Clinical Trials /

Chemo-Immunotherapy Followed by Durvalumab and Ceralasertib in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer

NCT04699838

Description:

The primary objective of this single arm study is to estimate the progression free survival of previously-untreated patients with extensive stage small cell lung cancer. Patients will receive initial chemo-immunotherapy followed by maintenance therapy with durvalumab and oral ceralasertib.

Related Conditions:
  • Small Cell Lung Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Chemo-Immunotherapy Followed by Durvalumab and Ceralasertib in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer
  • Official Title: A Phase II Study of Chemo-Immunotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer (ES-SCLC) Big Ten Cancer Research Consortium BTCRC-LUN18-363

Clinical Trial IDs

  • ORG STUDY ID: BTCRC-LUN18-363
  • NCT ID: NCT04699838

Conditions

  • Extensive Stage Small Cell Lung Cancer

Interventions

DrugSynonymsArms
CisplatinCisplatin or Carboplatin + Etoposide + Durvalumab + Ceralasertib
CarboplatinCisplatin or Carboplatin + Etoposide + Durvalumab + Ceralasertib
EtoposideCisplatin or Carboplatin + Etoposide + Durvalumab + Ceralasertib
DurvalumabCisplatin or Carboplatin + Etoposide + Durvalumab + Ceralasertib
CeralasertibCisplatin or Carboplatin + Etoposide + Durvalumab + Ceralasertib

Purpose

The primary objective of this single arm study is to estimate the progression free survival of previously-untreated patients with extensive stage small cell lung cancer. Patients will receive initial chemo-immunotherapy followed by maintenance therapy with durvalumab and oral ceralasertib.

Trial Arms

NameTypeDescriptionInterventions
Cisplatin or Carboplatin + Etoposide + Durvalumab + CeralasertibExperimentalInitial Phase: Cycles 1-4 Cisplatin or Carboplatin: Day 1 Etoposide: Days 1-3 Durvalumab, 1500 mg: Day 1 q 3 weeks Maintenance Phase, Cycles 5+ Durvalumab, 1500 mg: Day 1 q 4 wks. Ceralasertib at 240mg po BID: Days 15-28
  • Cisplatin
  • Carboplatin
  • Etoposide
  • Durvalumab
  • Ceralasertib

Eligibility Criteria

        Inclusion Criteria:

          -  Written informed consent and HIPAA authorization for release of personal health
             information. NOTE: HIPAA authorization may be included in the informed consent or
             obtained separately.

          -  Age >= 18 years at the time of consent.

          -  ECOG Performance Status of 0-1 within 14 days prior to registration (Appendix A of
             Protocol).

          -  Histological or cytological confirmed small cell lung carcinoma

          -  Extensive stage disease

          -  Patient must be considered suitable to receive a platinum-based chemotherapy as 1st
             line treatment for ES-SCLC. Chemotherapy must contain either Carboplatin or Cisplatin
             in combination with Etoposide.

          -  Measurable disease according to RECIST v1.1 for solid tumors within 28 days prior to
             registration.

          -  Prior treatment must be completed within the following number of days prior to
             registration:

             --Palliative radiation: for painful bony lesion must be completed prior to
             registration and any bone marrow toxicity recovered. For patients who received WBRT,
             14 days washout is required prior to study therapy. Patient's must be off steroids
             without worsening of symptoms related to brain metastases. Patient should be on stable
             doses of anti-convulsant.

          -  Demonstrate adequate organ function as defined in the protocol; all screening labs to
             be obtained within 14 days prior to registration

          -  Female subjects of childbearing potential and non-sterilized male subjects who intend
             to be sexually active during the study must agree to use a highly effective method of
             contraception from the time of screening, throughout the total duration of the drug
             treatment, and during the 90-day post-drug washout period. See section 5.6.2.3 of the
             protocol for full details.

          -  Evidence of post-menopausal status or negative urinary or serum pregnancy test for
             female pre-menopausal patients. Women will be considered post-menopausal if they have
             been amenorrheic for 12 months without an alternative medical cause. The following
             age-specific requirements apply:

               -  Women <50 years of age would be considered post-menopausal if they have been
                  amenorrheic for 12 months or more following cessation of exogenous hormonal
                  treatments and if they have luteinizing hormone and follicle-stimulating hormone
                  levels in the post-menopausal range for the institution or underwent surgical
                  sterilization (bilateral oophorectomy or hysterectomy).

               -  Women ≥50 years of age would be considered post-menopausal if they have been
                  amenorrheic for 12 months or more following cessation of all exogenous hormonal
                  treatments, had radiation-induced menopause with last menses >1 year ago, had
                  chemotherapy-induced menopause with last menses >1 year ago, or underwent
                  surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or
                  hysterectomy).

          -  As determined by the enrolling physician or protocol designee, ability of the subject
             to understand and comply with study procedures for the entire length of the study

          -  Ability to swallow and retain oral medication

          -  Must have a life expectancy of at least 12 weeks

        Exclusion Criteria:

          -  Prior systemic therapy for extensive stage or recurrent SCLC

          -  Patients with recurrent SCLC, who received chemotherapy or definitive chest radiation
             in the past for limited-stage SCLC.

          -  Clinically significant active infection requiring systemic therapy

          -  Pregnant or breastfeeding (NOTE: breast milk cannot be stored for future use while the
             mother is being treated on study).

          -  Participants who have undergone major surgery within 28 days before first dose of
             study drug

          -  Participants who are currently receiving any other investigational agents

          -  Active malignancy requiring therapy other than small cell lung cancer, excluding:
             non-melanoma skin cancer, noninvasive colonic polyps, superficial bladder tumors,
             cervical cancer in-situ, ductal carcinoma in situ of the breast, monoclonal B-cell
             lymphocytosis, or monoclonal gammopathy of undetermined significance.

          -  Diagnosis of immunodeficiency or is receiving systemic steroid therapy (> 10 mg of
             prednisone or equivalent) or any other form of immunosuppressive therapy within 7 days
             prior to study enrolment. Patient's on physiologic corticosteroid replacement therapy
             for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic
             treatment. Topical, inhaled or intra-articular steroids are not considered as systemic
             steroids. Steroids as premedication for hypersensitivity reaction (e.g. CT scan
             premedication) or prior to chemotherapy is allowed.

          -  Active autoimmune or inflammatory disorders (including inflammatory bowel disease
             [e.g., colitis or Crohn's disease], systemic lupus erythematosus, or Wegener syndrome
             [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis,
             hypophysitis, uveitis, etc]). The following are exceptions to this criterion:

               -  Patients with vitiligo or alopecia

               -  Patients with hyperthyroidism or hypothyroidism (e.g., following Hashimoto
                  syndrome) clinically stable on hormone replacement

               -  Any chronic skin condition that does not require systemic immunosuppressive
                  therapy

               -  Patients with celiac disease controlled by diet alone

               -  Diabetes mellitus with or without insulin replacement therapy

          -  Has history of immune therapy related pneumonitis that required steroids

          -  Patients with untreated or symptomatic central nervous system (CNS) metastases or
             leptomeningeal carcinomatosis will be excluded. Previously-treated CNS metastases and
             have no requirement for steroids for at least 2- week prior to study entry is allowed.
             Anticonvulsant therapy at a stable dose is permitted. May have residual symptoms as
             new baseline. Brain imaging with either MRI (preferred) or CT with contrast must be
             performed on all subjects at screening to evaluate brain metastases.

          -  Known history of Hepatitis B (known positive HBV surface antigen (HBsAg) result),
             hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients
             positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction
             is negative for HCV RNA

          -  Known history of active tuberculosis

          -  History of allogeneic stem cell or solid organ transplant

          -  History of Ataxia telangiectasia

          -  Uncontrolled intercurrent illness including, but not limited to, serious and active
             uncontrolled infection, symptomatic congestive heart failure (NYHA class III-IV),
             active inflammatory bowel disease, unstable angina pectoris, uncontrolled seizures, or
             psychiatric illness/social situations that would limit compliance with study
             requirements

          -  Participants with a known hypersensitivity to durvalumab, ceralasertib or any
             excipient of the product

          -  Patients who have been vaccinated with live, attenuated vaccines within 4 weeks of
             first dose of study drug

          -  Refractory nausea and vomiting, chronic gastrointestinal diseases or previous
             significant bowel resection, with clinically significant sequelae that would preclude
             adequate absorption of ceralasertib.

