Advancing Brigatinib Properties in ALK+ NSCLC Patients by Deep Phenotyping

Advancing Brigatinib Properties in Anaplastic Lymphoma Kinase Positive Non-small Cell Lung Cancer (ALK+ NSCLC) Patients

This is a prospective, randomized, open-label, multicenter phase II study investigating the advancing Brigatinib properties in anaplastic lymphoma kinase positive non-small cell lung cancer (ALK+ NSCLC) patients by deep phenotyping

Study Overview

• Status: Active, not recruiting
• Conditions: NSCLC
• Intervention / Treatment: Drug: Tyrosine kinase inhibitor; Drug: Brigatinib

Detailed Description

The aim of this study is to compare efficacy of brigatinib and other 2nd-generation ALK tyrosin kinase inhibitor (TKI) in 1st and 2nd line treatment and to explore resistance patterns according to treatment and molecular properties of the tumors

• Study Type: Interventional
• Enrollment (Actual): 118
• Phase: Phase 2

Contacts and Locations

Study Locations

• Germany
  • Berlin, Germany, 14165
    • Helios Klinikum Emil Von Behring
  • Berlin, Germany
    • Charite Berlin
  • Essen, Germany, 45147
    • Universitätsmedizin Essen
  • Esslingen, Germany, 73730
    • Klinikum Esslingen
  • Frankfurt am main, Germany, 60488
    • Krankenhaus Nordwest Frankfurt
  • Freiburg, Germany
    • Universitatsklinikum Freiburg
  • Georgsmarienhütte, Germany, 49124
    • Niels-Stensen-Kliniken Georgsmarienhütte
  • Gießen, Germany
    • Universitätsklinikum Gießen
  • Hamburg, Germany, 20251
    • Studiengesellschaft Hämato-Onkologie Hamburg
  • Hamm, Germany
    • Evangelisches Krankenhaus Hamm
  • Hannover, Germany
    • Medizinische Hochschule Hannover
  • Hannover, Germany, 30459
    • KRH Klinikum Siloah Hannover
  • Heidelberg, Germany, 69126
    • Thoraxklinik am Universitatsklinikum Heidelberg
  • Hemer, Germany
    • Lungenklinik Hemer
  • Jena, Germany, 07740
    • Universitätsklinikum Jena
  • Köln, Germany, 51109
    • Lungenklinik Köln - Merheim
  • Leipzig, Germany, 04103
    • Universitätsklinikum Leipzig
  • Mainz, Germany, 55131
    • Universitätsmedizin Mainz
  • München, Germany
    • Klinik der LMU München - Innenstadt
  • Münster, Germany
    • Universitatsklinikum Munster
  • Nürnberg, Germany, 90419
    • Klinikum Nürnberg
  • Oldenburg, Germany, 26121
    • Pius Hospital Oldenburg
  • Regensburg, Germany, 93053
    • Universitätsklinikum Regensburg
  • Stuttgart, Germany
    • Klinik Schillerhohe
  • Ulm, Germany, 89081
    • Universitätsklinikum Ulm
  • Würzburg, Germany
    • Universitätsklinikum Würzburg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Fully informed written consent and any locally-required authorization (EU Data Privacy Directive) given by the patient
2. Male or female ≥ 18 years of age NOTE: There are no data that indicate special gender distribution. Therefore, patients will be enrolled in the study gender-independently.
3. Histologically confirmed locally advanced (stage III) and not suitable for curative treatment, i.e. R0 operation or definitive chemo-/radiation, or metastatic (stage IV) ALK+ NSCLC NOTE: Documentation of ALK rearrangement by a positive result of any ALK assay approved in Germany [i.e. positivity for at least one of the three: immunohistochemistry (IHC), NGS, fluorescence in situ hybridisation (FISH)] must be available at baseline. Treatment can already be started based on a local ALK+ test result, but subsequent central testing of the baseline biopsy for molecular profiling, incl. determination of ALK variant and TP53 status, should be made possible for all patients.
4. No prior therapy for metastatic ALK+ NSCLC including therapy with ALK inhibitors. However, 1 or 2 cycles of chemotherapy, chemo-immunotherapy or immunotherapy as well as cerebral irradiation before inclusion in the study will be allowed.
5. At least 1 measurable (i.e., target) lesion per RECIST v1.1 or otherwise evaluable lesion (e.g. brain lesion with at least 5 mm of longest diameter if measured by high-resolution cMRT e.g. using 1 mm slices thickness and not planned for irradiation before the first response assessment).
6. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2

