Anlotinib Hydrochloride Combined With EGFR TKIs in Advanced Non-small Cell Lung Cancer

A Prospective, Single-arm, Multicenter Study of Anlotinib Hydrochloride Combined With First-generation EGFR TKIs as Second-line Treatment in Acquired (Non-T790M Mutation) Resistance Advanced Non-small Cell Lung Cancer

After the second-line treatment of patients with non-T790M mutations, chemotherapy with platinum-containing drugs was used, and chemotherapy-related toxicity was high. Studies have shown that bevacizumab combined with EGFR TKI have a good trend of benefit. This study is aimed to evaluate the efficacy and safety of Anlotinib Hydrochloride combined with first-generation EGFR TKIs as second-line treatment in advanced non-small cell lung cancer . The patients with IV non-small lung cancer have acquired resistance to prior first-generation EGFR TKIs and have non-T790M mutation.

Study Overview

• Status: Unknown
• Conditions: Non-Small-Cell Lung
• Intervention / Treatment: Drug: Anlotinib Hydrochloride; Drug: Gefitinib; Drug: Icotinib

• Study Type: Interventional
• Enrollment (Anticipated): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Jangsu
    • Suzhou, Jangsu, China
      • The First Affiliated Hospital of Soochow University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Participants must have histlogically confirmed stage IV non-small cell lung cancer .
• The initial treatment with gefitinib/icotinib evaluated PR/NC and the efficacy lasted for more than 6 months, then the disease progressed later. (The efficacy was assessed as PD according to the evaluation standard of RECIST1.1)
• At least a measurable lesion that meets the RECIST 1.1 criteria.
• Any gender. Age ≥18 years and ≤75 years
• Life expectancy >3 months.
• Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1.
• Previously, EGFR gene test showed EGFR exon 19 deletion or exon 21 (L858R) mutation, and the gene test showed no T790M mutation before enrollment.
• Adequate organ function: haemoglobin ≥ 90 g/L;neutrophils count ≥1.5×109/L; platelet count ≥ 90 × 109/L; total bilirubin ≤ 1.5 × ULN ;ALT < 2 × ULN, (ALT < 5 × ULN, for those with liver metastases);AST < 2 × ULN, (AST < 5 × ULN, for those with liver metastases); Cr≤1.5× ULN.
• Echocardiography : LVEF≥50%
• 12-leads electrocardiogram : QTcF<450ms (man), <470ms(woman)
• Patient informed consent and signed written consent
• Patient compliance was good and voluntary follow-up, treatment, laboratory testing, and other research steps were performed as planned.

Exclusion Criteria:

• The patient has previously received anti-tumor therapy for EGFR TKIs other than gefitinib and ectinib for lung cancer.
• Patients that cannot detect EGFR gene, or patients with known T790M mutation.
• Small cell lung cancer (including lung cancer mixed with small cell lung cancer and non-small cell lung cancer).
• CT or MRI shows that the tumor lesion is ≤ 5 mm from the large vessel, or there is a central tumor that invades the local large blood vessel; or there is a significant pulmonary cavity or necrotizing tumor.
• Active brain metastasis, cancerous meningitis, spinal cord compression patients.
• Other active malignancies that require simultaneous treatment.
• Has a history of malignant tumors in the past 5 years.
• Patients with previous anti-tumor treatment-related adverse reactions who have not recovered to NCI-CTC AE≤1.
• Abnormal coagulation ,with bleeding tendency or undergoing thrombolysis or anticoagulant therapy.
• Renal insufficiency: urinary protein ≥ ++, or confirmed 24-hour urine protein ≥ 1.0g, or creatinine clearance <60ml / min.
• Severe acute or chronic infection requiring systemic treatment.
• Suffering from severe cardiovascular disease: myocardial ischemia ,myocardial or arrhythmia.
• Clinically significant hemoptysis occurred within 3 months prior to enrollment; or significant clinically significant bleeding symptoms or a clear tendency to hemorrhage.
• Untreated active hepatitis : Hepatitis B or Hepatitis C

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Anlotinib Hydrochloride plus gefitinib or icotinib	Drug: Anlotinib Hydrochloride; Capsule, P.O. 12mg qd ,days 1-14, 21 days a cycle; Drug: Gefitinib; Tablet, P.O. 250mg qd; Drug: Icotinib; Tablet, P.O. 125mg tid

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PFS（Progress free survival）	PFS defined as the time from first dose of study treatment until the first date of either objective disease progression or death due to any cause.	each 42 days up to PD or death(up to 24 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective Response Rate (ORR)	ORR is defined as the percentage of subjects with evidence of a confirmed complete response (CR) or partial response (PR) as per Response Evaluation Criteria In Solid Tumors (RECIST) Version 1.1.prior to progression or any further therapy.	each 42 days up to intolerance the toxicity or PD (up to 24 months)
Overall Survival (OS)	OS is defined as the time until death due to any cause.	From randomization until death (up to 24 months)
Quality of Life(QoL)	use EORTC QLQ-C30(version 3) questionnaire to evaluate the quality of life.	each 42 days up to intolerance the toxicity or PD (up to 24 months)
Disease Control Rate (DCR)	Defined as the proportion of patients with a documented complete response, partial response, and stable disease (CR + PR + SD) based on RECIST 1.1.	each 42 days up to intolerance the toxicity or PD (up to 24 months)

Collaborators and Investigators

• Sponsor: The First Affiliated Hospital of Soochow University
• Collaborators: Affiliated Hospital of Jiangnan University; Chia Tai Tianqing Pharmaceutical Group Co., Ltd.; Nantong University; Second Affiliated Hospital of Soochow University; Jiangyin People's Hospital; The First People's Hospital of Changzhou; Changzhou No.2 People's Hospital
• Investigators: Principal Investigator: Min Tao, Doctor, The First Affiliated Hospital of Soochow University

Study record dates

Study Major Dates

• Study Start (Anticipated): March 30, 2019
• Primary Completion (Anticipated): December 20, 2019
• Study Completion (Anticipated): December 20, 2020

Study Registration Dates

• First Submitted: December 2, 2018
• First Submitted That Met QC Criteria: December 5, 2018
• First Posted (Actual): December 6, 2018

Study Record Updates

• Last Update Posted (Actual): January 30, 2019
• Last Update Submitted That Met QC Criteria: January 28, 2019
• Last Verified: December 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Neoplasms; Lung Diseases; Neoplasms by Site; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Protein Kinase Inhibitors; Gefitinib
• Other Study ID Numbers: ALTER-L010

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No