Clinical Trials /

Lung-MAP: Biomarker-Targeted Second-Line Therapy in Treating Patients With Recurrent Stage IV Squamous Cell Lung Cancer

NCT02154490

Description:

This screening and multi-sub-study randomized phase II/III trial will establish a method for genomic screening of similar large cancer populations followed by assigning and accruing simultaneously to a multi-sub-study hybrid ?Master Protocol? (S1400). The type of cancer trait (biomarker) will determine to which sub-study, within this protocol, a participant will be assigned to compare new targeted cancer therapy, designed to block the growth and spread of cancer, or combinations to standard of care therapy with the ultimate goal of being able to approve new targeted therapies in this setting. In addition, the protocol includes a ?non-match? sub-study which will include all screened patients not eligible for any of the biomarker-driven sub-studies. This sub-study will compare a non-match therapy to standard of care also with the goal of approval.

Related Conditions:
  • Squamous Cell Lung Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2/Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Lung-MAP: Biomarker-Targeted Second-Line Therapy in Treating Patients With Recurrent Stage IV Squamous Cell Lung Cancer
  • Official Title: A Biomarker-Driven Master Protocol for Previously Treated Squamous Cell Lung Cancer (Lung-Map)

Clinical Trial IDs

  • ORG STUDY ID: S1400
  • SECONDARY ID: NCI-2014-00627
  • SECONDARY ID: S1400A
  • SECONDARY ID: S1400E
  • SECONDARY ID: S1400I
  • SECONDARY ID: S1400C
  • SECONDARY ID: S1400
  • SECONDARY ID: S1400D
  • SECONDARY ID: S1400B
  • SECONDARY ID: S1400
  • SECONDARY ID: S1400
  • SECONDARY ID: U10CA180888
  • NCT ID: NCT02154490

Conditions

  • Recurrent Squamous Cell Lung Carcinoma
  • Stage IV Squamous Cell Lung Carcinoma AJCC v7

Interventions

DrugSynonymsArms
DocetaxelDocecad, RP56976, Taxotere, Taxotere Injection ConcentrateS1400A Arm II (CLOSED TO ACCRUAL 4/2015)
DurvalumabImfinzi, Immunoglobulin G1, Anti-(Human Protein B7-H1) (Human Monoclonal MEDI4736 Heavy Chain), Disulfide with Human Monoclonal MEDI4736 Kappa-chain, Dimer, MEDI-4736, MEDI4736S1400A Arm I (MEDI4736) (CLOSED TO ACCRUAL 12/2015)
Erlotinib HydrochlorideCp-358,774, OSI-774, TarcevaS1400E Arm I (CLOSED TO ACCRUAL 11/2014)
FGFR Inhibitor AZD4547AZD4547S1400D Arm I (AZD4547) (CLOSED TO ACCRUAL 04/12/2017)
IpilimumabAnti-Cytotoxic T-Lymphocyte-Associated Antigen-4 Monoclonal Antibody, BMS-734016, MDX-010, MDX-CTLA4, YervoyS1400I Arm I (nivolumab, ipilimumab)
NivolumabBMS-936558, MDX-1106, NIVO, ONO-4538, OpdivoS1400I Arm I (nivolumab, ipilimumab)
PalbociclibIbrance, PD-0332991, PD-332991S1400C Arm I (palbociclib)
RilotumumabAMG 102, Anti-HGF Monoclonal Antibody AMG 102, Fully Human Anti-HGF Monoclonal Antibody AMG 102S1400E Arm I (CLOSED TO ACCRUAL 11/2014)
TalazoparibBMN 673, BMN-673S1400G (talazoparib)
TaselisibGDC-0032S1400B Arm I (taselisib) (CLOSED TO ACCRUAL 12/12/2016)
TremelimumabAnti-CTLA4 Human Monoclonal Antibody CP-675,206, CP-675, CP-675,206, CP-675206, ticilimumabS1400F (durvalumab, tremelimumab)

Purpose

This screening and multi-sub-study randomized phase II/III trial will establish a method for genomic screening of similar large cancer populations followed by assigning and accruing simultaneously to a multi-sub-study hybrid ?Master Protocol? (S1400). The type of cancer trait (biomarker) will determine to which sub-study, within this protocol, a participant will be assigned to compare new targeted cancer therapy, designed to block the growth and spread of cancer, or combinations to standard of care therapy with the ultimate goal of being able to approve new targeted therapies in this setting. In addition, the protocol includes a ?non-match? sub-study which will include all screened patients not eligible for any of the biomarker-driven sub-studies. This sub-study will compare a non-match therapy to standard of care also with the goal of approval.

