Description:
This open-label, multicenter study will assess the safety, tolerability, and pharmacokinetics
of intravenous (IV) dosing of atezolizumab in combination with oral erlotinib or alectinib in
participants with NSCLC.
This study has two stages. In the erlotinib group, the combination treatment will be given to
participants with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor
(TKI)-treatment-naive, advanced (nonresectable) NSCLC in a safety-evaluation stage and to
participants with previously untreated EGFR mutation-positive, advanced NSCLC in an expansion
stage (Stage 2). In the alectinib group, for both the safety-evaluation and expansion stages
(Stages 1 and 2), the combination will be given to participants who are treatment-naive with
anaplastic lymphoma kinase (ALK)-positive advanced NSCLC.
In Stage 1, erlotinib will be given at a starting dose of 150 milligrams (mg) by mouth (PO)
once daily (QD) and the starting dose of alectinib will be 600 mg twice daily (BID), for 28
consecutive days during Cycle 1 and on Days 1 through 21 of each cycle thereafter. The
starting dose of atezolizumab will be 1200 mg, administered every 3 weeks (q3W) starting on
Day 8 of Cycle 1. If the starting regimen for a combination treatment is not tolerated,
alternative doses and/or schedules of erlotinib and atezolizumab or alectinib and
atezolizumab may be tested to determine potential recommended Phase 2 dose (RP2D) for that
combination treatment. In Stage 2, a potential RP2D and schedule for each combination
treatment will be investigated in an expansion cohort.
For both stages, continuation of treatment beyond Cycle 1 will be at the discretion of the
treating investigator. Study treatment will be discontinued in participants who experience
disease progression or unacceptable toxicity, are not compliant with the study protocol, or,
in their opinion or in the opinion of the investigator, are not benefiting from study
treatment. However, in the absence of unacceptable toxicity, participants with second-line or
greater NSCLC who are still receiving atezolizumab at the time of radiographic disease
progression may be permitted to continue study treatment.
Title
- Brief Title: A Phase 1b Study of Atezolizumab in Combination With Erlotinib or Alectinib in Participants With Non-Small Cell Lung Cancer (NSCLC)
- Official Title: A Phase 1b Study of the Safety and Pharmacology of Atezolizumab (Anti-PD-L1 Antibody) Administered With Erlotinib or Alectinib in Patients With Advanced Non-Small Cell Lung Cancer
Clinical Trial IDs
- ORG STUDY ID:
WP29158
- SECONDARY ID:
2013-004382-13
- NCT ID:
NCT02013219
Conditions
- Non-Small Cell Lung Cancer
Interventions
Drug | Synonyms | Arms |
---|
Alectinib | Alecensa | Stage 1: Alectinib and Atezolizumab |
Atezolizumab | TECENTRIQ, MPDL3280A | Stage 1: Alectinib and Atezolizumab |
Erlotinib | Tarceva | Stage 1: Erlotinib and Atezolizumab |
Purpose
This open-label, multicenter study will assess the safety, tolerability, and pharmacokinetics
of intravenous (IV) dosing of atezolizumab in combination with oral erlotinib or alectinib in
participants with NSCLC.
This study has two stages. In the erlotinib group, the combination treatment will be given to
participants with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor
(TKI)-treatment-naive, advanced (nonresectable) NSCLC in a safety-evaluation stage and to
participants with previously untreated EGFR mutation-positive, advanced NSCLC in an expansion
stage (Stage 2). In the alectinib group, for both the safety-evaluation and expansion stages
(Stages 1 and 2), the combination will be given to participants who are treatment-naive with
anaplastic lymphoma kinase (ALK)-positive advanced NSCLC.
In Stage 1, erlotinib will be given at a starting dose of 150 milligrams (mg) by mouth (PO)
once daily (QD) and the starting dose of alectinib will be 600 mg twice daily (BID), for 28
consecutive days during Cycle 1 and on Days 1 through 21 of each cycle thereafter. The
starting dose of atezolizumab will be 1200 mg, administered every 3 weeks (q3W) starting on
Day 8 of Cycle 1. If the starting regimen for a combination treatment is not tolerated,
alternative doses and/or schedules of erlotinib and atezolizumab or alectinib and
atezolizumab may be tested to determine potential recommended Phase 2 dose (RP2D) for that
combination treatment. In Stage 2, a potential RP2D and schedule for each combination
treatment will be investigated in an expansion cohort.
For both stages, continuation of treatment beyond Cycle 1 will be at the discretion of the
treating investigator. Study treatment will be discontinued in participants who experience
disease progression or unacceptable toxicity, are not compliant with the study protocol, or,
in their opinion or in the opinion of the investigator, are not benefiting from study
treatment. However, in the absence of unacceptable toxicity, participants with second-line or
greater NSCLC who are still receiving atezolizumab at the time of radiographic disease
progression may be permitted to continue study treatment.
