Clinical Trials /

Tiragolumab With Atezolizumab Plus Bevacizumab in Previously-Treated Advanced Non-squamous NSCLC

NCT04958811

Description:

To evaluate the efficacy of tiragolumab with atezolizumab and bevacizumab in previously-treated advanced non-squamous NSCLC.

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

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Tiragolumab With Atezolizumab Plus Bevacizumab in Previously-Treated Advanced Non-squamous NSCLC
  • Official Title: A Phase II Open-label Multi-cohort Study Evaluating the Efficacy of Tiragolumab With Atezolizumab Plus Bevacizumab in Previously-Treated Advanced Non-squamous NSCLC

Clinical Trial IDs

  • ORG STUDY ID: Study00003943
  • NCT ID: NCT04958811

Conditions

  • Non-squamous Non-small-cell Lung Cancer

Interventions

DrugSynonymsArms
TiragolumabTiragolumab plus atezolizumab and bevacizumab
AtezolizumabTiragolumab plus atezolizumab and bevacizumab
BevacizumabTiragolumab plus atezolizumab and bevacizumab

Purpose

To evaluate the efficacy of tiragolumab with atezolizumab and bevacizumab in previously-treated advanced non-squamous NSCLC.

Trial Arms

NameTypeDescriptionInterventions
Tiragolumab plus atezolizumab and bevacizumabExperimentalTiragolumab 600mg IV will be administered together with atezolizumab 1200mg IV and bevacizumab 15mg/kg IV every 3 weeks (q3w) until progressive disease or unacceptable toxicity.
  • Tiragolumab
  • Atezolizumab
  • Bevacizumab

Eligibility Criteria

        Inclusion Criteria:

          -  Signed Informed Consent Form (ICF)

          -  Age ≥ 18 years at time of signing ICF

          -  Ability to comply with the study protocol, in the investigator's judgment

          -  Histologically or cytologically confirmed advanced non-squamous NSCLC that is not
             amenable to definitive therapy

          -  Tumor PD-L1 expression (TPS ≥ 1%) (cohort A only)

          -  EGFR, ALK, ROS1 wild-type (cohort A only)

          -  Confirmed activating alteration in EGFR (cohort B only)

          -  Disease progression during or following treatment with anti-PD(L)1 containing therapy
             (cohort A only)

          -  Disease progression during or following treatment with appropriate EGFR TKI therapy
             (cohort B only)

          -  Measurable disease per RECIST v1.1

          -  Biopsy post-progression on anti-PD(L)1 (cohort A) or EGFR TKI therapy (cohort B)
             confirming non-squamous histology prior to study treatment initiation

          -  ECOG Performance Status of 0-2

          -  Adequate hematologic and end-organ function, defined by the following laboratory test
             results, obtained within 14 days prior to initiation of study treatment:

               -  ANC ≥ 1.0 x 10^9/L without granulocyte colony-stimulating factor support

               -  Lymphocyte count ≥ 0.5 x 10^9/L

               -  Platelet count ≥ 100 x 10^9/L without transfusion

               -  Hemoglobin ≥ 80 g/L (8 g/dL) - patients may be transfused to meet this criterion.

               -  AST, ALT, and alkaline phosphatase (ALP) ≤ 2.5 x upper limit of normal (ULN),
                  with the following exceptions: Patients with documented liver metastases: AST and
                  ALT ≤ 5 x ULN; Patients with documented liver or bone metastases: ALP ≤ 5 x ULN

               -  Serum bilirubin ≤ 1.5 x ULN with the following exception: Patients with known
                  Gilbert disease: serum bilirubin ≤ 3 x ULN

               -  Creatinine clearance ≥ 30 mL/min (calculated using the Cockcroft-Gault formula)

               -  For patients not receiving therapeutic anticoagulation: INR and aPTT ≤ 1.5 x ULN

          -  For patients receiving therapeutic anticoagulation: stable anticoagulant regimen
             defined as clinical stability on unchanged dose of therapeutic anticoagulation for ≥14
             days

          -  For women of childbearing potential: agreement to remain abstinent (refrain from
             heterosexual intercourse) or use contraceptive methods, and agreement to refrain from
             donating eggs, as defined below:

               -  Women must remain abstinent or use contraceptive methods with a failure rate of <
                  1% per year during the treatment period and for 6 months after the final dose of
                  study treatment. Women must refrain from donating eggs during this same period.

