Phase I Clinical Study to Assess Safety and Efficacy of Repotrectinib Combined With Osimertinib in Patients With Advanced, Metastatic EGFR Mutant NSCLC (TOTEM).

Who is this study for? Patients with Non-Small-Cell Lung Carcinoma
What treatments are being studied? Repotrectinib+Osimertinib
Status: Recruiting
Location: See all (4) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 1
SUMMARY

This is a Phase I study of repotrectinib in combination with osimertinib in patients with advanced or metastatic EGFR mutant non small cell lung cancer (NSCLC). The study will be conducted in 2 parts, Part Ia and Part Ib, and its purpose will be to find the incidence of dose-limiting toxicities (DLTs) as defined by the primary safety and tolerability endpoint. The Phase Ia study will also determine the impact of repotrectinib on osimertinib pharmacokinetics (PK) and the maximum tolerated dose (MTD), if reached, of repotrectinib given in combination with osimertinib and the recommended Phase II dose (RP2D). Dose escalation will be conducted according to a 'Rolling-6' based study design with 3 dose levels for repotrectinib: 80 mg once a day (QD), 160 mg QD or 160 mf QD during 14 days followed by 160 mg twice a day (BID); in combination with 80 mg QD of osimertinib. A total of 6 patients will be enrolled in each dose level cohort. In addition, this Phase Ib study will test early drug activity (efficacy) of the proposed combination treatment in an expansion cohort at the RP2D.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Patients of age ≥18.

• Histological or cytological confirmation of locally advanced or metastatic, non-squamous cell lung carcinoma (NSCLC) in patients who are not candidates for local curative treatment through radical surgery and/or radiotherapy.

• Stage IV, according to Tumor-nodes-metastasis (TNM) Version 8, including M1a (malignant effusion) or M1b (distant metastasis), or locally advanced disease for which there is no curative treatment (including patients who progress after chemoradiotherapy in Stage III disease).

• Patients must have been locally diagnosed with EGFR activating mutation (including exon 18, exon 19, exon 21 and mutation T790M) based on FDA approved test (or a local equivalent laboratory developed) test (LDT)). Confirmatory central review will be performed for all patients, in case of discrepancy on EGFR status, central review will prevail.

• Eastern cooperative oncology group (ECOG) performance status 0-1.

• Existence of measurable or evaluable disease (according to RECIST 1.1 criteria).

• Patients with asymptomatic central nervous system (CNS) metastases (treated or untreated) and/or asymptomatic leptomeningeal carcinomatosis are eligible to enroll if they satisfy the following criteria:

‣ Patients requiring steroids at a stable or decreasing dose (≤ 12 mg/day dexamethasone or equivalent) for at least 14 days are eligible. Patients on stable doses of levetiracetam (same dose for 14 days) are eligible to be enrolled.

⁃ A minimum of 14 days must have elapsed from the completion of whole brain radiation treatment (WBRT) before the start of treatment with repotrectinib, and all side effects (with the exception of alopecia) from WBRT are resolved to CTCAE grade ≤ 1.

• Having available tumor tissue samples, via a biopsy or surgical resection of the primary tumor or metastatic tumor tissue, within 60 days prior to the start of treatment.

• Life expectancy ≥12 weeks, as determined by a physician.

⁃ Adequate hematological function, defined as: absolute neutrophil count (ANC) \>1.5 x 109/L, platelet count \>100.0 x 109/L, and hemoglobin \>9.0 g/dL (transfusion allowed at baseline).

⁃ Adequate liver function, defined as: total bilirubin \<1.5 x upper limit of normal (ULN), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) \<2.5 x ULN.

⁃ Adequate renal function, defined as: calculated (Cockcroft-Gault formula) or measured creatinine clearance \>50 mL/min and proteinuria \<2+ (dipstick).

⁃ Ability to take part in all study procedures, per investigators.

⁃ Prior cytotoxic chemotherapy and prior immunotherapy (e.g., anti-PD-1, anti-programmed death ligand 1 (PDL1), anti-T cell immunoglobulin and mucin domain- containing protein 3 (TIM3), anti-OX40) for advanced or metastatic disease is allowed if:

∙ At the time of starting treatment with repotrectinib, at least 14 days or 5 half-lives (whichever is shorter) must have elapsed after discontinuation of prior therapy (or at least 42 days for prior nitrosoureas, mitomycin C, and liposomal doxorubicin).

‣ All side effects from prior treatments must have resolved to grade ≤ 1 (NCI CTCAE Version 5.0) with the exception of alopecia or other side effects that the investigator does not consider to be a risk to patient safety.

‣ Patients with advanced solid tumors harboring ALK, ROS1, neurotrophic tyrosine kinase (NTRK) 1, 2, or 3 rearrangements are eligible if at the time of starting treatment at least 14 days or 5 half-lives (whichever is shorter) have elapsed after discontinuation of prior therapy.

‣ There is no limit to the number of prior chemotherapies, immunotherapy, or TKI regimens.

⁃ All women of childbearing potential (WOCBP), must agree to use highly effective contraception methods during the study treatment period and for at least 2 months after the last dose of EGFR TKI. Male partners of female (WOCBP) patients agree to use condoms during the study and for 2 months after the last dose. Male patients with female partners of WOCBP should use condom protection for 6 months in addition to their female partner (WOCBP) using highly effective contraceptive methods for 4 months after the last dose. Sexually active men, and women of childbearing potential, who are unwilling to use a contraception method are not eligible for the study.

⁃ Provision of written informed consent, signed and dated by the patient and the investigator, before any study interventions are performed.

⁃ Part B expansion cohorts only (after the RP2D has been identified):

∙ Disease progression following osimertinib with no evidence of tertiary EGFR mutation (i.e., C797S) or MET amplification.

‣ Disease progression following first or second generation EGFR TKI (for example, erlotinib,gefitinib, afatinib, dacomitinib) regardless of T790M status.

Locations
Other Locations
Spain
Quiron Dexeus
RECRUITING
Barcelona
Hospital Universitario Gregorio Marañón
RECRUITING
Madrid
Hospital Regional Universitario de Málaga
RECRUITING
Málaga
Hospital Son Espases
RECRUITING
Palma
Contact Information
Primary
A responsible person designated by the sponsor
investigacion@mfar.net
0034934344412
Backup
Responsible person designated by the sponsor, Ph.D.
investigacion@mfar.net
0034934344412
Time Frame
Start Date: 2022-02-11
Estimated Completion Date: 2026-06
Participants
Target number of participants: 32
Treatments
Experimental: Advanced and/or metastatic EGFR mutant NSCLC
Eligible advanced and/or metastatic EGFR mutant NSCLC patients will receive the combination of osimertinib and repotrectinib.
Authors
Marga Majem Tarruella, Aitor Azkarate, Delvys Rodriguez Abreu
Sponsors
Leads: Instituto Oncológico Dr Rosell
Collaborators: Turning Point Therapeutics, Inc.

This content was sourced from clinicaltrials.gov

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