A Phase II Study of Neoadjuvant Sotorasib in Combination With Cisplatin or Carboplatin and Pemetrexed for Surgically Resectable Stage IIA-IIIB Non-Squamous Non-Small Cell Lung Cancer With a KRAS p.G12C Mutation

Who is this study for? Patients with surgically resectable stage IIA-IIIB non-squamous non-small cell lung cancer with a KRAS p.G12C mutation
What treatments are being studied? AMG 510+Cisplatin+Carboplatin+Pemetrexed
Status: Recruiting
Location: See all (2) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

This is a phase II, single-arm, open-label study evaluating the efficacy, safety and tolerability of neoadjuvant sotorasib in combination with cisplatin (or carboplatin) and pemetrexed chemotherapy for patients with surgically resectable stage IIA - IIIB (T3-T4/N2) (based on AJCC 8th edition), non-squamous NSCLC with a KRAS p.G12C mutation. The primary objective of the study is to determine whether neoadjuvant therapy with 4 cycles of at least one dose of sotorasib plus cisplatin (or carboplatin) and pemetrexed can be administered safely and result in improved MPR rate in patients with KRAS p.G12C-mutant non-squamous NSCLC compared with the historical control MPR rate for platinum-based chemotherapy alone.

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

• \[\*\] Subject or subject's legally acceptable representative has provided signed and dated written informed consent prior to initiation of any study specific activities/procedures in accordance with ICH-GCP guidelines and the local legislation.

• \[\*\]Age \> 18 years old.

• \[\*\]Histologically or cytologically confirmed previously untreated non-squamous non-small cell lung cancer. If a diagnostic biopsy is available, a pre-treatment biopsy is not required. Patients with a suspected lung cancer are eligible, but pathology must be confirmed prior to initiating treatment on study. Pure squamous cell carcinomas are not eligible but mixed histologies (for example adenosquamous carcinoma) are eligible. Sarcomatoid carcinomas are not eligible.

• Neuroendocrine carcinomas are not eligible. Carcinomas with neuroendocrine differentiation are eligible. Patients with mixed small-cell lung cancer and NSCLC are not eligible.

• Identification of a KRAS p.G12C mutation in tumor tissue or plasma by an approved diagnostic device for detection of KRAS p.G12C in NSCLC or through any nucleic acid-based diagnostic testing method \[including droplet-digital PCR, real-time PCR based methods such as the Idylla KRAS Mutation Assay (Biocartis), tissue and circulating tumor DNA -based next generation sequencing, Sanger-sequencing etc\] performed in a Clinical Laboratory Improvement Amendments (CLIA)-certified or equivalently accredited laboratory. Patients meeting \[\*\] highlighted criteria will be offered study-provided droplet digital PCR or alternative PCR-based method such as the Idylla KRAS Mutation Assay (Biocartis) for detection of KRAS p.G12C using tumor tissue (1st choice if adequate tissue is available) or plasma (if tumor tissue is not available or cannot be accessed within 5 working days). Turnaround time for reporting of the presence or absence of a KRAS p.G12C mutation will be ≤ 5 working daysfor plasma-based testing and ≤7 working days from the date of confirmation of tissue availability for tissue-based testing. If analysis of tumor tissue fails due to technical reasons, the same patient can undergo analysis of circulating tumor DNA using droplet-digital PCR or alternative PCR-based method such as the Idylla KRAS Mutation Assay (Biocartis). If plasma-based analysis failes to detect a KRAS p.G12C mutation and tumor tissue becomes available, the same patient can undergo analysis of tumor tissue using droplet digital PCR or alternative PCR-based method such as the Idylla KRAS Mutation Assay (Biocartis).

• Patients with disease stage IIA to select stage IIIB (T3-4N2) (according to version 8 of the International Association for the Study of Lung Cancer Staging Manual in Thoracic Oncology \[IASLC Staging Manual in Thoracic Oncology 2016\]). Patients with multistation N2 disease are eligible provided that complete surgical resection is considered feasible by multidisciplinary evaluation which must include a thoracic surgeon that performs lung cancer surgery as a prominent part of his/her practice Invasive mediastinal staging with endosonography (EBUS or EUS) with fine-needle aspiration (FNA) and/or mediastinoscopy should be completed within 42 days from the start of treatment in the following cases:

‣ In case of mediastinal lymph nodes that are enlarged by CT criteria and/or PET-positive mediastinal lymph nodes.

