Carcinoma, Non-Small-Cell Lung
Conditions
Keywords
squamous cell, NSCLC, TKI, Erlotinib, Docetaxel, VeriStrat, protein signature
Brief summary
Using a laboratory test (VeriStrat), patients with relapsed squamous cell lung cancer are assigned to two strata, VSG (VeriStrat Good) and VSP (VeriStrat Poor). They are then randomized between an EGFR-TK inhibitor (erlotinib) and chemotherapy (Docetaxel). It is hypothesized that the VeriStrat test results are able to predict the benefit of treatment with erlotinib vs docetaxel. This would suggest a significant improvement in progression-free survival for VSG patients when treated with Erlotinib, and no significant improvement in VSP patients who receive the same treatment.
Detailed description
Goals of the study: 1. Explore the predictive ability of the VeriStrat signature, by testing for interaction between treatment arms (Arm A: erlotinib vs Arm B: docetaxel) and VeriStrat status (VSG vs VSP) using as outcome progression free survival. 2. Explore whether treatment with erlotinib provides progression free survival benefit as compared to docetaxel in the VSG group. 3. Compare progression free survival in the two treatment arms (Arm A: erlotinib vs Arm B: docetaxel) in the VSP group. 4. Explore the prognostic ability of the VeriStrat signature by testing for an overall difference in progression free survival between the two VeriStrat groups (in case of no significant interaction). 5. Explore the predictive ability of the VeriStrat signature using the secondary measures of clinical efficacy including overall survival, objective response rate, and disease control rate. 6. Compare overall survival, objective response rate and disease control rate between treatment groups separately in the VSG and VSP groups. 7. Explore the prognostic ability of the VeriStrat signature by testing for an overall difference in overall survival, objective response rate and disease control rate between the two VeriStrat groups (in case of no significant interaction). 8. Assess the safety and the tolerability of the two treatments separately in each VeriStrat group and overall. Recruitment period: 18 months Sample Size: 500
Interventions
DRUGErlotinib
Erlotinib 150 mg/day p.o. continuously with 21 days cycle.
DRUGDocetaxel
Docetaxel 75 mg/m2 as an IV infusion every 21 days.
Sponsors
ETOP IBCSG Partners Foundation
Biodesix, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically or cytologically confirmed locally advanced stage IIIB, not amenable to radical radiotherapy, or metastatic stage IV non-small cell lung cancer (NSCLC) of predominant squamous subtype, according to the 7th edition of the TNM classification, including M1a (separate tumor nodule in a contralateral lobe, tumor with pleural nodules or malignant pleural or pericardial effusion) and/or M1b (distant metastasis). * Progressive disease upon or after previous chemotherapy including at least one line of platinum-based chemotherapy. * Measurable or evaluable disease according to RECIST v1.1 (Appendix 2). * ECOG PS 0-2. * Age ≥ 18 years. * Adequate organ function, including: * Adequate bone marrow reserve: ANC \> 1.5 x 109/L, platelets \> 100 x 109/L. * Hepatic: bilirubin \<1.5 x ULN; AP, ALT \< 3.0 x ULN; AP, ALT \<5 x ULN is acceptable in case of liver metastasis. * Renal: calculated creatinine clearance \> 40 ml/min based on the Cockroft and Gault formula. * Signed and dated informed consent form. * Male and female patients with reproductive potential must use an approved contraceptive method, during the trial and 12 months thereafter. Female patients with reproductive potential must have a negative pregnancy test within 7 days prior to study registration. * Estimated life expectancy \>12 weeks. * Patient compliance and geographical proximity that allow adequate follow-up.
