Description:
The third generation epidermal growth gactor receptor-tyrosine Kinase Inhibitor(EGFR-TKI)
osimertinib has obvious curative effect for EGFR sensitive mutation and T790M mutation(PMID
27959700), but acquired drug resistance will occur. Previous studies show that apoptosis
escape can lead to EGFR-TKI resistance.Osimertinib resistant cells show abnormal activation
of PI3K/AKT/BIM activation(PMID 28765329). The classical drug aspirin can effectively
decrease AKT phosphorylation and activate of BIM(PMID 28881293).So Investigators speculate
that aspirin may decrease the PI3K/AKT/BIM signaling pathways, then promote osimertinib
resistant cells apoptosis. The current study aims to evaluate the combination of aspirin and
osimertinib in patients with EGFR/T790M mutations.
Title
- Brief Title: Combination of Osimertinib and Aspirin to Treat Osimertinib Resistance Non-small Cell Lung Cancer ( NSCLC)
- Official Title: Prospective Observational Trial to Evaluate the Efficacy of the Combination of Osimertinib and Aspirin in Patients With Disease Progression to 3st Generation Epidermal Growth Factor Receptor-tyrosine Kinase Inhibitor(EGFR-TKI) Osimertinib
Clinical Trial IDs
- ORG STUDY ID:
COAST 2
- NCT ID:
NCT03532698
Conditions
- Non-Small Cell Lung Cancer Stage IIIB
- Non-small Cell Lung Cancer Stage IV
- EGFR T790M
Interventions
Drug | Synonyms | Arms |
---|
Aspirin | ASP | osimertinib and aspirin |
Osimertinib | OSI | osimertinib |
Purpose
The third generation epidermal growth gactor receptor-tyrosine Kinase Inhibitor(EGFR-TKI)
osimertinib has obvious curative effect for EGFR sensitive mutation and T790M mutation(PMID
27959700), but acquired drug resistance will occur. Previous studies show that apoptosis
escape can lead to EGFR-TKI resistance.Osimertinib resistant cells show abnormal activation
of PI3K/AKT/BIM activation(PMID 28765329). The classical drug aspirin can effectively
decrease AKT phosphorylation and activate of BIM(PMID 28881293).So Investigators speculate
that aspirin may decrease the PI3K/AKT/BIM signaling pathways, then promote osimertinib
resistant cells apoptosis. The current study aims to evaluate the combination of aspirin and
osimertinib in patients with EGFR/T790M mutations.
Detailed Description
Reversible small-molecule EGF receptor tyrosine kinase inhibitors (EGFR-TKI) have shown
dramatic therapeutic efficacy in non-small cell lung cancer (NSCLC) patients with
EGFR-activating mutations, and have been recommended as the standard first-line therapy in
these patients. However, despite excellent initial clinical responses, nearly all patients
eventually develop drug resistance after a median period of about 10 months(PMID 26497205).
Osimertinib is a 3rd-generation EGFR-TKI used to treat NSCLC patients with resistance to 1st
generation EGFR-TKI due to T790M mutation. But Osimertinib also face the problem of acquired
drug-resistance(PMID 27959700). Thus, innovative treatment strategies are urgently needed to
overcome therapeutic resistance to Osimertinib to improve the survival of patients with
NSCLC.
Molecular mechanisms underlying acquired Osimertinib resistance are still not fully
understood. Previous study showed that one principal mechanism accounting for majority of
acquired resistance to Osimertinib in lung cancer is mediated by an exon 20 C797S mutation
etc(PMID 29596911). More molecular mechanisms are still to be found. Apoptosis is a process
of programmed cell death that occurs in multicellular organisms. Biochemical events lead to
characteristic cell changes (morphology) and death. These changes include blebbing, cell
shrinkage, nuclear fragmentation, chromatin condensation, chromosomal DNA fragmentation, and
global mRNA decay. Apoptosis has been found to be related to drug resistance to 1st
generation EGFR-TKI(PMID 29731879). The investigators previous found apoptosis is also
related to Osimertinib resistance(PMID 28765329). Therefore, promoting apoptosis may be an
effective way to improve the response to Osimertinib treatment.
Investigators' group has focused on lung cancer targeted therapy for several years.
Previously, investigators have reported that metformin in combination with 1st generation
EGFR-TKI could enhance the effect of TKI (PMID 24644001). Therefore, investigators further
asked whether the drug combination approach could overcome osimertinib resistance. Aspirin is
a widely used and well-tolerated drug for Kawasaki disease, pericarditis, and rheumatic and
has arisen keen interest as a potential anticancer agent ever since the report of the
clinical evidence that the cancer risk and mortality are reduced in Colon cancer. Aspirin
exerts remarkable antitumor properties in tumor cells and mouse models. It strongly inhibited
the growth of lung cancer cells, and its combination with TKI agents, including Sorafenib
(PMID: 28857200), significantly suppressed RAS-mutant cancers growth and prolonged remission
in a xenograft model. Interestingly, Aspirin exposure significantly promoted the apoptosis
suggesting that aspirin may overcome Osimertinib resistance by promoting the apoptosis.
Here, investigators'group observed that in clinic, several patients who took osimertinib and
aspirin together have shown excellent effect.Investigators therefore conduct this clinical
trial to observe whether the combination of Aspirin and Osimertinib could enhance efficacy of
Osimertinib in lung cancer patients resistant to 1st generation EGFR-TKI with T790M.
Trial Arms
Name | Type | Description | Interventions |
---|
osimertinib and aspirin | | Osimertinib and Aspirin starting at a dose of 80 mg and 100mg once a day, orally with meals. Aspirin treatment will be initiated one week before beginning TKI therapy, if possible, but TKI therapy will not be delayed for Aspirin loading. Drug: Osimertinib and Aspirin will be administered once every day. If subject has complete response, partial response, stable disease, or unacceptable toxicity. | |
osimertinib | | Osimertinib starting at a dose of 80 mg once a day, orally with meals. Drug: Osimertinib will be administered once every day. If subject has complete response, partial response, stable disease, or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
•Patients must have Histologically or cytologically confirmed non small cell carcinoma of
the lung who harbors EGFR-mutation and are previously disease progression to 3st generation
EGFR-TKI Osimertinib.
Patient must have measurable stage IV disease (includes M1a, M1b stages or recurrent
disease) (according to the 7th edition of the tumor node metastasis (TNM) classification
system). However, patients with T4NX disease (stage III B) with nodule(s) in ipsilateral
lung lobe are not eligible, because such patients were not included in historical controls.
- Patients be age >18 years and < 75 years.
- Patients must have a Life Expectancy of greater than 12 weeks.
- Patients must have an electrocorticography (ECOG) performance status 0 or 1 (Karnofsky
> 70).
- Patients must have normal organ and marrow function as defined below, within one week
prior to randomization: absolute neutrophil count >1,500/mL platelets > 100,000/mL
total bilirubin: within normal institutional limits AST(SGOT)/ALT(SGPT) < 2.5 X
institutional upper limit of normal creatinine < 1.5 X institutional upper limit of
normal urine dipstick for proteinuria of < less than 1+. If urine dipstick is > 1+
then a 24 hour urine for protein must demonstrate < 500 mg of protein in 24 hours to
allow participation in the study.
Women of child-bearing potential and men must agree to use adequate contraception (hormonal
or barrier method of birth control; abstinence) prior to study entry and for the duration
of study participation. Should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately.
- Patients must have an international normalized ratio (INR) < 1.5 and a partial
thromboplastin time (PTT) no greater than upper limits of normal within 1 week prior
to randomization.
- Patients with a history of hypertension must be well-controlled (<150 systolic/<100
diastolic) on a stable regimen of anti-hypertensive therapy.
- Patients must have the ability to understand and the willingness to sign a written
informed consent document.
Exclusion Criteria:
- Patients with uncontrolled intercurrent illness including, but not limited to, ongoing
or active infection,symptomatic congestive heart failure, unstable angina pectoris,
cardiac arrhythmia,gastric ulcer,hemophilia,thrombopenia,active
hemorrhage,podagra,kidney failure or psychiatric illness/social situation that would
limit compliance with study requirements.
- Patients receiving chronic daily treatment with aspirin (> 325 mg/day) or nonsteroidal
anti-inflammatory agents known to inhibit platelet function. Treatment with
dipyridamole (Persantine), ticlopidine (Ticlid),clopidogrel (Plavix) and/or cilostazol
(Pletal)is also not allowed.
- Patients receiving therapeutic anticoagulation. Prophylactic anticoagulation of venous
access devices is allowed provided Section 3.10 is met. Caution should be taken on
treating patients with low dose heparin or low molecular weight heparin for DVT
prophylaxis during treatment with bevacizumab as there may be an increased risk of
bleeding.
- Prior use of chemotherapy.
- Patients receiving immunotherapy, hormonal-therapy and or radiotherapy within 2 weeks
prior to entering the study. Note: Those who have not recovered from adverse events
due to these agents administered will be considered ineligible.
- Patients receiving any other investigational agents.
- Patients with uncontrolled brain metastasis. Note: Patients with brain metastases must
have stable neurologic status following local therapy (surgery or radiation) for at
least 2 weeks, and must be without neurologic dysfunction that would confound the
evaluation of neurologic and other adverse events.
- Patients with a history of allergic reactions attributed to compounds of similar
chemical or biologic composition to Osimertinib and Aspirin or other agents used in
the study are excluded.
- Women that are pregnant or breastfeeding Note: Pregnant women are excluded from this
study because the agents used in this study may be teratogenic to a fetus. Because
there is an unknown but potential risk for adverse events in nursing infants secondary
to treatment of the mother with paclitaxel, breastfeeding women are also excluded from
this study.
- Patients that are HIV-positive on combination antiretroviral therapy due to the
potential for lethal infections when treated with marrow-suppressive therapy.
Maximum Eligible Age: | 75 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Objective Response Rate(ORR) according to resist 1.1 |
Time Frame: | 2years |
Safety Issue: | |
Description: | To evaluate the response to therapy and Objective Response Rate of the combination of Osimertinib and Aspirin in patients who has metastatic pulmonary adenocarcinoma disease progression to 3st generation EGFR-TKI Osimertinib. |
Secondary Outcome Measures
Measure: | disease control rate(DCR) according to resist 1.1 |
Time Frame: | 2years |
Safety Issue: | |
Description: | To evaluate the response to therapy and disease control rate of the combination of Osimertinib and Aspirin in patients who has metastatic pulmonary adenocarcinoma disease progression to 3st generation EGFR-TKI Osimertinib. |
Measure: | Time to progression(TTP) according to resist 1.1 |
Time Frame: | 2years |
Safety Issue: | |
Description: | To evaluate the response to therapy and Time to progression of the combination of Osimertinib and Aspirin in patients who has metastatic pulmonary adenocarcinoma disease progression to 3st generation EGFR-TKI Osimertinib. |
Measure: | duration of Response(DOR) according to resist 1.1 |
Time Frame: | 2years |
Safety Issue: | |
Description: | To evaluate the response to therapy and duration of Response of the combination of Osimertinib and Aspirin in patients who has metastatic pulmonary adenocarcinoma disease progression to 3st generation EGFR-TKI Osimertinib. |
Details
Phase: | |
Primary Purpose: | Observational |
Overall Status: | Not yet recruiting |
Lead Sponsor: | Daping Hospital and the Research Institute of Surgery of the Third Military Medical University |
Trial Keywords
- lung cancer
- Aspirin
- Osimertinib
- EGFR-TKI
- resistance
Last Updated
July 23, 2020