Osimertinib Plus Savolitinib in EGFRm+/MET+ NSCLC Following Prior Osimertinib

Carcinoma Clinical Trial

— SAVANNAH  

Official title:

A Phase II Study Assessing the Efficacy of Osimertinib in Combination With Savolitinib in Patients With EGFRm+ and MET+, Locally Advanced or Metastatic Non Small Cell Lung Cancer Who Have Progressed Following Treatment With Osimertinib.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03778229
• Other study ID #: D5084C00007
• Secondary ID: 2018-003012-51
• Status: Recruiting
• Phase: Phase 2
• Start date: January 9, 2019
• Est. completion date: May 28, 2025

Study information

• Verified date: April 2024
• Source: AstraZeneca
• Contact: AstraZeneca Clinical Study Information Center
• Phone: 1-877-240-9479
• Email: information.center[@]astrazeneca.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study (the SAVANNAH study) will investigate the efficacy of osimertinib in combination with savolitinib in patients with EGFRm+ and MET+, locally advanced or metastatic NSCLC who have progressed following treatment with osimertinib

Description:

The combination of osimertinib with savolitinib in this study (the SAVANNAH study) will explore if the combination will overcome MET-amplification as a mechanism of resistance. The SAVANNAH study will investigate the efficacy of osimertinib in combination with savolitinib in patients with EGFRm+ and MET-amplified/overexpressed, locally advanced or metastatic NSCLC who have progressed following treatment with osimertinib. Eligible patients will be those with histologically or cytologically confirmed diagnosis of EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+) NSCLC that is locally advanced or metastatic and is not amenable to further surgery or radiotherapy with curative intent. The disease must have progressed following treatment with first line osimertinib. Patients must have confirmation of MET-amplified/overexpressed tumour by central FISH and IHC testing (requirements summarised in the main body of the protocol and fully explained in the Central Laboratory Manual). Patients must not have received prior or current treatment with savolitinib or another MET inhibitor. All patients confirmed as eligible will begin treatment on Day 1 with osimertinib + savolitinib combination therapy or placebo to osimertinib + savolitinib. Treatment will continue in 28 day cycles until either objective disease progression by investigator per RECIST 1.1 is assessed, unacceptable toxicity occurs, consent is withdrawn or another discontinuation criterion is met.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 360
• Est. completion date: May 28, 2025
• Est. primary completion date: August 23, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion criteria:

• Patients must be =18 years of age (=20 years of age in Japan). All genders are permitted.
• Histologically or cytologically confirmed locally advanced or metastatic EGFRm+ NSCLC harbouring an EGFR mutation known to be associated with EGFR TKI sensitivity and permitted in the osimertinib national label (such as either exon 19 deletion and/or L858R) which is not amenable to curative therapy.
• Documented radiologic disease progression on 1L osimertinib.
• MET amplification and/or overexpression (FISH10+ and/or IHC90+) as determined by FISH (central) and IHC (central) testing on tumour sample collected following progression on 1L osimertinib treatment.
• Available tumour sample for central MET FISH and IHC analysis or willingness to collect additional sample for central testing which fulfils the following requirements: Obtained following progression on previous osimertinib therapy; obtained within 2 years of submission for MET analysis; sufficient tissue to meet the minimum tissue requirement defined in the current Laboratory Manual.
• At least 1 lesion, not previously irradiated, not biopsied during the screening period, that can be accurately measured at baseline as =10 mm in the longest diameter (except lymph nodes which must have short axis =15 mm) with CT or MRI which is suitable for accurate repeated measurements. If only 1 measurable lesion exists, it is acceptable to be used as long as baseline tumour assessment scans are done at least 14 days after the screening tumour sample collection is performed.
• Prior lines of therapy in locally advanced/metastatic setting: Only prior 1L osimertinib treatment in metastatic setting is permitted.
• Adequate haematological function defined as:
• Absolute neutrophil count =1500/µL
• Haemoglobin =9 g/dL (no transfusion in the past 2 weeks)
• Platelets =100,000/µL (no transfusion in the past 10 days)
• Adequate liver function
• ALT, AST =2.5 x ULN with TBL = ULN OR
• TBL >ULN to =1.5x ULN with ALT and AST = ULN
• Adequate renal function - defined as a serum creatinine <1.5 times the institutional ULN OR a glomerular filtration rate =50 mL/min. Confirmation of creatinine clearance is only required when creatinine is only required when creatinine is >1.5 times ULN.
• Adequate coagulation parameters: INR <1.5 and activated partial thromboplastin time <1.5 x ULN unless patients are receiving therapeutic anti coagulation which affects these parameters.
• Patients with known tumour thrombus or deep vein thrombosis are eligible if clinically stable on low molecular weight heparin for =2 weeks. The use of direct oral anticoagulants such as apixaban/rivaroxaban will be accepted as treatment for cancer related thromboembolism treatment. The use of warfarin for oral anticoagulation is not recommended.
• ECOG/WHO performance status of 0 or 1 with no deterioration over the previous 2 weeks and a minimum life expectancy of 12 weeks.
• Females must be using highly effective contraceptive measures, should not be breast feeding and must have a negative pregnancy test if of childbearing potential, or must have evidence of non-childbearing potential.
• Males with a female partner of childbearing potential should be willing to use barrier contraception during the study and for 6 months following discontinuation of study drug.

