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.
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
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.
Studietype
Registrering (Antatt)
Fase
- Fase 2
- Fase 1
Kontakter og plasseringer
Studiekontakt
- Navn: Jing Cai, MD, PhD
- Telefonnummer: +86+0791-86297662
- E-post: cjdl879@163.com
Studer Kontakt Backup
- Navn: Liangqian Lv, MD
- Telefonnummer: +86+0791-86297662
- E-post: 369848857@qq.com
Studiesteder
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Jianxi
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Nanchang, Jianxi, Kina, 330006
- Rekruttering
- The Second Affiliated Hospital of Nanchang University
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Ta kontakt med:
- Jian Li, PhD
- Telefonnummer: +86-0791-86297662
- E-post: efyyjs@126.com
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Ta kontakt med:
- Jing Cai, MD
- Telefonnummer: +86-0791-86265873
- E-post: cjdl879@163.com
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Hovedetterforsker:
- Anwen Liu, PhD
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Beskrivelse
Inclusion Criteria:
- Voluntarily agree to participate in this study and sign a written informed consent form
- Age ≥18 years and ≤75 years, regardless of gender
- 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
- 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)
- Central laboratory-confirmed PD-L1 Tumor Proportion Score (TPS) ≥50%
- At least one measurable target lesion according to RECIST v1.1 criteria
- Asymptomatic or locally treated stable brain metastases are allowed.
- ECOG performance status 0-1
- Expected survival ≥3 months
- Adequate organ function
Exclusion Criteria:
- Histological type of small cell lung cancer or mixed small cell lung cancer
- Prior treatment with any EGFR-TKI or MET-TKI
- Presence of ALK fusion positive or ROS1 fusion positive
- 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)
- 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)
- Require use of strong CYP3A4 inhibitors or inducers within 1 week before first dose or during the study
- Uncontrolled systemic diseases
- Cardiac dysfunction: QTcF >470ms (average of three ECGs) at screening; NYHA functional class ≥3 or LVEF <50%
- Dysphagia, active digestive system disease, or history of major gastrointestinal surgery that may affect drug absorption
- History of acute or chronic pancreatitis or pancreatic surgery
- Other conditions deemed unsuitable for participation by the investigator
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
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Eksperimentell: 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.
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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
Administered orally on an empty stomach, 80mg once daily, taken concurrently with Vebreltinib.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Phase Ib: Incidence of Dose-Limiting Toxicities as assessed by protocol-defined criteria and CTCAE v5.0
Tidsramme: Up to 28 days from first dose
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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
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Up to 28 days from first dose
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Phase Ib: Incidence of Grade ≥2 Treatment-Emergent Adverse Events as assessed by CTCAE v5.0
Tidsramme: Up to 8 weeks from first dose
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Number of participants experiencing Grade 2 or higher treatment-related adverse events
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Up to 8 weeks from first dose
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Phase Ib: Rate of dose reduction, interruption, or discontinuation due to treatment-related adverse events as assessed by CTCAE v5.0
Tidsramme: Up to 8 weeks from first dose
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Proportion of participants requiring dose reduction, interruption, or discontinuation due to treatment-related toxicity
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Up to 8 weeks from first dose
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Phase II: Investigator-Assessed Progression-Free Survival (PFS)
Tidsramme: From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Time from first dose to first documented disease progression or death from any cause, assessed according to RECIST v1.1
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From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Phase Ib: Objective Response Rate (ORR)
Tidsramme: Up to 8 weeks from first dose
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Proportion of participants achieving complete response (CR) or partial response (PR) per RECIST v1.1, assessed at 8 weeks after first dose
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Up to 8 weeks from first dose
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Phase II: Objective Response Rate (ORR)
Tidsramme: From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Proportion of participants achieving complete response (CR) or partial response (PR) per RECIST v1.1
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From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Phase II: Disease Control Rate (DCR)
Tidsramme: From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Proportion of participants achieving complete response (CR), partial response (PR), or stable disease (SD) per RECIST v1.1
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From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Phase II: Overall Survival (OS)
Tidsramme: From first dose until death from any cause, assessed up to 36 months
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Time from first dose to death from any cause
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From first dose until death from any cause, assessed up to 36 months
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Andre resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Exploratory: Objective response rate by baseline MET aberration status as assessed by RECIST 1.1
Tidsramme: From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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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)
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From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Exploratory: Objective response rate by MET overexpression level as assessed by RECIST 1.1
Tidsramme: From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Proportion of participants achieving CR or PR, stratified by MET overexpression level ( IHC 1+,2+, 3+) measured by immunohistochemistry
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From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Exploratory: Progression-free survival by baseline MET aberration status as assessed by RECIST 1.1
Tidsramme: From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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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)
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From first dose until first documented disease progression or death from any cause, assessed up to 24 months
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Samarbeidspartnere og etterforskere
Samarbeidspartnere
Etterforskere
- Studiestol: Anwen Liu, PhD, Second Affiliated Hospital of Nanchang University
Studierekorddatoer
Studer hoveddatoer
Studiestart (Antatt)
Primær fullføring (Antatt)
Studiet fullført (Antatt)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- IIT-I-2026-021
- I-MRER[2026] No. 10 (Annen identifikator: Ethics Committee, The Second Affiliated Hospital of Nanchang University)
Plan for individuelle deltakerdata (IPD)
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