A Prospective Study of Savolitinib Plus Docetaxel in Pretreated EGFR/ALK/ROS1/MET ex14m-wildtype Advanced NSCLC Patients With MET Overexpression (FirstMET)
This is a prospective, pilot, single-arm, single-center study exploring the efficacy and safety of savolitinib plus docetaxel as second-line therapy in patients with MET overexpressed, EGFR/ALK/ROS1/MET ex14m-wildtype advanced NSCLC. Participants will receive treatment of docetaxel (60 mg/m2, ivgtt, q3w) in combination with savolitinib (300mg or 200mg according to safety run-in recommendation, p.o., BID) after informed consent signed. Treatment will continue until either objective disease progression, unacceptable toxicity occurs, consent is withdrawn, other discontinuation criterion is met, or study completion.
• Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
• Provision of signed and dated, written ICF prior to any mandatory study specific procedures, sampling, and analyses.
• Female or males age ≥18 years at the time of signing the ICF.
• Histologically or cytologically confirmed locally advanced or metastatic EGFR/ALK/ROS1/MET ex14m-wildtype NSCLC.
• Has only received first line systemic treatment of non-targeted advanced NSCLC.
‣ Prior MET inhibitor therapy is not allowed.
⁃ At least 28 days since last treatment.
• MET overexpression as determined IHC on tumor tissue.
‣ MET overexpression by IHC, 3+ in ≥50% of tumor cells
⁃ Local IHC results are acceptable.
• WHO or Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 with no deterioration over the previous 2 weeks prior to baseline or day of first dosing and a minimum life expectancy of 12 weeks.
• At least 1 lesion that can be accurately measured at baseline as ≥10 mm in the longest diameter (except lymph nodes, which must have short axis ≥15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI) and is suitable for accurate repeated measurements.
• Adequate haematological function defined as:
‣ Haemoglobin ≥9 g/dL (no transfusion in the past 2 weeks).
⁃ Absolute neutrophil count ≥1.5×10\^9/L.
⁃ Platelet count ≥100,000/μL (no transfusion in the past 10 days)
⁃ Adequate liver function defined as:
∙ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 x the upper limit of normal (ULN) with total bilirubin (TBL) ≤ ULN
‣ OR TBL \>ULN to ≤1.5x ULN with ALT and AST ≤ ULN, alkaline phosphatase (ALP) ≤ 2.5x ULN
⁃ Adequate renal function defined as a serum creatinine \<1.5 times the institutional ULN OR a glomerular filtration rate ≥50 mL/min, as assessed using the standard methodology at the investigating centre (eg, Cockcroft-Gault, Modification of Diet in Renal Disease or Chronic Kidney Disease Epidemiology Collaboration formulae, ethylenediaminetetraacetic acid clearance or 24-hour urine collection). Confirmation of creatinine clearance is only required when creatinine is \>1.5 times ULN.
⁃ Adequate coagulation parameters, defined as:
‣ International Normalisation Ratio (INR) \<1.5 and activated partial thromboplastin time \<1.5 x ULN unless patients are receiving therapeutic anti coagulation which affects these parameters.
⁃ Patients with known tumor thrombus or deep vein thrombosis are eligible if clinically stable on low molecular weight heparin (LMWH) for ≥2 weeks.
⁃ Ability to swallow and retain oral medications.
⁃ Willingness and ability to comply with study and follow-up procedures.
⁃ Females of childbearing potential should be willing to use highly effective contraceptive measures, should not be breast feeding, and must have a negative pregnancy test if of childbearing potential or must have evidence of non-childbearing potential by fulfilling one of the following criteria at screening:
⁃ Post-menopausal is defined as aged more than 50 years and amenorrhoeic for at least 12 months following cessation of all exogenous hormonal treatments; women under the age of 50 years would be considered postmenopausal if they have been amenorrhoeic for 12 months or more following cessation of exogenous hormonal treatments and with LH and FSH levels in the post-menopausal range for the institution; or women with documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy.
⁃ Male patients with a female partner of childbearing potential should be willing to use barrier contraception during the study and for 6 months following discontinuation of study drug. Patients should refrain from donating sperm from the start of dosing until 6 months after discontinuing study treatment.