Trial Arms
Name | Type | Description | Interventions |
---|
Stage 1: Alectinib and Atezolizumab | Experimental | In Stage 1, starting dose of atezolizumab will be 1200 mg IV q3w administered on Day 8 of Cycle 1 and on Day 1 (21-day cycle) of each cycle thereafter along with alectinib at a starting dose of 600 mg PO BID for 28 consecutive days during Cycle 1 and on Days 1-21 of each cycle thereafter; unless maximum tolerable dose (MTD) is exceeded. The combination will be given to treatment-naive participants with ALK-positive, locally advanced or metastatic NSCLC. | |
Stage 1: Erlotinib and Atezolizumab | Experimental | In Stage 1, starting dose of atezolizumab will be 1200 mg IV q3w administered on Day 8 of Cycle 1 and on Day 1 (21-day cycles) of each cycle thereafter along with erlotinib at a starting dose of 150 mg PO QD, for 28 consecutive days during Cycle 1 and on Days 1-21 of each cycle thereafter; unless MTD is exceeded. The combination will be given to participants with EGFR TKI treatment-naive, locally advanced or metastatic NSCLC. | |
Stage 2: Alectinib and Atezolizumab | Experimental | In Stage 2, participants received the RP2D on the basis of the MTD or maximum allowed dose (MAD) of the combination treatment established in Stage 1. Treatment-naive participants with ALK-positive, locally advanced or metastatic NSCLC will be included. | |
Stage 2: Erlotinib and Atezolizumab | Experimental | In Stage 2, participants received the RP2D on the basis of the MTD or MAD of the combination treatment established in Stage 1. Previously untreated (or with one prior treatment that was not an EGFR TKI), EGFR mutation positive, locally advanced or metastatic NSCLC participants will be included. | |
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically documented, locally advanced or metastatic NSCLC.
- Participants in Stage 1 (Safety Evaluation) receiving erlotinib: No limit to the
number of prior therapies (except for EGFR TKIs).
- Participants in Stage 2 (Expansion) receiving erlotinib: i) sensitizing mutation in
the EGFR gene and ii) consent to collection of tumor tissue samples before, during,
and after treatment for biopsy and PD biomarker analyses.
- Participants receiving alectinib in either Stage 1 or Stage 2: must be ALK positive as
assessed by Food and Drug Administration (FDA) approved test and must not have
received prior treatment for their advanced NSCLC.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
- Life expectancy of at least 12 weeks.
- Measurable disease, as defined by RECIST Version 1.1 (v1.1).
- Adequate hematologic and end-organ function.
- Use of highly effective contraception (as defined by protocol) and until 5 months
after the last dose of atezolizumab and for 3 months after the last dose of alectinib
or for 2 weeks after the last dose of erlotinib, whichever is longer; Males must also
refrain from sperm donatation during this same time period. Participants must not be
pregnant or breastfeeding.
- Archival tumor tissue specimen meeting protocol specifications or the participant will
be offered the option of a pre-treatment biopsy to obtain adequate tissue sample.
Exclusion Criteria:
- For participants receiving erlotinib group: prior treatment with any EGFR
mutant-targeting TKI
- Any approved anticancer therapy, including chemotherapy, or hormonal therapy (except
hormone-replacement therapy or oral contraceptives) within 3 weeks of first dose.
- Treatment with any other test drug or participation in another clinical trial within
28 days of enrollment.
- Known symptomatic central nervous system (CNS) metastases. Participants with a history
of treated or untreated asymptomatic CNS metastases may be eligible.
- Leptomeningeal disease.
- Uncontrolled tumor-related pain.
- Uncontrolled pleural effusion, pericardial effusion, or ascites requiring drainage at
least once monthly.
- High levels of calcium requiring bisphosphonate therapy or denosumab.
- Malignancies other than NSCLC within 5 years prior to enrollment, with the exception
of those with a negligible risk of metastasis or death (such as adequately treated
carcinoma in-situ of the cervix, basal or squamous cell skin cancer, localized
prostate cancer, or ductal carcinoma in situ).
- History of severe allergic, anaphylactic, or other reactions to chimeric or humanized
antibodies or fusion proteins.
- Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells
or any component of the atezolizumab formulation.
- History of autoimmune disease.
- Participants with prior bone marrow or solid organ transplantation.
- History of lung inflammation or disease.
- Serum albumin less than (<) 2.5 grams per deciliter (g/dL).
- Positive for Human Immunodeficiency Virus (HIV).
- Liver disease.
- Current or active tuberculosis, hepatitis B, or hepatitis C.
- Participants with past or resolved hepatitis B virus (HBV) infection are eligible;
participants positive for hepatitis C virus (HCV) antibody are eligible only if
polymerase chain reaction (PCR) is negative for HCV Riboxy Nucleic Acid (RNA).