7. Have adequate organ function, as determined by:

   • Total bilirubin ≤1.5x the upper limit of the normal range (ULN) (< 3x the ULN if Gilbert's disease is present)
   • Estimated glomerular filtration rate ≥30 mL/minute/1.73 m2 (calculated by Modification of Diet in Renal Disease (MDRD) or any other validated formula, see Appendix 13.4)
   • Alanine aminotransferase/aspartate aminotransferase ≤2.5x ULN NOTE: ≤5x ULN is acceptable if liver metastases are present.
   • Serum lipase or serum amylase ≤ 1.5x ULN
   • Platelet count ≥75x 109/L
   • Hemoglobin ≥9 g/dL
   • Absolute neutrophil count ≥1.5x 109/L
8. Willingness and ability to comply with scheduled visit and study procedures
9. Patient willing to participate in accompanying research program
10. Collection of current biopsy during screening must be feasible NOTE: For each patient a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block must be available for biomarker evaluation. Excisional, incisional or core needle biopsies are appropriate, while fine needle aspirations are insufficient.
11. Women of childbearing potential (WOCBP) must have a negative pregnancy test within 7 days prior to randomization. Women must not be breastfeeding.

12. Female patients who:

    • are postmenopausal for at least 1 year before the screening visit, OR
    • are surgically sterile, OR
    • if they are of childbearing potential, agree to practice highly effective non-hormonal contraception from the time of signing the informed consent through at least 4 months after the last dose of study drug, or agree to completely abstain from heterosexual intercourse.

Male patients, even if surgically sterilized (i.e., status post-vasectomy), who:

• agree to practice effective barrier contraception during the entire study treatment period and through at least 3 months after the last dose of study drug, OR
• agree to completely abstain from heterosexual intercourse.

Exclusion Criteria:

1. History or presence at baseline of pulmonary interstitial disease, drug-related pneumonitis, or radiation pneumonitis

2. Uncontrolled hypertension, defined as hypertension treated* with anti-hypertensive drugs AND blood pressure ≥ 160 mmHg (systolic) or ≥ 100 mmHg (diastolic) in repeated measurements. Untreated elevated blood pressure is not an exclusion criterion and should receive adequate anti-hypertensive adjustment.

   *Please notecase of treatment, at least 3 anti-hypertensive drugs should have been used with the intention to control hypertensive disease

3. Systemic treatment with strong cytochrome P-450 (CYP) 3A inhibitors, strong CYP3A inducers, or moderate CYP3A inducers or treatment with any investigational systemic anticancer agents, chemotherapy or radiation therapy (except for stereotactic radiosurgery or stereotactic radiation therapy or palliative radiotherapy) within 14 days of randomization
4. Treatment with antineoplastic monoclonal antibodies within 30 days of randomization
5. Major surgery within 30 days of randomization. Minor surgical procedures, such as catheter placement or minimally invasive biopsies, are allowed.
6. Current symptomatic spinal cord compression as confirmed by radiographic imaging. Patients with leptomeningeal disease without symptomatic cord compression are allowed.

