Clinical Trials /

Testing the Use of Targeted Treatment (AMG 510) for KRAS G12C Mutated Advanced Non-squamous Non-small Cell Lung Cancer (A Lung-MAP Treatment Trial)

NCT04625647

Description:

This phase II Lung-MAP treatment trial studies the effect of AMG 510 in treating non-squamous non-small cell lung cancer that is stage IV or has come back (recurrent) and has a specific mutation in the KRAS gene, known as KRAS G12C. Mutations in this gene may cause the cancer to grow. AMG 510, a targeted treatment against the KRAS G12C mutation, may help stop the growth of tumor cells.

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

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Testing the Use of Targeted Treatment (AMG 510) for KRAS G12C Mutated Advanced Non-squamous Non-small Cell Lung Cancer (A Lung-MAP Treatment Trial)
  • Official Title: A Phase II Study of AMG 510 in Participants With Previously Treated Stage IV or Recurrent KRAS G12C Mutated Non-Squamous Non-Small Cell Lung Cancer (ECOG-ACRIN LUNG-MAP SUB-STUDY)

Clinical Trial IDs

  • ORG STUDY ID: S1900E
  • SECONDARY ID: NCI-2020-08103
  • SECONDARY ID: S1900E
  • SECONDARY ID: S1900E
  • SECONDARY ID: U10CA180888
  • NCT ID: NCT04625647

Conditions

  • Lung Adenocarcinoma
  • Lung Non-Small Cell Carcinoma
  • Recurrent Lung Non-Squamous Non-Small Cell Carcinoma
  • Stage IV Lung Cancer AJCC v8
  • Stage IVA Lung Cancer AJCC v8
  • Stage IVB Lung Cancer AJCC v8

Interventions

DrugSynonymsArms
SotorasibAMG 510, AMG-510, AMG510Treatment (AMG 510)

Purpose

This phase II Lung-MAP treatment trial studies the effect of AMG 510 in treating non-squamous non-small cell lung cancer that is stage IV or has come back (recurrent) and has a specific mutation in the KRAS gene, known as KRAS G12C. Mutations in this gene may cause the cancer to grow. AMG 510, a targeted treatment against the KRAS G12C mutation, may help stop the growth of tumor cells.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To evaluate the response rate (confirmed, complete or partial) of AMG 510 in participants
      with KRAS^G12C mutated stage IV or recurrent non-squamous non-small cell lung cancer (NSCLC).

      SECONDARY OBJECTIVES:

      I. To evaluate investigator assessed progression-free survival (IA-PFS) within each cohort.

      II. To evaluate overall survival (OS) within each cohort. III. To evaluate duration of
      response (DOR) among responders within each cohort.

      IV. To evaluate the frequency and severity of toxicities within the full study population
      (all cohorts combined).

      TRANSLATIONAL MEDICINE OBJECTIVES:

      I. To evaluate the association between clinical outcomes (response, IA-PFS, OS) and other
      co-mutations (e.g., CDKN2A/B/C, ATM, PIK3CA) identified by the Foundation Medicine Inc (FMI)
      FoundationOne CDx from LUNGMAP, within cohorts and across the full study population of
      KRAS^G12C positive participants.

      II. To evaluate the association between clinical outcomes (response, IA-PFS, OS) and PD-L1
      total proportion score determined by screening in LUNGMAP, within cohorts and across the full
      study population of KRAS^G12C positive participants.

      III. To evaluate the association between clinical outcomes (response, IA-PFS, OS) and Tumor
      Mutational Burden Score determined by the FMI FoundationOne CDx from LUNGMAP, within cohorts
      and across the full study population of KRAS^G12C positive participants.

      IV. To collect, process, and bank cell-free deoxyribonucleic acid (cfDNA) at pre-treatment on
      cycle 1 day 1, cycle 2 day 1, cycle 3 day 1, and at progression for future development of a
      proposal to evaluate comprehensive next-generation sequencing of circulating tumor DNA
      (ctDNA) and association with clinical outcomes.

      Note: The translational medicine proposal to use these specimens will be submitted as a
      revision to CTEP for approval, prior to the SWOG Statistical and Data Management Center
      (SDMC) review of assay results.

