Patient case: 70-year-old male with non-small cell lung cancer; genetic feature: KRAS (G12C)

Clinical trial: Toripalimab Plus Pemetrexed+Platinus in Advanced Non-small-cell Lungcancer Patients Previsouly Treated EGFR-TKI

Summary: This is a Randomized, Double-Blind, Placebo-Controlled, Multicenter, Phase III Study to evaluate the efficacy and safety of Toripalimab injection (JS001) or placebo combined with chemotherapyin Advanced Non-small Cell Lung Cancer (NSCLC) Participants with TKI-resistant EGFR-mutated Tumors; and evaluate the population with the best predictive biomarkers, i.e., positive diagnosis population.
  About 350 subjects with advanced non-small cell lung cancer with activated EGFR mutation will be 1:1 randomized into two groups, JS001 combined with the standard 1st-line chemotherapy will be given in the study group whereas placebo combined with standard 1st-line chemotherapy will be given in the control group. The stratification will be based on the following factors:
  The history of the previous lines of EGFR-TKI treament ( 1st or 2nd line of TKI vs. 3rd line of TKI vs. 1st or 2nd line of TKI + 3rd line of TKI) ; Disease stage (IIIB-C vs. IV);


Eligibility: Inclusion Criteria:
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  Only the patients meeting all the following criteria can be eligible to participate in the trial:
  -  Fully informed consent and signed ICF;
  -  Age of 18-75 years;
  -  Histologically and/or cytologically confirmed advanced or recurrent stage III B-C or IV (AJCC Version 8) NSCLC with TKI-resistant EGFR-mutated tumors, which also satisfy following conditions: Without T790M mutation in exon 20 after 1st or 2nd generation EGFR-TKI (eg, gefitinib, erlotinib, icotinib, afatinib,etc.) treatment failure;If with T790M mutation in exon 20 after 1st or 2nd generation EGFR-TKI (eg, gefitinib, erlotinib, icotinib, afatinib,etc.),participants are required to have osimertinib or other 3rd generation EGFR-TKI treatment failure prior to enrollment.Participants with osimertinib treatment failure as 1st line therapy (regardless of their EGFR T790M mutation status);Previous neoadjuvant/adjuvant chemotherapy is allowed, but the time interval between the last dose of chemotherapy and recurrence/metastasis must be at least 6 months.
  -  With at least one measurable disease per RECIST 1.1;
  -  Agree to provide formalin fixed tumor specimen after EGFR-TKI treatment failure or provide fresh biopsy tissue;
  -  ECOG performance status of 0-1;
  -  Life expectancy ≥ 3 months;
  -  Good organ function;
  -  Any adverse event resulting from prior treatment, surgery, or radiotherapy must return to grade 0 or 1 according to NCI-CTCAE v5.0, except for alopecia of any grade;
  -  Willing and able to follow protocol visits, treatment plans, laboratory tests and other study procedures;
  -  Women of childbearing potential must have negative serum pregnancy test within 3 days prior to the first dose of investigational product:
  Exclusion Criteria:
  -  Exclusion of tumor histology or cytology confirmed the presence of small cell lung cancer components, or squamous cell carcinoma components of more than 10%;
  -  Combined with other driver mutations with known therapeutic drug, including but not limited to: ALK rearrangement, ROS1 mutation, BRAF600E mutation, and KRAS mutation;
  -  Previous systematic chemotherapy for advanced NSCLC;
  -  Subjects with no measurable lesions;
  -  Subjects with cancer meningitis and spinal cord compression;
  -  Subjects with untreated central nervous system (CNS) tumor metastasis;
  -  Subjects were previously treated with an anti-PD-1, anti-PD-L1 or anti-CTLA-4 agent;
  -  Subjects with any active, known or suspected autoimmune disease;
  -  Subjects who are now participating in other clinical studies or the last dose of prior investigational drug was given in < 4 weeks (or 5 half-lives) from the first investigational product administration of this study;
  -  Subjects who were expected to receive any other antitumor therapy (eg, other maintenance therapy for NSCLC, radiotherapy, and/or surgical excision);
  -  Subjects who received major surgery within 4 weeks prior to enrollment or were not fully recovered from prior surgery;
  -  Subjects with other malignancies requiring concurrent treatment;
  -  Subjects with grade II or above myocardial ischemia or myocardial infarction, or subjects with arrhythmia with poor control;
  -  Subjects with uncontrolled pleural/pericardial effusion, or with ascites requiring repeated drainage;
  -  Subjects with uncontrolled tumor-related pain;
  -  Subjects with severe allergic reactions to other monoclonal antibodies and subjects with severe allergic reactions to pemetrexed, platinum or its prophylaxis;
  -  Subjects with psychological disorder, alcohol alcoholism, drug abuse or drug dependency

Relevance to patient case: not relevant