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| Name | Class |
|---|---|
| Korea University Anam Hospital | OTHER |
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The primary objective is to evaluate the intracranial efficacy of pemetrexed/carboplatin chemotherapy and lazertinib combination therapy after osimertinib failure in EGFR-positive non-small cell lung cancer patients with brain metastasis. The primary endpoint is the incracranial objective response rate (iORR). Secondary endpoints are intracranial progression free survival, (iPFS), objective response rate (ORR), duration of response (DoR), disease control rate, (DCR), overall survival (OS), the pattern of treatment failure, intracranial salvage treatment rate, and toxicity.
Patients should take lazertinib 240 mg (80 mg, 3 tablets) once a day at the same time as possible before meals. Chemotherapy will be administered on the 1st day every 3 weeks. (Pemetrexed 500mg/m2, Carboplatin AUC x 5 mg/mL.min) One cycle of treatment is defined as continuous administration for 21 days.
The treatment will be applied to the all patients until documented evidence of disease progression, unacceptable toxicity, noncompliance, or withdrawal of consent, or the investigator decides to discontinue treatment, whichever comes first. If the investigator decides to reduce the dose due to an adverse reaction during the administration of lazertinib 240 mg, the dose may be reduced to 160 mg (80 mg, 2 tablets) of lazertinib. Pemetrexed and carboplatin can be administered in reduced doses according to the principles of each institution.
The primary objective is to evaluate the intracranial efficacy of pemetrexed/carboplatin chemotherapy and lazertinib combination therapy after osimertinib failure in EGFR-positive non-small cell lung cancer patients with brain metastasis. The primary endpoint is the incracranial objective response rate (iORR), defined as the proportion of patients achieving a complete response or partial response of intracranial lesions per RECIST v1.1 by investigator's assessments. Secondary endpoints are intracranial progression free survival, (iPFS), objective response rate (ORR), duration of response (DoR), disease control rate, (DCR), overall survival (OS), the pattern of treatment failure, intracranial salvage treatment rate, and toxicity.
Intracranial objective response rate (iORR): percentage of subjects with at least one confirmed response (CR or PR or responding) in the intracranial lesion before evidence of progression in patients with brain metastases Intracranial progression free survival (iPFS): From C1D1 to the date of either disease progression of intracranial lesions or death Objective response rate (ORR): proportion of patients achieving a complete response or partial response of overall lesions Duration of response (DoR): From the first recorded response to the first recorded disease progression or death Disease control rate, (DCR): proportion of patients achieving a complete response or partial response or stable disease of overall lesions Overall survival: From C1D1 to the date of all-cause mortality Safety: Evaluated by NCI-CTCAE v5.0 Pattern of treatment failure: intracranial progression, extracranial progression, or both Intracranial salvage treatment rate: Percentage of subjects who underwent salvage treatment(surgery or radiation) due to intracranial disease progression
The exploratory objective is to identify molecular profiling using next generation sequencing.
Patients should take lazertinib 240 mg (80 mg, 3 tablets) once a day at the same time as possible before meals. Chemotherapy will be administered on the 1st day every 3 weeks. (Pemetrexed 500mg/m2, Carboplatin AUC x 5 mg/mL.min) One cycle of treatment is defined as continuous administration for 21 days.