Detailed Description

      PRIMARY OBJECTIVES:

      Screening component:

      I. To establish a National Clinical Trials Network (NCTN) mechanism for genomically screening
      large but homogeneous cancer populations and subsequently assigning and accruing
      simultaneously to a multi-sub-study ?Master Protocol.? II. To evaluate the screen success
      rate defined as the percentage of screened patients that register for a therapeutic
      sub-study.

      Sub-study-specific Objectives:

      Design #1: Phase II/III Design:

      III. To evaluate if there is sufficient evidence to continue to the Phase III component of
      the sub-study by comparing investigator-assessed progression-free survival (IA-PFS) between
      investigational therapy versus standard therapy (SoC) in patients with advanced stage
      refractory squamous cell carcinoma (SCCA) of the lung. (Phase II) IV. To determine if there
      is both a statistically and clinically-meaningful difference in IA-PFS among advanced stage
      refractory SCCA of the lung randomized to receive investigational therapy versus SoC. (Phase
      III) V. To compare overall survival (OS) in patients with advanced stage refractory SCCA of
      the lung randomized to investigational therapy versus SoC. (Phase III)

      Design #2: Phase II followed by Phase III (Sequential Phase II to Phase III):

      VI. To evaluate the objective response rate (confirmed and unconfirmed, complete and
      partial). (Phase II) VII. To determine if there is both a statistically and
      clinically-meaningful difference in IA-PFS among advanced stage refractory SCCA of the lung
      randomized to receive investigational therapy versus SoC. (Phase III) VIII. To compare
      overall survival (OS) in patients with advanced stage refractory SCCA of the lung randomized
      to investigational therapy versus SoC. (Phase III)

      SECONDARY OBJECTIVES:

      Sub-study-specific Objectives:

      Design #1: Phase II/III Design:

      I. To compare response rates (confirmed and unconfirmed, complete and partial responses)
      among patients randomized to receive investigational therapy versus SoC. (Phase II) II. To
      evaluate the frequency and severity of toxicities associated with investigational therapy
      versus SoC. (Phase II) III. To evaluate the duration of response (DoR) among patients who
      achieve a complete response (CR) or a partial response (PR) by Response Evaluation Criteria
      in Solid Tumors (RECIST) (1.1). (Phase II) III. To compare the response rates (confirmed and
      unconfirmed, complete and partial) among patients randomized to receive investigational
      therapy versus SoC. (Phase III) IV. To evaluate the frequency and severity of toxicities
      associated with investigational therapy versus SoC. (Phase III)

      Design #2: Phase II followed by Phase III (Sequential Phase II to Phase III):

      V. To evaluate PFS and OS with investigational therapy. (Phase II) VI. To evaluate the DoR
      among patients who achieve a CR or PR (confirmed and unconfirmed) by RECIST 1.1. (Phase II)
      VII. To evaluate the frequency and severity of toxicities associated with investigational
      therapy. (Phase II) VIII. To compare the response rates (confirmed and unconfirmed, complete
      and partial) among patients randomized to receive investigational therapy versus SoC. (Phase
      III) IX. To evaluate the frequency and severity of toxicities associated with investigational
      therapy versus SoC. (Phase III)

      TERTIARY OBJECTIVES:

      I. To evaluate the treatment arm randomization acceptance rate (TARAR) within each treatment
      arm of each sub-study defined as the percentage of patients randomized to a treatment arm
      that receive any protocol treatment. (Design #1: Phase II/III Design) II. To identify
      additional predictive tumor/blood biomarkers that may modify response or define resistance to
      the targeted therapy (TT)/targeted therapy combination (TTC) beyond the chosen biomarker for
      biomarker-driven sub-studies.

      III. To evaluate potentially predictive biomarkers for non-match therapy (NMT) in the
      non-match studies.

      IV. To identify potential resistance biomarkers at disease progression. V. To establish a
      tissue/ blood repository from patients with refractory SCCA of the lung.

      OUTLINE: Patients are assigned to a biomarker-driven targeted therapy phase II study. If the
      objectives response rate observed is judged sufficient, patients proceed to a randomized
      phase III trial and are randomized to biomarker-driven targeted therapy or standard of care.

