study of oral cmet inhibitor inc280 in patients with egfr wild-type (wt), advanced non-small cell lung cancer (nsclc) (geometry mono-1)

Conditions: Carcinoma, Non-Small-Cell Lung

Summary: study to evaluate the efficacy and safety of capmatinib as a single-agent treatment for subjects with advanced/metastatic (stage iiib or iv) non-small cell lung cancer (nsclc) who had wild-type epidermal growth factor receptor (egfr wt) (for exon 19 deletions and exon 21 l858r substitution mutations), anaplastic lymphoma kinase (alk)-negative rearrangement, and mesenchymal epithelial transition (met) mutations leading to exon 14 deletion (referred to as met mutation hereafter) and/or met amplification.

this was a phase ii, multicenter, open-label study. patients were enrolled in different cohorts based on their met status (amplification and/or mutation) and prior treatment status: cohort 1a, cohort 1b, cohort 2, cohort 3, cohort 4, cohort 5a, cohort 5b, cohort 6, and cohort 7. met mutation (by rt-pcr) and/or met amplification status by gene copy number (gcn, by fish) was determined by central laboratory. patients in cohorts 1, 2, 3, and 4 had previously failed 1 or 2 prior lines of systemic therapy, while patients enrolled in cohorts 5 and 7 were treatment-naïve for advanced disease/metastatic disease. patients enrolled in cohort 6 had failed 1 prior line of systemic therapy for advanced/ metastatic disease. patients with met mutation were enrolled in cohort 4 (pre-treated), cohort 5b (treatment naïve) or cohort 7 (treatment naïve expansion cohort of cohort 5b), irrespective of their met gcn. the enrollment in expansion cohort 7 started after the completion of enrollment in cohort 5b. patients without met mutation, were enrolled in cohorts 1a, 1b, 2, 3 (pre-treated) or 5a (treatment naïve), based on their met gcn. patients enrolled in cohort 6 (expansion cohort of cohort 1a and cohort 4) had either met gcn ≥10 without met mutation (cohort 6.1) or met mutation, irrespective to their met gcn (cohort 6.2). the enrollment in cohort 6 started upon enrollment completion of the respective cohort 1a or cohort 4. all participants in the study received oral capmatinib 400 mg twice daily. a treatment cycle was defined as 21 days. treatment with capmatinib continued until patient experienced any of the following: disease progression according to recist 1.1 as determined by investigator and confirmed by blinded independent review committee (birc), unacceptable toxicity that precluded further treatment, treatment discontinuation at the discretion of the investigator or patient, lost to follow-up, or death. treatment with capmatinib was allowed beyond recist 1.1-defined disease progression (as determined by investigator and confirmed by birc) if, in the judgment of the investigator, there was evidence of clinical benefit and the patient wished to continue on the study treatment. all patients continued to have safety evaluations for 30 days after the last dose of study treatment. patients who discontinued treatment with capmatinib for any reason other than disease progression, as determined by the investigator and confirmed by birc, death, withdrawal of consent for further assessments, or being lost to follow-up, continued to have tumor assessments (post-treatment efficacy follow-up) until disease progression confirmed by birc, death, withdrawal of consent for further assessments, or lost to follow-up. all patients who discontinued treatment with capmatinib were followed for survival (post-treatment survival follow-up) until death, loss to follow-up, withdrawal of consent to survival follow-up, or the end of the study.

Eligibility criteria:
key inclusion criteria: * subjects with stage iiib or iv nsclc (any histology) at the time of study entry * subjects with histologically or cytologically confirmed diagnosis of nsclc that is: 1. egfr wt status (for exon 19 deletions and exon 21 l858r substitution mutations) 2. and alk rearrangement-negative 3. and met-mutation and/or amplification status (as defined in the protocol). * for cohorts 1a, 1b, 2, 3, 4 subjects must have failed one or two prior lines of systemic therapy for advanced disease (stage iiib or iv nsclc). for cohort 6, subjects must have failed one prior line of systemic therapy for advanced disease (stage iiib or iv nsclc). * for cohorts 5a, 5b, and 7, subjects must not have received any systemic therapy for advanced disease (stage iiib or iv nsclc). * subjects with at least one measurable lesion as defined by recist 1.1. a previously irradiated site lesion may only be counted as a target lesion if there was clear sign of progression since the irradiation. * subjects who recovered from all toxicities related to prior anticancer therapies to grade ≤ 1 (common terminology criteria for adverse events \[ctcae\] v 4.03). subjects with any grade of alopecia were allowed to enter the study. * subjects with adequate organ function * eastern cooperative oncology group (ecog) performance status (ps) of 0 or 1 key exclusion criteria: * prior treatment with crizotinib, or any other met or hgf inhibitor * characterized egfr mutations that predict sensitivity to egfr therapy, including, but not limited to exon 19 deletions and exon 21 mutations. * characterized alk-positive rearrangement. * symptomatic central nervous system (cns) metastases who are neurologically unstable or have required increasing doses of steroids within the 2 weeks prior to study entry to manage cns symptoms. * clinically significant, uncontrolled heart diseases * thoracic radiotherapy to lung fields ≤ 4 weeks prior to starting capmatinib or subjects who had not recovered from radiotherapy-related toxicities. for all other anatomic sites (including radiotherapy to thoracic vertebrae and ribs), radiotherapy ≤ 2 weeks prior to starting capmatinib or subjects who had not recovered from radiotherapy-related toxicities. palliative radiotherapy for bone lesions ≤ 2 weeks prior to starting capmatinib was allowed. * receiving treatment with strong inducers of cyp3a4 and/or any enzyme-inducing anticonvulsant and could not be discontinued ≥ 1 week prior to the start of treatment with capmatinib and for the duration of the study. * receiving treatment with unstable or increasing doses of corticosteroids. * impairment of gastrointestinal (gi) function or gi disease that may significantly alter the absorption of capmatinib. * applicable to cohorts 1-4 and cohort 6 only: previous anticancer and investigational agents within 4 weeks or ≤ 5 × half-life of the agent (whichever was longer) before first dose of- capmatinib. if previous treatment was a monoclonal antibody, then the treatment must have been discontinued ≥ 4 weeks before first dose of capmatinib. if previous treatment was an oral targeted agent, then the treatment must have been discontinued ≥ 5 × half-life of the agent before the first dose of capmatinib. * pregnant or nursing (lactating) women. * women of child-bearing potential, unless they are using highly effective methods of contraception during dosing and for 7 days after stopping treatment * sexually active males unless they used a condom during intercourse while taking drug and for 7 days after stopping treatment and should not father a child in this period. * presence or history of interstitial lung disease or interstitial pneumonitis, including clinically significant radiation pneumonitis (i.e., affecting activities of daily living or requiring therapeutic intervention).

Keywords: non small cell lung non small cell lung cancer non-small cell lung cancer nsclc inc280 egfr wild-type (wt) advanced non-small cell lung cancer advanced/metastatic disease non-small cell lung carcinoma (nsclc) treatment of lung cancer after first metastasis lung cancer lung adenocarcinoma non small cell lung carcinoma met exon 14 deletion metex14del met exon 14 skipping met exon 14 mutation met mutation met amplification met inhibitor met dysregulation met activation met signaling met pathway met cmet geometry mono-1 geometry