The treatment will be applied to the all patients until documented evidence of disease progression, unacceptable toxicity, noncompliance, or withdrawal of consent, or the investigator decides to discontinue treatment, whichever comes first. If the investigator decides to reduce the dose due to an adverse reaction during the administration of lazertinib 240 mg, the dose may be reduced to 160 mg (80 mg, 2 tablets) of lazertinib. Pemetrexed and carboplatin can be administered in reduced doses according to the principles of each institution. To prevent side effects of pemetrexed, start at least 7 days before cycle 1 daily dose of 350-1,000 μg/day of folic acid and 1000 μg/3 of vitamin B12.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| lazertinib/pemetrexed/carboplatin | Experimental | combination of lazertinib with pemetrexed/carboplatin chemotherapy - Lazertinib 240mg once daily and chemotherapy (pemetrexed and carboplatin) is administered on the 1st day every 3 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lazertinib | Drug | - Lazertinib 240mg (3 tablets, 80mg/1tablet) once a day, oral, before disease progression |
|
| Measure | Description | Time Frame |
|---|---|---|
| intracranial objective response rate | "Percentage of subjects who had at least one confirmed response among evaluable subjects who performed more than one response assessment" | "every 6 weeks up to 24 weeks, and every 12 weeks thereafter up to 2 years " |
| Measure | Description | Time Frame |
|---|---|---|
| intracranial progression-free survival | "The period (in months) from the first administration of the investigational drug to the date of onset of objective intracranial disease progression evaluated by the investigator or death from any cause, whichever occurs first" | "every 6 weeks up to 24 weeks, and every 12 weeks thereafter up to 2 years " |
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Inclusion Criteria:
B. Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-2, with no deterioration in the last 2 weeks C. Life expectancy judged by the Investigator of at least 3 months D. Disease status
Exclusion Criteria:
H. Previous anticancer treatment-related toxicities not recovered to baseline or Grade 0-1 (except alopecia) 2) Medical history and current disease A. Symptomatic spinal cord compression (However, registration is allowed if steroid treatment is not required within at least 2 weeks before the start of administration of the investigational drug) B. Symptomatic and unstable central nervous system (CNS) or brain metastasis requiring local treatment at screening. (Asymptomatic or mild symptomatic leptomeningeal metastasis is also permitted to be registered) C. Symptomatic or intracranial bleeding that needs treatment D. History of interstitial lung disease (ILD), drug-induced ILD, radiation pneumonitis which required steroid treatment, or any evidence of clinically active ILD E. Carcinoma other than non-small cell lung cancer, if the investigator is judged to be inadequate to participate in this clinical trial due to evidence of severe or uncontrolled systemic disease, uncontrolled hypertension, or active bleeding tendency, or that it is difficult to follow this protocol. (Screening for chronic disease is not required)
F. Any of the following cardiovascular diaseases:
i. A history of congestive heart failure (CHF) of grade 3 or higher according to the New York Heart Association Classification (NYHA) or cardiac arrhythmia requiring treatment ii. A History of unstable angina or myocardial infarction experienced within 6 months before the first administration of the investigational drug iii. Left ventricular ejection fraction <45% on recent echocardiography or MUGA scan G. Known human immunodeficiency virus (HIV) infection H. Patients with refractory nausea and vomiting, chronic gastrointestinal disorders, inability to swallow the product, or undergoing enterectomy deemed to interfere with the proper absorption of lazertinib.
I. History of hypersensitivity to drugs J. Clinically significant chronic infection or major medical or mental illness K. Subjects with any concurrent medical condition or disease that will potentially compromise the conduct of the study at the discretion of the Investigators L. History of allogeneic hematopoietic stem cell transplantation, history of whole blood transfusions that did not remove leukocytes within 120 days before the date of collection of genetics specimens 3) Criteria for cardiology and clinical laboratory testing
A. Cardiac criteria in any of the following:
i. Based on the QTc value measured with an electrocardiogram (ECG) device during screening, the average of the correction of the QT interval (QTc) at rest on an electrocardiogram (ECG) measured three times> 470 msec ii. Clinically important abnormalities of rhythm, conduction, or shape on the ECG at rest. For example, complete left block, 3rd degree cardiac block, 2nd degree cardiac block, PR interval> 250 msec iii. Increased risk of QTc prolongation or arrhythmia, such as heart failure, hypokalemia, congenital QT prolongation syndrome, concomitant medications known to prolong QT intervals, QT prolongation syndrome or a family history of unexplained sudden deaths under 40.
