phase 1/2 study of bdtx-1535 in patients with glioblastoma or non-small cell lung cancer with egfr mutations

Conditions: Non-Small Cell Lung Cancer; Advanced Non-Small Cell Squamous Lung Cancer; Metastatic Lung Non-Small Cell Carcinoma; Metastatic Lung Cancer; NSCLC; Advanced Lung Carcinoma; Epidermal Growth Factor Receptor C797S; Epidermal Growth Factor Receptor G719X; EGF-R Positive Non-Small Cell Lung Cancer; EGFR-TKI Resistant Mutation

Summary: bdtx-1535-101 is an open-label, phase 1 dose escalation and phase 2 multiple cohort study designed to evaluate the safety, pharmacokinetics (pk), optimal dosage, central nervous system (cns) activity, and antitumor activity of bdtx-1535. the study population comprises adults with either advanced/metastatic non-small cell lung cancer (nsclc) with non-classical or acquired epidermal growth factor receptor (egfr) resistance (egfr c797s) mutations with or without cns disease (in phase 1 and phase 2), or glioblastoma (gbm) expressing egfr alterations (phase 1 only). all patients will self-administer bdtx-1535 monotherapy by mouth in 21-day cycles. phase 1 enrollment is now complete. phase 2 is currently enrolling.


Eligibility criteria:
phase 2 eligibility: key inclusion criteria required for locally advanced or metastatic nsclc: * measurable disease by recist 1.1 criteria. * adequate bone marrow or organ function. * life expectancy of ≥ 3 months. * sufficient performance status. * confirmed nsclc, without small cell lung cancer transformation with or without brain metastases. * disease progression following or intolerance of standard of care (excluding patients in the treatment-naïve non-classical driver cohort): * cohort 1 (non-classical driver cohort): advanced/metastatic nsclc with a non-classical driver egfr mutation (eg, g719x) following up to 2 lines of therapy with only 1 prior egfr tki regimen (third-generation preferred; other approved egfr tki acceptable). * cohort 2 (acquired resistance c797s cohort): advanced/metastatic nsclc with the acquired resistance c797s egfr mutation following up to 2 lines of therapy, including only one egfr tki, which must be a third generation egfr tki (eg, osimertinib). * cohort 3 (first-line non-classical driver cohort): treatment-naïve advanced/metastatic nsclc with a non-classical driver egfr mutation (1 cycle of chemotherapy or immune checkpoint inhibitor are permitted). patients with co-occurring l858r mutations and a non-classical mutation are eligible for inclusion. * identification of one (or more) of the following egfr mutations by next generation sequencing (ngs) as determined by a local assay performed in a validated laboratory in the absence of other known resistance mutations (eg, t790m, met): * non-classical driver egfr mutations (eg, l861r, s768i, g719x). * egfr acquired resistance mutation (eg, c797s) to a 3rd generation egfr tki. * for phase 2, dose expansion, patients in cohort 1 who received 3rd generation egfr tki (eg, osimertinib), the ngs report within 6 months prior to the start of screening is acceptable. for patients in cohort 2, the ngs report must be from the last disease progression on the immediate prior therapy. for patients in cohort 3, the ngs report must be at the time of diagnosis. key exclusion criteria: * known resistant mutations in tumor tissue or by liquid biopsy (eg, t790m, met). * received more than 1 egfr tki therapy (ie, erlotinib or gefitinib) for the treatment of metastatic or recurrent egfr nsclc. * any history of interstitial lung disease related to egfr tki use. * symptomatic or radiographic leptomeningeal disease. * symptomatic brain metastases or spinal cord compression requiring urgent clinical intervention. * unresolved toxicity from prior therapy. * significant cardiovascular disease. * major surgery within 4 weeks of study entry or planned during study. * ongoing or recent anticancer therapy or radiation therapy. * evidence of malignancy (other than study-specific malignancies) requiring active therapy within the next 2 years. * active hepatitis b or c infection and/or known human immunodeficiency virus (hiv) carrier. * poorly controlled gastrointestinal disorders.

Keywords: egfr alterations egfr l858r egfr exon 19 del egfr inhibitor intrinsic resistance nsclc egfr acquired resistance nsclc egfr intracranial disease brain metastases central nervous system metastases cns metastases uncommon nsclc egfr mutations c797s acquired resistance egfr mutation non-classical nsclc egfr mutations classical nsclc egfr mutations egfr pacc nsclc mutations egfr e709a/g/k/q/v egfr e709_t710delinsd/t egfr g719a/c/d/r/s egfr g724s egfr l718q/v egfr l747s/p, l747_a750delinsp, l747_p753delinss second-site egfr mutation