Exclusion Criteria:

• Unresolved toxicities from any prior therapy greater than CTCAE Grade 1 at the time of starting study treatment with the exception of alopecia and Grade 2 prior platinum therapy related neuropathy.
• As judged by the investigator, active gastrointestinal disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of oral therapy (eg, ulcerative disease, uncontrolled nausea, vomiting, diarrhoea Grade =2, malabsorption syndrome or previous significant bowel resection).
• Any of the following cardiac diseases currently or within the last 6 months:

Unstable angina pectoris Congestive heart failure (New York Heart Association [NYHA] =Grade 2) Acute myocardial infarction Stroke or transient ischemic attack Uncontrolled hypertension (blood pressure [BP] =150/95 mmHg despite medical therapy). Mean resting correct QT interval (QTcF) >470 msec for women and >450 msec for men at Screening, obtained from 3 ECGs using the screening clinic ECG machine derived QTcF value. Any factors that may increase the risk of QTcF prolongation or risk of arrhythmic events such as heart failure, chronic hypokalaemia not correctable with supplements, congenital or familial long QT syndrome, family history of unexplained sudden death under 40 years of age in first-degree relatives or any concomitant medication known to prolong the QT interval and cause Torsade de Pointes. Any clinically important abnormalities in rhythm, conduction or morphology of resting ECGs, eg, complete left bundle branch block, third degree heart block, second degree heart block, P-R interval >250 msec. Acute coronary syndrome

