Description:
This is a multi-center open-label proof-of-concept study consisting of two parts: PART A - a
phase I dose-finding study (3 + 3 classical design) evaluating the RP2D of afatinib in
combination with selumetinib in KRASm NSCLC; and PART B - a randomized phase II study
investigating the progression free survival and safety of selumetinib/afatinib combination
therapy compared to standard of care chemotherapy in KRASm NSCLC.
Title
- Brief Title: Afatinib and Selumetinib in Advanced KRAS Mutant and PIK3CA Wildtype Non-small Cell Lung Cancer
- Official Title: Phase I/II Study With the Combination of Afatinib and Selumetinib in Advanced KRAS Mutant Positive and PIK3CA Wildtype Non-small Cell Lung Cancer
Clinical Trial IDs
- ORG STUDY ID:
M14AFS
- NCT ID:
NCT02450656
Conditions
- Colorectal Neoplasms
- Gastrointestinal Neoplasms
- Pancreatic Neoplasms
- Carcinoma, Non-Small-Cell Lung
Interventions
Drug | Synonyms | Arms |
---|
Afatinib | BIBW2992 | Afatinib plus selumetinib |
Selumetinib | AZD6244 | Afatinib plus selumetinib |
Docetaxel | | Control |
Purpose
This is a multi-center open-label proof-of-concept study consisting of two parts: PART A - a
phase I dose-finding study (3 + 3 classical design) evaluating the RP2D of afatinib in
combination with selumetinib in KRASm NSCLC; and PART B - a randomized phase II study
investigating the progression free survival and safety of selumetinib/afatinib combination
therapy compared to standard of care chemotherapy in KRASm NSCLC.
Trial Arms
Name | Type | Description | Interventions |
---|
Afatinib plus selumetinib | Experimental | Combination of afatinib and selumetinib at the optimal dose and regimen as determined in the phase I part of this study | |
Control | Active Comparator | Standard-of-care second line treatment for non small cell lung cancer (docetaxel) | |
Eligibility Criteria
Inclusion Criteria:
- Histological or cytological proof of advanced NSCLC; for PART B: treated with first
line therapy for metastatic disease only.
- Written documentation of a known pathogenic KRAS (exon 2, 3 or 4) mutation and PIK3CA
wildtype (defined as absence of mutations in exon 9 and 20)
- Able and willing to give written informed consent
- Able and willing to undergo blood sampling for PK and PD analysis
- Life expectancy >=3 months allowing adequate follow up of toxicity evaluation and
antitumor activity.
- WHO performance status of 0 or 1.
- Able and willing to undergo a tumor biopsies prior to start, after two weeks (part A
only) and upon progression of disease
- Measurable disease according to RECIST 1.1
- Adequate organ system function measured by laboratory values
Exclusion Criteria:
- Any treatment with investigational drugs within 30 days prior to receiving the first
dose of investigational treatment.
- History of another malignancy Exception PART A: Patients who have been disease-free
for at least 3 years, or patients with a history of completely resected non-melanoma
skin cancer and/or patients with indolent second malignancies are eligible. Exception
PART B: Adequately treated carcinoma in situ of the cervix and adequately treated
basal cell carcinoma of the skin. 3. Symptomatic or untreated leptomeningeal disease.
- Symptomatic brain metastasis.
- Patients previously treated with any drug combination known to interfere with EGFR,
HER2, HER3, HER4 or MAPK- and PI3K-pathway components, including inhibitors of PTEN,
PI3K, AKT, mTOR, BRAF, MEK and ERK.
- History of interstitial lung disease or pneumonitis
- Radio-, immuno- or chemotherapy within the last 2 weeks prior to receiving the first
dose of investigational treatment. Palliative radiation (1x 8Gy) is allowed.
- Opthalmological diseases
- Patients with left ventricular ejection fraction (LVEF) < 55%
- Patients with cardiac comorbidities
- Concomitant or recent use (in the past 14 days) of strong inhibitors and inducers of
CYP1A2, CYP2C19, CYP3A4, 3A5 and P-glycoprotein (P-gp)
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose Limiting Toxicities (Phase I) |
Time Frame: | Cycle 1 (4 weeks) |
Safety Issue: | |
Description: | Incidence of DLTs in the first treatment cycle |
Secondary Outcome Measures
Measure: | Tolerability (Incidence and severity of adverse events per CTCAE v4.03) |
Time Frame: | Up to 28 days after last study drug intake |
Safety Issue: | |
Description: | Incidence and severity of adverse events per CTCAE v4.03 |
Measure: | Plasma concentrations of afatanib and selumetinib |
Time Frame: | On day 1, 2, 4, 8, 15, 22 in cycle 1, on day 1 and 2 in cycle 2 and subsequently at every treatment cycle pre-dose |
Safety Issue: | |
Description: | Plasma concentrations of afatanib and selumetinib will be measured at day 1,2,4,8,15, 22 in cycle 1, on day 1 and 2 in cycle 2 and subsequently before every treatment cycle to determine pharmacokinetics of both substances in combination and interindividual differences after a single dose and after multiple doses. |
Measure: | Efficacy (Phase II) (Overall response rate (ORR), duration of response (DOR) , time to response (TTR) and overall survival (OS) per RECIST v1.1) |
Time Frame: | Assessed by CT scans every 6 weeks and by monthly phone call until all patients have been followed up for at least 18 months or have been lost to follow up, whichever occurs first. |
Safety Issue: | |
Description: | Overall response rate (ORR), duration of response (DOR) , time to response (TTR) and overall survival (OS) per RECIST v1.1 |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Unknown status |
Lead Sponsor: | The Netherlands Cancer Institute |
Last Updated
August 27, 2018