      S1400A: (CLOSED TO ACCRUAL 12/18/2015) Patients with tumors that do not match one of the
      currently active drug-biomarker combinations or did not meet the eligibility requirements for
      that bio-marker driven sub-study are assigned to Arm I. Upon evidence of progression
      following discontinuation of 12 months of treatment, patients may restart treatment for up to
      12 months with the same treatment guidelines followed during the initial 12-month treatment
      period (Arm III).

      ARM I: (CLOSED TO ACCRUAL 12/18/2015) Patients receive anti-B7H1 monoclonal antibody MEDI4736
      intravenously (IV) over 60 minutes on day 1. Treatment repeats every 14 days for 12 months in
      the absence of disease progression or unacceptable toxicity.

      ARM II (CLOSED TO ACCRUAL 4/2015): Patients receive docetaxel IV on day 1. Courses repeat
      every 21 days in the absence of disease progression or unacceptable toxicity. (closed to
      accrual with Revision #2 4/22/15)

      ARM III: For patients assigned to Arm 1, MEDI4736: Upon evidence of progression following
      discontinuation of 12 months of treatment, patients may restart treatment with Arm 3,
      MEDI4736 for up to 12 months with the same treatment guidelines followed during the initial
      12-month treatment period. Patients will only be able to restart treatment once; thus a
      maximum of two 12-month periods will be allowed. Patients receive anti-B7H1 monoclonal
      antibody MEDI4736 intravenously (IV) over 60 minutes on day 1. Treatment repeats every 14
      days for 12 months in the absence of disease progression or unacceptable toxicity.

      S1400B (CLOSED TO ACCRUAL 12/12/2016): Patients with tumors positive for phosphoinositide
      3-kinase (PI3KCA) are assigned to Arm I. Patients currently on Arm 2, docetaxel will be given
      the option to re-register to Arm 3, GCD-0032 after disease progression on current treatment
      (Arm III).

      ARM I: Patients receive taselisib orally (PO) daily on days 1-21. Courses repeat every 21
      days in the absence of disease progression or unacceptable toxicity.

      ARM II (CLOSED TO ACCRUAL 12/18/2015): Patients receive docetaxel IV on day 1. Courses repeat
      every 21 days in the absence of disease progression or unacceptable toxicity. (closed to
      accrual with Revision #3 12/18/2015)

      ARM III: Re-Registration Treatment with GDC-0032 (Taselisib) Upon progression patients in Arm
      2 may be eligible for Re-Registration to receive GDC-0032. Patients receive taselisib orally
      (PO) daily on days 1-21. Courses repeat every 21 days in the absence of disease progression
      or unacceptable toxicity.

      S1400C (CLOSED TO ACCRUAL 09/01/2016): Patients with tumors positive for cyclin dependent
      kinase 4 (CDK4), cyclin D1 (CCND1), cyclin D2 (CCND2), and cyclin D3 (CCND3) are assigned to
      Arm I. Patients currently on Arm 2, docetaxel will be given the option to re-register to Arm
      3, palbociclib, after disease progression on current treatment (Arm III).

      ARM I: Patients receive palbociclib PO on days 1-21. Courses repeat every 28 days in the
      absence of disease progression or unacceptable toxicity.

      ARM II (CLOSED TO ACCRUAL 12/18/2015): Patients receive docetaxel IV on day 1. Courses repeat
      every 21 days in the absence of disease progression or unacceptable toxicity. (closed to
      accrual with Revision #3 12/18/2015)

      ARM III: Re-Registration Treatment with Palbociclib. Upon progression patients in Arm 2 may
      be eligible for Re-Registration to receive palbociclib. Patients receive palbociclib PO on
      days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable
      toxicity.

      S1400D (CLOSED TO ACCRUAL 10/31/2016): Patients with tumors positive for fibroblast growth
      factor receptor (FGFR) 1, FGFR2, and FGFR3 are assigned to Arm I. Patients currently on Arm
      2, docetaxel will be given the option to re-register to Arm 3, AZD4547, after disease
      progression on current treatment (Arm III).

      ARM I: Patients receive FGFR inhibitor AZD4547 PO BID on days 1-21. Courses repeat every 21
      days in the absence of disease progression or unacceptable toxicity.

      ARM II (CLOSED TO ACCRUAL 12/18/2015): Patients receive docetaxel IV on day 1. Courses repeat
      every 21 days in the absence of disease progression or unacceptable toxicity. (closed to
      accrual with Revision #3 12/18/2015)

      ARM III: Re-Registration Treatment with AZD4547. Upon progression patients in Arm 2 may be
      eligible for Re-Registration to receive AZD4547. Patients receive FGFR inhibitor AZD4547 PO
      BID on days 1-21. Courses repeat every 21 days in the absence of disease progression or
      unacceptable toxicity.