• Wide field radiotherapy (including therapeutic radioisotopes such as strontium 89) administered =28 days or limited field radiation for palliation =7 days prior to starting study drug or has not recovered from side effects of such therapy.
• Major surgical procedures =28 days of beginning study drug or minor surgical procedures =7 days
• Evidence of severe or uncontrolled systemic diseases, including renal transplant, active bleeding diatheses or uncontrolled hypertension, which in the investigator's opinion makes it undesirable for the patient to participate
• Active hepatitis B or C or known serious active infection e.g. tuberculosis or human immunodeficiency virus. Viral testing is not required for assessment of eligibility for the study.
• Known serious active infection including, but not limited to, tuberculosis, or human immunodeficiency virus (positive human immunodeficiency virus 1/2 antibodies).
• Presence of other active cancers, or history of treatment for invasive cancer, within the last 5 years. Patients with Stage I cancer who have received definitive local treatment at least 3 years previously, and are considered unlikely to recur are eligible. All patients with previously treated in situ carcinoma (ie, non-invasive) are eligible, as are patients with history of non-melanoma skin cancer.
• Spinal cord compression or brain metastases unless asymptomatic, stable and not requiring steroids for at least 2 weeks prior to start of study treatment.
• Past medical history of interstitial lung disease(ILD), drug-induced ILD, radiation pneumonitis which required steroid treatment, or any evidence of clinically active ILD.
• History of liver cirrhosis of any origin and clinical stage; or history of other serious liver disease or chronic disease with relevant liver involvement, with or without normal LFTs,
• Prior or current treatment with a 3rd generation EGFR-TKI other than osimertinib
• Prior or current treatment with savolitinib or another MET inhibitor (eg, foretinib, crizotinib, cabozantinib, onartuzumab, capmatinib).
• Any cytotoxic chemotherapy, investigational agents or other anticancer drugs for the treatment of advanced NSCLC from a previous treatment regimen or clinical study within 14 days prior to the first dose of study treatment with the exception of monotherapy osimertinib which may continue uninterrupted during screening.
• Patients currently receiving (or unable to stop use prior to receiving the first dose of study treatment) medications or herbal supplements known to be strong inducers of CYP3A4, strong inhibitors of CYP1A2 within 3 weeks of the first dose of study treatment (including St John's Wort).
• Participation in another clinical study with a cytotoxic, investigational product (IP), or other anticancer drug for the treatment of advanced NSCLC if received IP from that study within 14 days of the first dose of study treatment.
• Known hypersensitivity to the active or inactive excipients of osimertinib or savolitinib or drugs with a similar chemical structure or class.

Related Conditions & MeSH terms

• Carcinoma

Intervention

Drug:
• osimertinib
osimertinib (80 mg oral OD).
• savolitinib
savolitinib (300 mg oral OD or 300 mg oral BID or 600 mg oral OD)
• placebo
placebo to osimertinib (oral OD)

