Carcinoma, Non-Small-Cell Lung
Conditions
Keywords
Non-Small Cell Lung Cancer, NSCLC, Advanced Non-Small Cell Lung Cancer, Metastatic Non-Small Cell Lung Cancer, Lung Cancer, Erlotinib, Tarceva, MM-121, ErbB3, Her3, Epidermal Growth Factor Receptor, anti-ErbB3 human monoclonal antibody, ErbB3 antagonist
Brief summary
A Phase 1-2 study of MM-121 in combination with standard therapy for non-small cell lung cancer (NSCLC).
Detailed description
Phase 1: Patients with Non-Small Cell Lung Cancer (NSCLC) may be enrolled to evaluate the safety, tolerability and recommended Phase 2 dose of MM-121 in combination with standard therapy. Phase 2: Patients with Non-Small Cell Lung Cancer (NSCLC) may be enrolled to estimate the progression-free survival of the MM-121 + standard therapy.
Interventions
MM-121 (SAR256212) = intravenous solution
erlotinib = daily oral tablet
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients with locally advanced or metastatic non-small cell lung cancer. * Patients must be \>/= 18 years of age. * Patients must have adequate Performance Status (PS) as measured by ECOG and adequate end organ function.
Exclusion criteria
* Patients with a recent history (within 5 years) of another malignancy. * Patients who are pregnant or nursing. * Patients with clinically significant heart failure. * Patients with clinically significant eye or gastrointestinal abnormalities.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | From date of first dose to 30 days after termination, the longest 175 weeks | To establish the safety of escalating doses of MM-121 in combination with erlotinib in order to determine the recommended phase 2 dose of the combination for the second part of the study. Dose-escalation conducted using standard 3+3 model to determine maximum tolerated dose. Reports of Dose-Limiting Toxicities (DLTs) were assessed to determine the MTD. |
| Phase 1: Determine the Maximum Tolerated Dose Dependent on Reports of Dose-limiting Toxicities | From date of first dose to 30 days after termination, the longest 175 weeks | Using a 3+3 dose escalation model, the maximum tolerated dose was determined by assessing dose-limiting toxicities in each cohort. If 3 patients were treated and passed the observation window, escalation to the next cohort was initiated. If a DLT was reported, 3-4 additional patients were enrolled and observed. If a DLT was observed in the expanded cohort, this dose was considered to be the maximum tolerated dose. The maximum tolerated dose was defined at the cohort in which two dose-limiting toxicities were observed, or as the highest target dose tested in the absence of DLTs. The determined MTD was used as the recommended Phase 2 dose. |
| Phase 2: Progression-free Survival of the MM-121 + Erlotinib Combination | Time from first dose to date of progression, with a median of 8.1 weeks | This was a time-to-event measure using Progression-Free Survival (PFS) comparing MM-121 + erlotinib vs.erlotinib alone. Progression of disease is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. Progression free survival was defined as the number of weeks from the date of randomization to the date of death or progression. If neither death nor progression was observed during the study, PFS data was censored at the last non-progressive disease valid tumor assessment unless the patient was discontinued due to symptomatic deterioration. If this occurred, the patient was counted as having progressive disease (PD). |
Countries
Canada, Germany, South Korea, Spain, Taiwan, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Phase 1: MM-121 + Erlotinib Escalating doses of MM-121 + Erlotinib in patients with NSCLC | 33 |
| Phase 2: MM-121 + Erlotinib EGFR wild-type, EGFR-TKI naive patients randomized to receive:
MM-121 every other week at a dose of 20 mg/kg IV in combination with daily 100 mg erlotinib p.o. | 85 |
| Phase 2: Erlotinib EGFR wild-type, EGFR-TKI naive patients randomized to receive:
daily 150 mg erlotinib p.o. alone | 44 |
| Total | 162 |
Baseline characteristics
| Characteristic | Phase 1: MM-121 + Erlotinib | Phase 2: MM-121 + Erlotinib | Phase 2: Erlotinib | Total |
|---|---|---|---|---|
| Age, Continuous | 63.5 years STANDARD_DEVIATION 10.12 | 62.9 years STANDARD_DEVIATION 10.74 | 63.9 years STANDARD_DEVIATION 10.16 | 63.2 years STANDARD_DEVIATION 10.53 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 3 Participants | 1 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 31 Participants | 82 Participants | 43 Participants | 156 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 7 Participants | 6 Participants | 13 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 3 Participants | 2 Participants | 7 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 31 Participants | 74 Participants | 36 Participants | 141 Participants |
| Sex: Female, Male Female | 17 Participants | 35 Participants | 17 Participants | 69 Participants |
| Sex: Female, Male Male | 16 Participants | 50 Participants | 27 Participants | 93 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 85 / 85 | 44 / 44 | 33 / 33 |
| serious Total, serious adverse events | 40 / 85 | 18 / 44 | 16 / 33 |
Outcome results
Phase 1: Determine the Maximum Tolerated Dose Dependent on Reports of Dose-limiting Toxicities
Using a 3+3 dose escalation model, the maximum tolerated dose was determined by assessing dose-limiting toxicities in each cohort. If 3 patients were treated and passed the observation window, escalation to the next cohort was initiated. If a DLT was reported, 3-4 additional patients were enrolled and observed. If a DLT was observed in the expanded cohort, this dose was considered to be the maximum tolerated dose. The maximum tolerated dose was defined at the cohort in which two dose-limiting toxicities were observed, or as the highest target dose tested in the absence of DLTs. The determined MTD was used as the recommended Phase 2 dose.
