Non Small Cell Lung Cancer
Conditions
Brief summary
This is a single center, single arm phase 2 study to establish the safety and efficacy of itacitinib (also known as INCB039110) administered in combination with pembrolizumab in patients with metastatic PD-L1 positive non-small cell lung cancer (NSCLC).
Interventions
DRUGItacitinib
a JAK 1 selective small molecule inhibitor
BIOLOGICALPembrolizumab
a highly selective humanized monoclonal antibody (mAb)
Sponsors
University of Pennsylvania
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
* 1\. Stage IV or metastatic non-small cell lung cancer (NSCLC) * 2\. Provide written informed consent for the trial. * 3\. Patients ≥ 18 years of age * 4\. Tumor PD-L1≥ 50% as assessed by the PD-L1 IHC 22C3 pharmDx assay (Dako North America). * 5\. Subject must have adequate tumor burden at a safely accessible site for biopsy. NOTE: If sites chosen for biopsy were previously irradiated, there must be evidence of tumor growth/viable tumor as assessed by the investigator. * 6\. At least one measurable lesion according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 * 7\. ECOG performance status 0 or 1 * 8\. Adequate Organ Function Laboratory Values: Absolute neutrophil count (ANC) ≥1,250/mcL; Platelets ≥100,000/mcL; Hemoglobin ≥9 g/dL or ≥5.6 mmol/L; Serum creatinine ≤1.5 X upper limit of normal (ULN) OR Measured or calculated creatinine clearance (GFR can also be used in place of creatinine or CrCl) ≥50 mL/min for subject with creatinine levels \> 1.5 X institutional ULN; Serum total bilirubin ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for subjects with total bilirubin levels \> 1.5 ULN; AST (SGOT) and ALT (SGPT) ≤ 2.5 X ULN OR ≤ 5 X ULN for subjects with liver metastases * 9\. Subjects of reproductive potential must agree to use acceptable birth control methods.
Exclusion criteria
* 1\. Sensitizing mutations in Epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) or ROS1 proto-oncogene receptor tyrosine kinase (ROS1) translocations * 2\. Currently participating in or has participated in a study of an investigational agent or anticipated use of an investigational device within 4 weeks of the first dose of study treatment. * 3\. Untreated symptomatic central nervous system (CNS) metastases and/or carcinomatous meningitis. * 4\. Received prior systemic cytotoxic chemotherapy, biologic therapy, targeted therapy or immunotherapy for incurable (metastatic) NSCLC. * 5\. Diagnosis of immunodeficiencywithin 7 days prior to eligibility confirmation by the physician-investigator. * 6\. Prior monoclonal antibodies used for the treatment of NSCLC within 4 weeks prior to eligibility confirmation by the physician-investigator, or individuals who have not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier. * 7\. Known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin, non-invasive bladder tumors, or in situ cervical cancer * 8\. 8. Active autoimmune disease requiring systemic immunosuppressive treatment within the past 3 months prior to eligibility confirmation by the physician-investigator. Subjects that require intermittent use of steroid-containing bronchodilators or local steroid injections or topical steroid medications are not excluded from the study. Subjects with hypothyroidism stable on hormone replacement or Sjogren's syndrome are not excluded from the study. * 9\. Interstitial lung disease or history of pneumonitis that has required oral or IV steroids * 10\. Active infection requiring systemic therapy with IV antibiotics * 11\. History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator. * 12\. Known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial. * 13\. Pregnant or breastfeeding women * 14\. Prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4). * 15\. Known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies). * 16\. Known active Hepatitis B (e.g., HBsAg positive or HBV DNA detectable) or Hepatitis C (e.g., HCV RNA \[qualitative\] is detected). * 17\. Anticipated receipt of any live vaccine within 30 days prior to the first dose of trial treatment. Note: For the purposes of determining eligibility above, enrollment is defined as the date of subject consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Subjects With a Response at 12 Weeks According to RECIST 1.1 for the Combination of Pembrolizumab and Itacitinib Among Patients With Previously Untreated, PD-L1 Positive Metastatic NSCLC. | 12 weeks | Responses will be compared subject's baseline assessment and historical controls using pembrolizumab monotherapy. |
