Clinical Trials /

Safety and Efficacy of Combining APL-101 With Frontline Osimertinib in Patients With EGFR-mutated Metastatic Non-small Cell Lung Cancer (NSCLC)

NCT04743505

Description:

In this study, patients with metastatic non-small cell lung cancer that is EGFR-mutated, who have received at least 8 and not more than 12 weeks of treatment with osimertinib without demonstrating disease progression, will receive APL-101 in combination with osimertinib until progression. Dosing of APL-101 will be escalated until the maximum tolerated dose is determined, at which point 10 additional patients will be enrolled at that dose in the expansion cohort.

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

Not yet recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Safety and Efficacy of Combining APL-101 With Frontline Osimertinib in Patients With EGFR-mutated Metastatic Non-small Cell Lung Cancer (NSCLC)
  • Official Title: Phase I/II Study Exploring the Safety and Efficacy of Combining APL-101 With Frontline Osimertinib in Patients With EGFR-mutated Metastatic Non-small Cell Lung Cancer (NSCLC)

Clinical Trial IDs

  • ORG STUDY ID: 202104039
  • NCT ID: NCT04743505

Conditions

  • Metastatic Non Small Cell Lung Cancer

Interventions

DrugSynonymsArms
APL-101Phase I Dose Level 1: APL-101 + Standard of Care Osimertinib
OsimertinibTagrissoPhase I Dose Level 1: APL-101 + Standard of Care Osimertinib

Purpose

In this study, patients with metastatic non-small cell lung cancer that is EGFR-mutated, who have received at least 8 and not more than 12 weeks of treatment with osimertinib without demonstrating disease progression, will receive APL-101 in combination with osimertinib until progression. Dosing of APL-101 will be escalated until the maximum tolerated dose is determined, at which point 10 additional patients will be enrolled at that dose in the expansion cohort.

Trial Arms

NameTypeDescriptionInterventions
Phase I Dose Level 1: APL-101 + Standard of Care OsimertinibExperimentalAPL-101 is an oral drug which will be administered on an outpatient basis at the assigned dose twice daily on Days 1 through 28 of each 28-day cycle Osimertinib is an oral drug which will be administered on an outpatient basis at a dose of 80 mg once daily on Days 1 through 28 of each 28-day cycle.
  • APL-101
  • Osimertinib
Phase I Dose Level 2: APL-101 + Standard of Care OsimertinibExperimentalAPL-101 is an oral drug which will be administered on an outpatient basis at the assigned dose twice daily on Days 1 through 28 of each 28-day cycle Osimertinib is an oral drug which will be administered on an outpatient basis at a dose of 80 mg once daily on Days 1 through 28 of each 28-day cycle.
  • APL-101
  • Osimertinib
Phase II: APL-101 + Standard of Care OsimertinibExperimentalAPL-101 is an oral drug which will be administered on an outpatient basis at the assigned dose (this dose will be determined in Phase I of the study) twice daily on Days 1 through 28 of each 28-day cycle Osimertinib is an oral drug which will be administered on an outpatient basis at a dose of 80 mg once daily on Days 1 through 28 of each 28-day cycle.
  • APL-101
  • Osimertinib

Eligibility Criteria

        Inclusion Criteria:

          -  Histologically confirmed metastatic non-small cell lung cancer with TKI-sensitive EGFR
             mutation through CLIA certified lab.

          -  Measurable disease by RECIST 1.1 with at least one lesion accessible for core biopsy.

          -  Planning to initiate treatment with standard of care osimertinib 80 mg QD. In order to
             continue treatment with osimertinib + APL-101, patients must have received at least 8
             and no more than 12 weeks of SOC osimertinib without disease progression.

          -  At least 18 years of age.

          -  ECOG performance status ≤ 1

          -  Normal bone marrow and organ function as defined below:

               -  Absolute neutrophil count ≥ 1,500/mcL

               -  Platelets ≥ 100,000/mcL

               -  Hemoglobin ≥ 9 g/dL (transfused Hgb allowed)

               -  Total bilirubin ≤ 1.5 mg/dL or ≤ 26 µmol/L

               -  AST(SGOT)/ALT(SGPT) ≤ 2.5 x institutional upper limit of normal (IULN) (≤ 5.0 x
                  IULN if liver metastases)

               -  Creatinine ≤2 x IULN or Creatinine clearance calculated by Cockcroft-Gault
                  formula ≥60 ml/min

               -  Serum calcium (after correcting for albumin level) ≤ IULN

               -  Serum phosphorus ≤ IULN

          -  The effects of APL-101 on the developing human fetus are unknown. For this reason,
             women of childbearing potential and men must agree to use adequate contraception
             (hormonal or barrier method of birth control, abstinence) prior to study entry and for
             the duration of study participation. Should a woman become pregnant or suspect she is
             pregnant while participating in this study, she must inform her treating physician
             immediately. Men treated or enrolled on this protocol must also agree to use adequate
             contraception prior to the study and for the duration of the study.

