Vebreltinib Plus Furmonertinib in Patients With EGFR-mutated Advanced Non-small Cell Lung Cancer and High PD-L1 Expression (DUAL-THRUST)

A Single-arm, Phase I/II Trial Aimed to Evaluate the Efficacy and Safety of Vebreltinib Plus Furmonertinb as First-line Treatment for Patients With Locally Advanced or Metastatic Non-small Cell Lung Cancer Harboring EGFR Mutations and High PD-L1 Expression

This is a single-arm, exploratory phase Ib/II study with a seamless design to evaluate the safety and efficacy of Vebreltinib combined with furmonertinib as first-line treatment in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring EGFR-sensitive mutations (exon 19 deletion or L858R) and PD-L1 TPS ≥50%.

In the phase Ib part, 12-16 patients will be enrolled to compare the safety and early efficacy of Vebreltinib 100mg BID versus 150mg BID in combination with furmonertinib 80mg QD, and to determine the recommended phase II dose (RP2D).

In the phase II part, 37 patients (including evaluable patients from the RP2D cohort in phase Ib) will receive treatment at the RP2D. The primary endpoint is investigator-assessed median progression-free survival (PFS). Secondary endpoints include objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. Exploratory endpoints will analyze the correlation between baseline MET abnormalities and treatment efficacy.

Study Overview

• Status: Recruiting
• Conditions: Non-Small-Cell Lung Cancer
• Intervention / Treatment: Drug: Vebreltinib; Drug: Furmonertinib 80mg

Detailed Description

Patients with advanced NSCLC harboring EGFR mutations and high PD-L1 expression (TPS ≥50%) have primary resistance to third-generation EGFR-TKI monotherapy, with a median PFS of only 3.8-5.0 months, representing an unmet clinical need.

Basic research has shown that PD-L1 can inhibit protein tyrosine phosphatase through a non-immune pathway, leading to sustained MET phosphorylation and induction of MET amplification, which mediates EGFR-TKI resistance.

This study aims to overcome primary resistance by simultaneously blocking the EGFR and MET pathways through the combination of the MET inhibitor Vebreltinib and the third-generation EGFR-TKI furmonertinib.

The study is divided into two phases: the phase Ib dose-escalation phase adopts a parallel cohort design, enrolling two dose groups simultaneously. Each group initially enrolls 3 patients for a 28-day DLT observation period. If DLT ≤1 case, the cohort will be expanded to at least 6 evaluable patients; if DLT ≥2 cases, the cohort will be terminated. The RP2D will be determined comprehensively based on DLT incidence, incidence of grade ≥2 AEs, dose adjustment rate, and 8-week ORR.

The phase II efficacy-expansion phase will use the RP2D, with the primary endpoint being median PFS. It is expected that combination therapy will prolong the median PFS from 4 months in historical data to 8.5 months.

Patients will receive treatment until disease progression, death, withdrawal of informed consent, or intolerable toxicity. Imaging assessments will be performed every 8 weeks, with an additional tumor assessment on day 28 of cycle 1 for phase Ib patients. Safety assessments include adverse events, laboratory tests, electrocardiograms, and echocardiograms, graded according to NCI-CTCAE v5.0.

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Jing Cai, MD, PhD; Phone Number: +86+0791-86297662; Email: cjdl879@163.com
• Study Contact Backup: Name: Liangqian Lv, MD; Phone Number: +86+0791-86297662; Email: 369848857@qq.com

Study Locations

• China
  • Jianxi
    • Nanchang, Jianxi, China, 330006
      • Recruiting
      • The Second Affiliated Hospital of Nanchang University
      • Contact: Jian Li, PhD; Phone Number: +86-0791-86297662; Email: efyyjs@126.com
      • Contact: Jing Cai, MD; Phone Number: +86-0791-86265873; Email: cjdl879@163.com
      • Principal Investigator: Anwen Liu, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Voluntarily agree to participate in this study and sign a written informed consent form
2. Age ≥18 years and ≤75 years, regardless of gender
3. Histologically or cytologically confirmed locally advanced (stage IIIB-IIIC), metastatic, or recurrent (stage IV) non-small cell lung cancer, not amenable to surgical resection and definitive concurrent chemoradiotherapy
4. No prior systemic antineoplastic therapy for advanced/metastatic disease Histologically or cytologically confirmed EGFR-sensitive mutations (exon 19 deletion or exon 21 L858R point mutation)
5. Central laboratory-confirmed PD-L1 Tumor Proportion Score (TPS) ≥50%
6. At least one measurable target lesion according to RECIST v1.1 criteria
7. Asymptomatic or locally treated stable brain metastases are allowed.
8. ECOG performance status 0-1
9. Expected survival ≥3 months
10. Adequate organ function

Exclusion Criteria:

