Clinical Trials /

AZD9291 in Combination With Ascending Doses of Novel Therapeutics

NCT02143466

Description:

The purpose of this study is to determine the safety, tolerability and preliminary anti-tumour activity of AZD9291 when given together with AZD6094 or selumetinib in patients with EGFR mutation positive advanced lung cancer

Related Conditions:
  • Non-Small Cell Lung Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: AZD9291 in Combination With Ascending Doses of Novel Therapeutics
  • Official Title: A Multi-arm, Phase Ib, Open-Label, Multicentre Study to Assess the Safety,Tolerability, Pharmacokinetics and Preliminary Anti-tumour Activity of AZD9291 in Combination With Ascending Doses of Novel Therapeutics in Patients With EGFRm+ Advanced NSCLC Who Have Progressed Following Therapy With an EGFR TKI (TATTON).

Clinical Trial IDs

  • ORG STUDY ID: D5160C00006
  • NCT ID: NCT02143466

Conditions

  • Advanced Non Small Cell Lung Cancer

Interventions

DrugSynonymsArms
Part A - AZD9291 in combination with AZD6094Osimertinib & Savolitinib/VolitinibAZD6094
Part A - AZD9291 in combination with continuous selumetinib (Asian subjects)Osimertinib & ARRY-142886Selumetinib
Part A - AZD9291 in combination with continuous selumetinib (non-Asian subjects)Osimertinib & ARRY-142886Selumetinib
Part A - AZD9291 in combination with intermittent selumetinibOsimertinib & ARRY-142886Selumetinib
Part A - AZD9291 in combination with MEDI4736Osimertinib & DurvalumabMEDI4736
Part B - AZD9291 in combination with AZD6094Osimertinib & Savolitinib/VolitinibAZD6094
Part B - AZD9291 in combination with selumetinibOsimertinib & ARRY-142886Selumetinib
Part B - AZD9291 in combination with MEDI4736Osimertinib & DurvalumabMEDI4736
Part C - AZD6094 monotherapy (Japan only)Savolitinib/VolitinibAZD6094 (monotherapy)
Part C - AZD9291 in combination with AZD6094 (Japan only)Osimertinib & Savolitinib/VolitinibAZD6094
Part D - AZD9291 in combination with AZD6094Osimertinib & Savolitinib/VolitinibAZD6094

Purpose

The purpose of this study is to determine the safety, tolerability and preliminary anti-tumour activity of AZD9291 when given together with AZD6094 or selumetinib in patients with EGFR mutation positive advanced lung cancer

Detailed Description

      This is a Phase Ib, open-label, multicentre study of AZD9291 administered orally in
      combination with novel therapeutics (AZD6094 or selumetinib (AZD6244, ARRY142886)) to
      patients with EGFRm+ advanced NSCLC. The study has been designed to allow an investigation of
      the optimal combination dose and schedule whilst ensuring the safety of patients with
      intensive safety monitoring. There are three main parts to this study; Part A, Combination
      dose finding and Parts B and D, Dose expansion. Part C, AZD6094 dose finding sub-study in
      advanced solid tumour patients is ongoing in Japan.

      AZD9291 (osimertinib) is a potent irreversible inhibitor of both the single epidermal growth
      factor receptor sensitising mutation positive (EGFRm+) (tyrosine kinase inhibitor [TKI]
      sensitivity-conferring mutation) and dual EGFRm+/T790M+ (TKI resistance-conferring mutation)
      receptor forms of EGFR. AZD9291 therefore has the potential to provide clinical benefit to
      patients with advanced non-small cell lung cancer (NSCLC) harbouring both the single
      sensitivity mutations and the resistance mutation following prior therapy with an EGFR TKI.
      AZD9291 (osimertinib) was awarded FDA accelerated approval in November 2015, followed by
      conditional approval in the EU, full approval in Japan and additional markets in 2016, for
      the treatment of patients with EGFR T790M+ NSCLC who have progressed on or after EGFR TKI
      therapy.

      Enrolment into the patient cohort that evaluated AZD9291 treatment in combination with
      MEDI4736 as 1st line treatment has been terminated due to an increased incidence of ILD-like
      events (interstitial lung disease/pneumonitis), and is no longer being evaluated in this
      study.

      .
    

Trial Arms

NameTypeDescriptionInterventions
AZD6094ExperimentalAZD9291 in combination with AZD6094
  • Part A - AZD9291 in combination with AZD6094
  • Part B - AZD9291 in combination with AZD6094
  • Part C - AZD9291 in combination with AZD6094 (Japan only)
  • Part D - AZD9291 in combination with AZD6094
SelumetinibExperimentalAZD9291 in combination with selumetinib
  • Part A - AZD9291 in combination with continuous selumetinib (Asian subjects)
  • Part A - AZD9291 in combination with continuous selumetinib (non-Asian subjects)
  • Part A - AZD9291 in combination with intermittent selumetinib
  • Part B - AZD9291 in combination with selumetinib
MEDI4736ExperimentalAZD9291 in combination with MEDI4736. Enrolment into the patient cohort that evaluated AZD9291 treatment in combination with MEDI4736 as 1st line treatment has been terminated due to an increased incidence of ILD-like events (interstitial lung disease/pneumonitis), and is no longer being evaluated in this study.
  • Part A - AZD9291 in combination with MEDI4736
  • Part B - AZD9291 in combination with MEDI4736
AZD6094 (monotherapy)ExperimentalAZD6094 in monotherapy (for Japan only)
  • Part C - AZD6094 monotherapy (Japan only)

Eligibility Criteria

        Inclusion Criteria Signed informed consent Male or female aged at least 18 years and older.
        Patients from Japan aged at least 20 years.

