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| ID | Type | Description | Link |
|---|---|---|---|
| 2019-002197-31 | EudraCT Number |
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| Name | Class |
|---|---|
| Boehringer Ingelheim | INDUSTRY |
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This randomized, open label Phase IV trial will be performed in patients with a diagnosis of advanced NSCLC (non-squamous cell histology), harboring EGFR mutation positive but T790M Mutation negative, who have no previous chemotherapy for metastatic NSCLC. Neoadjuvant or adjuvant systemic treatments had to be finished at least (≥) 6 months before study inclusion. In conclusion, this study is investigating the important clinical question whether tumor growth and long term overall survival for a patient is better controlled in a specific treatment sequence of different EGFR-inhibitors. Patients will be treated with registered compounds according to their label in both treatment arms. Thus, all patients will get an effective treatment regimen and patients who progressed on afatinib, and who developed a T790M mutation will be treated subsequently with osimertinib. Those who progressed under osimertinib or under afatinib without T790M mutation will be treated according to the current treatment guidelines with Investigator´s choice of active therapy (ICT) including but not limited to platin doublet chemotherapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Afatinib | Experimental | Afatinib followed by osimertinib or ICT depending on T790M status |
|
| Osimertinib | Active Comparator | Osimertinib followed by ICT |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Afatinib | Drug | Afatinib followed by osimertinib or ICT |
|
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| Measure | Description | Time Frame |
|---|---|---|
| Time to EGFR-TKI failure within 24 months for afatinib followed by osimertinib in T790Mpositive group vs osimertinib | The main objective is to investigate whether the time to EGFR-TKI failure at 24 months is better for the treatment sequence of afatinib followed by osimertinib in the T790M positive group compared to osimertinib. | 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Time to EGFR-TKI failure (afatinib versus osimertinib) | Time from randomization until ICT is indicated | 24 months |
| Progression-free survival (PFS: afatinib followed by osimertinib or ICT vs osimertinib followed by ICT) |
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Inclusion Criteria:
Histologically confirmed non-squamous NSCLC harboring EGFR mutation positive but T790M mutation negative by local testing
Unresectable stage UICC ≥ IIIb or metastatic stage UICC IV disease
TKI naïve for metastatic NSCLC, neoadjuvant or adjuvant chemotherapy allowed
At least one evaluable lesion according to RECIST v1.1
Age ≥ 18 years
ECOG performance status 0 - 2
Adequate organ function, defined as all of the following:
e. Total Bilirubin ≤ 1.5 times upper limit of normal (ULN), (if related to liver metastases ≤ 3 times ULN). (Patients with Gilbert's syndrome total Bilirubin must be ≤ 4 times institutional upper limit of normal) f. Aspartate amino transferase (AST) or alanine amino transferase (ALT) ≤ 3 times the upper limit of normal (ULN) (if related to liver metastases ≤ 5 times ULN)
Recovered from any previous therapy related toxicity to ≤ Grade 1 at before randomization (except for stable sensory neuropathy ≤ Grade 2 and alopecia)
Written informed consen
Exclusion Criteria:
Any investigational drug within 30 days or hormonal anticancer treatment within 2 weeks prior to randomization (continued use of anti-androgens and/or gonadorelin analogues for treatment of prostate cancer permitted)
T790M mutation positive tumors (by local testing)
Radiotherapy within 2 weeks prior to randomization, except as follows:
Major surgery within 2 weeks before starting study treatment or scheduled for surgery during the projected course of the study
Known hypersensitivity to afatinib or osimertinib or the excipients of any of the trial drugs
History or presence of clinically relevant cardiovascular abnormalities such as
Patients with a past or present medical history of
Pregnancy and contraception:
Requiring treatment with any of the prohibited concomitant medications protein Inhibitors/Inductors CYP3A4/5 Inhibitors/Inductors that cannot be stopped for the duration of trial participation or concomitant St. John's Wort
Uncontrolled brain metastases (Patients with brain or subdural metastases are not eligible, unless they have completed local therapy (≤ 2 weeks apart from last radiotherapy or radiosurgery) and have discontinued the use of corticosteroids, anticonvulsants or have been on stable dose of corticosteroids (i.e. Dexamethasone ≤ 8 mg) for at least 4 weeks before starting study treatment. Any symptoms attributed to brain metastases must be stable for at least 4 weeks before starting study treatment) or Leptomeningeal carcinomatosis 11. Other contraindications to study treatment (Investigators opinion) or legal incapacity or limited legal capacity
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| Name | Affiliation | Role |
|---|---|---|
| Thomas Wehler, Prof Dr med | Universitätsklinikum Gießen Marburg | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Klinikum der Ludwig-Maximilians-Universität München | München | Bavaria | 80336 | Germany | ||
| Universitätsklinikum Gießen Marburg |
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| Osimertinib | Drug | Osimertinib followed by ICT |
|
Time from randomization until disease progression according to RECIST or death
| 24 months |
| Overall Survival (OS) | Survival Status | 24 months |
| Response Rate (RR) | CR+PR according to RECIST | 12 months |
| Response Rate (RR) | CR+PR according to RECIST | 24 months |
| Disease Control Rate (DCR) | CR+PR+SD according to RECIST | 12 months |
| Disease Control Rate (DCR) | CR+PR+SD according to RECIST | 24 months |
| Adverse Events | Adverse Events as assessed by intensity of the of the adverse events and the causal relation to trial medication Intensity/Severity: investigator will use the following definitions of severity in accordance with National Cancer Institute common terminology criteria for adverse events, CTCAE, version 5.0; assessment of the relationship of an adverse event to the administration of study drug is a clinical decision by the investigator Institute common terminology criteria for adverse events, CTCAE, version 5.0 | 24 months |
| Symptom control assessed by patient-reported quality of life (QoL): EQ-5D | patient-reported quality of life assessed by European Quality of Life 5 Dimensions Questionnaire (EQ-5D) | 24 months |
| Symptom control assessed by patient-reported quality of life (QoL): EORTC QLQ-C30 | patient-reported quality of life assessed by Questionnaire of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) | 24 months |
| Symptom control assessed by patient-reported quality of life (QoL): EORTC QLQ-LC29 | EORTC QLQ-LC29 | 24 months |
| Giessen |
| Hesse |
| 35392 |
| Germany |
| Sana-Klinikum Offenbach | Offenbach | Hesse | 63069 | Germany |
| Evangelische Lungenklinik Berlin | Berlin | 13125 | Germany |
| Klinikum Bremen-Ost | Bremen | 28325 | Germany |
| Studiengesellschaft Hämato-Onkologie Hamburg | Hamburg | 20251 | Germany |
| Evangelisches Krankenhaus Hamm | Hamm | 59063 | Germany |
| Klinikverbund Allgäug gGmbH, Klinik für Pneumologie, c/o Klinik | Immenstadt im Allgäu | 87509 | Germany |
| Gemeinnützige Krankenhausbetriebsgesellschaft Konstanz Mbh | Konstanz | 78464 | Germany |
| Klinik Löwenstein gGmbH | Löwenstein | 74245 | Germany |
| Universitätsklinikum Regensburg | Regensburg | 93053 | Germany |
| ID | Term |
|---|---|
| D000077716 | Afatinib |
| C000596361 | osimertinib |
| ID | Term |
|---|---|
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D011799 | Quinazolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
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