Patient case: 57-year-old male with lung adenocarcinoma; genetic feature: KRAS (G12V), high tumor mutational burden

Clinical trial: Phase II Study of VS-6063 in Patients With KRAS Mutant Non-Small Cell Lung Cancer

Summary: This is a Phase II, open-label, multicenter, multi cohort, study of VS-6063 (defactinib), a focal adhesion kinase inhibitor, in patients with KRAS mutant non-small cell lung cancer (NSCLC). NSCLC with a KRAS mutation is required for study entry and subjects will be enrolled into 1 of 4 cohorts based on the status of their INK4a/Arf and p53 mutations. The purpose of this study is to demonstrate if VS-6063 (defactinib) improves PFS within each cohort. The safety and tolerability of VS-6063, tumor response rate, progression free survival and overall survival will also be assessed. The pharmacodynamic effects of VS-6063 (defactinib) will be examined in a tumor biopsy and a blood sample.

Detailed description: Eleven subjects will be enrolled into one of four cohorts: Cohort A (KRAS mutation, wild type INK4a/ARF and wildtype p53), Cohort B (KRAS mutation, INK4s/ARF mutation and wild type p53), Cohort C (KRAS mutation, wild type INK4a/ARF and p53 mutation), and Cohort D (KRAS mutation, INK4a/ARF mutation and p53 mutation). If >/= 4 patients demonstrate PFS at 12 weeks in each cohort, an additional 23 subjects will be enrolled.

Eligibility: Inclusion Criteria:
  -  ≥ 18 years of age.
  -  ECOG (Eastern Cooperative Oncology Group) Performance Score of 0 or 1.
  -  Histologic or cytologic confirmation of non-small cell lung cancer (NSCLC)
  -  Molecular characterization of the tumor demonstrating a KRAS mutation by a CLIA-certified assay. Adequate archival tissue, tissue core biopsy specimen, or DNA samples must be available for central testing of INK4a/Arf and p53 if not previously performed by a CLIA certified lab.
  -  Documented evidence of distant metastasis or locoregional recurrence per required assessments within 28 days prior to starting study therapy.
  Note: Histologic confirmation of metastatic disease is not required.
  -  For patients with brain metastases, the following criteria must be met:
  Previously untreated brain metastases that are asymptomatic and not requiring steroids are permitted.
  Previously treated brain metastases are permitted if most recent CNS radiographic imaging demonstrates no evidence of CNS disease progression For patients with previously untreated brain metastases, Central Nervous System (CNS) imaging is required at the time of disease imaging throughout treatment.
  -  At least one measurable disease site per RECIST v1.1.
  -  Received a minimum of one course of treatment that included at least one platinum-based chemotherapy doublet for metastatic or locally recurrent disease.
  -  Adequate hematologic function including ANC ≥ 1200/mm3, Hemoglobin ≥ 9 g/dL (transfusion is permitted), and platelets ≥ 100,000/mm3.
  -  Adequate hepatic function including ALT ≤ 2.5 x upper limit of normal (ULN) if liver metastasis is NOT present or ≤ 5 x ULN if liver metastasis is present, and total bilirubin ≤ 1.5 x ULN.
  -  QTc (corrected QT) interval < 480 msec.
  Exclusion Criteria:
  -  Presence of an activating EGFR (epidermal growth factor receptor) mutation or ALK (anaplastic lymphoma kinase) translocation in the tumor.
  -  Radiotherapy (RT) completed within 14 days prior to the first dose of study therapy.
  -  Known impairment of gastrointestinal function that would alter drug absorption.
  -  Leptomeningeal metastasis.
  -  Symptomatic or untreated brain metastases or spinal cord compression or any of these conditions requiring chronic steroids to control symptoms.
  -  History or evidence of cardiac risk
  -  Known history of malignant hypertension (severe hypertension >180/120 mmHg with end organ involvement.
  -  Another active concurrent malignancy.

Relevance to patient case: possibly relevant