        Histological or cytological confirmation of EGFRm+ NSCLC. Confirmation that the tumour
        harbours an EGFR mutation known to be associated with EGFR TKI sensitivity (including exon
        19 deletion and L858R). Radiological documentation of disease progression while on a
        previous continuous treatment with an EGFR TKI eg, gefitinib or erlotinib. These patients
        must have radiological progression (as per site assessment) on the last treatment
        administered prior to enrolling in the study.

        At least one lesion, not previously irradiated, not biopsied during the screening period,
        that can be accurately measured at baseline as ≥10 mm in the longest diameter (except lymph
        nodes which must have short axis ≥15 mm) with computerised tomography (CT) or magnetic
        resonance imaging (MRI) which is suitable for accurate repeated measurements. Adequate
        haematological, liver and renal function as well as coagulation parameters.

        ECOG/WHO performance status of 0 or 1 or KPS >80. Ability to swallow and retain oral
        medications. Prior to study entry, local confirmation of tumour cMET status is acceptable,
        a central result will be confirmed retrospectively. Local confirmation of tumour T790M
        status is acceptable if performed with an approved test and agreed by AstraZeneca.

        Agree to use adequate contraceptive measures.

        Exclusion Criteria Treatment with an EGFR TKI within approximately 5x half-life (eg, within
        8 days for erlotinib, gefitinib or afatanib, or within 10 days for dacomitinib) of the
        first dose of study treatment. Any cytotoxic chemotherapy, investigational agents or other
        anticancer drugs for the treatment of advanced NSCLC from a previous treatment regimen or
        clinical study within 14 days of the first dose of study treatment Patients currently
        receiving medications or herbal supplements known to be potent inducers of CYP3A4 (at least
        3 weeks prior). For AZD6094 patients currently receiving prior to receiving the first dose,
        medications known to be strong inhibitors of CYP1A2.

        Prior AZD9291 dosing in the present study. Prior treatment with a 3rd generation
        (T790M-directed) therapy (eg, AZD9291, rociletinib or HM61713) outside of this study is
        permitted if allocated to the 3rd generation EGFR TKI cohort. Prior or current treatment
        with AZD6094 or another cMET inhibitor (eg, foretinib, crizotinib, cabozantinib,
        onartuzumab) if allocated to AZD9291 plus AZD6094 combination. Radiotherapy with a limited
        field of radiation for palliation within 1 week of the first dose of study treatment, with
        the exception of patients receiving radiation to more than 30% of the bone marrow or with a
        wide field of radiation which must be completed within ≥4 weeks of the first dose of study
        treatment Major surgical procedure, or significant traumatic injury within 4 weeks of the
        first dose of study treatment, or have an anticipated need for major surgery during the
        study.

        Currently receiving treatment with warfarin sodium. LMWH is allowed. Active
        gastrointestinal disease or other condition that will interfere significantly with the
        absorption, distribution, metabolism, or excretion of oral therapy Any of the following
        cardiac diseases currently or within the last 6 months: Unstable angina pectoris,
        Congestive heart failure (NYHA ≥ Grade 2), Acute myocardial infarction, Stroke or transient
        ischemic attack.

        Known hypersensitivity to the active or inactive excipients of AZD6094. Uncontrolled
        hypertension (BP ≥150/95 mmHg despite medical therapy) Mean resting correct QT interval
        (QTcF) >470 msec for women and >450 msec for men or factors that may increase the risk of
        QTcF prolongation such as chronic hypokalaemia not correctable with supplements, congenital
        or familial long QT syndrome, or family history of unexplained sudden death under 40 years
        of age in first degree relatives or any concomitant medication known to prolong the QT
        interval and cause Torsade de Pointes.

        Any clinically important abnormalities in rhythm, conduction or morphology of resting
        electrocardiograms (ECGs), e.g. complete left bundle branch block, third degree heart
        block, second degree heart block, PR interval >250 msec. Serious underlying medical
        condition at the time of treatment that would impair the ability of the patient to receive
        protocol treatment.

        Active hepatitis B (positive HBsAg result) or hepatitis C (HCV). Patients with a past or
        resolved HBV infection are eligible if negative for HBsAg and positive for anti-HBc or
        positive for HBsAg, but for > 6 months have had normal transaminases and HBV DNA levels
        between 0-2000 IU/ml (inactive carrier state) and willing to start and maintain antiviral
        treatment for at least the duration of the study. HBV DNA levels > 2000 IU/ml but on
        prophylactic antiviral treatment for the past 3 months and will maintain the antiviral
        treatment during the study. Patients with positive HCV antibody are eligible only if the
        polymerase chain reaction is negative for HCV RNA.