Exclusion criteria
* Evidence of other medical condition which would impair the ability of the patient to participate in the trial or might preclude therapy with trial drugs (e.g. unstable or uncompensated respiratory, cardiac, hepatic or renal disease, active infection, uncontrolled diabetes mellitus). * Previous treatment with any EGFR-TKI or docetaxel. * Documented brain metastases unless the patient has completed local therapy for central nervous system metastases and has been off corticosteroids for at least 14 days prior to study registration. * Documented presence of activating EGFR mutations, if the patient was tested for EGFR mutations. * Previous malignancy within the past 5 years with the exception of adequately treated cervical carcinoma in situ, breast cancer in situ or localized non-melanoma skin cancer. * Psychiatric disorder precluding understanding of information on trial related topics, giving informed consent, or interfering with compliance for oral drug intake. * Concurrent treatment with experimental drugs or other anti-cancer therapy treatment in a clinical trial within 21 days prior to study registration. * Known hypersensitivity to trial drugs or hypersensitivity to any other component of the trial drugs or any concomitant drugs contraindicated.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival | The combined run in period, treatment and follow-up for PFS is expected to extend the study duration to a total of 24 months. | Time from the date of randomization until documented progression or death without documented progression. Assessment of Progressive Disease (PD) based on Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) Target lesions:At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.(Note: the appearance of one or more new lesions is also considered progression). Non-target lesions:Unequivocal progression of existing non-target lesions. (Note:the appearance of one or more new lesions is also considered progression). To achieve 'unequivocal progression', there must be an overall level of substantial worsening in non-target disease such that,even in presence of SD or PR in target disease, the overall tumour burden has increased sufficiently |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | All patients will be followed for survival status every 12 weeks up to 24 months after the last patient is randomized | Defined as time from the date of randomization until death from any cause. |
| Objective Response | Same as primary outcome: 24 months | Objective response is defined as best overall response (CR or PR) across all assessment time-points according to RECIST Criteria 1.1 during the period from randomization to termination of trial treatment. |
| Disease Control | Same as primary outcome: 24 months | Disease control is defined as achieving objective response or stable disease for at least 6 weeks. |
| Number of Participants With Adverse Events | Same as primary outcome: 24 months | Adverse events classified according to NCI CTCAE version 4 |
Countries
Austria, Belgium, Denmark, Greece, Hungary, Ireland, Israel, Italy, Netherlands, Spain, Switzerland, United Kingdom
Contacts
STUDY_CHAIRSolange Peters, MD-PhD
Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
STUDY_CHAIREgbert Smit, MD-PhD
Vrije Universiteit VU, Medical Centre, 1007MB Amsterdam, The Netherlands
STUDY_CHAIRRolf Stahel, MD
Laboratory of Molecular Oncology, Clinic of Oncology, University Hospital Zürich, 8044 Zürich, Switzerland
Participant flow
Recruitment details
Discrepancy between nb of enrolled pts and nb of pts who started treatment,because 1 patient,who shouldn't have been included (exclusion criteria),was enrolled in the database by mistake.In the database patient's status couldn't be changed from "Enrolled" to "Ineligible",thus this patient considered enrolled,but was not included in efficacy cohort.
Participants by arm
| Arm | Count |
|---|---|
| A: Erlotinib Erlotinib in standard dose. Until progression (clinical or radiological) or unacceptable toxicity.
Erlotinib: Erlotinib 150 mg/day p.o. continuously with 21 days cycle. | 38 |
| B: Docetaxel Docetaxel in standard dose. Until progression (clinical or radiological) or unacceptable toxicity.