B. Laboratory index at baseline:
iv. Hemoglobin ≤ 8.0 g/dL (without transfusion or growth factor support in the preceding 14 days) v. Neutrophils < 1.0 x 109/L vi. Platelets < 100 x 109/L (without transfusion or growth factor support in the preceding 7 days) vii. Total bilirubin > 3 mg/dL viii. Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) > 5 x upper limit of normal (ULN) ix. Renal impairment as evidenced by serum creatinine ≥ 1.5 x ULN, or calculated creatinine clearance (CrCl) < 50 mL/min by Cockroft-Gault formula (24-hour CrCl might be requested by the Investigator for confirmation, if calculated CrCl is < 60 mL/min. In such case, subjects with 24-hour CrCl < 50 mL/min should be excluded)
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jin Hyoung Kang | Contact | 82-2-2258-6043 | oncologykang@naver.com | |
| SoHee Park | Contact | 82-2-2259-6546 | vicky3018@naver.com |
| Name | Affiliation | Role |
|---|---|---|
| Jin Hyoung Kang | Seoul St. Mary's Hospital, The Catholic University of Korea | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gachon University Gil Medical Center | Gyeonggi-do | South Korea |
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| ID | Term |
|---|---|
| D002289 | Carcinoma, Non-Small-Cell Lung |
| ID | Term |
|---|---|
| D002283 | Carcinoma, Bronchogenic |
| D001984 | Bronchial Neoplasms |
| D008175 | Lung Neoplasms |
| D012142 | Respiratory Tract Neoplasms |
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| ID | Term |
|---|---|
| C000707992 | lazertinib |
| D000068437 | Pemetrexed |
| D016190 | Carboplatin |
| ID | Term |
|---|---|
| D006147 | Guanine |
| D007042 | Hypoxanthines |
| D011688 | Purinones |
| D011687 | Purines |
| D006574 |
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| Pemetrexed | Drug | - Pemetrexed 500mg/m2 is administered on the 1st day every 3 weeks. One cycle of treatment is defined as continuous administration for 21 days. Pemetrexed and carboplatin can be administered in reduced doses according to the principles of each institution. |
|
| Carboplatin | Drug | - Carboplatin AUC x 5 mg/mL.min is administered on the 1st day every 3 weeks. One cycle of treatment is defined as continuous administration for 21 days. Pemetrexed and carboplatin can be administered in reduced doses according to the principles of each institution. |
|
| overall response rate | the percentage of subjects who had at least one complete response (CR) or partial response (PR) with a confirmed response (RECIST 1.1) before evidence of disease progression appeared | every 6 weeks up to 2 years |
| duration of response | the time from the first documented date of a later confirmed response to the date of documented disease progression or death (equivalent to the occurrence of the PFS event), whichever occurs first. | every 6 weeks up to 2 years |
| disease control rate | the percentage of subjects with a Best Overall Response (BOR), extracranial and intracranial response of CR, PR, responding, or SD. | every 6 weeks up to 2 years |
| overall survival | the period from the first administration of the investigational drug to the date of death of any cause. | every 6 weeks up to 2 years |
| pattern of treatment failure | intracranial disease progression or extracranial disease progression, or both | every 6 weeks up to 2 years |
| salvage intracranial treatment rate | the percentage of subjects who received salvage treatment (brain radiation or surgery) due to intracranial disease progression. | every visit up to 2 years |
| adverse events | All subjects receiving at least one dose of Lazertinib will be included in the safety profile evaluation (safety analysis cohort). | every visit up to 2 years |
| Incheon St. Mary's hospital, Catholic university of Korea | Incheon | South Korea |
|
| Gachon University Gil Medical Center | Seoul | South Korea |
|
| Korea University Anam Hospital | Seoul | South Korea |
|
| Korea University Guro Hosptial | Seoul | South Korea |
|
| Seoul St. Mary's Hospital, Catholic University of Korea | Seoul | South Korea |
|
| D013899 |
| Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D005971 | Glutamates |
| D024342 | Amino Acids, Acidic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D000600 | Amino Acids, Dicarboxylic |
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |