Non-small Cell Lung Cancer
Conditions
Brief summary
This study aimed to evaluate the efficacy and safety of intrathecal pemetrexed with high-dose Furmonertinib plus bevacizumab for EGFR-mutant non-small cell lung cancer patients with leptomeningeal metastases after resistance to third-generation EGFR-TKIs.
Detailed description
This prospective interventional study aimed to evaluate the efficacy and safety of intrathecal pemetrexed with high-dose Furmonertinib plus bevacizumab for EGFR-mutant NSCLC patients with leptomeningeal metastases after resistance to third-generation EGFR-TKIs. Approximately 30 EGFR-mutant Non-small cell lung cancer patients with leptomeningeal metastasis or leptomeningeal progression after resistant to third generation EGFR-TKIs were enrolled and treated with intrathecal pemetrexed with high-dose furmonertinib plus bevacizumab. cerebrospinal fluid and blood samples will be collected before and after pemetrexed resistance to analyze molecular mechanisms. Second-generation gene detection will be performed to identify potential resistance mechanisms to pemetrexed. The study is expected to commence recruitment in mainland China in about August 2024. It is expected that the trial will end in April 2026.
Interventions
DRUGIntrathecal Pemetrexed and high-dose Furmonertinib plus bevacizumab
* Intrathecal pemetrexed(50mg) twice a week for 1 week (day 1 and day 5) as induction treatment, then once monthly; * Furmonertinib(160mg QD); * bevacizumab(5mg/kg，once monthly) until progressive disease.
Sponsors
Hunan Province Tumor Hospital
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\. Understand the requirements and contents of the clinical trial, and provide a signed and dated informed consent form. * 2\. Age ≥ 18 years. * 3\. Histopathology confirmed Non-small cell lung cancer. * 4\. confirmed or probable leptomeningeal metastases according to EANO-ESMO guidelines or known leptomeningeal metastases progression after third generation of EGFR-TKIs failure. * 5.Leptomeningeal metastasis (LM) is defined by the presence of typical clinical symptoms, positive cerebrospinal fluid (CSF) cytology, detection of cell-free DNA (cfDNA) in CSF by next-generation sequencing (NGS), or imaging findings consistent with typical meningeal metastases. * 6.ECOG 0 - 2. * 7\. Predicted survival ≥ 12 weeks. * 8\. Adequate bone marrow hematopoiesis and organ function.
Exclusion criteria
* 1\. Previously received intrathecal pemetrexed therapy for locally advanced or metastatic disease. * 2\. Subjects who have received any of the following treatments must be excluded: Have received radiation within 14 days prior to the first dose or have not recovered from radiation-related toxicity. Chest and extra-brain palliative radiotherapy, stereotactic radiosurgery, and stereotactic body radiotherapy may be performed 7 days prior to the first dose. * 3\. Presence of spinal cord compression. * 4\. History of other malignant tumors within 2 years. * 5\. Adverse events (except alopecia of any degree) of CTCAE \> grade 4 due to prior treatment (e.g., adjuvant chemotherapy, radiotherapy, etc.) prior to the first dose. * 6\. History of stroke or intracranial hemorrhage within 6 months prior to the first dose. * 7\. The presence of any severe or poorly controlled systemic disease, including poorly controlled hypertension and active bleeding in the judgment of the investigator. * 8\. Subjects with persistent or active infection, including but not limited to hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV) and COVID-19 infection. * 9\. Heart-related diseases or abnormalities * 10\. Past history of interstitial lung disease, drug-induced interstitial lung disease, radiation pneumonitis requiring steroid therapy or interstitial lung disease with active clinical symptoms, immune pneumonia caused by immunotherapy. * 11\. Refractory nausea and vomiting, chronic gastrointestinal disease, difficulty swallowing drugs, or inability to adequately absorb Furmonertinib due to previous bowel resection. * 12\. Live vaccine was given 2 weeks before the first medication. * 13\. Women who are breastfeeding or pregnant. * 14\. Hypersensitivity to the test drug and the ingredients. * 15\. Other conditions assessed by the investigator to be unsuitable for participation in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| LM-overall survival | Time from first subject dose to study completion, or up to last follow up | LM-OS was defined as the duration from the start of intrathecal pemetrexed to patient death |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Extracranial progression-free survival | Time from first dose to the progression of extracranial disease or patient death or last follow up | Extracranial Progression-Free survival was defined as the duration from the start of intrathecal pemetrexed to the progression of extracranial disease or patient death or last follow up |
| Clinical response rate | Time from first dose to the improvement of neurological symptoms and KPS score | Clinical Response Rate was defined as the ratio of the patient whose neurological symptoms and KPS improved according to the criteria of clinical response |
| Adverse events (AEs) | From first dose until 28 days after the last dose, up to 24 month | Number of participants with adverse events (AEs) according to CTCAE 5.0 |
Countries
China
Contacts
Primary ContactYongchang Zhang, MD
Backup ContactLiang zeng, MD
Outcome results
None listed