Patient case: 72-year-old male with lung adenocarcinoma; genetic feature: EZR-ROS1 fusion

Clinical trial: Crizotinib in Pretreated Metastatic Non-small-cell Lung Cancer With MET Amplification or ROS1 Translocation (METROS)

Summary: Phase II, two arms, parallel, non comparative study with crizotinib in patients with ROS 1 translocation or MET amplification or MET exon 14 mutation

Detailed description: This is a phase II, prospective, two arms, parallel, non comparative study with crizotinib in pretreated NSCLC patients with ROS1 translocation or MET amplification or MET exon 14 mutation (figure 1). Patients with locally advanced or metastatic NSCLC, pretreated with at least one previous chemotherapy line and with at least one measurable tumor lesion will be considered eligible for the trial. All potentially eligible patients will be evaluated for MET and ROS1 by FISH to detect MET amplification or ROS1 translocation. MET mutation will be assessed using direct sequencing or high sensitive methods. After evaluation of inclusion and exclusion criteria, and after signature of informed consent form, all MET amplified or MET exon 14 mutation or ROS1 translocated eligible patients will receive crizotinib 250 mg BID p.o until disease progression, unacceptable toxicity or patient refusal.

Eligibility: Inclusion Criteria:
  -  Histologically confirmed diagnosis of NSCLC
  -  Availability of tumor tissue for ROS1 and MET analyses
  -  Patient positive for ROS1 translocation or MET amplification
  -  At least one radiological measurable disease according to RECIST criteria (Response Evaluation Criteria in Solid Tumors )
  -  At least 1 previous standard chemotherapy regimen
  -  Performance status 0-2 (ECOG)
  -  Patient compliance to trial procedures
  -  age ≥ 18 years
  -  Written informed consent
  -  Adequate BM function (ANC ≥ 1.5x109/L, Platelets ≥ 100x109/L, HgB > 9g/dl)
  -  Adequate liver function (bilirubin <G2, transaminases no more than 3xULN/<5xULN in present of liver metastases).
  -  Normal level of alkaline phosphatase and creatinine.
  -  If female: childbearing potential either terminated by surgery, radiation, or menopause, or attenuated by use of approved contraceptive method [intrauterine contraceptive device (IUD), birth control pills, or barrier device] during and for ninety(90) days after end of treatment.
  Exclusion Criteria:
  -  No tumor tissue available or patient negative for ROS1 translocation or MET amplification
  -  Absence of any measurable lesion
  -  For ROS1+ patients: Previous therapy with crizotinib or any anti-ALK agent
  -  For MET amplified patients: Evidence of MET amplification in tumor tissue collected in EGFR mutant patient at time of EGFR-TKI acquired resistance occurrence. An EGFR mutant patient is eligible if MET amplification is detected in a tumor specimen collected before starting an EGFR-TKI
  -  No previous chemotherapy
  -  Concomitant radiotherapy or chemotherapy.
  -  Previous radiotherapy on the target lesion(s). If all sites were included in radiotherapy fields patient is eligible only if there is evidence of progressive disease after completion of radiotherapy.
  -  Symptomatic brain metastases
  -  Diagnosis of any other malignancy during the last 5 years, except for in situ carcinoma of cervix uteri and squamous cell carcinoma of the skin
  -  Pregnancy or lactating
  -  Other serious illness or medical condition potentially interfering with the study

Relevance to patient case: possibly relevant