Advanced Non Small Cell Lung Cancer, Advanced (Inoperable) Non Small Cell Lung Cancer
Conditions
Keywords
Oncology,, Non Small Cell Lung Cancer,, Metastatic,, EGFR sensitivity mutation,, T790M resistance mutation
Brief summary
This study will treat patients with advanced NSCLC who have already received at least one course of specific anti-cancer treatment but the tumour has started to re-grow following that treatment. This is the first time this drug has ever been tested in patients, and so it will help to understand what type of side effects may occur with the drug treatment, it will measure the levels of drug in the body, it will also measure the anti-cancer activity. By using these pieces of information together the best dose of this drug to use in further clinical trials will be selected.
Detailed description
A Phase I/II, Open-Label, Multicentre Study to Assess the Safety, Tolerability, Pharmacokinetics and Anti-tumour Activity of Ascending Doses of AZD9291 in Patients with Advanced Non Small Cell Lung Cancer who have Progressed Following Prior Therapy with an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Agent (AURA)
Interventions
DRUGAZD9291
Starting dose 20 mg, administered once daily. If tolerated subsequent cohorts will test increasing doses of AZD9291, until a maximum tolerated dose or maximum feasible dose is defined
Sponsors
AstraZeneca
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 130 Years
Healthy volunteers
No
Inclusion criteria
* Provision of signed and dated, written informed consent prior to any study specific procedures, sampling and analyses * Aged at least 18 years. Patients from Japan aged at least 20 years. * Histological or cytological confirmation diagnosis of Non Small Cell Lung Cancer (NSCLC). * Radiological documentation of disease progression while on a previous continuous treatment with an EGFR TKI e.g. gefitinib or erlotinib (with the exception of 1st line expansion cohort). In addition other lines of therapy may have been given. All patients must have documented radiological progression on the last treatment administered prior to enrolling in the study. * Patients (with the exception of 1st line expansion cohort) must fulfil one of the following: * Confirmation that the tumour harbours an EGFR mutation known to be associated with EGFR TKI sensitivity (including G719X, exon 19 deletion, L858R, L861Q) OR * Must have experienced clinical benefit from EGFR TKI, according to the Jackman criteria (Jackman et al 2010) followed by systemic objective progression (RECIST or WHO) while on continuous treatment with EGFR TKI. * Previous treatment with a single-agent EGFR TKI (e.g. gefitinib or erlotinib). * Females should be using adequate contraceptive measures, should not be breast feeding and must have a negative pregnancy test prior to start of dosing or evidence of non-child bearing potential. * Male patients should be willing to use barrier contraception. * For 1st Line expansion cohort ONLY, confirmation that the tumour is EGFRm+ve and have had no prior therapy for their advanced disease (for 1st line patients biopsy will be at time of diagnosis of advanced disease). * For dose expansion and extension cohorts, patients must also have confirmation of tumour T790M mutation status (confirmed positive or negative) from a biopsy sample taken after disease progression on the most recent treatment regimen (irrespective of whether this is EGFR TKI or chemotherapy). Prior to entry a result from the central analysis of the patient's T790M mutation status must be obtained. \- World Health Organisation (WHO) performance status 0-1 with no deterioration over the previous 2 weeks and a minimum life expectancy of 12 weeks.