               -  A woman is considered to be of childbearing potential if she is postmenarchal,
                  has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with
                  no identified cause other than menopause), and has not undergone surgical
                  sterilization (removal of ovaries and/or uterus). The definition of childbearing
                  potential may be adapted for alignment with local guidelines or requirements.

               -  Examples of contraceptive methods with a failure rate of < 1% per year include
                  bilateral tubal ligation, male sterilization, hormonal contraceptives that
                  inhibit ovulation, hormone-releasing intrauterine devices, and copper
                  intrauterine devices.

               -  The reliability of sexual abstinence should be evaluated in relation to the
                  duration of the clinical trial and the preferred and usual lifestyle of the
                  patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or
                  post-ovulation methods) and withdrawal are not adequate methods of contraception.

          -  For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use
             contraceptive measures, and agreement to refrain from donating sperm, as defined
             below:

               -  With a female partner of childbearing potential who is not pregnant, men who are
                  not surgically sterile must remain abstinent or use a condom plus an additional
                  contraceptive method that together result in a failure rate of < 1% per year
                  during the treatment period and for 6 months after the final dose of bevacizumab
                  and 90 days after the final dose of tiragolumab. Men must refrain from donating
                  sperm during this this same period.

               -  With a pregnant female partner, men must remain abstinent or use a condom during
                  the treatment period and for 6 months after the final dose of bevacizumab and 90
                  days after the final dose of tiragolumab to avoid potential exposure to the
                  embryo.

               -  The reliability of sexual abstinence should be evaluated in relation to the
                  duration of the clinical trial and the preferred and usual lifestyle of the
                  patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or
                  post-ovulation methods) and withdrawal are not adequate methods of contraception.

        Exclusion Criteria:

          -  Prior treatment with anti-TIGIT antibody therapy

          -  Prior treatment with anti-PD(L)1 therapeutic antibodies for advanced NSCLC (cohort B
             only)

          -  Untreated or symptomatic CNS metastases

          -  History of leptomeningeal disease

          -  Active or history of clinically significant autoimmune disease that, in the opinion of
             the investigator, could compromise the health and safety of the patient if treated
             with investigational therapy. Notable exceptions include:

               -  Patients with a history of autoimmune-related hypothyroidism who are on
                  thyroid-replacement hormone.

               -  Patients with controlled Type 1 diabetes mellitus who are on an insulin regimen.

               -  Active or history of adrenal insufficiency on stable steroid regimen.

               -  Patients with eczema, psoriasis, lichen simplex chronicus, or vitiligo with
                  dermatologic manifestations only are eligible for the study provided all of
                  following conditions are met: disease is well controlled at baseline and requires
                  only low-potency topical corticosteroids; no occurrence of acute exacerbations of
                  the underlying condition requiring psoralen plus ultraviolet A radiation,
                  methotrexate, retinoids, biologic agents, oral calcineurin inhibitors, or
                  high-potency oral corticosteroids within the previous 12 months

          -  History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis
             obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of
             active pneumonitis on screening chest computed tomography (CT) scan. History of
             radiation pneumonitis in the radiation field (fibrosis) is permitted.

          -  Known active tuberculosis

          -  Current treatment with anti-viral therapy for HBV

          -  Positive EBV viral capsid antigen antibody (IgM) testing at screening. An EBV PCR test
             should be performed as clinically indicated to screen for acute infection or suspected
             chronic active infection. Patients with a positive EBV PCR test are excluded.

          -  Major surgical procedure, other than for diagnosis, within 4 weeks prior to initiation
             of study treatment, or anticipation of need for a major surgical procedure during the
             study

          -  History of malignancy other than NSCLC within 5 years prior to screening, with the
             exception of malignancies with a negligible risk of metastasis or death as assessed
             and confirmed by the study PI. Possible examples include: adequately treated carcinoma
             in situ of the cervix, non melanoma skin carcinoma, localized prostate cancer, ductal
             carcinoma in situ, or Stage I uterine cancer

          -  Severe infection within 3 weeks prior to initiation of study treatment, including, but
             not limited to, hospitalization for complications of infection (including COVID-19),
             bacteremia, or severe pneumonia

          -  Prior allogeneic stem cell or solid organ transplantation

          -  Any other disease, metabolic dysfunction, physical examination finding, or clinical
             laboratory finding that, in the view of the investigator, contraindicates the use of
             an investigational drug, may affect the interpretation of the results, or may render
             the patient at high risk from treatment complications