- Signs or symptoms of infection within 2 weeks prior to first dosing.
- Received therapeutic oral or IV antibiotics within 2 weeks prior to first dosing.
- Significant cardiovascular disease.
- Major surgical procedure other than for diagnosis within 28 days prior to first dosing
or during the course of the study.
- Administration of a live, attenuated vaccine within 4 weeks before first dosing or
during the study.
- Any other diseases, metabolic dysfunction, physical examination finding, or clinical
laboratory finding that may reasonably prevent the participant from participating.
- Hypersensitivity to erlotinib or alectinib or to any of the excipients.
- Any significant ophthalmologic abnormality. The use of contact lenses is not
recommended during the study.
- For participants receiving alectinib: baseline Fridericias corrected QT interval
(QTcF) greater than (>) 470 milliseconds (ms) or symptomatic bradycardia.
- Prior treatment with CD137 agonists or immune checkpoint blockade therapies.
- Treatment with systemic immunostimulatory agents within 6 weeks or five half-lives of
the drug, whichever is shorter, prior to first dosing.
- Treatment with systemic immunosuppressive medications within 2 weeks prior to first
dosing (inhaled corticosteroids and mineralocorticoids are allowed).
- Participants who received acute, low-dose systemic immunosuppressant medication or a
one-time pulse dose of systemic immunosuppressant medication are elgible for study
after discussion and approval by the Medical Monitor.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Percentage of Participants with Dose-Limiting Toxicities (DLTs) |
Time Frame: | 28 days |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | Minimum Plasma Concentration (Cmin) of Alectinib and Major Metabolites, as Appropriate |
Time Frame: | Pre-dose (0 hour) on Day 1 of Cycles 1-4, Day 8 of Cycle 1 (Cycle 1 =28 days; Cycle 2 onwards=21 days) |
Safety Issue: | |
Description: | |
Measure: | Progression-Free Survival (PFS) as Assessed Using the Response Evaluation Criteria in Solid Tumors (RECIST) |
Time Frame: | First dose of study treatment up to disease progression or death from any cause (up to approximately 6 years) |
Safety Issue: | |
Description: | |
Measure: | Overall Survival |
Time Frame: | First dose of study treatment up to death from any cause during the study (up to approximately 6 years) |
Safety Issue: | |
Description: | |
Measure: | Percentage of Participants with Objective Response (Complete Response [CR] or Partial Response [PR]) Using RECIST |
Time Frame: | Baseline up to disease progression or death from any cause (up to approximately 6 years) |
Safety Issue: | |
Description: | |
Measure: | Percentage of Participants with Adverse Events |
Time Frame: | Baseline up to approximately 6 years |
Safety Issue: | |
Description: | |
Measure: | Percentage of Participants with Anti-Drug Antibodies (ADAs) Against Atezolizumab |
Time Frame: | Baseline up to approximately 6 years |
Safety Issue: | |
Description: | |
Measure: | Maximum Serum Concentration (Cmax) of Atezolizumab |
Time Frame: | Day 1 of Cycles 1-4, Day 8 of Cycle 1 (Cycle 1 =21 days; Cycle 2 onwards=28 days) |
Safety Issue: | |
Description: | |
Measure: | Minimum Serum Concentration (Cmin) of Atezolizumab |
Time Frame: | Pre-dose (0 hour) on Day 1 of Cycles 1, 2, 3, 4, 6, and 8 and at study termination (up to approximately 5 years; Cycle 1=21 days; Cycle 2 onwards=28 days) |
Safety Issue: | |
Description: | |
Measure: | Maximum Plasma Concentration (Cmax) of Erlotinib |
Time Frame: | Day 1 of Cycles 1-4, Day 8 of Cycle 1 (Cycle 1 =21 days; Cycle 2 onwards=28 days) |
Safety Issue: | |
Description: | |
Measure: | Minimum Plasma Concentration (Cmin) of Erlotinib |
Time Frame: | Pre-dose (0 hour) on Day 1 of Cycles 1-4, Day 8 of Cycle 1 (Cycle 1 =21 days; Cycle 2 onwards=28 days) |
Safety Issue: | |
Description: | |
Measure: | Maximum Plasma Concentration (Cmax) of Alectinib and Major Metabolites, as Appropriate |
Time Frame: | Day 1 of Cycles 1-4, Day 8 of Cycle 1 (Cycle 1 =21 days; Cycle 2 onwards=28 days) |
Safety Issue: | |
Description: | |
Measure: | Duration of Objective Response as Assessed Using RECIST |
Time Frame: | First occurrence of a documented objective response up to disease progression or death from any cause (up to approximately 6 years) |
Safety Issue: | |
Description: | |
Measure: | Percentage of Participants with Best Overall Response |
Time Frame: | Baseline up to disease progression or death from any cause (up to approximately 6 years) |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Hoffmann-La Roche |
Last Updated
April 21, 2020