Inclusion Criteria:
1. Patient having signed an informed consent form
2. Histologically or cytologically confirmed NSCLC (per 2015 8th edition TNM
classification)
3. Not suitable for radiation, inoperable stage III or stage IV
4. HER2 exon 20 mutation or insertion among which: in-frame insertions in exon 20 between
codons 775 and 881 including the 12bp insertion with a duplication / insertion of 4
amino acids (YVMA) at codon 775, the 3bp insertion with a complex
insertion-substitution G776>VC and point mutations L755S and G776C. Other
mutation/insertion should be discussed with IFCT. Analysis must be performed in
INCa-labelled laboratories or platforms according to a validated procedure.
5. Prior treatment with at least one regimen of platinum-based chemotherapy with
documented disease progression.
Note: taxanes are allowed provided that no grade >2 associated adverse event occurred
(except hematological toxicity).
6. Presence of at least one lesion that can be measured by CT scan (RECIST v1.1)
7. Age ≥ 18 years
8. Adequate organ function, as evidenced by the following laboratory results:
ANC > 1500 cells/mm3 Platelet count > 100,000 cells/mm3 Hemoglobin > 9.0 g/dL Patients
are allowed to receive transfused RBC to achieve this level. Total bilirubin ≤ 1.5 ×
ULN, except in patients with previously documented Gilbert's syndrome, in which case
the direct bilirubin should be less than or equal to the ULN SGOT and SGPT ≤ 2.5 × ULN
Alkaline phosphatase ≤ 2.5 × ULN, Alkaline phosphatase < 5×ULN and SGOT and SGPT <
5×ULN for patients with hepatic and/or bone metastases Clearance creatinine ≥ 30
mL/min INR and aPTT ≤ 1.5 x ULN This applies only to patients who are not receiving
therapeutic anticoagulation; patients receiving therapeutic anticoagulation should be
on a stable dose.
9. WHO performance index of 0, 1 or 2
10. LVEF ≥ 50%
11. Patient who is capable, according to the investigator, of complying with the study's
requirements and restrictions
12. Estimated life expectancy > 3 months
13. A female is eligible to enter and participate in this study if she is of:
Non-childbearing potential (i.e., physiologically incapable of becoming pregnant),
including any female who has undergone:
- Hysterectomy.
- Bilateral oophorectomy (ovariectomy).
- Bilateral tubal ligation.
- Or who is post-menopausal:
- Patients not using hormone replacement therapy (HRT) must have experienced total
cessation of menses for ≥1 year and be greater than 45 years in age, OR, in
questionable cases, have a follicle stimulating hormone value >40 mIU/mL and an
estradiol value <40 pg/mL (<140 pmol/L).
- Patients must discontinue HRT prior to study enrolment due to the potential for
inhibition of cytochrome enzymes that metabolize estrogens and progestins. For
most forms of HRT, at least 2 4 weeks must elapse between the cessation of HRT
and determination of menopausal status; length of this interval depends on the
type and dosage of HRT. If a female subject is determined not to be
post-menopausal, they must use adequate contraception, as defined immediately
below.
Childbearing potential, including any female who has had a negative serum pregnancy
test within 2 weeks prior to the first dose of study treatment, preferably as close to
the first dose as possible, and agrees to use adequate contraception during the study
and for at least 7 months after the last dose of investigational product.
Contraceptive methods acceptable to IFCT, when used consistently and in accordance
with both the product label and the instructions of the physician, are as follow:
- A non-hormonal intrauterine device with a documented failure rate of less than 1%
per year.
- Vasectomized partner who is sterile prior to the female subject's entry and is
the sole sexual partner for that female.
- Complete abstinence from sexual intercourse for 14 days before exposure to
investigational product, through the dosing period, and for at least 7 months
after the last dose of investigational product.
- Two effective forms of non-hormonal contraception (condom with spermicidal jelly,
foam suppository or film; diaphragm with spermicide; or male condom and diaphragm
with spermicide).
Note: Oral contraceptives are not allowed.
14. Female patients who are lactating should discontinue nursing prior to the first dose
of study drug and should refrain from nursing throughout the treatment period and for
15 days following the last dose of study drug.
15. A male with a female partner of childbearing potential is eligible to enter and
participate in the study if he uses a barrier method of contraception or abstinence
during the study and for at least 7 months after the last dose of investigational
product.
16. Patient will be eligible for inclusion in this study only if either affiliated to or a
beneficiary of social security insurance.
Exclusion Criteria:
1. History of cancer except cancer dating from over two years ago and considered to be
cured, appropriately treated carcinoma in situ of the cervix, non-melanoma skin
carcinoma and stage I uterine cancer.
2. Any approved anti-cancer therapy ≤ 21 days before enrollment. Note: TKIs approved for
the treatment of NSCLC must be discontinued ≥ 7 days prior to the first study
treatment on Cycle 1, Day 1. (The baseline scan must be completed after
discontinuation of TKIs).
3. Patients with concomitant EGFR, ALK, ROS1, MET, BRAF and KRAS mutation. Other
molecular co-alterations should be discussed with IFCT before patient's enrollment.
4. Previous treatment with an anti-HER2 agent.
5. Any other investigational therapy ≤ 28 days before inclusion
6. Previous irradiation <14 days before enrollment.
7. Brain metastases that are symptomatic, or require any radiation, surgery, or
corticosteroid therapy to control symptoms from brain metastases within 4 weeks before
enrollment. Asymptomatic brain metastases with a fixed dose of steroids for at least 2
weeks are eligible.
8. Carcinomatous meningitis
9. History of intolerance (including Grade 3 or 4 infusion reaction) or hypersensitivity
to trastuzumab, pertuzumab or docetaxel or murine proteins or one of the excipients
10. Pregnancy and breast-feeding
11. Any evidence of severe or uncontrolled systemic disease. (E.g. unstable or
uncompensated respiratory, cardiac, hepatic, or renal disease) or other significant
clinical disorder or laboratory finding that makes it undesirable for the patient to
participate in the study.
12. Evidence of active pneumonitis during screening
13. Current unstable ventricular arrhythmia requiring treatment, history of symptomatic
congestive heart failure (CHF; New York Heart Association [NYHA] Classes II-IV) and
history of myocardial infarction or unstable angina within 6 months before enrollment.
14. Unresolved toxicity grade > 2 from previous anti-tumor treatments