        Known serious active infection including, but not limited to, tuberculosis, or human
        immunodeficiency virus (positive HIV 1/2 antibodies).

        Presence of other active cancers, or history of treatment for invasive cancer, within the
        last 5 years. Patients with Stage I cancer who have received definitive local treatment at
        least 3 years previously, and are considered unlikely to recur are eligible. All patients
        with previously treated in situ carcinoma (i.e., non-invasive) are eligible, as are
        patients with history of non-melanoma skin cancer.

        Women who are either pregnant or breast feeding. Previous allogeneic bone marrow transplant
        Judgment by the investigator that the patient should not participate in the study if the
        patient is unlikely to comply with study procedures, restrictions and requirements.
      
Maximum Eligible Age:130 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Number of participants with Adverse Events and/or Dose Limiting Toxicities as a Measure of Safety and Tolerability of AZD9291 when given in combination with AZD6094 or selumetinib
Time Frame:Adverse events will be collected from baseline until 28 days after the last dose in the AZD6094 or selumetinib arms.
Safety Issue:
Description:Part A: To investigate the safety and tolerability of AZD9291 when given in combination with AZD6094 or selumetinib who have progressed following prior therapy with an EGFR TKI agent, and define the combination dose(s) for further clinical evaluation.

Secondary Outcome Measures

Measure:Cmax after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Tmax after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:AUC after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:AUC0-t after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:AUC0-24 after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Terminal half life after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:CL/f after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Volume of distribution after single dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Cssmax after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 2 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Tssmax after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 2 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Cssmin after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times for the duration of treatment.
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:AUCss after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 2 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:CLss/f after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 2 day 1 up to 24 hours
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Rac after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 and cycle 2 day 1
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Time dependency of PK after multiple dosing
Time Frame:Blood samples will be collected from each subject at pre-specified times on cycle 1 day 1 and cycle 2 day 1
Safety Issue:
Description:To characterise the pharmacokinetics of AZD9291, AZD6094 or selumetinib and metabolites after single dosing and at steady state after multiple dosing when AZD9291 is given orally in combination with AZD6094 or selumetinib (or, in case of Part C monotherapy for Japanese subjects, when AZD6094 is given alone) to patients with EGFRm+ NSCLC through plasma concentrations.
Measure:Objective response rate
Time Frame:At baseline and every 6 weeks until disease progression or withdrawal from study.
Safety Issue:
Description:To obtain a preliminary assessment of the anti-tumour activity of the combination of AZD9291 and AZD6094 or selumetinib by evaluation of tumour response (objective response rate, duration of response, change in tumour size) and progression free survival using RECIST version 1.1.
Measure:Disease control rate
Time Frame:At baseline and every 6 weeks until disease progression or withdrawal from study.
Safety Issue:
Description:To obtain a preliminary assessment of the anti-tumour activity of the combination of AZD9291 and AZD6094 or selumetinib by evaluation of tumour response (objective response rate, duration of response, change in tumour size) and progression free survival using RECIST version 1.1
Measure:Duration of response
Time Frame:At baseline and every 6 weeks until disease progression or withdrawal from study.
Safety Issue:
Description:To obtain a preliminary assessment of the anti-tumour activity of the combination of AZD9291 and AZD6094 or selumetinib by evaluation of tumour response (objective response rate, duration of response, change in tumour size) and progression free survival using RECIST version 1.1
Measure:Percentage change in tumour size
Time Frame:At baseline and every 6 weeks until disease progression or withdrawal from study.
Safety Issue:
Description:To obtain a preliminary assessment of the anti-tumour activity of the combination of AZD9291 and AZD6094 or selumetinib by evaluation of tumour response (objective response rate, duration of response, change in tumour size) and progression free survival using RECIST version 1.1
Measure:Progression free survival
Time Frame:At baseline and every 6 weeks until disease progression or withdrawal from study.
Safety Issue:
Description:To obtain a preliminary assessment of the anti-tumour activity of the combination of AZD9291 and AZD6094 or selumetinib by evaluation of tumour response (objective response rate, duration of response, change in tumour size) and progression free survival using RECIST version 1.1 Expansion phase only
Measure:Overall survival
Time Frame:Confirmed during the FUP period and at least every 12 weeks until the data cut-off for the primary analysis and determination that no further OS collection is needed, approximately 5 years, death, or full withdrawal of consent, whichever comes first.
Safety Issue:
Description:To obtain a preliminary assessment of overall survival in the AZD9291+AZD6094 combination arms of the study for Parts B and D.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:AstraZeneca

Trial Keywords

  • Phase I
  • Safety
  • Tolerability
  • Efficacy
  • Anti-tumour
  • AZD9291
  • AZD6094
  • MEDI4736
  • Osimertinib
  • Savolitinib
  • Selumetinib
  • Durvalumab
  • Ascending Doses
  • Expansion cohorts
  • EGFR
  • Advanced Non-Small Cell Lung Cancer
  • Tyrosine Kinase Inhibitors

Last Updated

July 15, 2021