Exclusion criteria
* Treatment with an EGFR TKI (erlotinib or gefitinib) within 8 days (approximately 5x half-life) of the first dose of study treatment. * Any cytotoxic chemotherapy, investigational agents or other anticancer drugs from the treatment of advanced NSCLC from a previous treatment regimen or clinical study within 14 days of the first dose of study treatment. * AZD9291 in the present study (ie, dosing with AZD9291 previously initiated in this study). * Any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, active bleeding diatheses, or active infection. * Past medical history of interstitial lung disease, drug-induced interstitial lung disease, radiation pneumonitis which required steroid treatment, or any evidence of clinically active interstitial lung disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) for Dose Expansion Population | RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 21 months (at time of analysis) | Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions. ORR is the percentage of patients with at least 1 visit response of CR or PR (by investigator assessment) that was confirmed at least 4 weeks later, prior to progression or further anti-cancer therapy. |
| Best Objective Response (BOR) for Dose Escalation Population | RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 25 months (at time of analysis) | Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions; Stable disease (SD): Neither sufficient shrinkage to qualify as a response nor sufficient growth to qualify as progression; Progressive Disease (PD): \>= 20% increase in the sum of diameters of TLs and an absolute increase in sum of diameters of \>=5mm (compared to the previous minimum sum) or progression of NTLs or a new lesion. Not evaluable (NE): TL response is missing and there is no evidence of progression of NTLs and no new lesions. BOR is the best response (by investigator assessment) a patient has achieved where the order of best to worst is CR, PR, SD, PD, NE prior to or at progression and prior to further anti-cancer therapy. |
| Objective Response Rate (ORR) for Extension Population | RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 12 months (at the time of analysis) | Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions. ORR is the percentage of patients with at least 1 visit response of CR or PR (by independent central review) that was confirmed at least 4 weeks later, prior to progression or further anti-cancer therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response (DoR) for Dose Expansion Population | RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 21 months (at time of analysis) | Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions. DoR was defined as the time from the date of first documented response (CR or PR that was subsequently confirmed) until the date of documented progression (PD) or death in the absence of disease progression (by investigator assessment). |
| Progression-Free Survival (PFS) for Dose Expansion Population | RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 21 months (at time of analysis) | Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Progressive Disease (PD): \>= 20% increase in the sum of diameters of TLs and an absolute increase in sum of diameters of \>=5mm (compared to the previous minimum sum) or progression of NTLs or a new lesion. PFS is the time from date of first dose until the date of PD (by independent central review) or death (by any cause in the absence of progression) regardless of whether the patient withdrew from AZD9291 therapy or received another anti-cancer therapy prior to progression. Patients who had not progressed or died at the time of analysis were censored at the time of the latest date of assessment from their last evaluable RECIST 1.1 assessment. |
| Best Objective Response (BOR) for 80mg AZD9291 Extension Population | RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 12 months (at the time of analysis) | Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions; Stable disease (SD): Neither sufficient shrinkage to qualify as a response nor sufficient growth to qualify as progression; Progressive Disease (PD): \>= 20% increase in the sum of diameters of TLs and an absolute increase in sum of diameters of \>=5mm (compared to the previous minimum sum) or progression of NTLs or a new lesion. Not evaluable (NE): TL response is missing and there is no evidence of progression of NTLs and no new lesions. BOR is the best response (by investigator assessment) a patient has achieved where the order of best to worst is CR, PR, SD, PD, NE prior to or at progression and prior to further anti-cancer therapy. |
Countries
Australia, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, United Kingdom, United States
Participant flow
Recruitment details
Patients recruited to different cohorts. Dose escalation cohort of pre-treated patients in 5 dose groups. Dose expansion cohort (pre-treated) in same 5 dose groups. First line patient cohort. 80mg tablet cohort of pre-treated patients. Japan-only cohort (EGFR T790M+ by cytology). Phase II extension cohort in pre-treated EGFR T790M+ patients.
Pre-assignment details
603 patients were enrolled and received treatment.
