Advanced Non Small Cell Lung Cancer MedDRA version: 21.1 Level: PT Classification code 10029522 Term: Non-small cell lung cancer stage IV System Organ Class: 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Conditions
Interventions
Pharmaceutical Form: Powder for concentrate for solution for infusion
INN or Proposed INN: Pembrolizumab
Other descriptive name: Pembrolizumab
Concentration unit: mg milligram(s)
Concentration type: e
Sponsors
IFCT
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Signed Written Informed Consent: • Subjects must have signed and dated an IRB/IEC approved written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol related procedures that are not part of normal subject care. • Subjects must be willing and able to comply with scheduled visits, treatment schedule, and laboratory testing. 2. Patients with histologically confirmed metastatic NSCLC (Stage IV accordingly to 8th classification TNM, UICC 2015). A cytologically-proven NSCLC is allowed if a cytoblock has been prepared. 3. PD-L1 tumor content as assessed locally by the investigator center. 4. Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1. 5. Weight loss 3 months 9. Measurable tumor disease by CT or MRI per RECIST 1.1 criteria 10. The Investigator must confirm prior to enrolment that the patient has adequate tumor tissue available. Tumor biopsy should be exploitable for molecular analysis. Note: Tumor tissue collected after the patient was diagnosed with metastatic disease is preferred. Tumor tissue sample must not be from locations previously radiated. Tumor sample must be 1 block or at least 7 unstained slides of analyzable tissue. If archival tissue is either insufficient or unavailable, the patient may still be eligible upon discussion with IFCT. 11. Adequate biological functions: Creatinine Clearance = 45 mL/min (Cockroft or MDRD or CKD-epi); neutrophils= 1500/mm3 ; platelets =100 000/mm3 ; Hemoglobin= 9g/dL ; AST and ALT=65 years) yes F.1.3.1 Number of subjects for this age range 136
Exclusion criteria
Exclusion criteria: 1. Small cell lung cancer or tumors with mixed histology including a SCLC component. 2. Known EGFR activating tumor mutation (deletion LREA in exon 19, L858R ou L861X mutations in exon 21, G719A/S mutation in exon 18, exon 20 insertion) or HER2 exon 20 insertion (either tissue or plasma cfDNA mutation). 3. Known ALK, ROS1, Ret, NTRK, NRG1 gene rearrangement as assessed by immunohistochemistry, FISH or NGS (ADN or ARN) sequencing by local genetics and/or pathology laboratory. 4. Previous or active cancer within the previous 3 years (except for treated carcinoma in situ of the cervix, or basal cell skin cancer treated or not). Patients with a prostate adenocarcinoma history within the previous 3 years could be included in case of localized prostate cancer, with good prognostic factors according to d'Amico classification (=T2a, score de Gleason = 6 and PSA = 10 (ng/ml)) provided they were treated in a curative way (surgery or radiotherapy, without any chemotherapy). 5. Superior vena cava syndrome persisting despite VCS stenting. 6. Radiotherapy needed at initiation of tumour treatment, except bone palliative radiotherapy on a painful or compressive metastasis, respecting 1 week delay between the end of radiotherapy and the beginning of treatment 7. Symptomatic untreated brain metastasis (without previous whole brain radiotherapy or stereotactic ablative brain radiotherapy or without surgical resection). At least 2 weeks delay between the end of radiotherapy and the beginning of induction immunotherapy treatment should be respected. Asymptomatic brain metastasis, not needing corticosteroids greater than 10 mg prednisone equivalent daily or mannitol infusions, are allowed. 8. History of previous primary immunodeficiency, organ transplantation needing an immunosuppressive treatment, any immunosuppressive drug within 28 days before randomization date, or history of severe toxicity (grade 3/4) by immune mechanism linked to another immunotherapy treatment. 9. Systemic treatment with corticosteroids with greater dose than 10 mg prednisone equivalent daily, within 14 days before initiation of the immunotherapy induction. Inhaled, nasal or topic corticosteroids are allowed. 10. History of active autoimmune disease including but not limited to rheumatoid polyarthritis, myasthenia, autoimmune hepatitis, systemic Lupus, Wegener's granulomatosis, vascular thrombosis associated with antiphospholipid syndrome, Sjogren’s syndrome with interstitial pulmonary disease, recent Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis. Patients with type I diabetes, or hypothyroidy, or immune cutaneous disease (vitiligo, psoriasis, alopecia) or benign rheumatoid polyarthritis not needing any immunosuppressive systemic treatment, or benign sicca syndrome (Sjogren) without interstitial pulmonary disease, or history of past Guillain-Barre syndrome, totally reversible with no sequalae, no systemic immunosuppressive treatment during the last 20 years, are allowed to be included. 11. Active inflammatory intestinal disease (diverticulosis, Crohn disease, Hemorrhagic recto-colitis, coeliac disease) or any serious chronic intestinal disease with uncontrolled diarrhea. 12. Active uncontrolled infection including tuberculosis, known acute viral hepatitis B and C according to serological tests. Patients with serological sequalae of cured viral hepatitis are allowed to be included. Past primary pulmonary tuberculosis in youth does not consist of
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: To evaluate the efficacy of pembrolizumab or observation (squamous) ± pemetrexed (non-squamous carcinoma) after a 6-month induction treatment;Secondary Objective: To evaluate the tolerance of pembrolizumab or observation (squamous) ± pemetrexed (non-squamous carcinoma) after a 6-month induction treatment To evaluate the quality of life patient receiving pembrolizumab or observation (squamous) ± pemetrexed (non-squamous carcinoma) after a 6-month induction treatment To evaluate the efficacy of pembrolizumab or observation (squamous) ± pemetrexed (non-squamous carcinoma) after a 6-month induction treatment To evaluate the efficacy of pembrolizumab or observation (squamous) ± pemetrexed (non-squamous carcinoma) after a 6-month induction treatment according to the histological subtype squamous cell carcinoma vs. non-squamous To evaluate the efficacy of pembrolizumab or observation (squamous) ± pemetrexed (non-squamous carcinoma) after a 6-month induction treatment according to PD-L1 tumor level ;Primary end point(s): 18-month landmark OS from inclusion in both arms;Timepoint(s) of evaluation of this end point: 18 months from inclusion | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary end point(s): Incidence, nature, and severity of adverse events, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0) Change from baseline of EuroQol Quality of Life 5-Dimension 5-Level Scale (EQ-5D-5L) at all scheduled time points. Time until definitive HRQoL score deterioration using EORTC QLQ-C30/QLQ-LC13 questionnaire PFS from randomization at 6 months in both arms, as assessed according to RECIST1.1 by the investigators OS according to the histological subtype squamous cell carcinoma vs. non-squamous PFS from randomization at 6 months according to PD-L1 tumor level of expression in each arm with 1%, 1-49% and 50% cut-off OS and PFS according to PD-L1 tumor level of expression in each arm with 1%, 1-49% and 50% cut-off;Timepoint(s) of evaluation of this end point: From inclusion until end of trial | — |
Countries
France
Contacts
Public ContactContact
IFCT
Outcome results
None listed