Clinical Trials /

Temodar Plus Tyrosine Kinase Inhibitors for Progressive CNS Disease

NCT04541407

Description:

This trial is testing two novel combinations (temozolomide plus osimertinib OR temozolomide plus lorlatinib) which have not been evaluated in clinical trials. Thus, the exact benefits of these novel combinations are unclear. However, based on the mechanism of action of temozolomide and CNS(Central Nervous System) penetration/activity in other tumor types, it is hypothesized that adding temozolomide to osimertinib or temozolomide to lorlatinib may provide improvement in CNS disease control in patients with CNS progression on either of these latter two TKIs (Tyrosine kinase inhibitors).

Related Conditions:
  • Non-Small Cell Lung Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Temodar Plus Tyrosine Kinase Inhibitors for Progressive CNS Disease
  • Official Title: A Phase 1 Study of Temozolomide in Combination With Targeted Therapy for NSCLC Patients With CNS Progression on Either Osimertinib or Lorlatinib

Clinical Trial IDs

  • ORG STUDY ID: 20-0138.cc
  • SECONDARY ID: P30CA046934
  • NCT ID: NCT04541407

Conditions

  • Non Small Cell Lung Cancer
  • CNS Progression

Interventions

DrugSynonymsArms
Temozolomide plus OsimertinibExon 19 deletions or L858R point mutations in exon 21
Temozolomide plus LorlatinibPatients with anaplastic lymphoma kinase (ALK) fusions

Purpose

This trial is testing two novel combinations (temozolomide plus osimertinib OR temozolomide plus lorlatinib) which have not been evaluated in clinical trials. Thus, the exact benefits of these novel combinations are unclear. However, based on the mechanism of action of temozolomide and CNS(Central Nervous System) penetration/activity in other tumor types, it is hypothesized that adding temozolomide to osimertinib or temozolomide to lorlatinib may provide improvement in CNS disease control in patients with CNS progression on either of these latter two TKIs (Tyrosine kinase inhibitors).

Trial Arms

NameTypeDescriptionInterventions
Exon 19 deletions or L858R point mutations in exon 21ExperimentalWill include patients with exon 19 deletions or L858R point mutations in exon 21 of the epidermal growth factor receptor (EGFR) gene. Temozolomide plus Osimertinib will be the study drug combination administered. Osimertinib will be given at a fixed dose of 80 mg daily for dose level 1, with a potential to increase to 160 mg daily for dose level 2. Temozolomide will be started at a dose of 150 mg/m2 on days 1-5 of a 28 day cycle for cycle 1 and if tolerated will be increased to 200 mg/m2 on days 1-5 of a 28 day cycle for cycles 2+. There will be a -1 dose level.
  • Temozolomide plus Osimertinib
Patients with anaplastic lymphoma kinase (ALK) fusionsExperimentalWill include patients with anaplastic lymphoma kinase (ALK) fusions. Temozolomide plus Lorlatinib will be the study drug combination administered. Lorlatinib will be given at a fixed dose of 100 mg daily. Temozolomide will be started at a dose of 150 mg/m2 on days 1-5 of a 28 day cycle for cycle 1 and if tolerated will be increased to 200 mg/m2 on days 1-5 of a 28 day cycle for cycles 2+. There will be a -1 dose level depending on tolerability.
  • Temozolomide plus Lorlatinib

Eligibility Criteria

        Inclusion Criteria:

          1. Provision to sign and date the consent form.

          2. Stated willingness to comply with all study procedures and be available for the
             duration of the study.

          3. Male or female subject ≥ 18 years old

          4. ECOG performance status 0-2

          5. Stage IV NSCLC with progression of disease in the CNS on osimertinib 80 mg daily for
             patients with EGFR activating mutations (EGFR exon 19 deletions or EGFR L858R exon 21
             point mutations) -OR- Stage IV NSCLC with progression of disease in the CNS on
             lorlatinib 100 mg daily for patients with ALK fusions

          6. Evaluable CNS disease is required, measurable CNS disease is not required

          7. Patients who are on corticosteroids must be on stable or decreasing doses of
             corticosteroids for at least 14 days.

