Study of Nivolumab Verses Nivolumab and Ipilimumab Combination in EGFR Mutant Non-small Cell Lung Cancer
Randomised Phase 2 Study of Nivolumab Versus Nivolumab and Ipilimumab Combination in EGFR Mutant Non-small Cell Lung Cancer
研究概览
详细说明
This study examines the outcome of nivolumab single agent versus nivolumab-ipilimumab combination in patients with advanced EGFR+ NSCLC who have failed one line of standard EGFR Tyrosine Kinase Inhibitor (TKI) and not more than one line of chemotherapy regimen. The use of 3rd generation EGFR TKI for patients with acquired mutation that substitute a threonine (T) with a methionine (M) at position 790 of exon 20 (T790M) is allowed.
Patients will be randomized in a 1:1 ratio to treatment with either nivolumab monotherapy (Arm A) or nivolumab/ipilimumab combination therapy (Arm B) and will be stratified according to the following factors:
- Programmed Death-Ligand 1 (PDL1) status: <1% vs ≥1%
- Presence of brain metastasis
- Institution: National Cancer Centre Singapore, National University Cancer Institute, and Johns Hopkins Singapore-Tan Tock Seng Hospital
Both arms will continue with treatment regimen till disease progression or discontinuation of treatment due to adverse events.
Arm A patients are allowed to cross over to Arm B in the event of clear-cut disease progression.
On-study tumor assessments will be conducted every 6 weeks for 24 weeks and then every 12 weeks till clear-cut disease progression.
The radiologist will be blinded to the treatment arm that the patient is randomised to ensure an objective response evaluation.
研究类型
注册 (实际的)
阶段
- 阶段2
联系人和位置
学习地点
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Singapore、新加坡、119074
- National University Hospital
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Singapore、新加坡、169610
- National Cancer Centre Singapore
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Singapore、新加坡
- Tan Tock Seng Hospital
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
i. Signed informed consent
ii. Male or female, 21 years or older
- Women of childbearing potential (WOCBP) must use appropriate method(s) of contraception. WOCBP should use an adequate method to avoid pregnancy for 5 months (30 days plus the time required for nivolumab to undergo five half-lives) after the last dose of investigational drug
- Women of childbearing potential must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the start of nivolumab
- Women must not be breastfeeding
- Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 7 months after the last dose of investigational product Women who are not of childbearing potential (ie, who are postmenopausal or surgically sterile as well as azoospermic men do not require contraception
- WOCBP is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. In addition, women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level less than 40 milli-international units per millilitre (mIU/mL).
- Women of childbearing potential (WOCBP) receiving nivolumab will be instructed to adhere to contraception for a period of 5 months after the last dose of investigational product. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 7 months after the last dose of investigational product. These durations have been calculated using the upper limit of the half-life for nivolumab (25 days) and are based on the protocol requirement that WOCBP use contraception for 5 half-lives plus 30 days and men who are sexually active with WOCBP use contraception for 5 half-lives plus 90 days.
iii. Advanced EGFR+ NSCLC
iv. Eastern Cooperative Oncology Group (ECOG) 0-2 performance status
v. Progressed on one line of standard EGFR TKI and not more than one line of chemotherapy; 3rd generation EGFR TKI for patients with T790M mutation is allowed
- A 14-day washout period is required for EGFR TKI for patients who received this as the last therapy before recruitment
- A 28-day washout period is required for chemotherapy for patients who received this as the last therapy before recruitment. All drug-related toxicities should have returned to baseline with the exception of neuropathy, fatigue, and alopecia.
vi. Screening laboratory values must meet the following criteria and should be obtained within 14 days prior to randomization/registration
- White Blood Cell (WBC) ≥ 2000/µL
- Neutrophils ≥ 1000/µL
- Platelets ≥ 100 x 10^3/µL
- Hemoglobin > 9.0 g/dL
- Serum creatinine ≤ 1.5 x Upper Limit of Normal (ULN) or creatinine clearance (CrCl) ≥ 30 mL/min (if using the Cockcroft-Gault formula below):
- Aspartate Aminotransferase/ Alanine Aminotransferase (AST/ALT) ≤ 3 x ULN
- Total Bilirubin ≤ 1.5 x ULN (except subjects with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL)
vii. Measurable disease, as defined by RECIST v1.1; Previously irradiated lesions can only be considered as measurable disease if disease progression has been unequivocally documented at that site since radiation.
viii. Patients with a history of treated asymptomatic central nervous system (CNS) metastases are eligible, provided they meet all of the following criteria:
- Measurable disease outside CNS
- No ongoing requirement for corticosteroids as therapy for CNS disease; anticonvulsants at a stable dose allowed
- No stereotactic radiation within 7 days or whole-brain radiation within 14 days prior to randomization
- No evidence of interim progression between the completion of CNS-directed therapy and the screening radiographic study
ix. Tumor sites amenable for CT-guided core biopsies or trucut biopsies
x. Willing to undergo 2 biopsies and contribute research bloods for the study. Archived tissue that is less than 6 months old is acceptable as an alternative to biopsy at screening if a biopsy is not feasible; patients from arm A must be willing to undergo biopsy as baseline upon clear-cut disease progression and on-treatment repeat biopsy before they are allowed to cross over to receive ipilimumab in addition to nivolumab.