Docetaxel: Docetaxel 75 mg/m2 as an IV infusion every 21 days. | 42 |
| Total | 80 |
Baseline characteristics
| Characteristic | Total | A: Erlotinib | B: Docetaxel |
|---|---|---|---|
| Age, Continuous | 68.7 years | 66.7 years | 70.1 years |
| ECOG performance status 0 | 27 Participants | 12 Participants | 15 Participants |
| ECOG performance status 1 | 46 Participants | 24 Participants | 22 Participants |
| ECOG performance status 2 | 7 Participants | 2 Participants | 5 Participants |
| Sex: Female, Male Female | 14 Participants | 7 Participants | 7 Participants |
| Sex: Female, Male Male | 66 Participants | 31 Participants | 35 Participants |
| Smoking history Current | 28 Participants | 16 Participants | 12 Participants |
| Smoking history Former (>100 cigarettes & >12 months smoke-free) | 48 Participants | 20 Participants | 28 Participants |
| Smoking history Never | 4 Participants | 2 Participants | 2 Participants |
| VeriStrat status Good | 58 Participants | 28 Participants | 30 Participants |
| VeriStrat status Poor | 22 Participants | 10 Participants | 12 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 7 / 38 | 3 / 41 |
| other Total, other adverse events | 36 / 38 | 39 / 41 |
| serious Total, serious adverse events | 7 / 38 | 19 / 41 |
Outcome results
Primary
Progression-free Survival
Time from the date of randomization until documented progression or death without documented progression. Assessment of Progressive Disease (PD) based on Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) Target lesions:At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.(Note: the appearance of one or more new lesions is also considered progression). Non-target lesions:Unequivocal progression of existing non-target lesions. (Note:the appearance of one or more new lesions is also considered progression). To achieve 'unequivocal progression', there must be an overall level of substantial worsening in non-target disease such that,even in presence of SD or PR in target disease, the overall tumour burden has increased sufficiently
Time frame: The combined run in period, treatment and follow-up for PFS is expected to extend the study duration to a total of 24 months.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| A: Erlotinib | Progression-free Survival | 1.6 months |
| B: Docetaxel | Progression-free Survival | 3.0 months |
Secondary
Disease Control
Disease control is defined as achieving objective response or stable disease for at least 6 weeks.
Time frame: Same as primary outcome: 24 months
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| A: Erlotinib | Disease Control | Disease Control | 19 Participants |
| A: Erlotinib | Disease Control | No Disease Control | 19 Participants |
| B: Docetaxel | Disease Control | Disease Control | 24 Participants |
| B: Docetaxel | Disease Control | No Disease Control | 18 Participants |
Secondary
Number of Participants With Adverse Events
Adverse events classified according to NCI CTCAE version 4
Time frame: Same as primary outcome: 24 months
Population: One patient from the Docetaxel arm never started treatment.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| A: Erlotinib | Number of Participants With Adverse Events | Experienced AE/SAE | 36 Participants |
| A: Erlotinib | Number of Participants With Adverse Events | No AE/SAE | 2 Participants |
| A: Erlotinib | Number of Participants With Adverse Events | Experienced SAE | 7 Participants |
| B: Docetaxel | Number of Participants With Adverse Events | Experienced AE/SAE | 39 Participants |
| B: Docetaxel | Number of Participants With Adverse Events | No AE/SAE | 2 Participants |
| B: Docetaxel | Number of Participants With Adverse Events | Experienced SAE | 19 Participants |
Secondary
Objective Response
Objective response is defined as best overall response (CR or PR) across all assessment time-points according to RECIST Criteria 1.1 during the period from randomization to termination of trial treatment.
Time frame: Same as primary outcome: 24 months
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| A: Erlotinib | Objective Response | Partial response | 4 Participants |
| A: Erlotinib | Objective Response | Stable Disease | 15 Participants |
| A: Erlotinib | Objective Response | Progressive Disease | 17 Participants |
| A: Erlotinib | Objective Response | Non-Evaluable | 2 Participants |
| B: Docetaxel | Objective Response | Non-Evaluable | 4 Participants |
| B: Docetaxel | Objective Response | Partial response | 6 Participants |
| B: Docetaxel | Objective Response | Progressive Disease | 14 Participants |
| B: Docetaxel | Objective Response | Stable Disease | 18 Participants |
Secondary
Overall Survival
Defined as time from the date of randomization until death from any cause.
Time frame: All patients will be followed for survival status every 12 weeks up to 24 months after the last patient is randomized
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| A: Erlotinib | Overall Survival | 7.1 months |
| B: Docetaxel | Overall Survival | 7.1 months |