Non-small Cell Lung Cancer Stage IV
Conditions
Keywords
NSCLC
Brief summary
This is a single arm, open label, Phase II study in KRAS-positive and KRAS-negative patients with stage IV (including pleural effusion) non squamous NSCLC who have failed two lines of anti-cancer therapy. A maximum of 60 evaluable patients with NSCLC will receive antroquinonol, of which 30 patients will be KRAS-positive and 30 patients KRAS-negative. An evaluable patient will have received at least one dose of antroquinonol and have a valid baseline tumor assessment. Enrollment will continue until the target number of evaluable patients has been enrolled.
Detailed description
1. Progression free survival rate at 12 weeks, defined as the proportion of patients alive and progression free at Week 12. Patients will be progression free if they have no tumor assessments of progressive disease (defined according to RECIST guidelines, version 1.1) at any point from the start of treatment to Week 12. 2. Objective response rate (ORR), defined as the proportion of patients whose best overall response is either CR or PR according to RECIST version 1.1. The best overall response is the best response recorded during the first 12 week treatment cycle. 3. Disease control rate (DCR), defined as the proportion of patients with a documented CR, PR and SD during the first 12 week treatment cycle according to RECIST version 1.1. 4. Duration of overall tumor response (DR), defined as the interval between the date of the first observation of tumor response (CR or PR) and the date of disease progression or death. 5. Progression free survival defined as the time from randomization to objective tumor progression by RECIST version 1.1 or death due to any cause, whichever occurs first. 6. Overall survival (OS) defined as the time from randomization to death from any cause. 7. Time to progression (TTP) defined as the time from randomization to objective tumor progression by RECIST version 1.1.
Interventions
DRUGAntroquinonol
patients will receive one 12 week cycle of antroquinonol 200 mg t.i.d. or until disease progression, unacceptable toxicity, non compliance or withdrawal of consent by the patient, or the investigator decides to discontinue treatment, whichever comes first.
Sponsors
ICON Clinical Research
Golden Biotechnology Corporation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Cytologically or histologically confirmed non squamous NSCLC Stage IV (including pleural effusion). * Radiologically confirmed disease progression following two previous lines of anti-cancer therapy, one of which should be a platinum based regimen, OR the patient has refused treatment with approved treatment modalities * At least one radiologically measurable target lesion per RECIST version 1.1 * Fresh or archival biopsy tissue available to determine tumor mutation status * Written informed consent that is consistent with International Conference on Harmonisation Tripartite Guideline on Good Clinical Practice guidelines * Patient or legally acceptable representative has granted written informed consent before any study specific procedures (including special Screening tests) are performed * Eastern Cooperative Oncology Group (ECOG) performance score of 0, 1 or 2 * Hemoglobin ≥ 9.0 g/dL; platelets ≥ 100 x 109/L; absolute neutrophil count ≥ 1.5 x 109/L without the use of hematopoietic growth factors * Bilirubin and creatinine less than 2 × upper limit of normal (ULN) for the institution * Albumin ≥ 2.5 mg/dL * Aspartate aminotransferase and alanine aminotransferase less than 5 × ULN for the institution * Prothrombin time less than 1.5 × ULN for the institution * Potassium, magnesium and phosphorus within the normal range for the institution (supplementation is permissible) * Recovery to Grade 1 or baseline of any toxicities due to prior treatments, excluding alopecia
Exclusion criteria
* Chemo-, hormone- or immunotherapy, within 4 weeks or within less than four half lives of the date of first administration of study drug and/or persistence of toxicities of prior anti-cancer therapies which are deemed to be clinically relevant * Radiotherapy within the past 2 weeks prior to date of first administration of study drug * Previous treatment with an histone deacetylase inhibitor or an epidermal growth factor receptor inhibitor within at least 4 weeks of the date of first administration of study drug * Treatment with any drug(s) known to be an inhibitor or inducer of cytochrome P450 (CYP)2C19, CYP3A4, CYP2C8, and CYP2E1, within 14 days of the date of first administration of study drug * Brain metastases, which are symptomatic; patients with treated, brain metastases are eligible with stable brain disease for at least 4 weeks without the requirement for steroids or anti epileptic therapy * Inability to swallow oral medications or a recent acute gastrointestinal disorder with diarrhea e.g., Cohn's disease, malabsorption, or Common Terminology Criteria for Adverse Event (CTCAE) Grade \> 2 diarrhea of any etiology at baseline * Other malignancies diagnosed within the past five years (other than curatively treated cervical cancer in situ), non melanoma skin cancer, superficial bladder tumors Ta (non invasive tumor) and TIS (carcinoma in situ) * Patients with any serious active infection (i.e., requiring an intravenous antibiotic, antifungal, or antiviral agent) * Patients with known human immunodeficiency virus, active hepatitis B or active hepatitis C * Patients who have any other life threatening illness or organ system dysfunction, which in the opinion of the investigator, would either compromise patient safety or interfere with the evaluation of the safety of the study drug * Known or suspected substance abuse or alcohol abuse * Pregnancy or breast feeding * History of clinically significant or uncontrolled cardiac disease, including congestive heart failure, angina, myocardial infarction, arrhythmia, including New York Heart Association functional classification of three
