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Efficacy and Safety Study of Afatinib to Treat Lung Cancer Patients (TIMELY)

11 janvier 2019 mis à jour par: University College, London

Trial of Afatinib (BIBW 2992) in Suspected or Confirmed Mutant EGFR Lung Cancer Patients Unfit for Chemotherapy

The purpose of this study is to examine the efficacy and safety of using afatinib (BIBW 2992) to treat non-small cell lung cancer patients considered unfit for chemotherapy and have either suspected or confirmed Epidermal Growth Factor Receptor (EGFR) mutation.

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Description détaillée

Lung cancer is most common cause of death from cancer, of which non-small cell lung cancer (NSCLC) accounts for ~80% of all cases with most patients presenting with advanced disease. Patients medically unfit to receive radical or platinum-doublet palliative systemic therapy, because of poor performance status or comorbidity, account for at least 45% of newly diagnosed cases and have poor survival. Many oncologists have interpreted single-agent chemotherapy data as not clinically meaningful when balanced against toxicities, non-significant improvements in quality of life and comorbidity. Hence, in the UK, this group of patients are predominantly treated by best-supportive care (BSC).

This study aims to examine the efficacy and safety of using afatinib (BIBW 2992), an irreversible second generation EGFR inhibitor, in patients with non-small cell lung cancer, who are considered unfit for chemotherapy and have either suspected or confirmed Epidermal Growth Factor Receptor (EGFR) mutation.

Suspected EGFR mutant patients will have clinical characteristics likely to harbour the EGFR mutation (adenocarcinoma sub type and ex or never smokers) with EGFR genotype unknown either due to no tissue suitable for genotyping or failed genotype.

There has been only one small prospective study of medically unfit patients with EGFR mutation, but it demonstrated good efficacy with a TKI17. This phase II study of East Asian patients (n=30) with performance status 2-4 and treated with gefitinib demonstrated a rapid improvement in performance status at 1 month, an overall response rate of 66% and median survival of 17.8 months. Whilst gefitinib is licensed for EGFR mutant NSCLC, no prospective studies have yet been performed on medically unfit patients from Western countries. Despite dramatic initial responses, EGFR mutant NSCLC patients treated with gefitinib/erlotinib ultimately relapse. In ~50% of cases this is due to the gefitinib/erlotinib-resistant T790M genotype acquired through either secondary somatic mutation or clonal expansion. There is therefore a need to improve the outcomes of medically unfit patients with suspected EGFR mutation, who would otherwise be treated with best supportive care, and in proven EGFR mutation cases by using an effective EGFR-directed therapy that inhibits EGFRT790M.

Prospective data on medically unfit Western NSCLC patients with EGFR mutation are required to assess the efficacy of EGFR-TKIs. Additionally, given that 50% of such patients will become TKI-resistant through EGFRT790M, new therapies are required to overcome this resistance mechanism.

Type d'étude

Interventionnel

Inscription (Réel)

39

Phase

  • Phase 2

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • Royaume-Uni
      • Bournemouth, Royaume-Uni
        • Royal Bournemouth Hospital
      • Glasgow, Royaume-Uni
        • Beatson West of Scotland Cancer Centre
      • Great Yarmouth, Royaume-Uni
        • James Paget University Hospital
      • Kent, Royaume-Uni
        • East Kent Hospitals
      • Kent, Royaume-Uni
        • Maidstone Hospital
      • Leeds, Royaume-Uni
        • St James's University Hospital
      • London, Royaume-Uni
        • Charing Cross Hospital
      • London, Royaume-Uni
        • University College Hospital
      • London, Royaume-Uni
        • Guy's Hospital
      • London, Royaume-Uni
        • Barnet & Chase Farm Hospitals
      • London Borough of Sutton, Royaume-Uni
        • The Royal Marsden Hospitals
      • Somerset, Royaume-Uni
        • Musgrove Park Hospital
      • Sutton in Ashfield, Royaume-Uni
        • King's Mill Hospital
      • Weston Super Mare, Royaume-Uni
        • Weston General Hospital
      • York, Royaume-Uni
        • York Hospital

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans et plus (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • Any stage not suitable for radical treatment
  • Either:

Confirmed activating EGFR mutation (exons 18-21; e.g. L858R, exon 19 deletions, exon 20 insertions, T790M, list is not exhaustive), and WHO PS 0-3 Or No tissue suitable for EGFR genotyping, failed genotype, or EGFR genotyping unavailable, and NSCLC Adenocarcinoma sub-type, and

Eligible smoking history:

Never smoker (<100 cigarettes in lifetime), or Former smoker (stopped >1year ago and ≤10 pack-years) and WHO PS 0-2

  • Unsuitable for or patient declining chemotherapy due to significant co-morbidity
  • Measurable disease according to RECIST version 1.1
  • Adequate haematopoietic, hepatic and renal function defined as follows:

Absolute neutrophil count (ANC) ≤1.5 x 109/L and platelet count ≤100 x 109/L

  • Bilirubin ≤1.5 x ULN, ALT (SGPT) ≤3 x ULN (or ≤ 5 x ULN in cases of liver metastases)
  • Serum creatinine clearance ≥45 ml/min
  • Palliative radiotherapy allowed unless to a solitary target lesion
  • Age 18 or over (no upper age limit)
  • Written informed consent that is consistent with ICH-GCP guidelines

Exclusion Criteria:

