Clinical trial NCT02108964: A Phase I/II, Multicenter, Open-label Study of EGFRmut-TKI EGF816, Administered Orally in Adult Patients With EGFRmut Solid Malignancies
Official title: A Phase I/II, Multicenter, Open-label Study of EGFRmut-TKI EGF816, Administered Orally in Adult Patients With EGFRmut Solid Malignancies
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Advanced Non-small Cell Lung Cancer
Keywords: NSCLC
Non-small Cell Lung Cancer EGFRmut
EGFR TKIs (EGF816)
acquired T790M mutation
de novo T790M mutation
EGFR TKI activating mutation (i.e. L858R or ex19del)
Treatment naive advanced NSCLC with EGFR activating mutations
Locally advanced NSCLC (Stage IIIB NSCLC not amenable to definitive multi-modality therapy including surgery)
Metastatic NSCLC refers to Stage IV NSCLC
1st line
Lead sponsor: Novartis
Sponsor class: INDUSTRY
First posted: 2014-04-09
Enrollment: 225
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This is a Phase I/II, multi-center, open-label study, composed with a Phase I part (dose-escalation phase) followed by a Phase II part (expansion phase).

The dose escalation phase was designed to determine as primary objective the maximum tolerated dose (MTD) or recommended Phase II dose (RP2D) of EGF816 monotherapy in adult subjects with locally advanced (stage IIIB) or metastatic (stage IV) NSCLC harboring specific EGFR mutations. Patients may have or not have received prior lines of antineoplastic therapy. An adaptive Bayesian Logistic Regression Model (BLRM) employing the escalation with overdose control (EWOC) principle will be used during the dose escalation part for dose level selection and MTD recommendation. The primary objective of the Phase II part is to estimate antitumor activity of EGF816 as measured by overall response rate (ORR) determined by Blinded Independent Review Committee (BIRC) assessment in accordance to RECIST 1.1.

Detailed description: Following completion of screening procedures and confirmation of patient eligibility, the participants are enrolled in the study. The study treatment begin on Cycle 1, Day 1 with the first administration of EGF816. A treatment cycle is defined as 28 days. Oral EGF816 is administered once daily on a continuous schedule until patient experiences unacceptable toxicity, progressive disease (PD), and/or treatment is discontinued at the discretion of the investigator, patient withdrawal of consent, or due to any other reasons. Treatment with EGF816 may be continued beyond RECIST 1.1 defined PD, if, in the judgment of the investigator, there is evidence of clinical benefit and the patient wishes to continue with the study treatment.

Eligibility criteria: Inclusion Criteria: (For all patients unless otherwise specified)

* Histologically or cytologically confirmed locally advanced (stage IIIB not amenable to definitive multi-modality therapy including surgery) or metastatic (stage IV) EGFR mutant NSCLC.
* Patients with controlled brain metastases
* ECOG performance status: Phase I part: 0, 1, or 2; Phase II part: 0 or 1
* Presence of at least one measurable lesion according to RECIST 1.1 per investigator assessment
* Patients who are either Hepatitis B surface antigen (HBsAg) positive or hepatitis B virus (HBV)-DNA positive must be willing and able to take antiviral therapy 1-2 weeks prior to 1st dose of EGF816 treatment and continue on antiviral therapy for at least 4 weeks after the last dose of EGF816
* Patients must have negative hepatitis C antibody (HCV-Ab) or positive HCV-Ab but undetectable level of HCV-RNA. Note: patients with detectable HCV-RNA are not eligible for the study.
* For Phase I: patients must have failed no more than 3 lines of any systemic antineoplastic therapy for advanced NSCLC, including EGFR-TKI
* For Phase II: patients must be naïve from any systemic antineoplastic therapy in the advanced setting. Patients who have failed no more than 1 cycle of systemic antineoplastic therapy in the advanced setting are allowed.

Exclusion criteria: (For all patients unless otherwise specified)

* Patients with a history or presence of interstitial lung disease (ILD) or interstitial pneumonitis, including clinically significant radiation pneumonitis (i.e. affecting activities of daily living or requiring therapeutic intervention)
* Presence or history of another malignancy
* Undergone a bone marrow or solid organ transplant
* Known history of human immunodeficiency virus (HIV) seropositivity
* Patients receiving concomitant immunosuppressive agents or chronic corticosteroids use at the time of study entry except for control of brain metastases, topical applications, inhaled sprays, eye drops or local injections
* Patients with clinically significant, uncontrolled heart disease
* Any prior therapies ≤ 4 weeks prior to the first dose of study treatment
* Patients who are receiving treatment with medications that are known to be strong inhibitors or inducers of CYP3A4/5 and cannot be discontinued 1 week prior to the start of EGF816 treatment and for the duration of the study.
* Patients who have impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of EGF816
* Patients who are receiving treatment with any enzyme-inducing anticonvulsant that cannot be discontinued at least 1 week before first dose of study treatment, and for the duration of the study
* Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception
* Sexually active males unless they use a condom during intercourse while taking drug and for 3 months after stopping treatment

Other protocol-defined inclusion and exclusion criteria may apply.

