Clinical Trials /

Trastuzumab Deruxtecan in Participants With HER2-mutated Metastatic Non-small Cell Lung Cancer (NSCLC)

NCT04644237

Description:

This study was designed to evaluate the safety and efficacy of trastuzumab deruxtecan in HER2-mutated metastatic non-small cell lung cancer (NSCLC) participants who had disease recurrence or progression during/after at least one regimen of prior anticancer therapy (second line or later) that must have contained a platinum-based chemotherapy drug.

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

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Trastuzumab Deruxtecan in Participants With HER2-mutated Metastatic Non-small Cell Lung Cancer (NSCLC)
  • Official Title: A Phase 2, Multicenter, Randomized Study of Trastuzumab Deruxtecan in Subjects With HER2-mutated Metastatic Non-small Cell Lung Cancer (NSCLC) (DESTINY-LUNG02)

Clinical Trial IDs

  • ORG STUDY ID: DS8201-A-U206
  • NCT ID: NCT04644237

Conditions

  • Non-Small Cell Lung Cancer

Interventions

DrugSynonymsArms
Trastuzumab deruxtecanTrastuzumab deruxtecan 5.4 mg/kg

Purpose

This study was designed to evaluate the safety and efficacy of trastuzumab deruxtecan in HER2-mutated metastatic non-small cell lung cancer (NSCLC) participants who had disease recurrence or progression during/after at least one regimen of prior anticancer therapy (second line or later) that must have contained a platinum-based chemotherapy drug.

Detailed Description

      This randomized, two-arm, phase 2, multicenter study will evaluate the safety and efficacy of
      5.4 mg/kg and 6.4 mg/kg trastuzumab deruxtecan administered every 3 weeks (Q3W) in
      participants with HER2-mutated metastatic NSCLC. Each participant is expected to receive
      approximately 14 months of trastuzumab deruxtecan treatment. The primary endpoint of the
      study will be objective response rate (independent central review). Secondary endpoints will
      include, but not limited to, disease control rate, duration of response, progression-free
      survival, objective response rate (investigator), overall survival, and safety.
    

Trial Arms

NameTypeDescriptionInterventions
Trastuzumab deruxtecan 6.4 mg/kgExperimentalParticipants will be randomized to receive trastuzumab deruxtecan 6.4 mg/kg administered by intravenous infusion every 3 weeks (Q3W).
  • Trastuzumab deruxtecan
Trastuzumab deruxtecan 5.4 mg/kgExperimentalParticipants will be randomized to receive trastuzumab deruxtecan 5.4 mg/kg administered by intravenous infusion every 3 weeks (Q3W).
  • Trastuzumab deruxtecan

Eligibility Criteria

        Inclusion Criteria:

          -  Written informed consent

          -  Men or women ≥18 years, follow local regulatory requirements if the legal age of the
             consent for study participation is >18 years

          -  Pathologically documented metastatic NSCLC with a known activating HER2 mutation.
             Note: A HER2 mutation documented only from a liquid biopsy samples cannot be used for
             enrollment.

          -  Had previous treatment (second line or later [2L+], including platinum therapy), not
             amenable to curative surgery or radiation

          -  Presence of at least 1 measurable lesion confirmed by the blinded Independent Central
             Review based on RECIST version 1.1

          -  Willing and able to provide an archival tumor tissue sample. A fresh biopsy is
             required if an archival tumor tissue sample cannot be supplied. Fine needle aspirates
             are not acceptable.

          -  Eastern Cooperative Oncology Group performance status 0 to 1

          -  Left ventricular ejection fraction ≥ 50% within 28 days before randomization

          -  Adequate organ function as specified in protocol within 14 days before randomization

          -  Adequate treatment washout period before randomization

          -  Participants of reproductive/childbearing potential agree to use a highly effective
             form of contraception (or avoid intercourse) during study period and up to 7 months
             (females) and 4 months (males) after last study dose

          -  Males should not freeze or donate sperm throughout the study period up to at least 4
             months after last study dose; females should not donate or retrieve ova for their own
             use throughout the study period and up to at least 7 months after last study dose

          -  Life expectancy 3 months or more

        Exclusion Criteria:

          -  Known driver mutation in the epidermal growth factor receptor (EGFR) or BRAF gene or a
             known anaplastic lymphoma kinase (ALK) or ROS1 fusion