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival Rate | 12 weeks | Tumor response will be assessed at 6 week intervals during the first treatment cycle using the RECIST criteria, version 1.1. Each patient will be assigned one of the following categories: 1) complete response (CR), 2) partial response (PR), 3) stable disease (SD), or 4) progressive disease (PD). Patients who died from any cause or discontinued the study for any reason without a post screening or Week 12 tumor assessment will be considered as failing to respond to treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cmax | 8 hours | PK sampling will be performed on Days 0 and 28 in all patients enrolled in Stage 1.PK endpoints will be derived for intensively sampled PK profiles by non compartmental methods and include: Cmax: peak concentration;Ctrough: trough plasma concentration. |
| Disease Control Rate (DCR) | 12 weeks | the proportion of patients with a documented CR, PR and SD during the first 12 week treatment cycle according to RECIST version 1.1. |
| T½: the Time Required for a Quantity to Reduce to Half Its Initial Value | 8 hours | PK sampling will be performed on Days 0 and 28 in all patients enrolled in Stage 1.PK endpoints will be derived for intensively sampled PK profiles by T½: terminal half life |
Other
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) | 12 weeks | Defined as the proportion of patients whose best overall response is either CR or PR according to RECIST version 1.1. The best overall response is the best response recorded during the first 12 week treatment cycle. |
| Overall Survival | up to week 48 | the time from the date of first administration of study drug to death from any cause |
Countries
Taiwan, United States
Participant flow
Recruitment details
Unselected KRAS-positive and KRAS-negative patients with stage IV (including pleural effusion) non squamous NSCLC and radiologically-confirmed disease progression following greater than or equal to two, but less than or equal to four, prior lines of systemic anti cancer therapy.
Pre-assignment details
Written informed consent was obtained from all patients before initiating screening. The screening period was up to 42 days in duration (Days 42 to 1) for K-Ras testing result, if no history k-Ras result.
Participants by arm
| Arm | Count |
|---|---|
| K-Ras Negative Fresh or archival biopsy tissue to determine KRAS is not mutant. Patients will receive one 12 week cycle of antroquinonol 200 mg t.i.d. or until disease progression. | 15 |
| K- Ras Mutant Fresh or archival biopsy tissue to determine KRAS is mutant. Patients will receive one 12 week cycle of antroquinonol 200 mg t.i.d. or until disease progression. | 15 |
| Total | 30 |
Baseline characteristics
| Characteristic | K-Ras Negative | K- Ras Mutant | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 9 Participants | 12 Participants | 21 Participants |
| Age, Categorical Between 18 and 65 years | 6 Participants | 3 Participants | 9 Participants |
| ECOG performance status Capable of all selfcare more than 50% work | 1 Participants | 2 Participants | 3 Participants |
| ECOG performance status Fully active | 10 Participants | 1 Participants | 11 Participants |
| ECOG performance status Restricted in physically strenuous activity | 4 Participants | 12 Participants | 16 Participants |
| Race/Ethnicity, Customized Asian | 8 Participants | 1 Participants | 9 Participants |
| Race/Ethnicity, Customized Black or African American | 1 Participants | 1 Participants | 2 Participants |
| Race/Ethnicity, Customized White | 6 Participants | 13 Participants | 19 Participants |
| Region of Enrollment Taiwan | 8 Participants | 1 Participants | 9 Participants |
| Region of Enrollment United States | 7 Participants | 14 Participants | 21 Participants |
| Sex: Female, Male Female | 4 Participants | 7 Participants | 11 Participants |
| Sex: Female, Male Male | 11 Participants | 8 Participants | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 14 / 31 |
| other Total, other adverse events | 31 / 31 |
| serious Total, serious adverse events | 12 / 31 |
Outcome results
Primary
Progression Free Survival Rate
Tumor response will be assessed at 6 week intervals during the first treatment cycle using the RECIST criteria, version 1.1. Each patient will be assigned one of the following categories: 1) complete response (CR), 2) partial response (PR), 3) stable disease (SD), or 4) progressive disease (PD). Patients who died from any cause or discontinued the study for any reason without a post screening or Week 12 tumor assessment will be considered as failing to respond to treatment.