7. Significant or uncontrolled cardiovascular disease, defined as to the following:

   • If an acute myocardial infarction has ensued in the past 6 months, successful reperfusion has to be documented and the patient has to be free of symptoms
   • New York Heart Association Class III or IV heart failure (i.e. marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m). Comfortable only at rest) within 6 months prior to randomization
   • Any history of clinically significant ventricular arrhythmia, defined as ventricular tachycardia (VT), ventricular fibrillation (VF), or cardiac arrest
8. Cerebrovascular accident or transient ischemic attack within 6 months prior to first dose of study drug
9. Malabsorption syndrome or other gastrointestinal illness or condition that could affect oral absorption of the study drug
10. Active severe or uncontrolled chronic infection, including but not limited to, the requirement for intravenous antibiotics for longer than 2 weeks
11. History of HIV infection. Testing is not required in the absence of history.
12. Chronic hepatitis B (surface antigen-positive) or chronic active hepatitis C infection. Testing is not required in the absence of history.
13. Any serious medical condition or psychiatric illness that could, in the investigator's opinion, potentially compromise patient safety or interfere with the completion of treatment according to this protocol
14. Known or suspected hypersensitivity to brigatinib or other TKI or their excipients
15. Life-threatening illness unrelated to cancer
16. Involvement in the planning and/or conduct of the study (applies to both Takeda staff and/or staff of sponsor and study site)
17. Patient who might be dependent on the sponsor, site or the investigator
18. Patient who has been incarcerated or involuntarily institutionalized by court order or by the authorities [according to national Medicinal Products Act (Arzneimittelgesetz, AMG)]
19. Patients who are unable to consent because they do not understand the nature, significance and implications of the clinical trial and therefore cannot form a rational intention in the light of the facts [according to national AMG]
20. Legal incapacity or limited legal capacity
21. Females who are pregnant or breastfeeding

22. Patients who have symptomatic CNS metastases (parenchymal or leptomeningeal) at screening or asymptomatic disease requiring an increasing dose of corticosteroids to control symptoms within 7 days prior to randomization.

    NOTE: If a patient has worsening neurological symptoms or signs due to CNS metastasis, the patient needs to complete local therapy and be neurologically stable (with no requirement for an increasing dose of corticosteroids or use of anticonvulsants) for 7 days prior to randomization.

23. Rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard Arm with any available ALK TKI; st line: Any approved 2nd-generation TKI according to investigator's choice; nd line: Any available ALK TKI according to investigator's choice (patients from the standard Arm A can be offered brigatinib in the 2nd line)	Drug: Tyrosine kinase inhibitor; Treatment with any TKI; Other Names: Study treatment
Experimental: Experimental Arm with Brigatinib; st line: 90 mg brigatinib once daily p.o. for the first 7 days (lead-in) followed by 180 mg brigatinib once daily p.o. afterwards, starting with day 8; nd line: Any available ALK TKI according to investigator's choice	Drug: Brigatinib; Treatment with Brigatinib; Other Names: Study treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-free survival (PFS) of 1st-line treatment according to RECIST v1.1	Time from the first dosing date of any study medication to the date of the first objectively documented tumor progression or death due to any cause	68 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PFS of 2nd-line treatment according to RECIST v1.1	Time from the first dosing date of any 2nd-line TKI to the date of the objectively documented tumor progression or death due to any cause	68 months
TNT 1st line (TNT1, i.e. time-to-next treatment for the 1st line)	Time from begin of 1st-line treatment until begin of 2nd-line treatment	68 months
TNT 2nd line (TNT2, i.e. time-to-next treatment for the 2nd line	Time from begin of 2nd line until begin of 3rd-line treatment	68 months
TNT1/2 (time-to-next treatment for the 1st and 2nd line together)	Time from begin of 1st-line treatment until begin of 3rd-line treatment	68 months
Overall survival (OS)	Time from treatment start in the 1st line to the date of death (due to any cause)	68 months
Time to intracranial progression (TTiP)	Time from start of 1st-line treatment until the occurrence of a new central nervous system (CNS) lesion or progression of pre-existing CNS lesions	68 months
Safety (rate of adverse events)	Type, incidence and severity of adverse events (AEs) and serious adverse events (SAEs)graded according to NCI CTCAE v5.0	68 months
Quality of life (QoL) assessed by SF-12-questionnaire	Patient reported outcome assessed by the validated SF-12-questionnaire	68 months
Quality of life (QoL) assessed by EORTC-quality of life questionnaire (QLQ)-BN20-questionnaire	Patient reported outcome assessed by the validated EORTC-QLQ-BN20-questionnaire	68 months
Intracranial ORR (iORR)	Percentage of participants with a best overall intracranial response (BOR) of intracranial complete response (CR) or intracranial partial response (PR). Best overall intracranial response (BOR) is defined as the best response designation, recorded between the date of first dose and the date of the initial objectively documented intracranial tumor progression per RECIST criteria or the date of subsequent therapy or death, whichever occurs first.	68 months
Intracranial DOR (iDOR) according to RECIST v1.1	Time from first documentation of intracranial CR or PR according to RECIST v1.1 (whichever is first recorded) until the first date that the intracranial progressive disease (PD) is objectively documented or until death (whichever occurs first	68 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
ALK variant analysis in tumor tissue	Typing of ALK fusion variants in tumor samples	68 months
ALK variant analysis in blood samples	Typing of ALK fusion variants in blood samples	68 months
TP53 mutation status in tumor tissue	Assessment of TP53 mutation status in tumor samples	68 months
TP53 mutation status in blood samples	Assessment of TP53 mutation status in blood samples	68 months
Detection of "acquired resistance" mutations in tumor tissue	Detection of "acquired resistance" mutations via standardized next-generation sequencing (NGS)-based multiplex analysis in tumor samples	68 months
Detection of "acquired resistance" mutations in blood samples	Detection of "acquired resistance" mutations via standardized next-generation sequencing (NGS)-based multiplex analysis in blood samples	68 months
ALK variant analysis in cerebrospinal fluid	Typing of ALK fusion variants in cerebrospinal fluid in "brain-only" progression.	68 months
TP53 mutation status in cerebrospinal fluid	Assessment of TP53 mutation status in cerebrospinal fluid in "brain-only" progression.	68 months
Detection of "acquired resistance" mutations in cerebrospinal fluid	Detection of "acquired resistance" mutations via standardized circulating tumor DNA (ctDNA) next-generation sequencing (NGS)-based multiplex analysis in cerebrospinal fluid	68 months

Collaborators and Investigators

• Sponsor: Institut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest
• Investigators: Study Director: Salah-Eddin Al-Batran, Prof., Institut für Klinische Krebsforschung IKF GmbH

Publications and helpful links

General Publications

• Christopoulos P, Bozorgmehr F, Bruckner L, Chung I, Krisam J, Schneider MA, Stenzinger A, Eickhoff R, Mueller DW, Thomas M. Brigatinib versus other second-generation ALK inhibitors as initial treatment of anaplastic lymphoma kinase positive non-small cell lung cancer with deep phenotyping: study protocol of the ABP trial. BMC Cancer. 2021 Jun 28;21(1):743. doi: 10.1186/s12885-021-08460-w.

Study record dates

Study Major Dates

• Study Start (Actual): March 30, 2020
• Primary Completion (Estimated): December 31, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: March 18, 2020
• First Submitted That Met QC Criteria: March 20, 2020
• First Posted (Actual): March 24, 2020

Study Record Updates

• Last Update Posted (Actual): August 29, 2023
• Last Update Submitted That Met QC Criteria: August 25, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: ALK+ NSCLC; Resistance patterns; Molecular properties
• 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; Protein Kinase Inhibitors; Tyrosine Protein Kinase Inhibitors
• Other Study ID Numbers: ABP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No IPD will be shared

Drug and device information, study documents

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