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This trial will evaluate the efficacy and safety of various therapies in participants with Stage IB, IIA, IIB, IIIA, or selected IIIB resectable and untreated NSCLC tumors that meet protocol-specified biomarker criteria.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ALK Cohort (Enrolment Closed) | Experimental | Participants will receive up to 8 weeks of alectinib neoadjuvant treatment before undergoing surgical resection per standard of care (SOC). All participants that undergo surgical resection and whose tumors have pathological response or lack radiographic progression will be eligible for the adjuvant treatment phase with alectinib. Adjuvant therapy will consist of 4 cycles of chemotherapy followed by up to 2 years of alectinib. Enrolment Closed. |
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| ROS 1 Cohort (Enrolment Closed) | Experimental | Participants will receive up to 8 weeks of entrectinib neoadjuvant treatment before undergoing surgical resection per SOC. All participants that undergo surgical resection and whose tumors have pathological response or lack radiographic progression will be eligible for the adjuvant treatment phase with entrectinib. Adjuvant therapy will consist of 4 cycles of chemotherapy followed by up to 2 years of entrectinib. Enrolment Closed. |
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| NTRK Cohort (Enrolment Closed) | Experimental | Participants will receive up to 8 weeks of entrectinib neoadjuvant treatment before undergoing surgical resection per SOC. All participants that undergo surgical resection and whose tumors have pathological response or lack radiographic progression will be eligible for the adjuvant treatment phase with entrectinib. Adjuvant therapy will consist of 4 cycles of chemotherapy followed by up to 2 years of entrectinib. Enrolment Closed. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Alectinib | Drug | Participants will receive oral alectinib twice per day (BID). |
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| Measure | Description | Time Frame |
|---|---|---|
| Tyrosine Kinase Inhibitor (TKI) Cohort: Proportion of Participants With Major Pathologic Response (MPR) | MPR is defined as ≤ 10% residual viable tumor cells as scored by local pathologists. | After surgical resection (approximately study Week 8) |
| Checkpoint Inhibitor (CPI) Cohort: Pathological Complete Response (pCR) | Scored by local pathologists; defined as lack of any viable tumor cells on review of hematoxylin and eosin (H&E) slides after complete evaluation of a resected lung cancer specimen including all sampled regional lymph nodes. | After surgical resection (approximately study Week 8) |
| KRAS G12C Cohort: Percentage of Participants With 3-5 Grade Adverse Events (AEs) | After surgical resection (approximately study Week 8) | |
| KRAS G12C Cohort: Percentage of Participants Without Delays of Surgery due to Treatment-related AEs as Reported by the Investigator | After surgical resection (approximately study Week 8) |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of Participants With MPR | Defined as ≤10% residual viable tumor cells) based on surgical resection as defined by Hellmann et al. (2014) and Travis et al. (2020). TKI cohorts: MPR will be scored by a central pathology committee consensus read. CPI cohort: MPR will be scored by local pathologists and central pathology committee consensus read. KRAS G12C cohort: MPR will be scored by local pathologists and central pathology committee consensus read. |
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Inclusion Criteria for Neoadjuvant Therapy:
Inclusion Criteria for Adjuvant Therapy (TKI Cohorts and KRAS G12C cohort [if continuing on Divarasib]):
Exclusion Criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Reference Study ID Number: ML41591 https://forpatients.roche.com/ | Contact | 888-662-6728 | global-roche-genentech-trials@gene.com | |
| Fastest response: use the inquiry form. No email attachments. https://www.gene.com/contact-us/submit-medical-inquiry | Contact |
| Name | Affiliation | Role |
|---|---|---|
| Clinical Trials | Hoffmann-La Roche | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| City of Hope Comprehensive Cancer Center | Withdrawn | Duarte | California | 91010 | United States | |
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| Label | URL |
|---|---|
| Please use this form to submit your questions for a faster response: https://www.gene.com/contact-us/submit-medical-inquiry. Do not include or attach any medical records when emailing or completing the form. A nurse will respond within 24 business hours. | View source |
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For eligible studies, qualified researchers may request access to individual patient level clinical data. See Roche's commitment to transparency of clinical study information here: https://go.roche.com/data\_sharing