      S1400E (CLOSED TO ACCRUAL 11/25/2014): Patients with tumors positive for met proto-oncogene
      (MET) are randomized to 1 of 2 treatment arms. (permanently closed to accrual on 11/25/14)

      ARM I: Patients receive rilotumumab IV on day 1 and erlotinib hydrochloride PO daily on days
      1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable
      toxicity.

      ARM II: Patients receive erlotinib hydrochloride PO daily on days 1-21. Courses repeat every
      21 days in the absence of disease progression or unacceptable toxicity.

      S1400F: Patients with disease progression during or after prior anti-PD-1 or anti-PD-L1
      antibody monotherapy as their most recent line of treatment receive durvalumab (IV over 60
      minutes) and tremelimumab (IV over 60 minutes) on day 1 for courses 1-4 and durvalumab IV
      alone on day 1 of course 5 and subsequent courses until disease progression or unacceptable
      toxicity. Courses repeat every 28 days.

      S1400G: Patients with tumors positive for homologous recombination repair deficiency receive
      talazoparib PO daily on days 1-21. Courses repeat every 21 days in the absence of disease
      progression or unacceptable toxicity.

      S1400I: Patients with tumors that do not match one of the currently active drug-biomarker
      combinations or did not meet the eligibility requirements for that bio-marker driven
      sub-study are randomized to 1 of 2 treatment arms.

      ARM I: Patients receive nivolumab IV over 30 minutes on day 1 and ipilimumab IV over 60
      minutes on day 1 of every third course. Courses repeat every 14 days in the absence of
      disease progression or unacceptable toxicity.

      ARM II: Patients receive nivolumab IV over 30 minutes on day 1. Courses repeat every 14 days
      in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, all patients are followed up periodically for up to 3
      years from date of screening registration.
    