          8. Adequate hematologic function defined as:

               -  ANC ≥ 1.5 x 10^9/L

               -  Hemoglobin ≥ 9 g/dL

               -  Platelets ≥ 150 x 10^9/L

          9. Adequate hepatic function defined as:

               -  Total bilirubin ≤1.5 x upper limit of normal (ULN). For subjects with Gilbert's
                  Disease, Total bilirubin ≤3 x ULN

               -  ALT and AST ≤3 x ULN. For subjects with documented liver metastases, ALT and AST
                  ≤5×ULN

         10. Adequate renal function defined as:

               -  Estimated glomerular filtration rate (eGFR) ≥ 40 mL/minute as determined using
                  the Cockcroft-Gault formula

         11. Patients must be capable of taking oral medication and have no known gastrointestinal
             malabsorption disorder.

         12. Patients must not be planning to receive any concurrent chemotherapy, immunotherapy,
             biologic or hormonal therapy for cancer treatment while receiving treatment on this
             study. Concurrent use of hormones for non-cancer-related conditions (e.g., insulin for
             diabetes and hormone replacement therapy) is acceptable.

         13. Brain MRI with contrast is required to have demonstrated progressive CNS disease or an
             LP with cytology is required to have demonstrated progressive leptomeningeal disease
             on osimertinib or lorlatinib within 21 days of starting study drugs. CT of brain with
             contrast can be used to demonstrate progressive disease if patients have a documented
             anaphylaxis to gadolinium contrast and/or other contraindication to MRI (e.g., severe
             claustrophobia that cannot be managed with anxiolytics).

         14. Patients must not be pregnant. Women/men of reproductive potential must have agreed to
             use an effective contraceptive method (see section 6.6 for list of effective methods).
             Women must use an effective contraceptive method during the study and for 6 months
             following the last dose. Men having sex with women of reproductive potential are
             required to use effective contraception during the study and for 6 months following
             the last dose. A woman is considered to be of "reproductive potential" if she has had
             menses at any time in the preceding 12 consecutive months. In addition to routine
             contraceptive methods, "effective contraception" (see section 6.6 for list of
             effective contraceptive methods) also includes heterosexual celibacy and surgery
             intended to prevent pregnancy (or with a sideeffect of pregnancy prevention) defined
             as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation. However, if at
             any point a previously celibate patient chooses to become heterosexually active during
             the time period for use of contraceptive measures outlined in the protocol, he/she is
             responsible for beginning contraceptive measures. Women of reproductive potential are
             not to be nursing during the study and for six months following the last dose of all
             study drugs.

         15. Women on the lorlatinib arm who are of reproductive potential agree to use a
             non-hormonal method of contraception during the study and for the time periods
             outlined above.

        Exclusion Criteria:

          1. Patients with compound mutations in EGFR will be excluded from this study. Compound
             mutations are defined as 2 or more mutations in the EGFR tyrosine kinase domain with
             the following exceptions:

               1. C797S and EGFR exon 19 deletion or EGFR exon 21 point mutation and

               2. T790M mutation and EGFR exon 19 deletion or EGFR exon 21 point mutation.

          2. Prior therapy with temozolomide.

          3. Patients must not receive surgery or radiation as local therapies for the progressing
             CNS disease for which they are being enrolled on this trial. Ventriculoperitoneal
             shunt placement will be allowed for leptomeningeal disease with symptomatic
             hydrocephalis. Radiation or surgery for progressing extra-CNS disease is allowed.

          4. Patients with a history of an allergic/hypersensitivity reaction to any component of
             temozolomide, dacarbazine, osimertinib (for temozolomide plus osimertinib arm) or
             lorlatinib (for temozolomide plus lorlatinib arm).