Participants by arm
| Arm | Count |
|---|---|
| AZD9291 80mg Extension Phase II dose extension cohort in pre-treated EGFR T790M mutation positive patients in AZD9291 80mg tablet. | 201 |
| Dose Escalation Pre-treated patient cohort in doses 20, 40, 80, 160 and 240mg AZD9291 capsule. | 31 |
| Dose Expansion Pre-treated EGFR T790M mutation positive (by central testing) patient cohort. Dose groups were expanded to include more patients. | 271 |
| First Line Cohort of patients receiving first-line treatment for EGFRm advanced NSCLC, in 80mg and 160mg AZD9291 capsule. | 60 |
| 80mg Tablet US-only cohort of pre-treated EGFR patients receiving the tablet formulation of AZD9291 (80 mg). | 12 |
| Japan Cytology Japan-only cohort of patients (EGFR T790M mutation status determined from cytology samples) receiving AZD9291 80 mg tablet. | 28 |
| Total | 603 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Overall Study | Death | 28 | 1 | 38 | 0 | 2 | 0 |
| Overall Study | Objective Disease Progression | 1 | 12 | 104 | 6 | 4 | 4 |
| Overall Study | Ongoing Study at Data Cut-off | 168 | 16 | 115 | 50 | 6 | 22 |
| Overall Study | Other (not specified) | 0 | 0 | 7 | 1 | 0 | 1 |
| Overall Study | Withdrawal by Subject | 4 | 2 | 7 | 3 | 0 | 1 |
Baseline characteristics
| Characteristic | AZD9291 80mg Extension | Dose Escalation | Dose Expansion | First Line | 80mg Tablet | Japan Cytology | Total |
|---|---|---|---|---|---|---|---|
| Age, Customized >=50-<65 Years | 86 Participants | 19 Participants | 142 Participants | 23 Participants | 6 Participants | 13 Participants | 289 Participants |
| Age, Customized <50 Years | 30 Participants | 3 Participants | 42 Participants | 8 Participants | 3 Participants | 3 Participants | 89 Participants |
| Age, Customized >=65-<75 Years | 64 Participants | 8 Participants | 59 Participants | 22 Participants | 3 Participants | 9 Participants | 165 Participants |
| Age, Customized >=75 Years | 21 Participants | 1 Participants | 28 Participants | 7 Participants | 0 Participants | 3 Participants | 60 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Asian | 114 Participants | 21 Participants | 160 Participants | 43 Participants | 4 Participants | 28 Participants | 370 Participants |
| Race/Ethnicity, Customized Black Or African American | 1 Participants | 0 Participants | 3 Participants | 0 Participants | 1 Participants | 0 Participants | 5 Participants |
| Race/Ethnicity, Customized Missing | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Not Reported | 4 Participants | 4 Participants | 11 Participants | 1 Participants | 0 Participants | 0 Participants | 20 Participants |
| Race/Ethnicity, Customized Other | 4 Participants | 1 Participants | 2 Participants | 1 Participants | 0 Participants | 0 Participants | 8 Participants |
| Race/Ethnicity, Customized White | 76 Participants | 5 Participants | 95 Participants | 14 Participants | 7 Participants | 0 Participants | 197 Participants |
| Sex: Female, Male Female | 133 Participants | 20 Participants | 167 Participants | 45 Participants | 8 Participants | 21 Participants | 394 Participants |
| Sex: Female, Male Male | 68 Participants | 11 Participants | 104 Participants | 15 Participants | 4 Participants | 7 Participants | 209 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 191 / 201 | 31 / 31 | 265 / 271 | 60 / 60 | 12 / 12 | 24 / 28 |
| serious Total, serious adverse events | 41 / 201 | 9 / 31 | 78 / 271 | 14 / 60 | 4 / 12 | 4 / 28 |
Outcome results
Primary
Best Objective Response (BOR) for Dose Escalation Population
Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions; Stable disease (SD): Neither sufficient shrinkage to qualify as a response nor sufficient growth to qualify as progression; Progressive Disease (PD): \>= 20% increase in the sum of diameters of TLs and an absolute increase in sum of diameters of \>=5mm (compared to the previous minimum sum) or progression of NTLs or a new lesion. Not evaluable (NE): TL response is missing and there is no evidence of progression of NTLs and no new lesions. BOR is the best response (by investigator assessment) a patient has achieved where the order of best to worst is CR, PR, SD, PD, NE prior to or at progression and prior to further anti-cancer therapy.
Time frame: RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 25 months (at time of analysis)
Population: All pre-treated EGFR T790M mutation positive (by central testing) patients who received at least one dose of AZD9291.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Dose Expansion | Best Objective Response (BOR) for Dose Escalation Population | Partial Response | 58.1 % of participants |
| Dose Expansion | Best Objective Response (BOR) for Dose Escalation Population | Stable disease | 19.4 % of participants |
| Dose Expansion | Best Objective Response (BOR) for Dose Escalation Population | Progressive disease | 16.1 % of participants |
| Dose Expansion | Best Objective Response (BOR) for Dose Escalation Population | Not evaluable | 6.5 % of participants |
Primary
Objective Response Rate (ORR) for Dose Expansion Population
Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions. ORR is the percentage of patients with at least 1 visit response of CR or PR (by investigator assessment) that was confirmed at least 4 weeks later, prior to progression or further anti-cancer therapy.
