Non Small Cell Lung Cancer
Conditions
Keywords
non-G12C KRAS Mutations, Advanced NSCLC, MEK inhibitor-trametinib, RTKs inhibitor-Anlotinib
Brief summary
This is a Phase I exploratory study. The study is divided into two parts (A/B).In part A, the primary endpoint is the determination of the recommended phase 2 dose (RP2D). Secondary endpoint for phase Ia includes evaluating the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and adverse events (AEs). Following the establishment of the RP2D, the expansion cohort will be initiated. Transitioning to part B, 20 patients will be enrolled to further evaluate the ORR. All patients will receive the trametinib plus anlotinib regimen based on the RP2D determined in part A. The primary endpoint for part B is to assess the ORR, while secondary endpoint includes evaluating PFS, overall survival (OS), DCR, AEs, and duration of overall response (DoR). In part A, the study plans to enroll eligible patients to receive the MEK inhibitor trametinib (2 mg) in combination with anlotinib (6mg, 8 mg, 10 mg, 12 mg). The number of subjects is determined according to the actual situation of dose climbing. In part B, another 20 eligible patients will be enrolled and treated with trametinib (2mg) + anlotinib (RP2D), until the disease progression (PD) or unacceptable toxicity occurs to further evaluate the safety, tolerability and efficacy. Patients participated in safety follow-up after the first course of treatment until 3 months after discontinuation due to PD or toxicity. Dose-limiting toxicities from the first cycle were collected. Therapeutic efficacy evaluation was scheduled according to RECIST version 1.1 every 4-8 weeks. After the investigators' evaluation, the assessment cycle could extend to 12 weeks or longer due to the uncontrollable factors during the treatment period. Blood samples will be collected for pharmacokinetic analysis and biomarker discovery at baseline and at each periodic assessment.
Interventions
DRUGTrametinib
Trametinib 2 mg given orally, once daily
DRUGAnlotinib
Anlotinib given orally, every two weeks followed by a one-week discontinuation cycle
Sponsors
Shanghai Chest Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* For inclusion in the study subjects should fulfill the following criteria: 1. According to the 8th edition of the American Journal of Critical Care (AJCC)/Union for International Cancer Control (UICC) Tumor Node Metastasis (TNM) NSCLC staging system, locally advanced (stage III B/III C), metastatic or recurrent (stage IV) NSCLC patients confirmed by histology or cytology. The NSCLC patient cannot receive surgery and radical radiotherapy, and at least one measurable lesion is confirmed according to RECIST 1.1. 2. KRAS mutation positive excluded KRASG12C mutation. 3. No active brain metastases. 4. Age ≥18 years old and ≤75 years old. 5. ECOG PS score: 0-1. 6. Patients who had previously received at least 1st-line standard therapy. Note: the treatment naïve patients who refused immunotherapy/chemotherapy at 1st-line, and willingly enrolled in the clinical trial are also eligible. Part A: advanced NSCLC patients with non-G12C mutations who have previously received standard treatment or treatment naïve. Part B: advanced NSCLC patients with non-G12C mutations who have previously received standard 1st or more treatment. 7. Palliative radiotherapy must be completed 7 days before the first dose of study drug is administered. 8. The main organs are functioning normally, that is, they meet the following standards: Good hematopoietic function, defined as absolute neutrophil count ≥1.5 billion /L, platelet count ≥100 billion/L, hemoglobin ≥90 g/L \[no blood transfusion or no erythropoietin (EPO) within 7 days before enrollment dependence\]; The biochemical test results should meet the following standards: BIL \<1.25 times the upper limit of normal (ULN); ALT and AST \<2.5×ULN; if liver metastasis occurs, ALT and AST \<5×ULN; Cr ≤1.5×ULN or creatinine clearance Rate (CCr) ≥60 ml/min; good coagulation function, International Normalized Ratio (INR) and PT ≤1.5 times of ULN; if the subject is receiving anticoagulation therapy, PT should be within the prescribed range of anticoagulation drugs; Women of childbearing age should agree to take contraceptive measures (such as intrauterine devices, contraceptives, or condoms) during the study and within 6 months after the study; the serum or urine pregnancy test of non-breastfeeding patients should be negative; male patients should agree to take contraceptive measures during the study period and within 6 months after the study. 9. The patients voluntarily participated in the study, signed an informed consent form and had good compliance. 10. The expected survive time is longer than 3 months.
Exclusion criteria
* Subjects must not enter the study if any of the following
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Part A: Recommended phase 2 dose (RP2D) | 1 year | The determination of RP2D relied on several priority indexes: firstly, the MTD, followed by ORR, and mean tumor shrinkage rate. If the highest dose of anlotinib (12 mg) did not reach MTD, ORR would be the main index for defining the RP2D. Subsequently, if 2 or more dosage groups had same ORR, the average tumor shrinkage rate would replace MTD and ORR in determining RP2D. |
| Part B: Objective response rate (ORR) | 1.5 year | Percentage of participants achieving CR and PR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival (OS) | 2 years | OS defined as the time from randomization to death from any cause. Participants who do not die at the end of the extended follow-up period, or were lost to follow-up during the study, were censored at the last date they were known to be alive. |
| Progression Free Survival (PFS) | 2 years | The time from the start of systemic treatment date to the date of first documented disease progression (event: disease progression - DP, based on RECIST, death, adverse events, which provide to disqualification from further therapy). |
| Duration of overall response (DoR) | 2 years | The time from date of the first documentation of objective response (CR or PR) to the first documentation of PD or to death due to any cause in the absence of documented PD. |
| Adverse Event (AE) | 2 years | Adverse event caused by the combination treatments. |
| Disease control rate (DCR) | 2 years | Percentage of participants achieving CR and PR and SD. |
Countries
China
Outcome results
None listed