Time frame: 12 weeks
Population: Defined as the proportion of patients alive and progression free at Week 12.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Progression-free Survival Rate/KRAS Negative Group | Progression Free Survival Rate | 4 Participants |
| Progression-free Survival Rate/KRAS Mutant Group | Progression Free Survival Rate | 0 Participants |
Secondary
Cmax
PK sampling will be performed on Days 0 and 28 in all patients enrolled in Stage 1.PK endpoints will be derived for intensively sampled PK profiles by non compartmental methods and include: Cmax: peak concentration;Ctrough: trough plasma concentration.
Time frame: 8 hours
Population: There were 22 patients with reported concentration data who were eligible for the PK population.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Progression-free Survival Rate/KRAS Negative Group | Cmax | 276.87 ng/mL | Standard Deviation 211.162 |
| Progression-free Survival Rate/KRAS Mutant Group | Cmax | 393.55 ng/mL | Standard Deviation 315.434 |
Secondary
Disease Control Rate (DCR)
the proportion of patients with a documented CR, PR and SD during the first 12 week treatment cycle according to RECIST version 1.1.
Time frame: 12 weeks
Population: 26 patients can be run the full analysis
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Progression-free Survival Rate/KRAS Negative Group | Disease Control Rate (DCR) | 40 percentage of participants |
| Progression-free Survival Rate/KRAS Mutant Group | Disease Control Rate (DCR) | 0 percentage of participants |
| Two Lines Failed Prior Chemotherapies | Disease Control Rate (DCR) | 42.9 percentage of participants |
| More Than Two Lines Failed Prior Chemotherapies | Disease Control Rate (DCR) | 72.7 percentage of participants |
Secondary
T½: the Time Required for a Quantity to Reduce to Half Its Initial Value
PK sampling will be performed on Days 0 and 28 in all patients enrolled in Stage 1.PK endpoints will be derived for intensively sampled PK profiles by T½: terminal half life
Time frame: 8 hours
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Progression-free Survival Rate/KRAS Negative Group | T½: the Time Required for a Quantity to Reduce to Half Its Initial Value | 3 hours |
| Progression-free Survival Rate/KRAS Mutant Group | T½: the Time Required for a Quantity to Reduce to Half Its Initial Value | 2 hours |
Other Pre-specified
Objective Response Rate (ORR)
Defined as the proportion of patients whose best overall response is either CR or PR according to RECIST version 1.1. The best overall response is the best response recorded during the first 12 week treatment cycle.
Time frame: 12 weeks
Population: full sey analysis group
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Progression-free Survival Rate/KRAS Negative Group | Objective Response Rate (ORR) | 0 patients |
Other Pre-specified
Overall Survival
the time from the date of first administration of study drug to death from any cause
Time frame: up to week 48
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Progression-free Survival Rate/KRAS Negative Group | Overall Survival | week 12 | 60 percentage of participants |
| Progression-free Survival Rate/KRAS Negative Group | Overall Survival | week 48 | 0 percentage of participants |
| Progression-free Survival Rate/KRAS Mutant Group | Overall Survival | week 48 | 100 percentage of participants |
| Progression-free Survival Rate/KRAS Mutant Group | Overall Survival | week 12 | 100 percentage of participants |
| Two Lines Failed Prior Chemotherapies | Overall Survival | week 12 | 100 percentage of participants |
| Two Lines Failed Prior Chemotherapies | Overall Survival | week 48 | 28.6 percentage of participants |
| More Than Two Lines Failed Prior Chemotherapies | Overall Survival | week 12 | 90.9 percentage of participants |
| More Than Two Lines Failed Prior Chemotherapies | Overall Survival | week 48 | 39.3 percentage of participants |