Locations

Country	Name	City	State
Brazil	Research Site	Barretos
Brazil	Research Site	Curitiba
Brazil	Research Site	Goiania
Brazil	Research Site	Porto Alegre
Brazil	Research Site	Porto Alegre
Brazil	Research Site	Rio de Janeiro
Brazil	Research Site	Salvador
Brazil	Research Site	São José do Rio Preto
Brazil	Research Site	Sao Paulo
Brazil	Research Site	São Paulo
Canada	Research Site	Calgary	Alberta
Canada	Research Site	Edmonton	Alberta
Canada	Research Site	Newmarket	Ontario
Canada	Research Site	North York	Ontario
Canada	Research Site	Toronto	Ontario
Canada	Research Site	Toronto	Ontario
Chile	Research Site	Santiago
Chile	Research Site	Santiago
Chile	Research Site	Santiago
Denmark	Research Site	Ålborg
Denmark	Research Site	Herlev
Denmark	Research Site	København Ø
Denmark	Research Site	Næstved
Denmark	Research Site	Odense C
Denmark	Research Site	Vejle
France	Research Site	Dijon
France	Research Site	Marseille Cedex 20
France	Research Site	Nantes
France	Research Site	Paris
France	Research Site	Paris Cedex 5
France	Research Site	Rennes
India	Research Site	Bangalore
India	Research Site	Chennai
India	Research Site	Kolkata
India	Research Site	New Delhi
Italy	Research Site	Avellino
Italy	Research Site	Firenze
Italy	Research Site	Milano
Italy	Research Site	Milano
Italy	Research Site	Orbassano
Italy	Research Site	Padova
Italy	Research Site	Parma
Italy	Research Site	Perugia
Italy	Research Site	Peschiera Del Garda
Japan	Research Site	Fukuoka
Japan	Research Site	Hiroshima-shi
Japan	Research Site	Kanazawa-shi
Japan	Research Site	Nagoya-shi
Japan	Research Site	Niigata-shi
Japan	Research Site	Osakasayama
Japan	Research Site	Sapporo-shi
Japan	Research Site	Sunto-gun
Japan	Research Site	Wakayama-shi
Japan	Research Site	Yokohama-shi
Korea, Republic of	Research Site	Goyang-si
Korea, Republic of	Research Site	Seongnam-si
Korea, Republic of	Research Site	Seoul
Korea, Republic of	Research Site	Seoul
Korea, Republic of	Research Site	Seoul
Korea, Republic of	Research Site	Seoul
Korea, Republic of	Research Site	Suwon
Puerto Rico	Research Site	Hato Rey
Spain	Research Site	Cordoba
Spain	Research Site	Madrid
Spain	Research Site	Madrid
Spain	Research Site	Málaga
Spain	Research Site	San Sebastian
Spain	Research Site	Valencia
Spain	Research Site	Zaragoza
Taiwan	Research Site	Hsinchu
Taiwan	Research Site	Kaohsiung
Taiwan	Research Site	New Taipei
Taiwan	Research Site	Taichung
Taiwan	Research Site	Taichung City
Taiwan	Research Site	Tainan City
Taiwan	Research Site	Taipei
Taiwan	Research Site	Taipei
Taiwan	Research Site	Taipei City
Taiwan	Research Site	Taoyuan
United States	Research Site	Baltimore	Maryland
United States	Research Site	Boca Raton	Florida
United States	Research Site	Boston	Massachusetts
United States	Research Site	Boston	Massachusetts
United States	Research Site	Boston	Massachusetts
United States	Research Site	Brooklyn	New York
United States	Research Site	La Jolla	California
United States	Research Site	Los Angeles	California
United States	Research Site	New Haven	Connecticut
United States	Research Site	Philadelphia	Pennsylvania
United States	Research Site	Pittsburgh	Pennsylvania
United States	Research Site	Rochester	Minnesota
United States	Research Site	Sacramento	California
United States	Research Site	Santa Rosa	California
United States	Research Site	Seattle	Washington
United States	Research Site	Washington	District of Columbia
Vietnam	Research Site	Ha Noi
Vietnam	Research Site	Ha Noi
Vietnam	Research Site	Ho Chi Minh
Vietnam	Research Site	Ho Chi Minh City

Sponsors (2)

