TGRX-326 Chinese Phase II for Advanced Non-small Cell Lung Cancer (NSCLC)

Study Overview
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Brief Summary
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This is a multi-center, single-arm, open-label, Phase II clinical trial which explores the safety and efficacy of TGRX-326 in patients with ALK-positive advanced NSCLC who have failed prior 2nd-generation ALK treatments due to progressive disease or intolerance.

Detailed Description
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This Phase II studyaims to evaluate the safety profile and efficacy profile in patients with ALK-positive advanced NSCLC. The primary purpose of this study is to evaluate the efficacy profile of TGRX-326, with the objective response rate (ORR) as end point. Secondary objectives include evaluating efficacy profile of other endpoints and safety profiles of the investigational drug. Exploratory objective includes the evaluation of population pharmacokinetic (PK) profile of TGRX-326.

Official Title
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A Multi-centered, Open-label, Single-arm Phase II Study to Evaluate the Safety and Efficacy of TGRX-326 Monotherapy in Patients of Advanced ALK-positiveNon-Small Cell Lung Cancer Who Failed 2nd-Generation ALK Inhibitor Therapies

Conditions
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Non-small Cell Lung Cancer

Intervention / Treatment
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* Drug: TGRX-326


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willing to follow the treatment protocol and visit schedule, and participate in the study with the ICF signed; ≥ 18 years of age on the day of ICF signing, regardless of gender. With ALK-positive advanced inoperable NSCLC and having disease progression or intolerance after continuous treatment with second-generation ALK inhibitors; Providing prior ALK positive test results at screening; Patients could have metastases to central nervous system at screening if the condition is asymptomatic, stable or completely recovered; Drug discontinuation for ≥ 5 half-lives prior to the first dose for subjects previously treated with ALK inhibitors; At least one measurable lesion; An ECOG PS score within 0-2; Adequate bone marrow, liver, kidney, coagulation and pancreatic functions; Expected survival ≥ 3 months; Willing to take effective contraceptive measures (for men of reproductive potential and women of reproductive age only) from ICF signing to 6 months after administration of the investigational drug. Women of reproductive age include women before menopause and within 2 years after menopause. Those women must have a negative pregnancy test ≤ 7 days prior to the first dose of the investigational drug. Exclusion Criteria: Previous use of any third-generation ALK inhibitors other than TGRX-326; Known hypersensitivity to any of the active ingredients or excipients of TGRX-326 or a history of severe allergic reactions that makes himself/herself unsuitable for TGRX-326 treatment in the judgment of the investigator; Having another type of cancer except for lung cancer; Major surgery within 4 weeks prior to the first dose; Spinal cord compression caused by tumor, unless the subject achieves significant pain control and full recovery of neurological function within 4 weeks prior to the first dose. Abnormal gastrointestinal function that affect absorption within the past 6 months; History of active pneumonia or clinically significant interstitial pneumonia, or radiation or drug-induced lung disorder with treatment needs; Cardiac insufficiency; Abnormal and clinically significant QTc on ECG or need of concomitant use of any drug known to prolong QT interval and cause torsades de pointes; Uncontrolled hypertension after drug treatment; Uncontrolled hyperglycaemia, acute attack of cholelithiasis, and susceptibility to acute pancreatitis; Severe or uncontrolled systemic diseases causing expected intolerance to the investigational drug as judged by the investigator; Use within 14 days before the first dose or expected concomitant use during the treatment period of drugs that pose risk of QTC interval prolongation and/or ventricular tachycardia; Previous antineoplastic treatments within 28 days prior to the first dose of the investigational drug; Toxic reactions associated with prior surgery and prior antineoplastic therapies that have not recovered and may affect the subject safety as assessed by the investigator. Clinically significant active bacterial, fungal or viral infections, including a positive result for hepatitis B surface antigen and HBV DNA ≥ ULN, one or more positive results for hepatitis C antibody or HIV antibody, or the presence of any uncontrolled infection. Use of strong CYP3A4 inducers or inhibitors or CYP3A4 substrates with a narrow therapeutic window within two weeks prior to the first dose of the investigational drug; Pregnant and breastfeeding female; Women of childbearing age who are unwilling or unable to use acceptable methods for contraception during the entire treatment period in the trial and within 6 months after the last dose of the investigational drug (women of childbearing age include: any one with menarche, and those who have not received successful artificial sterilization [hysterectomy, bilateral fallopian tube ligation, or bilateral oophorectomy] or premenopausal women); a fertile male patient who is unwilling or unable to take effective contraceptive measures, and whose partner is a woman of childbearing age; Being involved in other clinical studies (except for the non-interventional phase of interventional clinical study, such as survival follow-up period); less than 4 weeks from the end of the dose of other investigational drug to the first dose of the investigational drug or 5 half-lives of the previous drug, whichever is shorter; Any mental or cognitive disorders which may limit subjects' understanding and implementation of the informed consent form; Other situations, such as poor compliance, which are considered by the investigator to be not suitable for participation in the study.

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: Experimental: TGRX-326<br>Subjects to be treated with the investigational drug TGRX-326 at 60 mg once day in 21-day cycles. | Drug: TGRX-326<br>* Subjects will be treated with the investigational drug TGRX-326 at 60 mg once day in 21-day cycles<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective Response Rate (ORR) | ORR defined by the ratio of patients who reachedthe treatment response; ORR as evaluated by independed review committee (IRC) | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease Control Rate (DCR) | DCR defined by the ratio of patients who reached the treatment response or maintained as stable desease; DCR as evaluated by IRC and investigator | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Duration of Response (DOR) | DOR defined as the duration from first occurence of treatment response to progressive disease/relapse; DOR as evaluated by IRC and investigator | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Time to Response (TTR) | TTR defined by the time from the start of treatment to the first ORR; TTR as evaluated by IRC and investigator | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Progression Free Survival (PFS) | PFS defined by the time from randomization to progressive disease or death of any cause; PFS as evaluated by IRC and investigator. | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Intracranial Objective Response Rate (IC-ORR) | IC-ORR defined by the ratio of patients who reached the intracranial treatment response; ORR as evaluated by independed review committee (IRC) and investigator. | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Intracranial Disease Control Rate (IC-DCR) | IC-DCR defined by the ratio of patients who reached the treatment response intracranially or maintained as stable desease; IC-DCR as evaluated by IRC and investigator | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Intracranial Duration of Response (IC-DOR) | IC-DOR defined as the duration from first occurence of Intracranial treatment response to progressive disease/relapse; DOR as evaluated by IRC and investigator | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Intracranial Time to Response (IC-TTR) | IC-TTR defined by the time from the start of treatment to the first IC-ORR; TTR as evaluated by IRC and investigator | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Intracranial Progression Free Survival (IC-PFS) | IC-PFS defined by the time from randomization to progressive disease or death of any cause inpatients with intracranial lesions; PFS as evaluated by IRC and investigator. | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Overall Survival (OS) | OS defined by the time from randomization to death of any cause; PFS as evaluated by IRC and investigator. | Every 2 cycles between Cycle 1 and Cycle 17, and every 12 weeks from Cycle 17 and onwards (every cycle is 21 days); an average of 1.5 years | 
| Adverse Events (AEs) | To record and analyse subjects with adverse events (AEs) | Through completion of the study, an average of 1.5 years | 
| Serious Adverse Events (SAEs) | To record and analyse subjects with serious adverse events (SAEs) | Through completion of the study, an average of 1.5 years |