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| BRAF Cohort (No Participants Enrolled, Cohort Closed) | Experimental | Participants will receive up to 8 weeks of vemurafenib plus cobimetinib neoadjuvant treatment before undergoing surgical resection per SOC. All participants that undergo surgical resection and whose tumors have pathological response or lack radiographic progression will be eligible for the adjuvant treatment phase with vemurafenib plus cobimetinib. Adjuvant therapy will consist of 4 cycles of chemotherapy followed by up to 2 years of of vemurafenib plus cobimetinib. Cohort closed. |
|
| RET Cohort (Cohort closed) | Experimental | Participants will receive up to 8 weeks of pralsetinib neoadjuvant treatment before undergoing surgical resection per SOC. All participants that undergo surgical resection and whose tumors have pathological response or lack radiographic progression will be eligible for the adjuvant treatment phase with pralsetinib. Adjuvant therapy will consist of 4 cycles of chemotherapy followed by up to 2 years of pralsetinib. Cohort closed. |
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| PD-L1 Cohort (Enrolment Closed) | Experimental | Participants with positive programmed death-ligand 1 (PD-L1) in ≥1% tumor cells will receive 4 cycles of atezolizumab neoadjuvant treatment. During neoadjuvant Cycle 1 of atezolizumab, participants will also receive low-dose stereotactic body radiation therapy (SBRT) (8 gray [Gy] X 3). Adjuvant treatment consists of SOC treatment as determined by the investigator, per National Comprehensive Cancer Network (NCCN) guidelines. Enrolment Closed. |
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| KRAS G12C Cohort | Experimental | Participants will receive up to 8 weeks of divarasib as neoadjuvant treatment before undergoing surgical resection per SOC. PD-L1 negative participants whose tumors have pathological response or lack radiographic progression will be have the option of continuing divarasib alone for up to 3 years or 1-4 cycles of SOC chemotherapy followed by divarasib for 3 years as adjuvant therapy. For participants who test positive PD-L1, they will have the option to receive 1-4 cycles of SOC chemotherapy followed by atezolizumab for up to 16 cycles or SOC alone. |
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| Entrectinib | Drug | Participants will receive oral entrectinib daily. |
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| Vemurafenib | Drug | Participants will receive oral vemurafenib BID. |
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| Cobimetinib | Drug | Participants will receive oral cobimetinib daily. |
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| Pralsetinib | Drug | Participants will receive oral pralsetinib daily. |
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| Atezolizumab | Drug | Atezolizumab will be administered by intravenous (IV) infusion. |
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| SBRT | Drug | Participants will receive SBRT given concurrently, starting with the first dose of atezolizumab. |
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| Resection | Procedure | Participants will receive surgical resection of the primary tumor along with selected lymph nodes per SOC. |
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| Chemotherapy | Drug | Participants will receive SOC chemotherapy as determined by the treating physician. |
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| Divarasib | Drug | Participants in the KRAS G12C cohort will receive oral divarasib for approximately 8 weeks until the day before surgery as neoadjuvant therapy up to 3 years as adjuvant therapy. |
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| After surgical resection (approximately study Week 8) |
| Proportion of Participants With pCR | Defined as lack of any viable tumor cells on review of H&E slides after complete evaluation of a resected lung cancer specimen, including all sampled regional lymph nodes. TKI cohorts: pCR will be scored by local pathologists and a central pathology committee consensus read. CPI cohort: pCR will be scored by a central pathology committee consensus read. KRAS G12C cohort: pCR will be scored by a central pathology committee consensus read. | After surgical resection (approximately study Week 8) |
| Pathological Regression Based on Weighted % Viable Tumor Cell Assessment | After surgical resection (approximately study Week 8) |
| Investigator-assessed Response Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) | After neoadjuvant treatment (after approximately study Week 8) |
| Disease-free Survival (DFS) | From the first date of no disease to local or distant recurrence or death from any cause, whichever occurs first, through the end of the study (up to 9 years) |
| Event-free Survival (EFS) | From first dose of study treatment to first documented disease progression per RECIST v1.1, or local or distant disease recurrence as determined by investigator, or death from any cause, whichever occurs first, through the end of study (up to 9 years) |
| Overall Survival (OS) | From the first dose of study medication to death from any cause, through the end of the study (up to 9 years) |
| Percentage of Participants With AEs | Up to 9 years |