  • Previous treatment with afatinib (BIBW 2992), or any EGFR-directed inhibitor
  • Any concurrent anticancer systemic therapy
  • Prior chemotherapy for relapsed and/or metastatic NSCLC
  • Neoadjuvant/adjuvant chemotherapy is permitted if at least 12 months has elapsed between the end of chemotherapy and registration
  • Suitable for radical radiotherapy
  • Palliative radiotherapy within 2 weeks prior to registration
  • Palliative radiotherapy to a solitary target lesion
  • Surgery (other than biopsy) within 4 weeks prior to registration
  • Inability to take oral medication, requirement for intravenous feeding, active peptic ulcer, prior surgical procedures affecting absorption, any medical co- morbidity affecting gastrointestinal absorption
  • Patients with current or pre-existing interstitial lung disease
  • Active or uncontrolled infections or serious illnesses or medical conditions that could interfere with the patient's participation in the trial
  • Significant or recent acute gastrointestinal abnormalities with diarrhoea as a major symptom e.g., Crohn's disease, mal-absorption, or CTCAE version 4.0 Grade ≥3 diarrhoea of any etiology at baseline
  • Active brain metastases (defined as stable for <4 weeks and/or symptomatic and/or requiring treatment with anticonvulsants and/or leptomeningeal disease). Steroids will be allowed if administered as a stable (same) dose for at least one month before trial entry.
  • Any other current malignancy or malignancy diagnosed within the past five years (other than non-melanomatous skin cancer and in situ cervical cancer)
  • History or presence of clinically relevant cardiovascular abnormalities such as uncontrolled hypertension, congestive heart failure NYHA classification of 3 or more, unstable angina or poorly controlled arrhythmia. Myocardial infarction within 6 months prior to registration
  • Symptomatic left ventricular failure with NYHA classification of 3 or more
  • Active viral hepatitis and/or known HIV positive
  • Known or suspected active drug or alcohol abuse
  • Use of any investigational drug within 8 weeks of registration.
  • Known allergy to BIBW 2992 or other ingredients.
  • Patients on steroids must have been on the same dose for at least 4 weeks.
  • Inability to understand or to comply with the requirements of the trial, trial protocol or to provide informed consent.
  • Women of childbearing potential, or men who are able to father a child, unwilling to use a medically acceptable method of contraception during the trial
  • Women who are pregnant or breast feeding
  • Requirement for treatment with any of the prohibited concomitant medications listed in protocol

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: N / A
  • Modèle interventionnel: Affectation à un seul groupe
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Afatinib (BIBW 2992)
All patients will be given daily oral afatinib (BIBW 2992) administered every 28 days until disease progression/toxicity/clinician decision to stop. Starting dose is 40mg. 30mg and 20mg will be administered according to protocol dose modification requirements following toxicity.
Médicament: Afatinib (BIBW 2992)
All patients will be given daily oral afatinib (BIBW 2992) administered every 28 days until disease progression/toxicity/clinician decision to stop. Starting dose is 40mg. 30mg and 20mg will be administered according to protocol dose modification requirements following toxicity.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Progression free survival
Délai: At 6 months
Progression free survival will be determined by measurement of tumour size using RECIST version 1.1 at progression or date of patient death.
At 6 months

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Overall response
Délai: CT scan of chest & abdomen 4 weeks after registartion, then every 8 calender weeks until disease progression. CT scans every 12 weeks if patient is still on BIBW 2992 after 1 year of treatment.
CT scan of chest & abdomen 4 weeks after registartion, then every 8 calender weeks until disease progression. CT scans every 12 weeks if patient is still on BIBW 2992 after 1 year of treatment.
Overall survival
Délai: This will be measured in days, from the first day of treatment to the day of death.
This will be measured in days, from the first day of treatment to the day of death.
Change in performance status
Délai: At 1 month
At 1 month
Safety
Délai: To be assessed at every timepoint i.e. baseline, fortnightly for the first 2 cycles and then monthly for 12 months and 2 monthly thereafter
For each type of adverse event, the maximum toxicity grade will be obtained for each patient using CTCAE version 4.0 to closely monitor tolerability to BIBW 2992. Focus will be on those with a grade 3 or 4 BIBW 2992 related toxicities. The proportion of patients with any grade 3 or 4 event will also be examined.
To be assessed at every timepoint i.e. baseline, fortnightly for the first 2 cycles and then monthly for 12 months and 2 monthly thereafter
Progression free survival in patients aged 70 and over
Délai: At progression or patient death
At progression or patient death
Treatment compliance
Délai: Compliance will be examined based on the time between starting treatment and stopping it completely
Compliance will be examined based on the time between starting treatment and stopping it completely

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

University College, London

Collaborateurs

Boehringer Ingelheim

Les enquêteurs

  • Chercheur principal: Sanjay Popat, BSc MBBS MRCP PhD, Royal Marsden Hospital London

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Liens utiles

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 décembre 2012

Achèvement primaire (Réel)

1 août 2015

Achèvement de l'étude (Réel)

30 novembre 2018

Dates d'inscription aux études

Première soumission

10 août 2011

Première soumission répondant aux critères de contrôle qualité

10 août 2011

Première publication (Estimation)

11 août 2011

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

15 janvier 2019

Dernière mise à jour soumise répondant aux critères de contrôle qualité

11 janvier 2019

Dernière vérification

1 octobre 2017

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • UCL/09/0426
  • 2011-003608-19 (Numéro EudraCT)

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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