          -  Medical history of myocardial infarction within 6 months before randomization,
             symptomatic congestive heart failure (CHF) (New York Heart Association Class II to
             IV). Participants with troponin levels above upper limit of normal at screening (as
             defined by the manufacturer) and without any myocardial infarction (MI)-related
             symptoms should have a cardiologic consultation before enrollment to rule out MI

          -  Corrected QT interval (QTcF) prolongation > 470 msec (females) or >450 msec (males)
             based on average of the triplicate12-lead electrocardiogram at screening

          -  History of non-infectious interstitial lung disease (ILD)/pneumonitis that required
             steroids, current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled
             out by imaging at screening

          -  Spinal cord compression or clinically active central nervous system metastases,
             defined as untreated and symptomatic, or requiring therapy with corticosteroids or
             anticonvulsants to control associated symptoms

          -  Multiple primary malignancies within 3 years, except adequately resected non-melanoma
             skin cancer, curatively treated in-situ disease, or other solid tumors curatively
             treated

          -  History of severe hypersensitivity reactions to either the drug substances or inactive
             ingredients in the drug product

          -  History of severe hypersensitivity reactions to other monoclonal antibodies

          -  Uncontrolled infection requiring IV antibiotics, antivirals, or antifungals

          -  Substance abuse or any other medical conditions such as clinically significant cardiac
             or psychological conditions, that may, in the opinion of the investigator, interfere
             with the participant's participation in the clinical study or evaluation of the
             clinical study results

          -  Known human immunodeficiency virus (HIV) infection

          -  Known active, clinically relevant liver disease (eg, active hepatitis B, or active
             hepatitis C), based on available blood tests, liver ultrasound, or liver biopsy
             results

          -  Unresolved toxicities from previous anticancer therapy, defined as toxicities (other
             than alopecia) not yet resolved to Grade ≤ 1 or baseline

          -  Pregnant, breastfeeding, or planning to become pregnant

          -  Otherwise considered inappropriate for the study by the Investigator

          -  Lung-specific intercurrent clinically significant illnesses including, but not limited
             to, any underlying pulmonary disorder (eg. pulmonary emboli within three months of the
             study randomization, severe asthma, severe COPD, restrictive lung disease, pleural
             effusion, etc.)

          -  Any autoimmune, connective tissue or inflammatory disorders (e.g., Rheumatoid
             arthritis, Sjogren's, sarcoidosis etc.) where there is documented, or a suspicion of
             pulmonary involvement at the time of screening

          -  Prior complete pneumonectomy
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Objective Response Rate by Blinded Independent Central Review Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
Time Frame:9 months after the last participant is randomized or later, up to approximately 31 months
Safety Issue:
Description:Confirmed objective response rate (ORR), defined as the proportion of participants with complete response (CR) or partial response (PR), will be assessed by blinded independent central review (BICR) based on Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions.