      OUTLINE:

      Patients receive AMG 510 orally (PO) once daily (QD) on days 1-21. Cycles repeat every 21
      days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 3 months for 3 years if
      the disease has not gotten worse at the time of finishing study treatment. If the disease has
      gotten worse, patients are followed up every 6 months for 2 years, then at the end of the 3
      years from the time they go on study.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (AMG 510)ExperimentalPatients receive AMG 510 PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Sotorasib

Eligibility Criteria

        Inclusion Criteria:

          -  Participants must be assigned to S1900E. Assignment to S1900E is determined by the
             LUNGMAP protocol genomic profiling using the FoundationOne assay. Biomarker
             eligibility for S1900E is based on the identification of a KRAS^G12C mutation

          -  Participants must have confirmed stage IV or recurrent non-squamous non-small cell
             lung cancer (NSCLC). Mixed histology NSCLC with less than 50% squamous component is
             allowed

          -  Participants must have measurable disease documented by computed tomography (CT) or
             magnetic resonance imaging (MRI). The CT from a combined positron emission tomography
             (PET)/CT may be used to document only non-measurable disease unless it is of
             diagnostic quality. Measurable disease must be assessed within 28 days prior to
             sub-study registration. Pleural effusions, ascites and laboratory parameters are not
             acceptable as the only evidence of disease. Non-measurable disease must be assessed
             within 42 days prior to sub-study registration. Participants whose only measurable
             disease is within a previous radiation therapy port must demonstrate clearly
             progressive disease (in the opinion of the treating investigator) prior to
             registration

          -  Participants must have a CT or MRI scan of the brain to evaluate for central nervous
             system (CNS) disease within 42 days prior to sub-study registration

          -  Participants with known human immunodeficiency virus (HIV) infection must be receiving
             anti-retroviral therapy and have an undetectable viral load at their most recent viral
             load test within 6 months prior to sub-study registration

          -  Participants with EGFR sensitizing mutations, EGFR T790M mutation, ALK gene fusion,
             ROS1 gene rearrangement, or BRAF V600E mutation must have progressed following all
             standard of care targeted therapy

          -  Participants with spinal cord compression or brain metastases must have received local
             treatment to these metastases and remained clinically controlled and asymptomatic for
             at least 7 days following stereotactic radiation and/or 14 days following whole brain
             radiation, and prior to sub-study registration

          -  Participants must have received at least one line of systemic treatment for stage IV
             or recurrent NSCLC

          -  Participants must have progressed (in the opinion of the treating physician) following
             the most recent line of systemic therapy for NSCLC

          -  Participants must have recovered (=< grade 1) from side effects of prior therapy. The
             exception is if a side effect from a prior treatment is known to be permanent without
             expected further recovery or resolution (i.e., endocrinopathy from immunotherapy or
             cisplatin neurotoxicity)

          -  Participants must be able to swallow tablets whole

          -  Pre-study history and physical exam must be obtained within 28 days prior to sub-study
             registration

          -  Absolute neutrophil count (ANC) >= 1,500/uL obtained within 28 days prior to sub-study
             registration

          -  Platelet count >= 75,000/uL obtained within 28 days prior to sub-study registration

          -  Hemoglobin >= 9 g/dL obtained within 28 days prior to sub-study registration

          -  Serum bilirubin =< institutional upper limit of normal (IULN) within 28 days prior to
             sub-study registration

          -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2 x IULN within
             28 days prior to sub-study registration. For participants with liver metastases, and
             ALT and AST must be =< 5 x IULN

          -  Participants must have a serum creatinine =< 1.5 x IULN or calculated creatinine
             clearance >= 50 mL/min using the following Cockcroft-Gault Formula. This specimen must
             have been drawn and processed within 28 days prior to sub-study registration

          -  Participants must have Zubrod performance status 0-1 documented within 28 days prior
             to sub-study registration

          -  Participants of reproductive potential must have a negative serum pregnancy test
             within 28 days prior to sub-study registration

          -  Participants must agree to have blood specimens submitted for circulating tumor DNA
             (ctDNA)

          -  Participants must be offered the opportunity to participate in specimen banking and in
             correlative studies for collection and future use of specimens. With participant
             consent, specimens must be collected and submitted via the Southwest Oncology Group
             (SWOG) Specimen Tracking System

          -  Participants must be informed of the investigational nature of this study and must
             sign and give informed consent in accordance with institutional and federal guidelines

               -  NOTE: As a part of the Oncology Patient Enrollment Network (OPEN) registration
                  process the treating institution's identity is provided in order to ensure that
                  the current (within 365 days) date of institutional review board approval for
                  this study has been entered in the system

          -  As a part of the Oncology Patient Enrollment Network (OPEN) registration process the
             treating institution's identity is provided in order to ensure that the current
             (within 365 days) date of institutional review board approval for this study has been
             entered in the system

          -  Participants with impaired decision-making capacity are eligible as long as their
             neurological or psychological condition does not preclude their safe participation in
             the study (e.g., tracking pill consumption and reporting adverse events to the
             investigator). For participants with impaired decision-making capabilities, legally
             authorized representatives may sign and give informed consent on behalf of study
             participants in accordance with applicable federal, local, and Central Institutional
             Review Board (CIRB) regulations

        Exclusion Criteria:

          -  Participants with spinal cord compression or brain metastases must not have residual
             neurological dysfunction, unless no further recovery is expected, and the participant
             has been stable on weaning doses of corticosteroids prior to sub-study registration