| Nodal Downstaging | Defined as percentage of participants with reduced stages in regional lymph nodes at surgery. | After surgical resection (approximately study Week 8) |
| Circulating tumor DNA (ctDNA) Clearance Rate | Prior to surgery (before study Week 8) |
| KRAS G12C Cohort: Plasma Concentration of Divarasib at Specified Timepoints |
| Neo-adjuvant: pre-dose & 2 hours post-dose on Day 1 of Cycles 1 & 2; Pre-surgery (before Week 8): pre-dose; Adjuvant treatment: pre-dose & 2 hours post-dose on Day 1 of Cycles 1-6, pre-dose on Day 1 of Cycle 9 (each cycle=28 days); |
| City of Hope - Orange County Lennar Foundation Cancer Center |
| Withdrawn |
| Irvine |
| California |
| 92618 |
| United States |
| USC Norris Cancer Center | Withdrawn | Los Angeles | California | 90033 | United States |
| Cedars-Sinai Medical Center | Withdrawn | Los Angeles | California | 90048 | United States |
| University of California Los Angeles - Jonsson Comprehensive Cancer Center | Recruiting | Los Angeles | California | 90095 | United States |
| The Center for Cancer Prevention and Treatment at St.Joseph Hospital of Orange | Recruiting | Orange | California | 92868 | United States |
| UC Davis Comprehensive Cancer Center | Recruiting | Sacramento | California | 95817 | United States |
| UCSF Helen Diller Family CCC | Withdrawn | San Francisco | California | 94158 | United States |
| University of Colorado - Anschutz Medical Campus (University of Colorado Health Sciences Center) | Withdrawn | Aurora | Colorado | 80045 | United States |
| Yale Cancer Center | Recruiting | New Haven | Connecticut | 06511 | United States |
| MedStar Georgetown University Hospital (Lombardi Comprehensive Cancer Center) | Recruiting | Washington D.C. | District of Columbia | 20007 | United States |
| Moffitt Cancer Center | Recruiting | Tampa | Florida | 33612 | United States |
| Northwestern University | Recruiting | Chicago | Illinois | 60611 | United States |
| Northwestern Medicine Cancer Center Kishwaukee | Recruiting | DeKalb | Illinois | 60115 | United States |
| Northwestern Medicine Cancer Center Delnor | Recruiting | Geneva | Illinois | 60134 | United States |
| Northwestern Medicine Cancer Center Warrenville | Recruiting | Warrenville | Illinois | 60555 | United States |
| Boston Medical Center | Withdrawn | Boston | Massachusetts | 02118 | United States |
| Dana-Farber Cancer Institute | Recruiting | Boston | Massachusetts | 02215 | United States |
| University of Michigan | Recruiting | Ann Arbor | Michigan | 48109 | United States |
| Karmanos Cancer Institute - Farmington Hills/Weisberg Cancer Treatment Center | Withdrawn | Farmington Hills | Michigan | 48334 | United States |
| Mayo Clinic | Recruiting | Rochester | Minnesota | 55905 | United States |
| Ellis Fischel Cancer Center | Recruiting | Columbia | Missouri | 65201 | United States |
| Siteman Cancer Center - Washington University Medical Campus | Recruiting | St Louis | Missouri | 63108 | United States |
| Dartmouth Hitchcock Medical Center | Recruiting | Lebanon | New Hampshire | 03756 | United States |
| Laura and ISAAC Perlmutter Cancer Center at NYU Langone. | Recruiting | New York | New York | 10016 | United States |
| Columbia University Medical Center | Recruiting | New York | New York | 10032 | United States |
| Memorial Sloan Kettering Cancer Center | Recruiting | New York | New York | 10065 | United States |
| University Hospitals Cleveland Medical Center | Withdrawn | Cleveland | Ohio | 44016 | United States |
| Ohio State University | Recruiting | Columbus | Ohio | 43210 | United States |
| AHN Cancer Institute ? Allegheny General Hospital | Completed | Pittsburgh | Pennsylvania | 15212 | United States |
| Baptist Clinical Research Institute | Recruiting | Memphis | Tennessee | 38120 | United States |
| Tennessee Oncology - Nashville | Withdrawn | Nashville | Tennessee | 37203 | United States |
| Kelsey Seybold Clnic | Withdrawn | Houston | Texas | 77025 | United States |
| University of Texas MD Anderson Cancer Center | Recruiting | Houston | Texas | 77030-4008 | United States |
| Baylor College of Medicine | Withdrawn | Houston | Texas | 77030 | United States |
| Lumi Research | Withdrawn | Kingwood | Texas | 77339 | United States |
| Virginia Cancer Specialists (Fairfax) - USOR | Recruiting | Fairfax | Virginia | 22031 | United States |
| Seattle Cancer Care Alliance | Withdrawn | Seattle | Washington | 98109 | United States |
| ID | Term |
|---|---|
| D002289 | Carcinoma, Non-Small-Cell Lung |
| ID | Term |
|---|---|
| D002283 | Carcinoma, Bronchogenic |
| D001984 | Bronchial Neoplasms |
| D008175 | Lung Neoplasms |
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| C582670 | alectinib |
| C000607349 | entrectinib |
| D000077484 | Vemurafenib |
| C574276 | cobimetinib |
| C000655704 | pralsetinib |
| C000594389 | atezolizumab |
| D004358 | Drug Therapy |
| ID | Term |
|---|---|
| D013449 | Sulfonamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D013450 | Sulfones |
| D013457 | Sulfur Compounds |
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D013812 | Therapeutics |
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