-small cell lung cancer mixed with histologic types such as small cell lung cancer or neuroendocrine carcinoma;
2. Confirmed EGFR exon 20 insertion mutation or non-classical mutations such as L861Q, G719X, or S768I;
3. Prior systemic anti-tumor therapy for advanced/metastatic NSCLC (e.g., standard chemotherapy, targeted therapy, biologic therapy, immunotherapy, etc.);
4. Patients with symptomatic brain metastases, carcinomatous meningitis, or spinal cord compression, or imaging (CT or MRI) findings of brain or leptomeningeal disease at screening (except those with previously treated brain metastases who have been stable and without progression for ≥4 weeks before enrollment, and confirmed by brain MRI, CT, or venography to have no evidence of intracranial hemorrhage);
5. Known history of hypersensitivity to the active or inactive excipients of Befotertinib or to drugs with similar chemical structures or classes;
6. Factors that significantly affect oral drug absorption, such as inability to swallow, chronic diarrhea, intestinal obstruction, etc.;
7. History of interstitial lung disease, drug-induced interstitial lung disease, or radiation pneumonitis requiring steroid treatment;
8. Any evidence of severe or uncontrolled systemic disease, including uncontrolled hypertension, diabetes, active bleeding, etc., that in the investigator's judgment would compromise patient participation or protocol compliance, or any active infection including uncontrolled hepatitis B, hepatitis C, or human immunodeficiency virus (HIV);
9. QTc prolongation >470 ms or any clinically significant arrhythmia;
10. Any condition that, in the investigator's judgment, would preclude participation in this study, including patients deemed unlikely to comply with study procedures, constraints, and requirements, or other situations at the investigator's discretion.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Befotertinib; Subjects will receive treatment with Befotertinib. Peripheral blood will be collected 8 weeks (±7 days) later for ctDNA testing. Those who test positive for ctDNA will undergo treatment intensification with Befotertinib combined with radiotherapy, while those who test negative will continue with Befotertinib monotherapy.	Drug: Befotertinib; Subjects will receive treatment with Befotertinib. Peripheral blood will be collected 8 weeks (±7 days) later for ctDNA testing. Those who test positive for ctDNA will undergo treatment intensification with Befotertinib combined with radiotherapy, while those who test negative will continue with Befotertinib monotherapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-Free Survival	Progression-Free Survival is defined as the time from the initiation of treatment until the first documented radiological progression of disease (PD) or death from any cause, whichever occurs first. If a subject has not experienced PD or death by the study cutoff date, or has received other antitumor therapy, the date of the last efficacy assessment before the cutoff date or the start date of other antitumor therapy (whichever is earlier) will be used as the censoring time.	From date of initiation of treatment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 mont
PFS	Progression-Free Survival (PFS) is defined as the time from the initiation of treatment until the first documented radiological progression of disease (PD) or death from any cause, whichever occurs first. If a subject has not experienced PD or death by the study cutoff date, or has received other antitumor therapy, the date of the last efficacy assessment before the cutoff date or the start date of other antitumor therapy (whichever is earlier) will be used as the censoring time.	From date of initiation of treatment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 22 months

Collaborators and Investigators

• Sponsor: Hebei Medical University Fourth Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): February 10, 2026
• Primary Completion (Estimated): February 28, 2030
• Study Completion (Estimated): February 28, 2030

Study Registration Dates

• First Submitted: February 8, 2026
• First Submitted That Met QC Criteria: February 8, 2026
• First Posted (Actual): February 13, 2026

Study Record Updates

• Last Update Posted (Actual): February 13, 2026
• Last Update Submitted That Met QC Criteria: February 8, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Carcinoma, Non-Small-Cell Lung
• Other Study ID Numbers: BD-BF-IV034-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No