| Number of Subjects With Toxicities (CTCAE v5.0 Scoring) of Pembrolizumab and Itacitinib in Patients With Previously Untreated, PD-L1 Positive Metastatic NSCLC | 16 weeks | Number of subjects treated with the combination. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Had a Progression Free Survival (PFS) Treated With Pembrolizumab and Itacitinib. | 12 weeks | Number of participants who remained progression free at week 12 |
| Number of Participants Treated With Pembrolizumab and Itacitinib, Who Had a Minimum Duration of Response (DOR) of 12 Weeks. | 12 weeks | — |
| Overall Survival (OS) for Subjects Treated With Pembrolizumab and Itacitinib. | 16 weeks | Number of subjects treated with pembrolizumab and itacitinib that survived to week 16. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Itacitinib and Pembrolizumab Itacitinib: a JAK 1 selective small molecule inhibitor
Pembrolizumab: a highly selective humanized monoclonal antibody (mAb) | 23 |
| Total | 23 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 1 |
| Overall Study | Physician Decision | 1 |
| Overall Study | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | Itacitinib and Pembrolizumab |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 9 Participants |
| Age, Categorical Between 18 and 65 years | 14 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants |
| Race (NIH/OMB) White | 18 Participants |
| Sex: Female, Male Female | 13 Participants |
| Sex: Female, Male Male | 10 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 1 / 23 |
| other Total, other adverse events | 22 / 23 |
| serious Total, serious adverse events | 6 / 23 |
Outcome results
Primary
Number of Subjects With a Response at 12 Weeks According to RECIST 1.1 for the Combination of Pembrolizumab and Itacitinib Among Patients With Previously Untreated, PD-L1 Positive Metastatic NSCLC.
Responses will be compared subject's baseline assessment and historical controls using pembrolizumab monotherapy.
Time frame: 12 weeks
Population: Of the 23 subjects enrolled, 2 subjects were not included in analysis because they did not receive Itacitinib due to pembrolizumab toxicity or subject withdrawal.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Itacitinib and Pembrolizumab | Number of Subjects With a Response at 12 Weeks According to RECIST 1.1 for the Combination of Pembrolizumab and Itacitinib Among Patients With Previously Untreated, PD-L1 Positive Metastatic NSCLC. | 13 Participants |
Primary
Number of Subjects With Toxicities (CTCAE v5.0 Scoring) of Pembrolizumab and Itacitinib in Patients With Previously Untreated, PD-L1 Positive Metastatic NSCLC
Number of subjects treated with the combination.
Time frame: 16 weeks
Population: Of the 23 subjects enrolled, 3 subjects were not included in analysis because they only received pembrolizumab and not itacitinib.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Itacitinib and Pembrolizumab | Number of Subjects With Toxicities (CTCAE v5.0 Scoring) of Pembrolizumab and Itacitinib in Patients With Previously Untreated, PD-L1 Positive Metastatic NSCLC | 20 Participants |
Secondary
Number of Participants Treated With Pembrolizumab and Itacitinib, Who Had a Minimum Duration of Response (DOR) of 12 Weeks.
Time frame: 12 weeks
Population: Of the 23 subjects enrolled, 2 subjects were not included in analysis because they did not receive Itacitinib.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Itacitinib and Pembrolizumab | Number of Participants Treated With Pembrolizumab and Itacitinib, Who Had a Minimum Duration of Response (DOR) of 12 Weeks. | 13 Participants |
Secondary
Number of Participants Who Had a Progression Free Survival (PFS) Treated With Pembrolizumab and Itacitinib.
Number of participants who remained progression free at week 12
Time frame: 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Itacitinib and Pembrolizumab | Number of Participants Who Had a Progression Free Survival (PFS) Treated With Pembrolizumab and Itacitinib. | 20 Participants |
Secondary
Overall Survival (OS) for Subjects Treated With Pembrolizumab and Itacitinib.
Number of subjects treated with pembrolizumab and itacitinib that survived to week 16.
Time frame: 16 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Itacitinib and Pembrolizumab | Overall Survival (OS) for Subjects Treated With Pembrolizumab and Itacitinib. | 23 Participants |