study of durvalumab+olaparib or durvalumab after treatment with durvalumab and chemotherapy in patients with lung cancer (orion)

Conditions: Non-small Cell Lung Cancer NSCLC

Summary: this is a randomized, double-blind, multi-center, global phase ii study to determine the efficacy and safety of durvalumab plus olaparib combination therapy compared with durvalumab monotherapy as maintenance therapy in patients whose disease has not progressed following standard of care (soc) platinum-based chemotherapy with durvalumab as first-line treatment in patients with stage iv non small-cell lung cancer (nsclc) with tumors that lack activating epidermal growth factor receptor (egfr) mutations and anaplastic lymphoma kinase (alk) fusions.

adult patients with a histologically or cytologically documented advanced nsclc not amenable to curative surgery or radiation with tumors that lack activation egfr mutations and alk fusions are eligible for enrollment. during the initial therapy phase, patients will receive treatment with durvalumab along with the investigator's choice of platinum-based doublet therapy for squamous nsclc (nab-paclitaxel plus carboplatin or gemcitabine plus carboplatin/cisplatin) and non-squamous nsclc (nab-paclitaxel plus carboplatin or pemetrexed plus carboplatin/cisplatin) for 4 cycles. patients who have completed 4 cycles and not progressed throughout the initial therapy phase will be randomized in a 1:1 ratio into the maintenance phase of the study to receive either durvalumab plus placebo or durvalumab plus olaparib maintenance therapy. patients will receive maintenance treatment until specific discontinuation criteria are met, including clinical disease progression (as assessed by the investigator) or recist 1.1-defined radiological progressive disease (pd), unacceptable toxicity, and withdrawal of consent. tumor evaluation scans will be performed until objective disease progression as efficacy assessments. all patients will be followed for survival until the end of the study.

Eligibility criteria:
inclusion criteria: - histologically or cytologically documented stage iv nsclc not amenable to curative surgery or radiation. patients must have tumors that lack activating egfr mutations and alk fusions. * (who)/(ecog) performance status of 0 or 1 * no prior chemotherapy or any other systemic therapy for stage iv nsclc * adequate organ and marrow function without blood transfusions in the past 28 days, * at least 1 tumor lesion, not previously irradiated, that can be accurately measured as per recist 1.1. key inclusion criteria for randomization to maintenance treatment: * documented radiographic evidence of cr, pr, or stable disease (sd) as per investigator-assessed recist 1.1 following 4 cycles of platinum-based chemotherapy. * creatinine clearance (crcl) ≥51 ml/min calculated by the investigator or designee using the cockcroft-gault equation or measured by 24-hour urine collection. * ability to swallow whole oral medications. * all patients must provide a formalin-fixed, paraffin embedded tumor sample for tissue-based immunohistochemistry staining and dna sequencing to determine pd-l1 expression, hrrm status, and other correlatives: either newly acquired or archival tumor samples (\<3 years old) are acceptable. if available, a newly acquired tumor biopsy, collected as part of routine clinical practice, is preferred. if not available, an archival sample taken \<3 years prior to screening is acceptable. if both an archival sample and a fresh tumor biopsy sample are available, both samples should be submitted for analysis and must be submitted as different samples using different accession numbers. slides from different blocks cannot be mixed and submitted with the same kit. exclusion criteria * mixed small-cell lung cancer and sarcomatoid variant nsclc histology. * prior exposure to any chemotherapy agents (except chemotherapy or chemoradiation for non-metastatic disease), polyadenosine 5'diphosphoribose \[poly (adp ribose)\] polymerase (parp) therapy, or immunomediated therapy * active or prior documented autoimmune or inflammatory disorders. * any concurrent chemotherapy, ip, biologic, or hormonal therapy for cancer treatment. * current or prior use of immunosuppressive medication within 14 days before the first dose of investigational product (ip) * untreated (cns) metastases and/or carcinomatous meningitis * active infection. exclusion criteria to be randomized to maintenance treatment: • inability to complete 4 cycles of platinum-based chemotherapy for any reason or discontinuation of durvalumab during initial therapy.

Keywords: nsclc durvalumab olaparib maintenance homologous recombination repair (hrr)