Primary outcomes:
measure: Number of Participants With Dose Limiting Toxicities (DLTs) (Phase I Part)
timeFrame: First 28 days of dosing
measure: Overall Response Rate (ORR) by Blinded Independent Review Committee (BIRC) (Phase II Part)
timeFrame: From baseline up to 64 weeks
Secondary outcomes:
measure: Progression-free Survival (PFS) by Investigator Assessment (Phase I & Phase II Parts)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Duration of Response (DOR) by Investigator Assessment (Phase I & II Parts)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Observed Maximum Plasma Concentration (Cmax) of EGF816 and Metabolite LMI258 (Phase I & Phase II Part)
timeFrame: Cycle (C) 1 Day (D) 1 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hours (hrs) post-dose), C1D15 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hrs post-dose) (for Phase I part only) and C2D1 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hrs post-dose).
measure: Time to Maximum Plasma Concentration (Tmax) of EGF816 and Metabolite LMI258 (Phase I & Phase II Part). Tmax is the Time to Reach Maximum (Peak) Plasma Drug Concentration (Time).
timeFrame: Cycle (C) 1 Day (D) 1 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hours (hrs) post-dose), C1D15 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hrs post-dose) (for Phase I part only) and C2D1 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hrs post-dose).
measure: Area Under the Serum Concentration-time Curve From Time Zero to the End of the Dosing Interval Tau (AUCtau) of EGF816 and Metabolite LMI258 (Phase I & Phase II Part)
timeFrame: Cycle (C) 1 Day (D) 1 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hours (hrs) post-dose), C1D15 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hrs post-dose) (for Phase I part only) and C2D1 (pre-dose and 0.5,1,2,3,4,6,8,12 and 24 hrs post-dose).
measure: Percentage Change From Baseline in H-score for Immunohistochemistry (IHC) Biomarkers From Tumor Tissue Samples (Phase I Part)
timeFrame: Baseline and Cycle 1 Day 15
measure: Overall Response Rate (ORR) by Investigator Assessment (Phase I & II Parts)
timeFrame: At least 24 weeks up to approx. 4 years
measure: Disease Control Rate (DCR) by Investigator Assessment (Phase I & II Parts)
timeFrame: At least 24 weeks up to approx. 4 years
measure: Time to Response (TTR) by Investigator Assessment (Phase I & II Parts)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Number of Participants With Dose Interruptions and Dose Reductions (Phase I & II Parts)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Duration of Response (DOR) by BIRC (Phase II Part)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Disease Control Rate (DCR) by BIRC (Phase II Part)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Progression-Free Survival (PFS) by BIRC (Phase II Part)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Time to Response (TTR) by BIRC (Phase II Part)
timeFrame: At least 24 weeks up to approx. 9 years
measure: Overall Survival (OS) (Phase II Part)
timeFrame: At least 24 weeks up to approx. 9 years
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital Mass General
state: Massachusetts
city: New York
country: United States
facility: Memorial Sloan Kettering Oncology Department
state: New York
city: Toronto
country: Canada
facility: Novartis Investigative Site
state: Ontario
city: Berlin
country: Germany
facility: Novartis Investigative Site
city: Koeln
country: Germany
facility: Novartis Investigative Site
city: Nagoya
country: Japan
facility: Novartis Investigative Site
state: Aichi
city: Fukuoka-city
country: Japan
facility: Novartis Investigative Site
state: Fukuoka
city: Seoul
country: Korea, Republic of
facility: Novartis Investigative Site
city: Seoul
country: Korea, Republic of
facility: Novartis Investigative Site
city: Zoetermeer
country: Netherlands
facility: Novartis Investigative Site
city: Singapore
country: Singapore
facility: Novartis Investigative Site
city: Barcelona
country: Spain
facility: Novartis Investigative Site
state: Catalunya
city: Madrid
country: Spain
facility: Novartis Investigative Site
city: Taipei
country: Taiwan
facility: Novartis Investigative Site
Study officials:
affiliation: Novartis Pharmaceuticals
name: Novartis Pharmaceuticals
role: STUDY_DIRECTOR
References:
citation: Tan DSW, Kim SW, Ponce Aix S, Sequist LV, Smit EF, Yang JCH, Hida T, Toyozawa R, Felip E, Wolf J, Grohe C, Leighl NB, Riely G, Cui X, Zou M, Ghebremariam S, O'Sullivan-Djentuh L, Belli R, Giovannini M, Kim DW. Nazartinib for treatment-naive EGFR-mutant non-small cell lung cancer: Results of a phase 2, single-arm, open-label study. Eur J Cancer. 2022 Sep;172:276-286. doi: 10.1016/j.ejca.2022.05.023. Epub 2022 Jul 7.
citation: Tan DS, Leighl NB, Riely GJ, Yang JC, Sequist LV, Wolf J, Seto T, Felip E, Aix SP, Jonnaert M, Pan C, Tan EY, Ko J, Moody SE, Kim DW. Safety and efficacy of nazartinib (EGF816) in adults with EGFR-mutant non-small-cell lung carcinoma: a multicentre, open-label, phase 1 study. Lancet Respir Med. 2020 Jun;8(6):561-572. doi: 10.1016/S2213-2600(19)30267-X. Epub 2020 Jan 15.