1. Histological type of small cell lung cancer or mixed small cell lung cancer
2. Prior treatment with any EGFR-TKI or MET-TKI
3. Presence of ALK fusion positive or ROS1 fusion positive
4. Other active malignant tumors (except completely resected carcinoma in situ, basal cell or squamous cell skin cancer, or tumors with no recurrence for ≥3 years after curative treatment)
5. Major surgery within 4 weeks before first dose (except brain metastasis resection, which requires ≥2 weeks); thoracoscopic biopsy or mediastinoscopy is excluded (requires ≥1 week)
6. Require use of strong CYP3A4 inhibitors or inducers within 1 week before first dose or during the study
7. Uncontrolled systemic diseases
8. Cardiac dysfunction: QTcF >470ms (average of three ECGs) at screening; NYHA functional class ≥3 or LVEF <50%
9. Dysphagia, active digestive system disease, or history of major gastrointestinal surgery that may affect drug absorption
10. History of acute or chronic pancreatitis or pancreatic surgery
11. Other conditions deemed unsuitable for participation by the investigator

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: Vebreltinib plus Furmonertinib; Participants with EGFR-sensitizing mutated, PD-L1-high locally advanced or metastatic non-small cell lung cancer (NSCLC) will receive Vebreltinib at the recommended phase 2 dose (RP2D) orally in combination with furmonertinib 80 mg orally once daily, until disease progression or unacceptable toxicity.	Drug: Vebreltinib; Administered orally on an empty stomach, 100mg or 150mg twice daily, with an interval of 12±4 hours between morning and evening doses. Dose adjustments are allowed based on toxicity, down to a minimum of 100mg BID; Drug: Furmonertinib 80mg; Administered orally on an empty stomach, 80mg once daily, taken concurrently with Vebreltinib.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phase Ib: Incidence of Dose-Limiting Toxicities as assessed by protocol-defined criteria and CTCAE v5.0	Number of participants experiencing dose-limiting toxicities during the dose-escalation phase of the study, based on CTCAE v5.0 grading and protocol-specified DLT criteria	Up to 28 days from first dose
Phase Ib: Incidence of Grade ≥2 Treatment-Emergent Adverse Events as assessed by CTCAE v5.0	Number of participants experiencing Grade 2 or higher treatment-related adverse events	Up to 8 weeks from first dose
Phase Ib: Rate of dose reduction, interruption, or discontinuation due to treatment-related adverse events as assessed by CTCAE v5.0	Proportion of participants requiring dose reduction, interruption, or discontinuation due to treatment-related toxicity	Up to 8 weeks from first dose
Phase II: Investigator-Assessed Progression-Free Survival (PFS)	Time from first dose to first documented disease progression or death from any cause, assessed according to RECIST v1.1	From first dose until first documented disease progression or death from any cause, assessed up to 24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phase Ib: Objective Response Rate (ORR)	Proportion of participants achieving complete response (CR) or partial response (PR) per RECIST v1.1, assessed at 8 weeks after first dose	Up to 8 weeks from first dose
Phase II: Objective Response Rate (ORR)	Proportion of participants achieving complete response (CR) or partial response (PR) per RECIST v1.1	From first dose until first documented disease progression or death from any cause, assessed up to 24 months
Phase II: Disease Control Rate (DCR)	Proportion of participants achieving complete response (CR), partial response (PR), or stable disease (SD) per RECIST v1.1	From first dose until first documented disease progression or death from any cause, assessed up to 24 months
Phase II: Overall Survival (OS)	Time from first dose to death from any cause	From first dose until death from any cause, assessed up to 36 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exploratory: Objective response rate by baseline MET aberration status as assessed by RECIST 1.1	Proportion of participants achieving complete response (CR) or partial response (PR), stratified by presence or absence of baseline MET aberrations (MET amplification or MET overexpression)	From first dose until first documented disease progression or death from any cause, assessed up to 24 months
Exploratory: Objective response rate by MET overexpression level as assessed by RECIST 1.1	Proportion of participants achieving CR or PR, stratified by MET overexpression level ( IHC 1+,2+, 3+) measured by immunohistochemistry	From first dose until first documented disease progression or death from any cause, assessed up to 24 months
Exploratory: Progression-free survival by baseline MET aberration status as assessed by RECIST 1.1	Time from first dose to first documented disease progression or death from any cause, whichever occurs first, stratified by presence or absence of baseline MET aberrations (MET amplification or MET overexpression)	From first dose until first documented disease progression or death from any cause, assessed up to 24 months

Collaborators and Investigators

• Sponsor: Second Affiliated Hospital of Nanchang University
• Collaborators: Beijing Pearl Biotechnology Limited Liability Company
• Investigators: Study Chair: Anwen Liu, PhD, Second Affiliated Hospital of Nanchang University

Study record dates

Study Major Dates

• Study Start (Estimated): July 3, 2026
• Primary Completion (Estimated): December 3, 2027
• Study Completion (Estimated): June 3, 2029

Study Registration Dates

• First Submitted: June 5, 2026
• First Submitted That Met QC Criteria: June 17, 2026
• First Posted (Actual): June 18, 2026

Study Record Updates

• Last Update Posted (Actual): June 18, 2026
• Last Update Submitted That Met QC Criteria: June 17, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Non-Small-Cell Lung Cancer; EGFR mutation; Furmonertinib; Vebreltinib; PD-L1 high expression
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Respiratory Tract Diseases; Lung Diseases; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Carcinoma, Non-Small-Cell Lung; aflutinib
• Other Study ID Numbers: IIT-I-2026-021; I-MRER[2026] No. 10 (Other Identifier: Ethics Committee, The Second Affiliated Hospital of Nanchang University)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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