Furmonertinib Plus Radiotherapy for EGFR+ NSCLC With Pleural Effusion

July 16, 2026 updated by: Lin Xiao, Jiangmen Central Hospital

A Prospective, Multicenter Study on the Safety and Efficacy of Furmonertinib Combined With Local Chest Radiotherapy in EGFR+ Non-small Cell Lung Adenocarcinoma Patients With Malignant Pleural Effusion

This study is designed as a prospective, multi-center investigation to explore the efficacy and safety of furmonertinib combined with upfront thoracic radiotherapy with or without metastatic lesion radiotherapy in subjects with EGFR-mutant NSCLC and malignant pleural effusion (MPE), aiming to provide additional evidence-based medical support for optimizing the management of NSCLC-MPE subjects. In addition, peripheral blood ctDNA next-generation sequencing (NGS) will be performed at two time points-before the first furmonertinib treatment and one month after the completion of thoracic radiotherapy-to identify subpopulations most likely to benefit from this therapeutic approach and to elucidate resistance mechanisms specific to the radiotherapy-plus-furmonertinib combination, ultimately facilitating more personalized care for these subjects.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This study is designed as a prospective, multi-center investigation that plans to enroll 63 subjects with stage IV non-small cell lung adenocarcinoma harboring EGFR-sensitive mutations (exon 19 deletion or exon 21 L858R mutation) complicated by malignant pleural effusions (MPE). Subjects will receive an initial 10-12 weeks of furmonertinib therapy with or without therapeutic thoracentesis to achieve adequate control of MPE, followed by thoracic radiotherapy targeting residual primary pulmonary lesions, regional lymph node metastases, and pleural metastatic lesions, with or without radiotherapy to osseous, adrenal, hepatic, or brain metastases (total irradiated sites ≤6, involved organs ≤3). For brain metastases, consolidative radiotherapy will be withheld if residual tumor diameter is <1 cm after furmonertinib treatment and no significant neurological symptoms are present.

  1. Radiotherapy techniques: Depending on the availability at each participating center, subjects may receive one of the following modalities:

    • Intensity-modulated radiation therapy (IMRT),
    • Volumetric-modulated arc therapy (VMAT),
    • Stereotactic body radiation therapy (SBRT),
    • Stereotactic radiosurgery (SRS), or
    • Fractionated stereotactic radiosurgery (fSRS).

  2. Prescription doses for primary and metastatic lesions: Based on institutional technical capabilities and the dose constraints of organs at risk in the radiotherapy plan, the following stereotactic or hypofractionated regimens are permissible:

    • Hypofractionated radiotherapy: DT 3000-4000 cGy/10 fractions, 3-4 Gy/fraction, once daily, 5 days/week;
    • SBRT: 27-50 Gy/3-5 fractions, 8-10 Gy/fraction, once daily, every other day;
    • SRS (for brain metastases): 20-24 Gy/fraction;
    • fSRS (for brain metastases): 27 Gy/3 fractions or 30 Gy/5 fractions.

Oral furmonertinib will be withheld before, during, and for 3 days after the completion of radiotherapy. Furmonertinib maintenance will be resumed 3 days after radiotherapy completion and continued until disease progression or unacceptable toxicity. We hypothesize that this treatment paradigm will effectively control MPE, significantly improve progression-free survival (and potentially overall survival), with manageable treatment-related toxicity.

Additionally, dynamic monitoring of peripheral blood ctDNA via next-generation sequencing (NGS) will be performed at two time points-before the first furmonertinib administration and one month after the completion of thoracic radiotherapy-to identify individuals most likely to benefit from this regimen and to elucidate resistance mechanisms to furmonertinib under the radiotherapy-plus-TKI combination, thereby informing clinical decision-making.

Study Type

Interventional

Enrollment (Estimated)

63

Phase

  • Phase 2

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Age ≥ 18 years.
  2. Histologically or cytologically confirmed advanced lung adenocarcinoma.
  3. Unlimited number of metastatic lesions, but with involvement of no more than 3 organs.
  4. Previously untreated, clinical stage IV disease per AJCC/UICC 9th edition.
  5. Presence of pleural effusion as indicated by chest CT or ultrasound; cytological confirmation of malignant cells in the pleural effusion is preferred. If malignant cells are not detected in the pleural effusion, chest CT with contrast or whole-body PET/CT must demonstrate unequivocal pleural nodular metastases.
  6. After 8-10 weeks of furmonertinib therapy with or without therapeutic thoracentesis, the overall radiographic response is assessed as effective (CR + PR + SD), and malignant pleural effusion is adequately controlled (defined as no pleural effusion or only minimal pleural effusion on ultrasound or chest CT: maximum depth < 3 cm, estimated volume < 500 mL). Concurrent minimal pericardial effusion is permissible (defined as maximum diastolic width < 1 cm on echocardiography, estimated volume < 100 mL).
  7. No prior thoracic radiotherapy.
  8. Positive for EGFR-sensitive mutations (exon 19 deletion or exon 21 L858R).
  9. No prior systemic anticancer therapy.
  10. ECOG performance status 0-2, with a life expectancy of ≥ 12 weeks.
  11. At least one measurable lesion per RECIST 1.1.
  12. Adequate bone marrow function to tolerate anticancer treatment: WBC ≥ 3 × 10⁹/L, Hb ≥ 80 g/L, PLT ≥ 75 × 10⁹/L, and absolute neutrophil count (NEUT) ≥ 1.5 × 10⁹/L.