          -  Treatment with a live, attenuated vaccine within 4 weeks prior to initiation of study
             treatment, or anticipation of need for such a vaccine during study treatment or within
             5 months after the final dose of study treatment

          -  Prior immune-related adverse event resulting in permanent discontinuation of immune
             checkpoint blockade therapy including but not limited to anti-PD-1, anti-PD-L1 and
             anti-CTLA4 therapeutic antibodies (cohort A only) that, in the view of the
             investigator, could compromise health and safety of prospective patient if enrolled in
             the study

          -  Inadequately controlled hypertension (defined as systolic blood pressure > 150 mmHg
             and/or diastolic blood pressure > 100 mmHg). Anti-hypertensive therapy to achieve
             these parameters is allowable

          -  Prior history of hypertensive crisis or hypertensive encephalopathy

          -  Significant vascular and cardiovascular disease (e.g., New York Heart Association
             Class II or greater heart failure, unstable arrhythmia, aortic aneurysm requiring
             surgical repair or recent peripheral arterial thrombosis - including but not limited
             to myocardial infarction, transient ischemic attack, stroke or unstable angina) within
             6 months prior to study treatment initiation

          -  History of hemoptysis (≥ ½ teaspoon of bright red blood per episode) or clinically
             significant hemorrhage within 1 month of study treatment initiation

          -  Evidence of bleeding diathesis or significant coagulopathy (in absence of therapeutic
             anticoagulation)

          -  Current or recent (within 10 days of first dose of study treatment) use of aspirin
             (>325 mg/day) or treatment with dipyramidole, ticlopidine, clopidogrel, and cilostazol

          -  Core biopsy or other minor surgical procedure, excluding placement of a vascular
             access device, < 7 days prior to the first dose of study treatment

          -  History of abdominal or tracheoesophageal fistula or GI perforation within 6 months
             prior to treatment initiation

          -  Clinical signs or symptoms of GI obstruction

          -  Serious, non-healing or dehiscing wound, active ulcer, or untreated bone fracture

          -  Proteinuria, as demonstrated by urine dipstick or > 1.0 g of protein in a 24-hour
             urine collection. All patients with ≥ 2+ protein on dipstick urinalysis at baseline
             must undergo a 24-hour urine collection for protein

          -  Treatment with systemic immunosuppressive medication (including, but not limited to:
             corticosteroids, cyclophosphamide, azathioprine, methotrexate, thalidomide, and
             anti-TNF agents) within 2 weeks prior to initiation of study treatment, or
             anticipation of need for systemic immunosuppressive medication during study treatment,
             with the following exceptions:

               -  Patients who received acute, low-dose systemic immunosuppressant medication or a
                  one-time pulse dose of systemic immunosuppressant medication (e.g., 48 hours of
                  corticosteroids for a contrast allergy) are eligible for the study after PI
                  confirmation has been obtained.

               -  Patients who received mineralocorticoids (e.g., fludrocortisone), corticosteroids
                  for chronic obstructive pulmonary disease (COPD) or asthma, or low-dose
                  corticosteroids for orthostatic hypotension or adrenal insufficiency are eligible
                  for the study.

          -  Pregnancy or breastfeeding, or intention of becoming pregnant during study treatment
             or within 6 months after the final dose of study treatment. Women of childbearing
             potential must have a negative serum pregnancy test result within 14 days prior to
             initiation of study treatment.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Objective Response Rate (ORR)
Time Frame:Up to end of treatment (average 9 months)
Safety Issue:
Description:As defined by investigator-assessed ORR according to RECIST v1.1

Secondary Outcome Measures

Measure:Incidence of Treatment-Related Adverse Events
Time Frame:At the end of each cycle of therapy (every ~21 days)
Safety Issue:
Description:Incidence and severity of adverse events, with severity determined according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0)
Measure:Progression Free Survival (PFS)
Time Frame:Up to 5 years
Safety Issue:
Description:
Measure:6-month PFS rate
Time Frame:Up to 5 years
Safety Issue:
Description:
Measure:Duration of Response (DOR)
Time Frame:Up to 5 years
Safety Issue:
Description:
Measure:Overall Survival (OS)
Time Frame:Up to 5 years
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Georgetown University

Trial Keywords

  • Lung Cancer
  • Non-squamous Non-small-cell Lung Cancer

Last Updated

July 30, 2021