Lead Sponsor	Collaborator
AstraZeneca	Hutchison MediPharma

Countries where clinical trial is conducted

United States,  Vietnam,  Brazil,  Canada,  Chile,  Denmark,  France,  India,  Italy,  Japan,  Korea, Republic of,  Puerto Rico,  Spain,  Taiwan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	CNS PFS by BICR assessments in accordance with RECIST 1.1	To assess the efficacy of savolitinib plus osimertinib and savolitinib plus placebo, respectively, on CNS metastases in patients with CNS metastases at baseline.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Other	The presence/absence of CNS lesions at progression by BICR assessments in accordance with RECIST 1.1	To assess the efficacy of savolitinib plus osimertinib and savolitinib plus placebo, respectively, on the prevention of CNS metastases in patients without CNS metastases at baseline.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Other	PRO CTCAE symptoms	To assess the impact of savolitinib in combination with osimertinib on patient reported treatment-related symptoms.	From date of consent until the date of first documented progression, up to approximately 36 months.
Other	Patient's Global Impression of Severity (PGIS)	To assess patients' overall impression of severity of cancer symptoms. In patients centrally confirmed as MET positive in all patients.	From date of consent until the date of first documented progression, up to approximately 36 months.
Other	EQ-5D-5L	To explore the impact of treatment and disease on health state utility. In patients centrally confirmed as MET positive in all patients.	From date of consent until the date of first documented progression, up to approximately 36 months.
Other	Longitudinal changes in circulating DNA and/or RNA compared with PFS, OS and ORR.	To assess the predictive value of changes in circulating biomarkers on clinical efficacy endpoints.	Blood samples collected at Screening within 28 days before the first dose of study treatment; on day of first dose of study treatment; at discontinuation 7 days after last dose of study treatment. (One cycle = 28 days)
Other	Pharmacogenetic analyses on blood samples.	To collect and store DNA (according to each country's local and ethical procedures) for future exploratory research into genes/genetic variation that may influence response (ie, distribution, safety, tolerability and efficacy) to study treatments and or susceptibility to disease (optional).	Screening within 28 days before first dose; at first dose; 7 days after last dose. (One cycle = 28 days)
Other	Disease relevant or response markers in tumour tissue and circulating tumour DNA/RNA including but not limited to EGFR mutations and MET amplifications.	To collect and store tissue, plasma and serum samples for diagnostic development and exploratory analyses.	Screening within 28 days before first dose; at first dose; 7 days after last dose. Tumour tissue collected during Pre-screening and at treatment discontinuation 7 days after last dose. (One cycle = 28 days)
Other	HLA alleles associated with susceptibility to drug related AEs (such as but not limited to hypersensitivity).	To collect and store germline DNA for exploration of the role of HLA alleles in developmental toxicity.	On first day of study treatment at Cycle 1 Day 1. (One cycle = 28 days)
Primary	Objective response rate (ORR) by investigator assessment in accordance with RECIST 1.1	To determine the efficacy of savolitinib (300 mg bid) in combination with osimertinib in patients with EGFRm+ and MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib	The primary (ORR) analysis for the study will be performed at 6 months after the last patient under CSP version 7.0 has been randomised to treatment.
Primary	Objective response rate (ORR) by investigator assessment in accordance with RECIST 1.1	To determine the efficacy of savolitinib (300 mg od) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH5+ and/or IHC50+), locally advanced or metastatic NSCLC who have progressed following osimertinib.	The primary (ORR) analysis for the study will be performed at 6 months after the last patient under CSP version 7.0 has been randomised to treatment.
Secondary	Duration of Response (DoR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg bid) in combination with osimertinib in patients with EGFRm+ and MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Progression-free survival (PFS) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg bid) in combination with osimertinib in patients with EGFRm+ and MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Overall Survival (OS) by all cause mortality.	To determine the efficacy of savolitinib (300 mg bid) in combination with osimertinib in patients with EGFRm+ and MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Objective response rate (ORR) by investigator assessment in accordance with RECIST 1.1.	To describe the difference in the efficacy of savolitinib (300 mg bid) in combination with osimertinib and savolitinib (300 mg bid) in combination with placebo in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib therapy under CSP version 7.0.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Objective response rate (ORR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Duration of Response (DoR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Progression-free survival (PFS) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Overall Survival (OS) by all cause mortality.	