Trial Arms

NameTypeDescriptionInterventions
S1400A Arm I (MEDI4736) (CLOSED TO ACCRUAL 12/2015)ExperimentalPatients with tumors that do not match one of the currently active drug-biomarker combinations randomized to Arm I receive anti-B7H1 monoclonal antibody MEDI4736 IV over 60 minutes on day 1. Treatment repeats every 14 days for 12 months in the absence of disease progression or unacceptable toxicity.
    S1400A Arm II (CLOSED TO ACCRUAL 4/2015)Active ComparatorPatients with tumors that do not match one of the currently active drug-biomarker combinations randomized to Arm II receive docetaxel IV on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. (closed to accrual with Revision #2 4/22/15)
    • Docetaxel
    S1400A Arm III (MEDI4736)ExperimentalFor patients assigned to Arm 1, MEDI4736: Upon evidence of progression following discontinuation of 12 months of treatment, patients may restart treatment with Arm 3, MEDI4736 for up to 12 months with the same treatment guidelines followed during the initial 12-month treatment period. Patients will only be able to restart treatment once; thus a maximum of two 12- month periods will be allowed. Patients registered to Arm III receive durvalumab IV over 60 minutes on day 1. Treatment repeats every 14 days for 12 months in the absence of disease progression or unacceptable toxicity.
      S1400B Arm I (taselisib) (CLOSED TO ACCRUAL 12/12/2016)ExperimentalPatients with tumors positive for PI3KCA randomized to Arm I receive taselisib PO daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
      • Taselisib
      S1400B Arm II (CLOSED TO ACCRUAL 12/18/2015)Active ComparatorPatients with tumors positive for PI3KCA randomized to Arm II receive docetaxel IV on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. (closed to accrual with Revision #3 12/18/2015)
      • Docetaxel
      S1400B Arm III (taselisib) (CLOSED TO ACCRUAL 12/12/2016)ExperimentalRe-Registration Treatment with GDC-0032 (Taselisib). Upon progression patients in Arm 2 may be eligible for Re-Registration to receive GDC-0032. Patients will receive taselisib PO daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
      • Taselisib
      S1400C Arm I (palbociclib)ExperimentalPatients with tumors positive for CDK4/6, CCND1, CCND2, and CCND3 randomized to Arm I receive palbociclib PO on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
      • Palbociclib
      S1400C Arm II (CLOSED TO ACCRUAL 12/18/2015)Active ComparatorPatients with tumors positive for CDK4, CCND1, CCND2, and CCND3 randomized to Arm II receive docetaxel IV on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. (closed to accrual with Revision #3 12/18/2015)
      • Docetaxel
      S1400C Arm III (palbociclib)ExperimentalRe-Registration Treatment with palbociclib. Upon progression patients in Arm 2 may be eligible for Re-Registration to receive palbociclib. Patients will receive palbociclib PO on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
      • Palbociclib
      S1400D Arm I (AZD4547) (CLOSED TO ACCRUAL 04/12/2017)ExperimentalPatients with tumors positive for FGFR1, FGFR2, and FGFR3 randomized to Arm I receive FGFR inhibitor AZD4547 PO BID on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
      • FGFR Inhibitor AZD4547
      S1400D Arm II (CLOSED TO ACCRUAL 10/31/2016)Active ComparatorPatients with tumors positive for FGFR1, FGFR2, and FGFR3 randomized to Arm II receive docetaxel IV on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. (closed to accrual with Revision #3 12/18/2015)
      • Docetaxel
      S1400D Arm III (AZD4547) (CLOSED TO ACCRUAL 10/31/2016)ExperimentalRe-Registration Treatment with AZD4547. Upon progression patients in Arm 2 may be eligible for Re-Registration to receive AZD4547. Patients will receive FGFR inhibitor AZD4547 PO BID on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
      • FGFR Inhibitor AZD4547
      S1400E Arm I (CLOSED TO ACCRUAL 11/2014)ExperimentalPatients with tumors positive for HGF/c-MET randomized to Arm I receive rilotumumab IV on day 1 and erlotinib hydrochloride PO daily. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. (permanently closed to accrual on 11/25/14)
      • Erlotinib Hydrochloride
      S1400E Arm II (CLOSED TO ACCRUAL 11/2014)Active ComparatorPatients with tumors positive for HGF/c-MET randomized to Arm II receive erlotinib hydrochloride PO daily. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. (permanently closed to accrual on 11/25/14)
      • Erlotinib Hydrochloride
      S1400F (durvalumab, tremelimumab)ExperimentalPatients with disease progression during or after prior anti-PD-1 or anti-PD-L1 antibody monotherapy as their most recent line of treatment receive durvalumab (IV over 60 minutes) and tremelimumab (IV over 60 minutes) on day 1 for courses 1-4 and durvalumab IV alone on day 1 of course 5 and subsequent courses until disease progression or unacceptable toxicity. Courses repeat every 28 days.
        S1400G (talazoparib)ExperimentalPatients with tumors positive for homologous recombination repair deficiency receive talazoparib PO daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
        • Talazoparib
        S1400I Arm I (nivolumab, ipilimumab)ExperimentalPatients with tumors that do not match one of the currently active drug-biomarker combinations or did not meet the eligibility requirements for that bio-marker driven sub-study randomized to Arm I receive nivolumab IV over 30 minutes on day 1 and ipilimumab IV over 60 minutes on day 1 of every third cycle. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.
          S1400I Arm II (nivolumab)Active ComparatorPatients with tumors that do not match one of the currently active drug-biomarker combinations or did not meet the eligibility requirements for that bio-marker driven sub-study randomized to Arm II receive nivolumab IV over 30 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.

            Eligibility Criteria

                    Inclusion Criteria:
            
                      -  SCREENING/PRE-SCREENING REGISTRATION:
            
                      -  Patients must have pathologically proven squamous cell carcinoma (SCCA) cancer of the
                         lung confirmed by tumor biopsy and/or fine-needle aspiration; disease must be stage IV
                         SCCA, or recurrent; the primary diagnosis of SCCA should be established using the
                         current World Health Organization (WHO)/International Association for the Study of
                         Lung Cancer (IASLC)-classification of Thoracic Malignancies; the diagnosis is based on
                         hematoxylin and eosin (H&E) stained slides with or without specific defined
                         immunohistochemistry (IHC) characteristic (p40/p63 positive, transcription termination
                         factor [TTF1] negative) if required for diagnosis; mixed histologies are not allowed
            
                      -  Patients must either be eligible to be screened at progression on prior treatment or
                         to be pre-screened prior to progression on current treatment; patients will either
                         consent to the screening consent or the pre-screening consent, not both; these
                         criteria are:
            
