A Study of the Combination of Osimertinib, Platinum and Etoposide for Patients With Metastatic EGFR Mutant Lung Cancers

Study Overview
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Brief Summary
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The purpose of this study is to test the safety of combining Osimertinib with either Cisplatin or Carboplatin (at different dose levels) and Etoposide, to find out what effects, if any, this combination of drugs has on people with EGFR mutant lung cancer.

Official Title
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Phase 1 Study of Combination Osimertinib, Platinum, Etoposide for Patients With Metastatic EGFR Mutant Lung Cancers With Concurrent RB1 and TP53 Alterations

Conditions
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Lung Cancer

Intervention / Treatment
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* Drug: Osimertinib
* Drug: Platinum
* Drug: Etoposide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Written informed consent Advanced biopsy-proven metastatic non-small cell lung cancer Either have not started an EGFR TKI or may have started osimertinib within the last 9 weeks Somatic activating mutation in EGFR in pre-treatment tumor biopsy or cfDNA Evidence of a concurrent P53 alteration by IHC or NGS on pre-treatment tumor biopsy or cfDNA Evidence of a concurrent RB1 alteration by IHC or NGS on pre-treatment tumor biopsy or cfDNA Must have a site of disease amenable to repeat biopsy and be willing to undergo a biopsy during treatment Measurable (RECIST 1.1) indicator lesion not previously irradiated Karnofsky performance status (KPS) ≥ 70% Age >18 years old Ability to swallow oral medication Adequate organ function AST, ALT ≤ 3 x ULN Total bilirubin ≤ 1.5x ULN Creatinine ≤ 1.5x ULN OR calculated creatinine clearance ≥ 60ml/min Absolute neutrophil count (ANC) ≥ 1000 cells/mm^3 Hemoglobin≥8.0 g/dL Platelets ≥100,000/mm^3 Exclusion Criteria: Pregnant or lactating women Started an EGFR TKI other than osimertinib or started osimertinib more than 9 weeks ago Any radiotherapy within 1 week of starting treatment on protocol. Any major surgery within 1 weeks of starting treatment on protocol. Any evidence of active clinically significant interstitial lung disease Continue to have unresolved > grade 1 toxicity from any previous treatment Have pure small cell histology Corrected QT interval using Fridericia's formula (QTcF)>475msec or any clinically significant (as deemed by the investigator) abnormalities in rhythm or conduction or morphology of the resting EKG. Patients are to be excluded from cisplatin treatment arm if they meet any of the following criteria: Creatinine clearance < 60 ml/min Hearing impairment requiring assistive device Neuropathy The treating provider does not feel as though the patient should receive cisplatin

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Osimertinib, Platinum (cisplatin or carboplatin) and Etoposide<br>Initially, 6 patients will be enrolled and will begin treatment with osimertinib 80mg orally daily (3 who will be receiving cisplatin and 3 who will be receiving carboplatin). Cisplatin or carboplatin treatment will be decided by the treating physician prior to study registration. After 9 weeks (+/- 1 week)( 3 cycles) on osimertinib alone, carboplatin or cisplatin and etoposide will be added. Carboplatin is doses at an AUC of 5 or cisplatin at 60mg/m2 will be given on C4D1. Etoposide is dosed at 100mg/m2 given on Days 1-3 of C4. Only patients on osimertinib 80mg orally daily at the start of cycle 4 will be included in the 3+3 dose de-escalation portion of the study. Chemotherapy and osimertinib will be administered concurrently during cycles 4-7, and from cycle 8 onward, osimertinib monotherapy will be continued. Patients will present every 2 cycles post-chemo (Cycles 8, 10, 12, etc.) | Drug: Osimertinib<br>* Osimertinib 80mg daily<br>Drug: Platinum<br>* Cisplatin 60mg/m2 or Cisplatin 45mg/m2 Carboplatin AUC 5 or Carboplatin AUC 4<br>Drug: Etoposide<br>* Etoposide 100mg/m2 or Etoposide 80mg/m2<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The MTD (maximum tolerated dose) | Determine the safety and toxicity profile of combination osimertinib, platinum (cisplatin or carboplatin), etoposide for patients with metastatic EGFR mutant lung cancers with concurrent RB1 and TP53 alterations. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Osimertinib, Platinum, Etoposide, EGFR Mutant, 18-211