          -  Participants must not have leptomeningeal disease unless: (1) asymptomatic and (2)
             only detected on radiographic imaging (i.e., not present in cytology from cerebral
             spinal fluid [CSF] if CSF sampled)

          -  Participants must not have received any prior systemic therapy (systemic chemotherapy,
             immunotherapy or investigational drug) within 21 days prior to sub-study registration

          -  Participants must not have received any radiation therapy within 14 days prior to
             sub-study registration, with the exception of stereotactic radiation to CNS metastases
             which must have been completed at least 7 days prior to sub-study registration

          -  Participants must not have received prior AMG 510 or other KRAS^G12C specific
             inhibitor

          -  Participants must not be planning to receive any concurrent chemotherapy,
             immunotherapy, biologic or hormonal therapy for cancer treatment while receiving
             treatment on this study

          -  Participants must not have had a major surgery within 14 days prior to sub-study
             registration. Participant must have fully recovered from the effects of prior surgery
             in the opinion of the treating investigator

          -  Participants must not have any grade III/IV cardiac disease as defined by the New York
             Heart Association criteria (i.e., participants 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

          -  Participants must not have a prior or concurrent malignancy whose natural history or
             treatment has the potential to interfere with the safety or efficacy assessment of the
             investigational regimen

          -  Participants must not have gastrointestinal disorders that may impact drug absorption

          -  Participants must not have received strong inducers of CYP3A4 (including herbal
             supplements such as St. John's wort) within 14 days prior to sub-study registration
             and must not be planning to use strong inducers of CYP3A4 throughout protocol
             treatment

          -  Participants must not have received CYP3A4 sensitive substrates (with a narrow
             therapeutic window) within 14 days prior to sub-study registration and must not be
             planning to use CYP3A4 sensitive substrates (with a narrow therapeutic window)
             throughout protocol treatment

          -  Participants must not be pregnant or nursing. Participants with uteri must have agreed
             to use an effective contraceptive method for at least one month after the last dose of
             AMG 510. Participants with sperm must have agreed to use an effective contraceptive
             method for at least 3 months after the last dose of AMG 510. Participants are
             considered to be of "reproductive potential" if they have had menses at any time in
             the preceding 12 consecutive months and no prior oophorectomy and/or hysterectomy. In
             addition to routine contraceptive methods, "effective contraception" for participants
             with uteri also includes heterosexual celibacy and surgery intended to prevent
             pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy,
             bilateral oophorectomy or bilateral tubal ligation. Acceptable methods of birth
             control for participants with sperm include sexual abstinence (refraining from
             heterosexual intercourse); vasectomy with testing showing there is no sperm in the
             semen; bilateral tubal ligation or occlusion in the partner; or a condom (the female
             partner should also consider a form of birth control). However, if at any point a
             previously celibate participant 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
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Response rate (confirmed, complete or partial)
Time Frame:Up to 3 years
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Incidence of adverse events
Time Frame:Up to 3 years
Safety Issue:
Description:The frequency and grade of individual toxicities attributable to treatment will be estimated.
Measure:Progression free survival
Time Frame:Up to 3 years
Safety Issue:
Description:Will be estimated using the method of Kaplan-Meier. Confidence intervals about medians will be estimated using the Brookmeyer-Crowley method and about landmark time points will be calculated using Greenwood's formula and based on a log-log transformation applied on the survival function. Binary proportions and associated confidence intervals will be estimated for within cohort objectives. With participants in Cohort 1 and 3 and participants in Cohort 2, binary proportions can be estimated to within 16% and 20% with 95% confidence, respectively.
Measure:Overall survival
Time Frame:Up to 3 years
Safety Issue:
Description:Will be estimated using the method of Kaplan-Meier. Confidence intervals about medians will be estimated using the Brookmeyer-Crowley method and about landmark time points will be calculated using Greenwood's formula and based on a log-log transformation applied on the survival function. Binary proportions and associated confidence intervals will be estimated for within cohort objectives. With participants in Cohort 1 and 3 and participants in Cohort 2, binary proportions can be estimated to within 16% and 20% with 95% confidence, respectively.
Measure:Duration of response
Time Frame:Up to 3 years
Safety Issue:
Description:Will be estimated using the method of Kaplan-Meier. Confidence intervals about medians will be estimated using the Brookmeyer-Crowley method and about landmark time points will be calculated using Greenwood's formula and based on a log-log transformation applied on the survival function. Binary proportions and associated confidence intervals will be estimated for within cohort objectives. With participants in Cohort 1 and 3 and participants in Cohort 2, binary proportions can be estimated to within 16% and 20% with 95% confidence, respectively.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Southwest Oncology Group

Last Updated

November 12, 2020