Time frame: From date of first dose to 30 days after termination, the longest 175 weeks
Population: All participants treated in the Phase 1 dose-escalation portion of the study
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1 | Phase 1: Determine the Maximum Tolerated Dose Dependent on Reports of Dose-limiting Toxicities | NA dose level of MTD |
Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC.
To establish the safety of escalating doses of MM-121 in combination with erlotinib in order to determine the recommended phase 2 dose of the combination for the second part of the study. Dose-escalation conducted using standard 3+3 model to determine maximum tolerated dose. Reports of Dose-Limiting Toxicities (DLTs) were assessed to determine the MTD.
Time frame: From date of first dose to 30 days after termination, the longest 175 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 0 participants reporting DLTs |
| Cohort 2 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 0 participants reporting DLTs |
| Cohort 3 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 1 participants reporting DLTs |
| Cohort 4 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 1 participants reporting DLTs |
| Cohort 5 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 1 participants reporting DLTs |
| Cohort 6 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 0 participants reporting DLTs |
| Cohort 7 | Phase 1: To Determine the Recommended Phase 2 Dose of the MM-121 + Erlotinib Combination Based Upon Either the Maximum Tolerated Dose (MTD) or the Maximum Feasible Dose of the Combination in Patients With NSCLC. | 0 participants reporting DLTs |
Phase 2: Progression-free Survival of the MM-121 + Erlotinib Combination
This was a time-to-event measure using Progression-Free Survival (PFS) comparing MM-121 + erlotinib vs.erlotinib alone. Progression of disease is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. Progression free survival was defined as the number of weeks from the date of randomization to the date of death or progression. If neither death nor progression was observed during the study, PFS data was censored at the last non-progressive disease valid tumor assessment unless the patient was discontinued due to symptomatic deterioration. If this occurred, the patient was counted as having progressive disease (PD).
Time frame: Time from first dose to date of progression, with a median of 8.1 weeks
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1 | Phase 2: Progression-free Survival of the MM-121 + Erlotinib Combination | 8.1 weeks |
| Cohort 2 | Phase 2: Progression-free Survival of the MM-121 + Erlotinib Combination | 7.7 weeks |
To Explore the Utility of an EGFR Family Receptor-ligand (Heregulin, HRG) as a Predictor of Response to MM-121 and /or Erlotinib in Formalin Fixed (FFPE) Tumor Samples
Tumor tissue samples were obtained from patients prior to enrollment. Samples were analyzed using RNA-ISH for the expression of the biomarker, heregulin. Progression-free survival was assessed using RECIST v 1.1 to determine whether patients whose tumors express HRG have a lower PFS than those whose tumors do not express HRG, and to assess whether the addition of MM-121 to erlotinib can increase PFS in HRG-high patients.
Time frame: Time from first dose to date of progression, with a median of 8.1 weeks
Population: Patients with available tissue for heregulin testing
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1 | To Explore the Utility of an EGFR Family Receptor-ligand (Heregulin, HRG) as a Predictor of Response to MM-121 and /or Erlotinib in Formalin Fixed (FFPE) Tumor Samples | 1.9 months PFS |
| Cohort 2 | To Explore the Utility of an EGFR Family Receptor-ligand (Heregulin, HRG) as a Predictor of Response to MM-121 and /or Erlotinib in Formalin Fixed (FFPE) Tumor Samples | 1.7 months PFS |
| Cohort 3 | To Explore the Utility of an EGFR Family Receptor-ligand (Heregulin, HRG) as a Predictor of Response to MM-121 and /or Erlotinib in Formalin Fixed (FFPE) Tumor Samples | 2.3 months PFS |
| Cohort 4 | To Explore the Utility of an EGFR Family Receptor-ligand (Heregulin, HRG) as a Predictor of Response to MM-121 and /or Erlotinib in Formalin Fixed (FFPE) Tumor Samples | 1.6 months PFS |