xi. Patients with confirmed concomitant HBV infection that are eligible for inclusion must be treated with antiviral therapy prior to enrollment to ensure adequate viral suppression (HBV DNA < 2000 IU/mL), must remain on antiviral therapy for the study duration, and continue therapy for 6 months after the last dose of investigational product(s). Subjects with confirmed Hepatitis C (HCV) infection who are negative for HBsAg and positive for anti-HBc, are eligible but must be started on active antiviral therapy (for HBV) prior to their first dose of investigational product.
xi. For female patients of childbearing potential and male patients with partners of childbearing potential, agreement (by patient and/or partner) to use a highly effective form(s) of contraception and to continue its use for 90 days after the last dose of nivolumab
xii. Women who are not postmenopausal (≥12 months of non-therapy-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 24 hours prior to initiation of study drug
xiii. Available for follow-up
Exclusion Criteria:
i. Symptomatic brain or leptomeningeal metastases (patients who have treated stable brain or Leptomeningeal disease are eligible; there is no magnetic resonance imaging (MRI) evidence of progression for [lowest minimum is 4 weeks or more] after treatment is complete and within 28 days prior to the first dose of nivolumab administration. There must also be no requirement for immunosuppressive doses of systemic corticosteroids (> 10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration).
ii. Poor performance status of ECOG 3-4
iii. Tumour sites not amenable to CT-guided core biopsies or trucut biopsies; However waiver for this criterion can be given for selected patients on a case-by-case basis for patients with sites of disease that are technically difficult to access after discussion with interventional radiologist. Waivers are allowed for not more than 70 patients for this study in order to allow sufficient number of quality tumour biopsies for biomarker analysis in this study. Waivers would have to be approved by the Principal Investigator.
iv. Unwilling to undergo 2 biopsies and contribute research bloods for the study
v. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
vi. Concurrent Autoimmune disease. Subjects are permitted to enroll if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger.
vii. Prior treatment with other anti-Programmed cell death protein 1 (anti-PD1) or anti-PDL1 or anti-CTLA4 therapies
viii. Treatment with systemic immunosuppressive medications (including but not limited to prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor (anti-TNF) agents) within 2 weeks prior to randomization
- Patients who have received acute, low-dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea) may be enrolled in the study.
- Patients with history of allergic reaction to IV contrast requiring steroid pre-treatment should have baseline and subsequent tumor assessments done by MRI.
- The use of inhaled corticosteroids for chronic obstructive pulmonary disease, mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension, and low-dose supplemental corticosteroids for adrenocortical insufficiency are allowed.
ix. Active interstitial lung disease or history of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan; History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
x. Active tuberculosis
xi. Patients should be excluded if they have known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)
xii. Prior allogeneic bone marrow transplantation or solid organ transplant
xiii. Administration of a live, attenuated vaccine within 4 weeks before randomization or anticipation that such a live attenuated vaccine will be required during the study
xiv. Not available for follow-up and unlikely to be compliant with follow-up or protocol requirements
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:纳武单抗和易普利姆玛
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Nivolumab 3 mg/kg administered every 2 weeks as a 30 min IV infusion
其他名称:
Ipilimumab 1 mg/kg administered every 6 weeks as a 30 min IV infusion
其他名称:
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实验性的:纳武单抗
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Nivolumab 3 mg/kg administered every 2 weeks as a 30 min IV infusion
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
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Overall Response Rate
大体时间:From baseline until best overall response of Complete Response (CR) or Partial Response (PR), up to 2 years
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From baseline until best overall response of Complete Response (CR) or Partial Response (PR), up to 2 years
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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Progression-Free Survival
大体时间:From time of randomisation until first documented disease progression or death due to any cause, up to 2 years
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From time of randomisation until first documented disease progression or death due to any cause, up to 2 years
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Duration of Response
大体时间:From time of first response until first documented disease progression or death due to any cause, up to 2 years
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From time of first response until first documented disease progression or death due to any cause, up to 2 years
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Overall Survival
大体时间:From time of randomisation until death due to any cause, up to 2 years
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From time of randomisation until death due to any cause, up to 2 years
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Evaluate the toxicity profiles of Nivolumab with or without Ipilimumab by measuring the number of participants with treatment-related adverse events
大体时间:From the time the Informed Consent Form is signed until at least 100 days after discontinuation of dosing, up to 2 years
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Safety data of all adverse events and serious adverse events, will be graded according to the NCI CTCAE v 4.0.
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From the time the Informed Consent Form is signed until at least 100 days after discontinuation of dosing, up to 2 years
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Evaluate capability of the addition of Ipilimumab to patients who progress on Nivolumab alone (Arm A) to achieve clinical benefit by measuring the time taken to achieve CR, PR or Stable Disease (SD)
大体时间:From time of first dose of Ipilimumab until best overall response of CR, PR, or SD, up to 2 years
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From time of first dose of Ipilimumab until best overall response of CR, PR, or SD, up to 2 years
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Evaluate an array of biomarkers in predicting response to Nivolumab and/or Ipilimumab
大体时间:From time of first dose of study treatment until clear-cut disease progression, up to 2 years
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Biomarkers: PD-L1, mutational burden, microsatellite instability, blood-based biomarkers
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From time of first dose of study treatment until clear-cut disease progression, up to 2 years
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合作者和调查者
调查人员
- 首席研究员:Eng Huat Tan、National Cancer Centre, Singapore
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.
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