  13. Essentially normal hepatic and renal function:

    1. Serum creatinine ≤ 1.5 × upper limit of normal (ULN) or creatinine clearance (CrCl) ≥ 50 mL/min;
    2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN (≤ 5 × ULN is acceptable in patients with liver metastases);
    3. Total bilirubin (TBIL) ≤ 1.5 × ULN;
    4. Albumin ≥ 30 g/L and prealbumin ≥ 150 g/L.
  14. Asymptomatic brain metastases.
  15. Written informed consent obtained from all subjects.

Exclusion Criteria:

  1. Pre-existing interstitial lung disease (ILD) or infectious fever prior to treatment.
  2. Radiographic progression (PD) after 8-10 weeks of TKI therapy, or development of grade ≥ 2 ILD.
  3. Concurrent autoimmune disease requiring long-term oral corticosteroid therapy.
  4. Severe anemia.
  5. Known hypersensitivity to furmonertinib.
  6. Significant respiratory symptoms (e.g., chest tightness, cough) that preclude tolerance to radiotherapy.
  7. Active hepatitis B or C virus infection with concomitant grade > 2 hepatic impairment. Patients may be considered eligible if liver function recovers to grade 1 after active hepatoprotective therapy and antiviral treatment.
  8. Poorly controlled or continuously progressive pleural effusion after 8-10 weeks of furmonertinib therapy.
  9. Symptomatic brain metastases.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: experimental
Subjects will receive an initial 10-12 weeks of furmonertinib therapy with or without therapeutic thoracentesis to achieve adequate control of malignant pleural effusion, followed by thoracic radiotherapy targeting residual primary pulmonary lesions, regional lymph node metastases, and pleural metastatic lesions, with or without radiotherapy to osseous, adrenal, hepatic, or brain metastases. Oral furmonertinib will be withheld before, during, and for 3 days after radiotherapy. Resumption of furmonertinib maintenance will occur 3 days after radiotherapy completion and continue until disease progression or unacceptable toxicity.
Drug: Furmonertinib
Subjects will receive furmonertinib 80 mg orally once daily. The drug will be suspended before radiotherapy initiation, maintained on hold during the entire radiotherapy course, and withheld for an additional 3 days after radiotherapy ends, after which it will be resumed.
Radiation: Thoracic Radiotherapy (TRT)
The radiotherapy target volume encompasses residual primary pulmonary lesions, regional lymph node metastases, and pleural metastases, with the option to additionally irradiate osseous, adrenal, hepatic, or brain metastases (with a maximum of 6 total irradiated sites and no more than 3 involved organs). Consolidative cranial irradiation for brain metastases will be deferred in cases where the residual lesion diameter is <1 cm following furmonertinib therapy and the patient remains free of clinically significant neurological symptoms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression-Free Survival (PFS)
Time Frame: From date of first dose to date of first documented disease progression or death from any cause, assessed up to 24 months.
PFS defined as time from first dose of furmonertinib to disease progression per RECIST v1.1 or death from any cause, whichever occurs first.
From date of first dose to date of first documented disease progression or death from any cause, assessed up to 24 months.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall Survival (OS)
Time Frame: From date of first dose to date of death from any cause, assessed up to 36 months .
Time from first dose of furmonertinib to death from any cause.
From date of first dose to date of death from any cause, assessed up to 36 months .
Overall Response Rate (ORR)
Time Frame: Evaluations are performed at 1 month post-radiotherapy, and subsequently every 3 months, with a total follow-up period of 18 months.
Proportion of subjects achieving complete response (CR) or partial response (PR) according to RECIST v1.1.
Evaluations are performed at 1 month post-radiotherapy, and subsequently every 3 months, with a total follow-up period of 18 months.
Malignant pleural effusion recurrence rate
Time Frame: Evaluations are performed at 1 month post-radiotherapy, and subsequently every 3 months, with a total follow-up period of 18 months.
Rate of MPE recurrence during the entire follow-up period following fumonertinib and local radiotherapy.
Evaluations are performed at 1 month post-radiotherapy, and subsequently every 3 months, with a total follow-up period of 18 months.
Disease Control Rate (DCR)
Time Frame: Evaluations are performed at 1 month post-radiotherapy, and subsequently every 3 months, with a total follow-up period of 18 months.
Proportion of subjects achieving CR, PR, or stable disease (SD) according to RECIST v1.1.
Evaluations are performed at 1 month post-radiotherapy, and subsequently every 3 months, with a total follow-up period of 18 months.
Adverse event
Time Frame: From date of first dose to 30 days after last dose .
Frequency, severity, and relationship of adverse events assessed by CTCAE v5.0.
From date of first dose to 30 days after last dose .
Peripheral Blood ctDNA Level
Time Frame: Next-generation sequencing (NGS) was used to detect circulating tumor DNA (ctDNA) in peripheral blood samples collected before the first furmonertinib treatment and 1 month after the completion of thoracic radiotherapy (2 time points in total).
Dynamic changes in circulating tumor DNA (ctDNA) concentration in peripheral blood measured by next-generation sequencing (NGS).
Next-generation sequencing (NGS) was used to detect circulating tumor DNA (ctDNA) in peripheral blood samples collected before the first furmonertinib treatment and 1 month after the completion of thoracic radiotherapy (2 time points in total).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Jiangmen Central Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

July 1, 2026

Primary Completion (Estimated)

October 30, 2027

Study Completion (Estimated)

January 1, 2028

Study Registration Dates

First Submitted

February 26, 2026

First Submitted That Met QC Criteria

March 16, 2026

First Posted (Actual)

March 19, 2026

Study Record Updates

Last Update Posted (Actual)

July 17, 2026

Last Update Submitted That Met QC Criteria

July 16, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2025 312 号 B

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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