          5. Grade III/IV cardiac disease as defined by the New York Heart Association Criteria
             (i.e., patients with cardiac disease resulting in marked limitation of physical
             activity or resulting in inability to carry on any physical activity without
             discomfort), unstable angina pectoris, and myocardial infarction within 6 months, or
             serious uncontrolled cardiac arrhythmia.

          6. Patients with a history of baseline QTcF interval greater than 470 msec on
             electrocardiogram for the osimertinib plus temozolomide arm only.

          7. Unstable or clinically significant concurrent medical condition, psychiatric illness
             or social situation that would, in the opinion of the investigator, jeopardize the
             safety of a subject and/or their compliance with the protocol.

          8. Clinically significant acute infection requiring systemic antibacterial, antifungal,
             or antiviral therapy. Suppressive therapy for chronic infections allowed, for example:

             Subjects with HIV/AIDS with adequate antiviral therapy to control viral load would be
             allowed. Subjects with viral hepatitis with controlled viral load would be allowed
             while on suppressive antiviral therapy.

          9. Treated with any investigational drug or chemotherapy within 3 weeks or ≤ 5 half-lives
             of first dose of study treatment.

         10. No other prior malignancy is allowed except for the following: adequately treated
             basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated
             Stage I or II cancer from which the patient is currently in complete remission, or any
             other cancer from which the patient has been disease free for five years.

         11. Patient is not taking any prohibited medications listed in section 6.4. (Strong CYP3A
             inducers should be stopped greater than 3 half-lives prior to starting study drugs for
             patients on either study drug combination. Moderate inducers of CYP3A should be
             stopped greater than 3 half-lives prior to starting study drugs for patients receiving
             lorlatinib plus temozolomide. Strong CYP3A inhibitors should be stopped greater than 3
             half-lives prior to starting study drugs for patients receiving lorlatinib plus
             temozolomide.)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Adverse events
Time Frame:Up to 3.5 years
Safety Issue:
Description:Adverse events will be determined by the common terminology criteria for adverse events version 5.0

Secondary Outcome Measures

Measure:CNS response rate
Time Frame:Up to 3.5 years
Safety Issue:
Description:Central Nervous System response rate according to the Response assessment in neuro-oncology (RANO) criteria per investigator assessment. Evaluable CNS lesions may not have been previously irradiated unless they are definitively progressing following radiation and prior to enrollment on the study.
Measure:Extra-CNS response rate
Time Frame:Up to 3.5 years
Safety Issue:
Description:Extra-CNS response rate according to response evaluation criteria in solid tumors (RECIST) v1.1 per investigator assessment.
Measure:Overall response rate
Time Frame:Up to 3.5 years
Safety Issue:
Description:Overall response rate including both RANO criteria for CNS response rate and RECIST v1.1 for extra-CNS response rate per investigator assessment.
Measure:Incidence of improvement in neurological function
Time Frame:Up to 3.5 years
Safety Issue:
Description:Incidence of improvement in neurological function on two successive exams when compared to baseline as determined by one of two study neuro-oncologists
Measure:Progression free survival (PFS)
Time Frame:Up to 3.5 years
Safety Issue:
Description:PFS will be defined as time from enrollment until development of CNS progressive disease according to the RANO criteria, development of extra-CNS disease progression according to RECIST v1.1 or death.
Measure:CNS PFS
Time Frame:Up to 3.5 years
Safety Issue:
Description:CNS PFS will be defined as time from enrollment until development of CNS progressive disease per investigator assessment according to the RANO criteria or death.
Measure:Extra-CNS PFS
Time Frame:Up to 3.5 years
Safety Issue:
Description:Extra-CNS PFS will be defined as time from enrollment until development of progressive disease outside the CNS per investigator assessment according RECIST v1.1 or death.
Measure:Overall Survival
Time Frame:Up to 3.5 years
Safety Issue:
Description:OS will be defined as time from enrollment until death.Patients alive at date of end of study visit will be censored for survival.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:University of Colorado, Denver

Last Updated

March 8, 2021