Clinical trial NCT04632758: Study Comparing WX-0593 to Crizotinib in ALK Positive Non-Small Cell Lung Cancer (NSCLC) Patients
Official title: An Open-label, Randomized, Multicenter Phase 3 Study Comparing WX-0593 to Crizotinib in Anaplastic Lymphoma Kinase (ALK) Positive Non-Small Cell Lung Cancer (NSCLC) Patients
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE3
Conditions: Non-small Cell Lung Cancer
Lead sponsor: Qilu Pharmaceutical Co., Ltd.
Sponsor class: INDUSTRY
First posted: 2020-11-17
Enrollment: 292
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The primary purpose of this study is to evaluate the efficacy and safety of WX-0593 vs. crizotinib in patients with ALK-positive non-small cell lung cancer who had not received prior systemic therapy

Detailed description: To evaluate the efficacy and safety of WX-0593 vs. crizotinib in patients with ALK-positive NSCLC who had not received prior systemic therapy, to obtain additional pharmacokinetic (PK) data from sparse PK sampling, to compare the quality of life (QoL) in patients receiving WX-0593 vs. crizotinib, to evaluate the status of exploratory biomarkers and correlate with clinical outcome, and to obtain germline DNA samples for possible pharmacogenetic analysis in the event that outliers with respect to efficacy, tolerability/safety, or exposure are identified.

Eligibility criteria: Inclusion Criteria:

1. ≥18 years
2. Female or male
3. Patient has an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.
4. Life expectancy of at least 12 weeks.
5. At least one measurable lesion (according to RECIST v1.1)
6. Histologically or cytologically confirmed diagnosis of advanced or recurrent or metastatic NSCLC that is ALK-positive by an Abbott FISH assay in the central lab. Randomization will occur after ALK positive confirmation is received from the central lab or local test using an method including Abbott FISH、RT-PCR or Ventana IHC.
7. No brain metastasis, or asymptomatic brain metastasis, or symptomatic brain metastasis but stable for more than 4 weeks after treatment, and have stopped systemic hormone treatment (prednisone of \> 10 mg/day or equivalent hormone) for more than 2 weeks
8. Patients must have normal function as defined: ANC≥1.5\*10\^9/L; PLT≥90\*10\^9/L, Hb≥90 g/L, Total Bilirubin （TBIL）≤1.5\*Upper Limit of Normal（ULN） ( Gilbert's Syndrome TBIL ≤3.0\*ULN and DBIL≤1.5\*ULN )，Alanine Transaminase （ALT）and Aspartate Aminotransferase（AST）≤2.5\*ULN. For liver metastasis patients, ALT and AST≤5\*ULN, Cr≤1.5\*ULN, LVEF≥50%.
9. Any surgery or prior radiation (expect for palliative radiation) /operations must have been completed at least 4 weeks prior to first dosing. Palliative radiation must have been completed at least 48 hours prior to first dosing.
10. Patients must be able to understand and volunteer to sign the informed consent.

Exclusion Criteria:

1. Patients that have previously received cancer therapy (i.e., other targeted therapies, chemotherapy, immunotherapy, biologic therapy, hormonal therapy).
2. Patients with tumor meningeal metastasis
3. Clinically significant cardiovascular disease within 6 months prior to first dosing.
4. Two consecutive corrected QT interval (QTc) \> 480 ms through ECG examination during screening, ≥2 arrhythmias, ≥2 heart failure (according to CTCAE 4.03), atrial fibrillation and ventricular fibrillation of any grade, or clinically significant supraventricular or ventricular arrhythmia requiring treatment or intervention
5. Patients need medications that may prolong QT interval or induce torsades de pointes within 14 days prior to the first dosing or during the study.
6. Continuous use of corticosteroids for more than 30 days, or require chronic use of corticosteroids or other immunosuppressants
7. Past history of a large area of diffuse/interstitial pulmonary fibrosis, or known history of Grade 3 or 4 interstitial pulmonary fibrosis or interstitial lung disease.
8. Patients with Grade \> 1 nausea, vomiting, or diarrhea (CTCAE 4.03), other GI dysfunction or GI disease that may potentially affect drug absorption.
9. Patients at risk for GI perforation or intestinal obstruction
10. Patient has received other investigational drug within 1 month prior to first dosing. Subject received other clinical trial treatment within 1 month prior to the first dose of the investigational drug.
11. Patients who are HBsAg-positive and/or HBcAB positive and HBV DNA \> 103copies/mL, or HCV antibody-positive, or syphilis antibody- positive or known HIV infected.
12. Patients who cannot suspend the use of a strong CYP3A4 inducer or inhibitor at least 1 weeks prior to this study and during the study.
13. Patients who cannot suspend the use of a CYP3A4 substrate at least 1 weeks prior to this study and during the study, and the therapeutic index is low.
14. Females who are pregnant or breastfeeding. Pregnant or lactating female patients or a positive pregnancy test at baseline for females of childbearing potential.
15. Female patients who are unwilling to use effective contraceptive measures during the entire course of the study and within 6 months after the end of the study, or male patients who plan to have children.
16. Concurrent diseases that may seriously affect patient safety or impact patient completion of the study as determined by the investigator (such as clinically uncontrolled hypertension (blood pressure \> 160/110 mmHg), severe diabetes, or thyroid disease).
17. Drug abusers and alcoholics. Drug or alcohol abuse. Alcohol abuse refers to drinking 14 units of alcohol per week: 1 unit = 285mL of beer, or 25mL of spirits, or 100mL of wine;
18. History of definitive neurological or mental disorder, including epilepsy or dementia
19. Patients with other malignant tumors within 5 years prior to screening (except for cured basal cell carcinoma of the skin, cervical carcinoma in situ, thyroid carcinoma in situ, and papillary thyroid carcinoma).
20. Patients with added risks associated with the study or may interfere with the interpretation of study results as determined by the investigator, or deemed unsuitable by the investigator and/or sponsor.

Primary outcomes:
measure: Progression-free Survival (PFS)
timeFrame: from randomization until firstly recorded disease progression or death (whichever occurs earlier), or to the date that the last patients observed for 12 months
Secondary outcomes:
measure: Progression-free survival (PFS)
timeFrame: from randomization until firstly recorded disease progression or death (whichever occurs earlier), or to the date that the last patients observed for 12 months
measure: OS
timeFrame: from randomization until death due to any cause, withdraws informed consent, is lost to follow-up or refuses phone visits, or study completion（up to 2.5 years）
measure: Confirmed Objective Response Rate (ORR) Assessed By independent radiology review
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Confirmed Objective Response Rate (ORR) Assessed By Investigators
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Time to Response (TTR) Assessed By independent radiology
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Time to Response (TTR) Assessed By Investigators
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Duration of response (DOR) Assessed By independent radiology
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Duration of response (DOR) Assessed By Investigators
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: CNS response rate based on independent radiology review
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: CNS response rate based on investigator assessment
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Time to CNS progression
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Percentage of patients with adverse events
timeFrame: from the signing of the informed consent form until at least 28 days after the last dose of study drug was administered.
measure: Plasma concentrations (Cssmin)
timeFrame: Cssmin before dosing on Cycle 1 Day 1, Cycle 1 Day 7, Cycle 1 Day 21, Cycle 2 Day 21, and Cycle 4 Day 21
measure: Patient reported time to deterioration (TTD)
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Patient reported time to deterioration (TTD)
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Patient reported health-related quality of life (HRQoL)
timeFrame: From fist administration to the date that the last patients observed for 12 months
measure: Patient reported health-related quality of life (HRQoL)
timeFrame: From fist administration to the date that the last patients observed for 12 months
Other outcomes:
Locations:
city: Beijing
country: China
facility: Cancer Institute and Hospital, Chinese Academy of Medical Sciences
state: Beijing
Study officials:
References: