Clinical Trials /

Tucatinib, Trastuzumab, Ramucirumab, and Paclitaxel Versus Paclitaxel and Ramucirumab in Previously Treated HER2+ Gastroesophageal Cancer

NCT04499924

Description:

This study is being done to see if tucatinib with trastuzumab, ramucirumab and paclitaxel works better than ramucirumab and paclitaxel to treat HER2-positive (HER2+) cancer of the gut (stomach or gastroesophageal cancer). This study will also look at what side effects happen when participants take this combination of drugs. A side effect is anything the drug does other than treating cancer. Study treatment will be given in 28-day cycles. In the Phase 2 part of the trial, participants and their doctors will know what drugs are being given (open-label). In the Phase 3 part, the study is "blinded." This means that participants, their doctor, and the study sponsor will not know which drugs are being given.

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Gastric Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2/Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Tucatinib, Trastuzumab, Ramucirumab, and Paclitaxel Versus Paclitaxel and Ramucirumab in Previously Treated HER2+ Gastroesophageal Cancer
  • Official Title: A Randomized, Double-blind, Placebo-controlled, Active Comparator Phase 2/3 Study of Tucatinib in Combination With Trastuzumab, Ramucirumab, and Paclitaxel in Subjects With Previously Treated, Locally-advanced Unresectable or Metastatic HER2+ Gastric or Gastroesophageal Junction Adenocarcinoma (GEC)

Clinical Trial IDs

  • ORG STUDY ID: SGNTUC-022
  • NCT ID: NCT04499924

Conditions

  • Gastric Adenocarcinoma
  • Gastroesophageal Junction Adenocarcinoma
  • Esophageal Adenocarcinoma

Interventions

DrugSynonymsArms
tucatinibTUKYSA, ONT-380, ARRY-380Arm 3A
trastuzumabArm 3A
ramucirumabCYRAMZAArm 3A
paclitaxelArm 3A

Purpose

This study is being done to see if tucatinib with trastuzumab, ramucirumab and paclitaxel works better than ramucirumab and paclitaxel to treat HER2-positive (HER2+) cancer of the gut (stomach or gastroesophageal cancer). This study will also look at what side effects happen when participants take this combination of drugs. A side effect is anything the drug does other than treating cancer. Study treatment will be given in 28-day cycles. In the Phase 2 part of the trial, participants and their doctors will know what drugs are being given (open-label). In the Phase 3 part, the study is "blinded." This means that participants, their doctor, and the study sponsor will not know which drugs are being given.

Trial Arms

NameTypeDescriptionInterventions
Phase 2 ArmExperimentalTucatinib + trastuzumab + ramucirumab + paclitaxel
  • tucatinib
  • trastuzumab
  • ramucirumab
  • paclitaxel
Arm 3AExperimentalTucatinib + trastuzumab + ramucirumab + paclitaxel
  • tucatinib
  • trastuzumab
  • ramucirumab
  • paclitaxel
Arm 3BActive ComparatorRamucirumab + paclitaxel + tucatinib placebo + trastuzumab placebo
  • ramucirumab
  • paclitaxel
Arm 3CExperimentalTucatinib + ramucirumab + paclitaxel + trastuzumab placebo
  • tucatinib
  • ramucirumab
  • paclitaxel

Eligibility Criteria

        Inclusion Criteria:

          -  Histologically or cytologically confirmed diagnosis of locally-advanced unresectable
             or metastatic HER2+ gastric or gastroesophageal junction adenocarcinoma (GEC)

          -  HER2+ disease documented since progression of the most recent line of systemic
             therapy, as follows:

               -  Phase 2 paclitaxel dose optimization stage:

                    -  HER2 amplification in a blood-based NGS assay performed at a central
                       laboratory, or

                    -  HER2 overexpression/amplification immunohistochemistry (IHC) and in situ
                       hybridization (ISH) (IHC3+ or IHC2+/ISH+) assay of a tumor tissue sample

               -  Phase 2 dose expansion stage:

                    -  Cohort 2A: HER2 amplification in a blood-based NGS assay performed at a
                       central laboratory

                    -  Cohort 2B: No HER2 amplification by blood-based NGS assay, but HER2
                       overexpression/amplification by IHC and ISH (IHC3+ or IHC2+/ISH+) assay of a
                       tumor tissue sample

               -  Phase 3: HER2 amplification in a blood-based NGS assay performed at a central
                  laboratory

          -  History of prior treatment with a HER2-directed antibody

          -  Progressive disease during or after first-line therapy for locally-advanced
             unresectable or metastatic GEC

          -  Phase 2: Measurable disease according to RECIST version 1.1

          -  Phase 3: Measurable or non-measurable disease according to RECIST version 1.1

          -  Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1

          -  Life expectancy of at least 3 months, in the opinion of the investigator

        Exclusion Criteria:

          -  Subjects with squamous cell or undifferentiated GEC

          -  Having received more than 1 line of prior systemic therapy for locally-advanced
             unresectable or metastatic disease

          -  Having received taxanes ≤12 months prior to enrollment, prior treatment with
             ramucirumab, or prior treatment with tucatinib, lapatinib, neratinib, afatinib, or any
             other investigational anti-HER2 and/or anti-EGFR tyrosine kinase inhibitor, or with
             T-DM1, T-Dxd, or any other HER2-directed antibody-drug conjugate

          -  Phase 2 paclitaxel dose optimization stage only: history of prior partial or total
             gastrectomy

          -  Unable to swallow pills
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall survival (OS) (Phase 3 only)
Time Frame:60 months
Safety Issue:
Description:OS is defined as the time from randomization to death due to any cause

Secondary Outcome Measures

Measure:Confirmed objective response rate (ORR) per RECIST version 1.1 according to investigator assessment (Phases 2 and 3)
Time Frame:36 months
Safety Issue:
Description:ORR is defined as the proportion of subjects with best overall response of CR or PR
Measure:ORR per RECIST version 1.1 according to investigator assessment (Phases 2 and 3)
Time Frame:36 months
Safety Issue:
Description:ORR is defined as the proportion of subjects with best overall response of CR or PR
Measure:Duration of response (DOR) per RECIST version 1.1 according to investigator assessment (Phases 2 and 3)
Time Frame:36 months
Safety Issue:
Description:DOR is defined as the time from first documentation of objective response of CR or PR to the first documentation of disease progression or death from any cause
Measure:Disease control rate (DCR) per RECIST version 1.1 according to investigator assessment (Phases 2 and 3)
Time Frame:36 months
Safety Issue:
Description:DCR is defined as subjects with CR, PR, or stable disease (SD or non-CR/non-progressive disease)
Measure:PFS per RECIST v1.1 according to blinded independent central review (BICR) assessment (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:PFS is defined as the time from randomization to the date of disease progression or death from any cause
Measure:Confirmed ORR per RECIST version 1.1 according to BICR assessment (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:ORR is defined as the proportion of subjects with best overall response of CR or PR
Measure:ORR per RECIST version 1.1 according to BICR assessment (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:ORR is defined as the proportion of subjects with best overall response of CR or PR
Measure:DOR per RECIST version 1.1 according to BICR assessment (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:DOR is defined as the time from first documentation of objective response of CR or PR to the first documentation of disease progression or death from any cause
Measure:DCR per RECIST version 1.1 according to BICR assessment (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:DCR is defined as subjects with CR, PR, or stable disease (SD or non-CR/non-progressive disease)
Measure:Incidence of AEs (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:An adverse event is any untoward medical occurrence in a subject or clinical investigational subject administered a medicinal product and which does not necessarily have a causal relationship with this treatment.
Measure:Incidence of laboratory abnormalities (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:To be summarized using descriptive statistics.
Measure:Incidence of dose modifications (Phase 3 only)
Time Frame:36 months
Safety Issue:
Description:
Measure:PFS per RECIST version 1.1 according to investigator assessment (Phase 2 only)
Time Frame:18 months
Safety Issue:
Description:PFS is defined as the time from the date of treatment initiation to the date of disease progression or death from any cause
Measure:Area under the plasma concentration-time curve (AUC) to the time of the last quantifiable concentration (AUClast) of tucatinib (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:Pharmacokinetic (PK) parameter
Measure:AUC to AUClast of paclitaxel (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:Maximum observed concentration (Cmax) of tucatinib (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:Cmax of paclitaxel (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:Time of Cmax (Tmax) of tucatinib (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:Tmax of paclitaxel (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:Trough concentration (Ctrough) of tucatinib (Phase 2 only)
Time Frame:18 months
Safety Issue:
Description:PK parameter
Measure:Ctrough of paclitaxel (Phase 2 only)
Time Frame:18 months
Safety Issue:
Description:PK parameter
Measure:Metabolic ratio of tucatinib based on AUC (MRAUC) (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:MRAUC of paclitaxel (Phase 2 only)
Time Frame:1 month
Safety Issue:
Description:PK parameter
Measure:Time to deterioration of GEC symptoms as assessed by the European Organisation for Research and Treatment or Cancer (EORTC) quality of life questionnaire (QLQ)-C30 and EORTC QLQ-OG25 questionnaires.
Time Frame:36 months
Safety Issue:
Description:The EORTC questionnaires measure aspects of health-related quality of life (HRQoL). Time to deterioration will be assessed in specific pre-specified single items from either the EORTC QLQ-C30 or EORTC QLQ OG25 and deterioration is defined as a 10-point increase from baseline in the symptom scales and a 10-point decrease from baseline for overall HRQoL.
Measure:Change from baseline in health-related quality of life (HRQoL)
Time Frame:36 months
Safety Issue:
Description:
Measure:Utility index values as assessed by the EQ-5D-5L
Time Frame:36 months
Safety Issue:
Description:The EQ-5D-5L questionnaire is used as a preference based measurement of HRQoL outcomes. Data will be summarized using descriptive statistics.

Details

Phase:Phase 2/Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Seagen Inc.

Trial Keywords

  • HER2+
  • HER2-positive
  • GEA
  • GEC
  • GEJ
  • Seattle Genetics

Last Updated

August 24, 2021