This is a multicentre randomised double-blind phase II trial, sponsored by Gustave Roussy and
involving one French center as well as the Spanish Lung Cancer Group (≈20 centers of the
SLCG).
Six hundred patients with diagnosis of stage IIIB/IV NSCLC will initially be registered prior
to receiving the first line platinum-based chemotherapy or during or at the end of the first
6 cycles of inducation platinium based chemotherapy and provide consent for retrieving
archival tissue collection and providing translational blood samples and tumor biopsies.
1. - Induction chemotherapy phase All patients will initially be treated with 6 cycles of
platinum-based induction chemotherapy. Cycle duration will be 21 days. Doublets should
either consist of a pemetrexed-platinum (cisplatin or carboplatin) doublet
(preferentially for non-squamous NSCLC) or a gemcitabine - or vinorelbine - platinum
doublet for squamous NSCLC. Taxanes-platinum doublets will not be accepted.
Translational blood samples will be taken at the beginning of induction chemotherapy for
all patients.
Patients displaying progressive disease or stable disease after induction chemotherapy
will be withdrawn and further optimally managed according to local practice. For them,
an optional tumour biopsy will be performed at the end of the induction treatment.
2. - Randomisation and maintenance phase Only patients who respond to platinum-based
induction chemotherapy will be further randomised between olaparib and placebo. These
patients must have been treated with 6 cycles of chemotherapy. However, patients who
haven't received 6 cycles of the induction chemotherapy due to severe toxicity (grade 3
or 4, NCI CTCAE v4.0) could be randomized only if they had received 4 chemotherapy
cycles at least and if all treatment related toxicities are resolved to a grade ≤ 1 (NCI
CTCAE v4.0).
Treatment will be administered at a dose of 600 mg daily (2 doses of 300 mg [2 tablets of 150
mg] taken approximately 12 hours apart) and cycle duration will be 28 days. Disease will be
assessed every 2 cycles by CTscan (MRI or PET-scan if the scan is not contributive) and
treatment will be administered until disease progression or unacceptable toxicity. Patients
will then be optimally managed according to local practice. Follow-up will be for a minimum
of 15 months from the time of randomization, and until last venue. All randomised patients
will be asked to provide translational blood samples at randomization, on treatment and at
the end of the treatment. Optional tumour biopsies will be performed at randomization, at the
end of the treatment (or at disease progression if available).
For inclusion in the study subjects should fulfill the following criteria:
1. Provision of written informed consent to treatment and companion translational studies
prior to any study specific procedures
2. Patients must be > 18 years of age.
3. Affiliation to an health insurance
4. Histological diagnosis of NSCLC
5. Advanced or metastatic disease (stage IIIB/IV)
6. Access to the original tumor biopsy or planning of a fresh tumor biopsy before start
the platinium based chemotherapy
7. Chemonaive for NSCLC or patient having received adjuvant chemotherapy at least 2 years
before trial enrolment or patient currently receiving his/her first platinum-based
chemotherapy for advanced NSCLC (first line or second line only if the first line was
an anti-PD-1 or anti-PD-L1 agent monotherapy)
8. No other cancer in the previous 3 years, except cervical cancer or cutaneous cancer
9. Absence of EGFR-sensitising mutation or ALK translocation
10. ECOG Performance Status of 0-1
11. Fit to receive 6 cycles or currently receiving of platinum-based induction
chemotherapy
12. At the start of the platinium based induction chemotherapy measurable lesions by
RECIST v1.1 criteria, i.e. at least one lesion, not previously irradiated, that can be
accurately measured at baseline as ≥ 10mm in the longest diameter (except lymph nodes
that must have short axis ≥ 15mm) with computed tomography (CT), magnetic resonance
imaging (MRI) or clinical examination and which is suitable for accurate repeated
measurements.
Inclusion criteria 13 is only for patients registered before starting the
platinum-based induction chemotherapy:
13. Patients must have normal organ and bone marrow function measured within 14 days prior
to administration of the platinum based treatment
- Haemoglobin ≥ 10.0 g/dL
- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
- Platelet count ≥ 100 x 109/L
- Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN)
- AST (SGOT)/ALT (SGPT) ≤ 2.5 x institutional upper limit of normal unless liver
metastases are present in which case it must be ≤ 5x ULN
- Creatinine clearance > 60mL/min as calculated by Cockroft-Gault formula for
cisplatin administration; creatinine clearance >/= 51mL/min by Cockroft-Gault
formula for carboplatin administration
14. Evidence of non-childbearing status for women of childbearing potential: negative
serum pregnancy test within 14 days of study treatment.
Postmenopausal is defined as:
- Amenorrheic for 1 year or more following cessation of exogenous hormonal
treatments,
- LH and FSH levels in the post-menopausal range for women under 50,
- Radiation-induced oophorectomy with last menses >1 year ago,
- Chemotherapy-induced menopause with >1 year interval since last menses,
- Or surgical sterilisation (bilateral oophorectomy or hysterectomy).
15. Both men and women (of childbearing potential) who are sexually active should accept
to use adequate contraception, during and for at least 6 months post-treatment
16. Patient is willing and able to comply with the protocol for the duration of the study
including undergoing treatment and scheduled visits and examinations including follow
up.
17. Previous surgery (in the adjuvant setting) for NSCLC, radiotherapy (with a curative
intent for local or locally-advanced disease) or immunotherapy by anti- PD-1 or
anti-PD-L1 agent in the metastatic setting are allowed
Non-inclusion criteria:
1. Uncontrolled or symptomatic brain metastases. Controlled brain metastases are defined
as stable for 1 month. A scan to confirm the absence of brain metastases is not
required. Corticosteroids therapy will be allowed if administered at a stable dose for
at least one month before entering the trial.
2. Previous enrolment (or randomisation) in the present study Any previous systemic
treatment for cancer in the previous 3 years.
3. Any previous systemic treatment for cancer in the previous 3 years except for NSCLC.
4. Patients receiving any radiotherapy or considering to require radiotherapy to the lung
at the time of study entry or in the near future, except for palliative reasons. The
patient can receive a stable dose of bisphosphonates for bone metastases, before and
during the study as long as these were started at least 4 weeks prior to inclusion.
5. Patients receiving the following classes of inhibitors of CYP3A4 (see Section 6.5 for
guidelines and wash out periods).
- Azole antifungals
- Macrolide antibiotics
- Protease inhibitors
6. Major surgery within 14 days before to start the induction chemotherapy and patients
who have not recovered from any effects of any major surgery.
7. Patients considered a poor medical risk due to a serious, uncontrolled medical
disorder, non-malignant systemic disease or active, uncontrolled infection. Examples
include, but are not limited to, uncontrolled ventricular arrhythmia, coronary artery
disease, cardiomyopathy, uncontrolled hypertension, myocardial infarction in the last
3 months, unstable spinal cord compression (untreated and unstable for at least 28
days prior to start the induction chemotherapy), superior vena cava syndrome,
extensive bilateral lung disease on HRCT scan or any psychiatric disorder that
prohibits obtaining informed consent.
8. Pregnant and/or breast-feeding women.
9. Patients who are known to be serologically positive for human immunodeficiency virus
(HIV) and/or are receiving antiviral therapy. Systematic serologies to confirm the
absence of this disease are not required.
10. Patients with known active hepatic disease (i.e., Hepatitis B or C) Systematic
serologies to confirm the absence of these diseases are not required.
11. Patients with a known hypersensitivity to olaparib/placebo, cisplatin, carboplatin, or
other platinum containing compounds, or any of the excipients of the product.
12. Concomitant yellow fever vaccine
13. Patients unable to swallow orally administered medication and patients with
gastrointestinal disorders likely to interfere with absorption of olaparib/placebo.
14. Symptomatic peripheral neuropathy ≥ grade 2
15. Patients with uncontrolled seizures
16. Patients with myelodysplastic syndrome/acute myeloid leukaemia.
17. Enrolment in another clinical trial (except observational study).