Time frame: RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 21 months (at time of analysis)
Population: All pre-treated EGFR T790M mutation positive (by central testing) patients who received at least one dose of AZD9291.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Expansion | Objective Response Rate (ORR) for Dose Expansion Population | 61.7 % of participants |
Primary
Objective Response Rate (ORR) for Extension Population
Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions. ORR is the percentage of patients with at least 1 visit response of CR or PR (by independent central review) that was confirmed at least 4 weeks later, prior to progression or further anti-cancer therapy.
Time frame: RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 12 months (at the time of analysis)
Population: All patients in the 80mg AZD9291 extension part of the study (second line or later, EGFR T790M mutation positive by central testing) who received at least one dose of AZD9291 and had measurable disease (by independent central review) at baseline.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Expansion | Objective Response Rate (ORR) for Extension Population | 61.3 % of participants |
Secondary
Best Objective Response (BOR) for 80mg AZD9291 Extension Population
Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions; Stable disease (SD): Neither sufficient shrinkage to qualify as a response nor sufficient growth to qualify as progression; Progressive Disease (PD): \>= 20% increase in the sum of diameters of TLs and an absolute increase in sum of diameters of \>=5mm (compared to the previous minimum sum) or progression of NTLs or a new lesion. Not evaluable (NE): TL response is missing and there is no evidence of progression of NTLs and no new lesions. BOR is the best response (by investigator assessment) a patient has achieved where the order of best to worst is CR, PR, SD, PD, NE prior to or at progression and prior to further anti-cancer therapy.
Time frame: RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 12 months (at the time of analysis)
Population: All patients in the 80mg AZD9291 extension part of the study (second line or later, EGFR T790M mutation positive by central testing) who received at least one dose of AZD9291 and had measurable disease (by investigator assessment) at baseline.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Dose Expansion | Best Objective Response (BOR) for 80mg AZD9291 Extension Population | Partial response | 70.1 % of participants |
| Dose Expansion | Best Objective Response (BOR) for 80mg AZD9291 Extension Population | Not evaluable | 0.5 % of participants |
| Dose Expansion | Best Objective Response (BOR) for 80mg AZD9291 Extension Population | Complete Response | 0.5 % of participants |
| Dose Expansion | Best Objective Response (BOR) for 80mg AZD9291 Extension Population | Stable disease | 22.9 % of participants |
| Dose Expansion | Best Objective Response (BOR) for 80mg AZD9291 Extension Population | Progressive disease | 6.0 % of participants |
Secondary
Duration of Response (DoR) for Dose Expansion Population
Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Complete Response (CR): Disappearance of all target and non-target lesions and no new lesions; Partial Response (PR): \>= 30% decrease in the sum of diameters of Target Lesions (compared to baseline) and no new lesions. DoR was defined as the time from the date of first documented response (CR or PR that was subsequently confirmed) until the date of documented progression (PD) or death in the absence of disease progression (by investigator assessment).
Time frame: RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 21 months (at time of analysis)
Population: All pre-treated EGFR T790M mutation positive (by central testing) patients who received at least one dose of AZD9291.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dose Expansion | Duration of Response (DoR) for Dose Expansion Population | 11.1 months |
Secondary
Progression-Free Survival (PFS) for Dose Expansion Population
Per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) assessed by MRI or CT: Progressive Disease (PD): \>= 20% increase in the sum of diameters of TLs and an absolute increase in sum of diameters of \>=5mm (compared to the previous minimum sum) or progression of NTLs or a new lesion. PFS is the time from date of first dose until the date of PD (by independent central review) or death (by any cause in the absence of progression) regardless of whether the patient withdrew from AZD9291 therapy or received another anti-cancer therapy prior to progression. Patients who had not progressed or died at the time of analysis were censored at the time of the latest date of assessment from their last evaluable RECIST 1.1 assessment.
Time frame: RECIST tumour assessments every 6 weeks from randomisation until objective disease progression, up to approximately 21 months (at time of analysis)
Population: All pre-treated EGFR T790M mutation positive (by central testing) patients who received at least one dose of AZD9291.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Dose Expansion | Progression-Free Survival (PFS) for Dose Expansion Population | 9.7 months |