To determine the efficacy of savolitinib (300 mg od and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Objective response rate (ORR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment of = 2L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Duration of Response (DoR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment of = 2L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Progression-free survival (PFS) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment of = 2L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Overall Survival (OS) by all cause mortality.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH10+ and/or IHC90+), locally advanced or metastatic NSCLC who have progressed following treatment of = 2L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Objective response rate (ORR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH5+ and/or IHC50+), locally advanced or metastatic NSCLC who have progressed following osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Duration of Response (DoR) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH5+ and/or IHC50+), locally advanced or metastatic NSCLC who have progressed following osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Progression-free survival (PFS) by investigator assessment in accordance with RECIST 1.1.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH5+ and/or IHC50+), locally advanced or metastatic NSCLC who have progressed following osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Overall Survival (OS) by all cause mortality.	To determine the efficacy of savolitinib (300 mg od, 300 mg bid, and 600 mg od, respectively) in combination with osimertinib in patients with EGFRm+, MET amplified/overexpressed (FISH5+ and/or IHC50+), locally advanced or metastatic NSCLC who have progressed following osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Objective response rate (ORR) assessed by BICR in accordance with RECIST 1.1	To determine the efficacy of (1) 300 mg od, 300 mg bid and 600 mg od of savolitinib in combination with osimertinib in patients with EGFRm+ MET amplified/ overexpressed (FISH 10+ and/or IHC90+); (2) 300 mg od, 300 mg bid and 600 mg od of savolitinib in combination with osimertinib in patients with EGFRm+ MET amplified/overexpressed (FISH5+ and/or IHC50+) (3) savolitinib 300 mg bid in combination with osimertinib and savolitinib 300 mg bid in combination with placebo, respectively, in patients with EGFRm+ MET amplified/ overexpressed (FISH10+ and/or IHC90+) following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Duration of Response (DoR) assessed by BICR in accordance with RECIST 1.1	To determine the efficacy of (1) 300 mg od, 300 mg bid and 600 mg od of savolitinib in combination with osimertinib in patients with EGFRm+ MET amplified/ overexpressed (FISH 10+ and/or IHC90+); (2) 300 mg od, 300 mg bid and 600 mg od of savolitinib in combination with osimertinib in patients with EGFRm+ MET amplified/overexpressed (FISH5+ and/or IHC50+) (3) savolitinib 300 mg bid in combination with osimertinib and savolitinib 300 mg bid in combination with placebo, respectively, in patients with EGFRm+ MET amplified/ overexpressed (FISH10+ and/or IHC90+) following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Progression-free survival (PFS) assessed by BICR in accordance with RECIST 1.1	To determine the efficacy of (1) 300 mg od, 300 mg bid and 600 mg od of savolitinib in combination with osimertinib in patients with EGFRm+ MET amplified/ overexpressed (FISH 10+ and/or IHC90+); (2) 300 mg od, 300 mg bid and 600 mg od of savolitinib in combination with osimertinib in patients with EGFRm+ MET amplified/overexpressed (FISH5+ and/or IHC50+) (3) savolitinib 300 mg bid in combination with osimertinib and savolitinib 300 mg bid in combination with placebo, respectively, in patients with EGFRm+ MET amplified/ overexpressed (FISH10+ and/or IHC90+) following treatment with 1L osimertinib.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Mean change from baseline in the European Organisation for Research and Treatment of Cancer (EORTC) 30-item core quality-of-life questionnaire (QLQ-C30).	To assess the impact of savolitinib and osimertinib on disease related symptoms and health related quality of life (HRQoL) in this patient population.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Mean change from baseline in the European Organisation for Research and Treatment of Cancer (EORTC) complementary 13-item quality-of-life questionnaire - lung cancer symptoms questionnaire (QLQ-LC13).	To assess the impact of savolitinib and osimertinib on disease related symptoms and health related quality of life (HRQoL) in this patient population.	Up to 15 months after the last patient under CSP version 7.0 has been randomised to treatment
Secondary	Plasma concentrations of osimertinib, savolitinib and their metabolites.	To evaluate the pharmacokinetics of osimertinib and savolitinib in this patient population.	Blood sampling on Cycles 1 and 2 on Day 1 pre-dose, 1 hour and 3 hours post-dose; Day 1 of Cycles 3, 6, and 11; discontinuation visit (if discontinued due to liver toxicity) (One cycle = 28 days)
Secondary	Total clearance in EGFR mutations at 6-weeks after therapy initiation (percentage and absolute change from baseline in EGFR mutation allele frequencies).	To determine the prevalence of ctDNA clearance after osimertinib and savolitinib treatment in this patient population.	From date of first dose until the date of first documented progression, up to approximately 36 months.
Secondary	AEs, SAEs and discontinuation rate due to AEs, as characterized and graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event [CTCAE] v5.	To evaluate the safety and tolerability of savolitinib in combination with osimertinib and savolitinib in combination with placebo.	Continuously from first dose to 28 (+/-7) days after discontinuation of study drug, or up to approximately 36 months.