Secondary Outcome Measures

Measure:Objective Response Rate by Investigator Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
Time Frame:9 months after the last participant is randomized or later, up to approximately 31 months
Safety Issue:
Description:Confirmed objective response rate (ORR), defined as the proportion of participants with complete response (CR) or partial response (PR), will be assessed by the Investigator based on Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions.
Measure:Duration of Response Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer
Time Frame:9 months after the last participant is randomized or later, up to approximately 31 months
Safety Issue:
Description:Duration of response (DoR) is defined as the time from the initial response (complete response [CR] or partial response [PR]) until documented tumor progression or death from any cause. DoR is only defined for participants who achieved confirmed CR or PR. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions.
Measure:Disease Control Rate Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer
Time Frame:9 months after the last participant is randomized or later, up to approximately 31 months
Safety Issue:
Description:Disease control rate (DCR) is the sum of complete response (CR), partial response (PR), and stable disease (SD) rates. CR was defined as a disappearance of all target lesions, PR was defined as at least a 30% decrease in the sum of diameters of target lesions, and stable disease (SD) was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD; at least a 20% increase in the sum of diameters of target lesions.
Measure:Progression-free Survival Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer
Time Frame:9 months after the last participant is randomized or later, up to approximately 31 months
Safety Issue:
Description:Progression-free survival (PFS) is defined as the time from date of randomization until first objective radiographic tumor progression or death from any cause, based on blinded independent central review (BICR) and investigator assessment.
Measure:Overall Survival Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
Time Frame:9 months after the last participant is randomized or later, up to approximately 31 months
Safety Issue:
Description:Overall survival (OS) is defined as the time from date of randomization until death from any cause.
Measure:The Percentage of Participants Reporting Treatment-emergent Adverse Events Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
Time Frame:Baseline up to 40 days after last dose, up to approximately 31 months
Safety Issue:
Description:
Measure:Pharmacokinetic Parameter Maximum Serum Concentration (Cmax) for Trastuzumab Deruxtecan, Total Anti-HER2 Antibody, and Active Metabolite MAAA-1181a
Time Frame:Cycle 1 Day 1; Cycle 2 Day 1, and Cycle 3 Day 1: pre- and post-dose; Cycle 1 Day 8: 7 days post-dose; Cycle 1 Day 15: 14 days post-dose; Cycle 4 Day 1 and Cycle 6 Day 1: pre-dose (each cycle is 21 days)
Safety Issue:
Description:
Measure:Pharmacokinetic Parameter Minimum Observed Concentration (Ctrough) for Trastuzumab Deruxtecan, Total Anti-HER2 Antibody, and Active Metabolite MAAA-1181a
Time Frame:Cycle 1 Day 1; Cycle 2 Day 1, and Cycle 3 Day 1: pre- and post-dose; Cycle 1 Day 8: 7 days post-dose; Cycle 1 Day 15: 14 days post-dose; Cycle 4 Day 1 and Cycle 6 Day 1: pre-dose (each cycle is 21 days)
Safety Issue:
Description:
Measure:Pharmacokinetic Parameter Area Under the Serum Concentration-Time Curve (AUC) for Trastuzumab Deruxtecan, Total Anti-HER2 Antibody, and Active Metabolite MAAA-1181a
Time Frame:Cycle 1 Day 1; Cycle 2 Day 1, and Cycle 3 Day 1: pre- and post-dose; Cycle 1 Day 8: 7 days post-dose; Cycle 1 Day 15: 14 days post-dose; Cycle 4 Day 1 and Cycle 6 Day 1: pre-dose (each cycle is 21 days)
Safety Issue:
Description:
Measure:Incidence of Anti-Drug Antibodies (ADA) Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
Time Frame:Pre-dose on Day 1 of Cycles 1, 2 and 4, and then every 4 cycles (each cycle is 21 days)
Safety Issue:
Description:
Measure:Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and EORTC Quality of Life Questionnaire for Lung Cancer Trials (QLQ-LC13) Scores
Time Frame:On Day 1 of every cycle (each cycle is 21 days), and at end of treatment visit 40-day follow-up visit
Safety Issue:
Description:The EORTC QLQ-C30 consists of 30 questions assessing global health-related quality of life, five aspects of subject functioning (physical, emotional, role, cognitive, and social), three symptom scales (fatigue, nausea and vomiting, and pain), and six single-items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). All of the scales and single-item measures range in score from 0 to 100. Higher scores for functioning scales and global health status indicate a better level of functioning while higher scores on the symptom and single-item scales indicate a higher level of symptoms. The QLQ-LC13 is a 13-item questionnaire designed to assess lung cancer-related symptoms and treatment side effects. The scales ranges from 1=not at all to 4=very much. The summation of scores range from 0 to 100, where higher scores represent increasing symptoms levels. scales.
Measure:Time to deterioration in European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) scores
Time Frame:On Day 1 of every cycle (each cycle is 21 days), and at end of treatment visit 40-day follow-up visit
Safety Issue:
Description:The EORTC QLQ-C30 consists of 30 questions assessing global health-related quality of life, five aspects of subject functioning (physical, emotional, role, cognitive, and social), three symptom scales (fatigue, nausea and vomiting, and pain), and six single-items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). All of the scales and single-item measures range in score from 0 to 100. Higher scores for functioning scales and global health status indicate a better level of functioning while higher scores on the symptom and single-item scales indicate a higher level of symptoms.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Daiichi Sankyo, Inc.

Trial Keywords

  • Non-small Cell Lung Cancer
  • Trastuzumab Deruxtecan

Last Updated

July 12, 2021