                           -  Screening at progression on prior treatment: to be eligible for screening at
                              progression, patients must have received at least one line of systemic therapy
                              for any stage of disease (stages I-IV) and must have progressed during or
                              following their most recent line of therapy; for patients whose prior systemic
                              therapy was for stage I-III disease only (i.e. patient has not received any
                              treatment for stage IV or recurrent disease), the prior systemic therapy must
                              have been a platinum-based chemotherapy regimen and disease progression on the
                              platinum-based chemotherapy must have occurred within one year from the last date
                              that patient received that therapy; for patients whose prior therapy was for
                              stage IV or recurrent disease, the patient must have received at least one line
                              of a platinum-based chemotherapy regimen or checkpoint inhibitor therapy (e.g.
                              nivolumab or pembrolizumab)
            
                           -  Pre-screening prior to progression on current treatment: to be eligible for
                              pre-screening, current treatment must be for stage IV or recurrent disease and
                              patient must have received at least one dose of the current regimen; patients
                              must have previously received or currently be receiving a platinum-based
                              chemotherapy regimen or checkpoint inhibitor therapy (e.g. nivolumab or
                              pembrolizumab); patients on first-line platinum-based treatment are eligible upon
                              receiving cycle 1, day 1 infusion; Note: patients will not receive their
                              sub-study assignment until they progress and the S1400 Notice of Progression is
                              submitted
            
                      -  Patients must have adequate tumor tissue available, defined as >= 20% tumor cells and
                         >= 0.2 mm^3 tumor volume
            
                           -  The local interpreting pathologist must review the specimen
            
                           -  The pathologist must sign the S1400 Local Pathology Review Form confirming tissue
                              adequacy prior to screening/pre-screening registration
            
                           -  Patients must agree to have this tissue submitted to Foundation Medicine for
                              common broad platform Clinical Laboratory Improvement Act (CLIA) biomarker
                              profiling; if archival tumor material is exhausted, then a new fresh tumor biopsy
                              that is formalin-fixed and paraffin-embedded (FFPE) must be obtained; a tumor
                              block or FFPE slides 4-5 microns thick must be submitted; bone biopsies are not
                              allowed; if FFPE slides are to be submitted, at least 12 unstained slides plus an
                              H&E stained slide, or 13 unstained slides must be submitted; however it is
                              strongly recommended that 20 FFPE slides be submitted; Note: previous
                              next-generation deoxyribonucleic acid (DNA) sequencing (NGS) will be repeated if
                              done outside this study for sub-study assignment; patients must agree to have any
                              tissue that remains after NGS testing retained for the use of the translational
                              medicine (TM) studies (if such TM studies are defined) within any sub-study the
                              patient is enrolled in
            
                      -  Patients must not have a known epidermal growth factor receptor (EGFR) mutation or
                         anaplastic lymphoma kinase (ALK) fusion; EGFR/ALK testing is not required prior to
                         registration and is included in the Foundation Medicine Incorporated (FMI) testing for
                         screening/prescreening
            
                      -  Patients must have Zubrod performance status 0-1 documented within 28 days prior to
                         screening/pre-screening registration
            
                      -  Patients must also be offered participation in banking for future use of specimens
            
                      -  Patients must be willing to provide prior smoking history as required on the S1400
                         Onstudy Form
            
                      -  As a part of the Oncology Patient Enrollment Network (OPEN) registration process the
                         treating institution's identity is provided in order to ensure that the current
                         (within 365 days) date of institutional review board approval for this study has been
                         entered in the system
            
                      -  Patients must be informed of the investigational nature of this study and must sign
                         and give written informed consent in accordance with institutional and federal
                         guidelines
            
                      -  SUB-STUDY REGISTRATION:
            
                      -  Patients whose biomarker profiling results indicate the presence of an EGFR mutation
                         or echinoderm microtubule-associated protein-like 4 (EML4)/ALK fusion are not eligible
            
                      -  Patients must have progressed (in the opinion of the treating investigator) following
                         the most recent line of therapy
            
                      -  Patients must not have received any prior systemic therapy (systemic chemotherapy,
                         immunotherapy or investigational drug) within 21 days prior to sub-study registration;
                         patients must have recovered (=< grade 1) from any side effects of prior therapy;
                         patients must not have received any radiation therapy within 14 days prior to
                         sub-study registration
            
                      -  Patients must have measurable disease documented by computed tomography (CT) or
                         magnetic resonance imaging (MRI); the CT from a combined positron emission tomography
                         (PET)/CT may be used to document only non-measurable disease unless it is of
                         diagnostic quality; measurable disease must be assessed within 28 days prior to
                         sub-study registration; pleural effusions, ascites and laboratory parameters are not
                         acceptable as the only evidence of disease; non-measurable disease must be assessed
                         within 42 days prior to sub-study registration; all disease must be assessed and
                         documented on the Baseline Tumor Assessment Form; patients whose only measurable
                         disease is within a previous radiation therapy port must demonstrate clearly
                         progressive disease (in the opinion of the treating investigator) prior to
                         registration
            
                      -  Patients must have a CT or MRI scan of the brain to evaluate for central nervous
                         system (CNS) disease within 42 days prior to sub-study registration; patient must not
                         have leptomeningeal disease, spinal cord compression or brain metastases unless: (1)
                         metastases have been locally treated and have remained clinically controlled and
                         asymptomatic for at least 14 days following treatment and prior to registration, AND
                         (2) patient has no residual neurological dysfunction and has been off corticosteroids
                         for at least 24 hours prior to sub-study registration
            
                      -  Patient must have fully recovered from the effects of prior surgery at least 14 days
                         prior to sub-study registration
            
                      -  Patients must not be planning to receive any concurrent chemotherapy, immunotherapy,
                         biologic or hormonal therapy for cancer treatment; concurrent use of hormones for
                         non-cancer-related conditions (e.g., insulin for diabetes and hormone replacement
                         therapy) is acceptable
            
                      -  Absolute neutrophil count (ANC) >= 1,500/mcl obtained within 28 days prior to
                         sub-study registration
            
                      -  Platelet count >= 100,000 mcl obtained within 28 days prior to sub-study registration
            
                      -  Hemoglobin >= 9 g/dL obtained within 28 days prior to sub-study registration
            
                      -  Serum bilirubin =< institutional upper limit of normal (IULN) within 28 days prior to
                         sub-study registration; for patients with liver metastases, bilirubin must be =< 5 x
                         IULN
            
                      -  Either alanine aminotransferase (ALT) or aspartate aminotransferase (AST) =< 2 x IULN
                         within 28 days prior to sub-study registration (if both ALT and AST are done, both
                         must be =< 2 IULN); for patients with liver metastases, either ALT or AST must be =< 5
                         x IULN (if both ALT and AST are done, both must be =< 5 x IULN)
            
                      -  Serum creatinine =< the IULN OR measured or calculated creatinine clearance >= 50
                         mL/min using the following Cockcroft-Gault Formula within 28 days prior to sub-study
                         registration
            
                      -  Patients must have Zubrod performance status 0-1 documented within 28 days prior to
                         sub-study registration
            
                      -  Patients must not have any grade III/IV cardiac disease as defined by the New York
                         Heart Association Criteria (i.e., patients with cardiac disease resulting in marked
                         limitation of physical activity or resulting in inability to carry on any physical
                         activity without discomfort), unstable angina pectoris, and myocardial infarction
                         within 6 months, or serious uncontrolled cardiac arrhythmia
            
                      -  Patients must not have documented evidence of acute hepatitis or have an active or
                         uncontrolled infection
            
                      -  Patients with a known history of human immunodeficiency virus (HIV) seropositivity:
            
                           -  Must have undetectable viral load using standard HIV assays in clinical practice
            
                           -  Must have cluster of differentiation (CD)4 count >= 400/mcL
            
                           -  Must not require prophylaxis for any opportunistic infections (i.e., fungal,
                              Mycobacterium avium complex [mAC], or pneumocystis jiroveci pneumonia [PCP]
                              prophylaxis)
            
                           -  Must not be newly diagnosed within 12 months prior to sub-study registration
            
                      -  Prestudy history and physical exam must be obtained within 28 days prior to sub-study
                         registration
            
                      -  No other prior malignancy is allowed except for the following: adequately treated
                         basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated
                         stage I or II cancer from which the patient is currently in complete remission, or any
                         other cancer from which the patient has been disease free for five years
            
                      -  Patients must not be pregnant or nursing; women/men of reproductive potential must
                         have agreed to use an effective contraceptive method; a woman is considered to be of
                         "reproductive potential" if she has had menses at any time in the preceding 12
                         consecutive months; in addition to routine contraceptive methods, "effective
                         contraception" also includes heterosexual celibacy and surgery intended to prevent
                         pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy,
                         bilateral oophorectomy or bilateral tubal ligation; however, if at any point a
                         previously celibate patient chooses to become heterosexually active during the time
                         period for use of contraceptive measures outlined in the protocol, he/she is
                         responsible for beginning contraceptive measures
            
                      -  As part of the OPEN registration process the treating institution?s identity is
                         provided in order to ensure that the current (within 365 days) date of institutional
                         review board approval for this study has been entered into the system
            
                      -  Patients with impaired decision-making capacity are eligible as long as their
                         neurological or psychological condition does not preclude their safe participation in
                         the study (e.g., tracking pill consumption and reporting adverse events to the
                         investigator)
            
                      -  Patients must be informed of the investigational nature of this study and must sign
                         and give written informed consent in accordance with institutional and federal
                         guidelines.
                  