⁃ In case of tumors \> 3 cm in maximum diameter

⁃ In case of centrally located tumors

⁃ For tumors with N1 nodes (cN1) Invasive mediastinal staging should include evaluation of contralateral stations 2 and/or 4 to exclude N3 disease as well as of subcarinal (station 7) lymph nodes. When there are no enlarged mediastinal lymph nodes by CT criteria and there is no uptake on PET/CT (cN0) direct surgical resection with lymph node dissection is indicated for tumors ≤ 3cm that are located in the outer third of the lung.

• \[\*\] Absence of unequivocal evidence of stage IV disease based on contrast-enhanced CT chest, abdomen, pelvis or PET/CT and brain MRI with IV contrast (or contrast-enhanced CT of the head) performed within 60 days is sufficient for study registration but must be confirmed with whole-body PET/CT as well as contrast-enhanced CT chest and abdomen (or contrast-enhanced CT chest including the whole liver and both adrenal glands) and brain MRI with IV contrast (or contrast-enhanced CT of the head) within 28 days prior to the start of treatment. Patients with lesions that are considered equivocal for metastatic disease in the opinion of the local principal investigator are elibile to register and undergo molecular testing if they meet all other \[\*\] marked criteria but must meet the full trial eligibility criteria prior to study enrollment. In patients with severe allergy to iodinated contrast absence of stage IV disease on PET/CT and brain MRI with IV contrast performed within 28 days prior to enrollment suffices to satisfy this eligibility criterion.

• \[\*\]Measurable disease based on RECIST 1.1 as determined by the local site investigator/radiology assessment.

• \[\*\]The patient must be a suitable candidate for surgery, in the opinion of the treating physician.

• \[\*\]ECOG performance status score 0-1and life expectancy \> 3 months (in the opinion of the investigator).

⁃ \[\*\]Patients must be able to take oral medications and willing to record daily adherence to investigational product.

⁃ Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) ≤ 470 msec in females and QTcF ≤ 450 msec in males (based on average of screening triplicates performed within 5 minutes).

⁃ Subjects must have available (or accessible) and be willing to provide archival tumor tissue samples (formalin-fixed paraffin-embedded \[FFPE\] sample \[FFPE of excisional biopsy, core needle biopsy or fine needle aspirates\] collected within 5 years) or be willing to undergo pretreatment tumor biopsy (excisional, core needle, or fine needle aspirates) prior to enrollment.

⁃ Subjects who do not have archived tissue available can be allowed to enroll without undergoing tumor biopsy upon agreement with the overall study PI if a tumor biopsy is not feasible.

⁃ Patients must have adequate hematologic laboratory assessments, defined as the following within 10 days prior to start of study therapy:

• Absolute neutrophil count (ANC) ≥ 1500 cells/µl (without granulocyte colony-stimulating factor support within 10 days of laboratory test used to determine eligibility).

∙ Hemoglobin ≥ 9.0 g/dL (without transfusion within 2 weeks of laboratory test used to determine eligibility).

∙ Platelet count ≥ 100,000/µl (without transfusion within 2 weeks of laboratory test used to determine eligibility).

⁃ Prothrombin time (PT)≤1.5 x ULN or International normalized ratio (INR) ≤1.5 x ULN (or within the target range if on prophylactic anticoagulation therapy) and (activated) partial thromboplastin time (PTT or aPTT)≤1.5 x ULN unless the patient is receiving therapeutic anticoagulation in which case they should be within therapeutic target limits.

⁃ Patients must have adequate liver function, defined as the following:

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 times the upper limit of normal (ULN), except if alkaline phosphatase \> 2.5 times the ULN in which case AST and/or ALT must be ≤ 1.5 times the ULN.

∙ Serum bilirubin ≤ 1.0 x ULN, except in subjects with Gilbert Syndrome, who can have total bilirubin \< 2.0 mg/dL.

⁃ Subjects must have calculated creatinine clearance ≥ 60 mL/min (based on the Cockroft-Gault formula1 ), using actual body weight. Twenty-four hour urine collection for calculation of creatinine clearance is not required but is allowed

Locations
United States
New York
Memorial Sloan Kettering Cancer Center
RECRUITING
New York
Texas
M D Anderson Cancer Center
RECRUITING
Houston
Contact Information
Primary
Ferdinandos Skoulidis, MD,PHD
fskoulidis@mdanderson.org
(713) 792-6363
Time Frame
Start Date: 2022-03-30
Estimated Completion Date: 2025-10-20
Participants
Target number of participants: 27
Treatments
Experimental: Sotorasib in Combination with Cisplatin/Carboplatin and Pemetrexed
4 cycles of at least one dose of sotorasib plus cisplatin (or carboplatin) and pemetrexed can be administered safely
Sponsors
Leads: M.D. Anderson Cancer Center
Collaborators: Amgen

This content was sourced from clinicaltrials.gov

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