          -  Ability to understand and willingness to sign an IRB approved written informed consent
             document (or that of legally authorized representative, if applicable).

        Exclusion Criteria:

          -  Prior treatment with osimertinib in the metastatic setting (outside of osimertinib
             given immediately prior to and during the enrollment period). Prior treatment with
             chemotherapy in the neoadjuvant, adjuvant, or first-line metastatic setting is however
             allowed.

          -  Prior immunotherapy and/or frontline EGFR-directed treatment in the metastatic
             setting. EGFR directed therapy in the adjuvant setting is permitted, as long as the
             disease-free interval between completion of adjuvant therapy with EGFR directed
             therapy and initiation of osimertinib is more than or equal to 1 year.

          -  Disease refractory to osimertinib, given immediately prior to and during enrollment
             period.

          -  A history of other malignancy with the exception of:

               -  malignancies for which all treatment was completed at least 1 year before
                  registration and the patient has no evidence of disease; or

               -  known indolent malignancies, or malignancies that do not require active treatment
                  and are unlikely not alter the course of treatment of metastatic NSCLC per
                  treating physician.

          -  Currently receiving any other investigational agents or herbal medications

          -  Presence of symptomatic central nervous system metastases or neurologically unstable
             CNS symptoms (unable to taper steroids). Patients with treated brain metastases are
             eligible. Patients with asymptomatic brain metastases prior to initiation of
             osimertinib will be eligible to receive combination therapy as long as their disease
             is shown to be responsive to osimertinib.

          -  A history of allergic reactions attributed to compounds of similar chemical or
             biologic composition to APL-101, osimertinib, or other agents used in the study.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, immune deficiencies, hepatitis B, untreated hepatitis C, uncontrolled
             diabetes, uncontrolled hypertension, symptomatic congestive heart failure, unstable
             angina pectoris, myocardial infraction within the past 6 months, uncontrolled cardiac
             arrhythmia, or prolonged QTc interval > 450 ms.

          -  Uncontrolled or symptomatic pleural or pericardial effusion.

          -  Decompensated heart failure or heart failure with reduced ejection fraction (<50%)

          -  Major surgery within 30 days prior to first day of study treatment.

          -  Poorly controlled diarrheal or gastrointestinal disorders (grade 2 or higher diarrhea,
             nausea, or vomiting at baseline).

          -  Pregnant and/or breastfeeding. Women of childbearing potential must have a negative
             pregnancy test within 14 days of study entry.

          -  Unresolved grade 2 or higher treatment-related toxicities (with the exception of
             endocrine abnormalities as a result of immunotherapies that are being managed with
             hormonal supplementation). However, if the treating physician is under the impression
             that the toxicity under question is unlikely to affect study participation, patient
             eligibility can be discussed with the PI on a subject by subject basis. After
             enrollment to this study, osimertinib-related toxicities must resolve to ≤ grade 1
             before patient may begin combination therapy.

          -  Presence of interstitial lung disease
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Toxicity as measured by number of study treatment related adverse events (Phase I only)
Time Frame:Through 30 days after last dose of treatment (estimated to be 21 months)
Safety Issue:
Description:-Toxicity is measured by CTCAE v 5.0

Secondary Outcome Measures

Measure:Maximum tolerated dose of APL-101 (MTD) (Phase I only)
Time Frame:Through completion of cycle 1 (each cycle is 28 days) for all Phase I participants (estimated to be 19 months)
Safety Issue:
Description:The maximum tolerated dose (MTD) is defined as the dose level immediately below the dose level at which 2 patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity during the first cycle.
Measure:Objective response rate as measured by the proportion of participants achieving a confirmed complete response or partial response (Phase II only)
Time Frame:Through completion of treatment (estimated to be 20 months)
Safety Issue:
Description:Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Measure:Duration of response (DOR) (Phase II only)
Time Frame:Through completion of treatment (estimated to be 20 months)
Safety Issue:
Description:-Measured from the time measurement criteria are met for complete response, partial response or stable disease (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Measure:Overall survival (OS) (Phase II only)
Time Frame:Through 1 year follow-up
Safety Issue:
Description:-Overall survival (OS), defined as the duration of time from the start date of study treatment to death from any cause. Patients who are alive by the data cutoff date will be censored at the last follow up date.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Washington University School of Medicine

Last Updated

August 25, 2021