            Maximum Eligible Age:N/A
            Minimum Eligible Age:18 Years
            Eligible Gender:All
            Healthy Volunteers:No

            Primary Outcome Measures

            Measure:Investigator-assessed progression-free survival as defined by Response Evaluation Criteria in Solid Tumors 1.1 (Design #1, Phase II)
            Time Frame:From date of sub-study registration to date of first documentation of progression assessed by local review or symptomatic deterioration, or death due to any cause, assessed up to 18 months since completion of accrual
            Safety Issue:
            Description:A stratified (using randomization stratification factors) log-rank test will be used to test the primary hypotheses related to investigator-assessed progression-free survival, comparing the two treatment arms.

            Secondary Outcome Measures

            Measure:Duration of response among patients who achieve a complete response or partial response by Response Evaluation Criteria in Solid Tumors 1.1 (Design #2, Phase II, Option for Biomarker-driven Sub-studies and Design #2, Option for Non-Match Sub-studies)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:Estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to calculate confidence intervals for median duration of response.
            Measure:Frequency and severity of toxicities associated with investigational therapy versus standard therapy (Design #2, Phase III, Option for Biomarker-driven Sub-studies)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:Analysis of toxicities will be performed using a chi-square or Fisher?s exact test, as appropriate.
            Measure:Investigator-assessed progression-free survival, censoring patients with symptomatic deterioration at the time of symptomatic deterioration (Design #1, Phase III)
            Time Frame:From date of sub-study registration to date of first documentation of progression assessed by local review or symptomatic deterioration, or death due to any cause, assessed up to 3 years
            Safety Issue:
            Description:Descriptive data will be presented.
            Measure:Overall survival with investigational therapy (Design #2, Phase II, Option for Biomarker-driven Sub-studies and Design #2, Option for Non-Match Sub-studies)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:A stratified (using randomization stratification factors) log-rank test will be used to test the primary hypotheses related to overall survival comparing the two treatment arms at the levels specified. A Cox PH model will be used to estimate the hazard ratios and associated confidence intervals.
            Measure:Progression free survival with investigational therapy (Design #2, Phase II, Option for Biomarker-driven Sub-studies and Design #2, Option for Non-Match Sub-studies)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:A stratified (using randomization stratification factors) log-rank test will be used to test the primary hypotheses related to progression free survival comparing the two treatment arms at the levels specified. A Cox PH model will be used to estimate the hazard ratios and associated confidence intervals.
            Measure:Response rate (confirmed and unconfirmed) in patients with measurable disease as defined by Response Evaluation Criteria in Solid Tumors 1.1 (Design #1, Phase II and III)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:Analysis will be performed using a chi squared or Fisher?s exact test, as appropriate. Response proportions will be compared using a 1-sided Fisher?s exact test at the 0.001 level.
            Measure:Response rates (confirmed and unconfirmed, complete and partial) among patients randomized to receive investigational therapy versus standard therapy (Design #2, Phase III, Option for Biomarker-driven Sub-studies)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:Analysis of response rates will be performed using a chi-square or Fisher?s exact test, as appropriate.
            Measure:Severity of toxicities associated with investigational therapy versus standard therapy (Design #2, Phase II, Option for Biomarker-driven Sub-studies and Design #2, Option for Non-Match Sub-studies)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:Analysis of toxicities will be performed using a chi-square or Fisher?s exact test, as appropriate.
            Measure:Toxicity frequencies, monitored using National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (Design #1, Phase II and III)
            Time Frame:Up to 3 years
            Safety Issue:
            Description:Analysis will be performed using a chi squared or Fisher?s exact test, as appropriate.

            Details

            Phase:Phase 2/Phase 3
            Primary Purpose:Interventional
            Overall Status:Recruiting
            Lead Sponsor:Southwest Oncology Group

            Last Updated

            November 21, 2017