          -  Patients weighing <= 30 Kg.

          -  Participants may not be receiving any medications or substances that are potent
             inhibitors or inducers of CYP3A4 (Appendix B of the protocol).

               -  There is a required wash-out period of 5 half-lives from such agents prior to
                  starting ceralasertib, or three weeks for St. John's Wort.

               -  For non-potent inhibitors or inducers of CYP3A4, the decision to allow a patient
                  to enroll on the study is per investigator best judgement. Note these include
                  common azole antifungals, macrolide antibiotics, and other medications listed in
                  the concomitant medications section. As part of the enrollment/informed consent
                  procedures, the patient will be counseled on the risk of interactions with other
                  agents, and what to do if new medications need to be prescribed or if the patient
                  is considering a new over-the-counter medicine or herbal product.

               -  Exposure of other drugs metabolized by CYP3A4 and/or CYP2B6 may be reduced and
                  additional monitoring may be required.

               -  The use of herbal supplements or 'folk remedies' (and medications and foods that
                  significantly modulate CYP3A activity) should be discouraged. If deemed
                  necessary, such products may be administered with caution and the reason for use
                  documented in the CRF.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression Free Survival (PFS)
Time Frame:From enrollment until the time of disease progression, assessed for a maximum of 24 months
Safety Issue:
Description:Progression free survival (PFS) is defined as the time from the initiation of treatment (C1D1) to the time when the criteria for disease progression is met as defined by RECIST v1.1 OR death due to any cause. The PFS is subject to right censoring due to loss to follow-up or at the end of study duration.

Secondary Outcome Measures

Measure:Time to disease progression
Time Frame:From enrollment until the time of disease progression,assessed for a maximum of 24 months
Safety Issue:
Description:Time to disease progression: Will be measured from C1D1 of treatment until the criteria for disease progression is met as defined by RECIST 1.1
Measure:Time to CNS Progression
Time Frame:From enrollment until the time of cns progression, assessed for a maximum of 24 months
Safety Issue:
Description:Time to CNS progression: Will be measured from C1D1 of treatment until the criteria for disease progression is met in the CNS (intracranial) by RANO criteria
Measure:Time to Systemic Progression
Time Frame:From enrollment until the time of systemic progression, assessed for a maximum of 24 months
Safety Issue:
Description:Time to Systemic progression: Will be measured from C1D1 of treatment until the criteria for systemic disease (extracranial) progression is met by RECIST 1.1
Measure:Progression free survival for maintenance therapy
Time Frame:From Cycle 5, Day 1 of maintenance therapy until disease progression, assessed for a maximum of 19 months
Safety Issue:
Description:Progression free survival for maintenance therapy: Will be measured from C5D1 of maintenance therapy until the criteria for disease progression is met as defined by RECIST 1.1
Measure:Objective response rate (ORR)
Time Frame:24 months
Safety Issue:
Description:Objective response rate (ORR): Will include complete response (CR) + partial response (PR) and will be determined as per RECIST1.1
Measure:Duration of Response
Time Frame:24 months
Safety Issue:
Description:Duration of Response: The period measured from the time that measurement criteria are met for complete or partial response (whichever status is recorded first) until the date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since treatment started).
Measure:Disease Control Rate
Time Frame:8 weeks from Cycle 1 Day 1
Safety Issue:
Description:Disease control rate: The disease control rate is the proportion of all subjects with stable disease (SD) for 8 weeks, or partial response (PR), or complete response (CR) according to RECIST v1.1, from the start of treatment until disease progression/recurrence (taking as reference for progressive disease the smallest measurements recorded since the start of treatment).
Measure:Overall Survival (OS)
Time Frame:24 months
Safety Issue:
Description:Overall survival: Will be measured from D1 to death from any cause
Measure:Toxicity Profile
Time Frame:24 months
Safety Issue:
Description:Describe the toxicity profile of durvalumab and ceralasertib combination therapy by the NCI Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Muhammad Furqan

Last Updated

June 30, 2021