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This study is a Phase III, international, multicenter, randomized, controlled, open-label clinical trial. The primary objective is to evaluate the efficacy and safety of furmonertinib plus platinum-based doublet chemotherapy (Arm A) versus osimertinib monotherapy (Arm B) in patients with EGFR sensitizing mutation-positive non-squamous non-small cell lung cancer (NSCLC) and brain metastases. Additionally, a proportion of subjects will receive furmonertinib monotherapy (Arm C) to further explore its efficacy and safety profile.
Stage 1 is the safety run-in phase, planned to enroll approximately 30 subjects who will be randomized at a 1:1 ratio to receive either furmonertinib 80 mg QD plus platinum-based chemotherapy or furmonertinib 160 mg QD plus platinum-based chemotherapy, aiming to evaluate the safety and tolerability of different furmonertinib doses in combination with platinum-based chemotherapy.
Stage 2 is the randomized controlled phase, in which approximately 350 subjects will be randomized in a 3:3:1 ratio (Arm A : Arm B : Arm C) to receive the investigational treatments.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Furmonertinib combined with chemotherapy | Experimental | Furmonertinib Mesilate Tablets+Carboplatin Injection/Cisplatin for injection+Pemetrexed Disodium for Injection |
|
| Osimertinib Mesylate Tablets | Active Comparator | Osimertinib Mesylate Tablets |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Furmonertinib Mesilate Tablets | Drug | Usage and dosage: 80mg, 240mg, or 160mg QD orally Medication duration: A cycle of 21 days until intolerable toxicity, disease progression, death, or initiation of new anti-tumor therapy occurs |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse Events (AE) | Safe import period | Up to 4 years |
| Serious Adverse Event (SAE) | Safe import period | Up to 4 years |
| Progression-free survival (PFS) | Randomized Controlled Phase:PFS assessed by BICR based on recist1.1; PFS was defined as the time from the date of randomization to the date of first documented disease progression (assessed according to RECIST v1.1 criteria) or death from any cause, whichever occurred first. | Up to 4 years |
| Measure | Description | Time Frame |
|---|---|---|
| Progression free survival (PFS) evaluated by researchers based on RECIST 1.1 | Both the safe introduction period and randomized controlled trials require evaluation of progression free survival (PFS) | Up to 4 years |
| Objective response rate (ORR) |
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Inclusion Criteria:
Exclusion Criteria:
The tumor histology or cytology confirmed that the combination of neuroendocrine carcinoma, sarcomatoid carcinoma or squamous cell carcinoma was more than 10%;
Known subjects with ALK positive, ros1 positive, RET fusion positive, ntrk fusion positive, BRAF V600 mutation, met exon 14 skipping variant and other approved drugs for this target;
Subjects with meningeal metastasis but no brain parenchymal metastasis confirmed by MRI and / or CSF malignant cell examination;
Subjects who have previously received any of the following treatments:
Chinese patent medicine that has received non-specific immune modulators (including but not limited to interferon and IL-2) and approved anti-tumor indications within 2 weeks before the first administration;
Have used any strong inhibitor of cytochrome P450 3A4 (CYP3A4) within 7 days before the first administration or any strong inducer of CYP3A4 within 21 days before the first administration;
Other malignant tumors in addition to the primary tumor; Skin basal cell or squamous cell carcinoma, superficial bladder cancer, cervical carcinoma in situ, breast ductal carcinoma in situ and papillary thyroid cancer that can be treated locally and have been cured can be selected; Subjects with a history of other malignancies and who have been cured for ≥ 3 years after radical treatment can be enrolled;
Brain metastasis subjects with known brain stem metastasis, spinal cord metastasis and / or compression; Subjects with acute or progressive intracranial hypertension related symptoms during the screening period; Subjects with brain herniation or near brain herniation; Brain imaging revealed significant brain midline deviation and other subjects requiring urgent local treatment;
According to CTCAE 5.0, there were subjects with grade 2 headache, vomiting, papilledema, etc. caused by increased intracranial pressure during the screening period; Subjects with grade 2 sensory / motor impairment and visual field damage caused by brain metastasis during the screening period; Subjects with mental symptoms (such as dementia, sluggish reaction, etc.) or seizures caused by brain metastasis during the screening period; Subjects who can control relevant central nervous system symptoms ≤ 1 grade by steroid hormones or anticonvulsants can be enrolled;
The tumor invades the surrounding important organs and blood vessels (such as the heart, esophagus, superior vena cava, etc.) or has the risk of esophago tracheal fistula or esophago pleural fistula;
Cardiovascular and cerebrovascular disease or cardiovascular and cerebrovascular risk factors exist.
There are uncontrollable systemic diseases.
There is a history of (non infectious) interstitial lung disease (ILD) or non infectious pneumonia requiring steroid treatment.
Pulmonary complications lead to clinically severe lung damage.
Severe acute or chronic infection
Subjects who are receiving long-term systemic corticosteroid therapy with prednisone > 10 mg/d or equivalent anti-inflammatory active drugs or any form of immunosuppressive therapy before the first administration [subjects who need bronchodilators, inhaled or topical steroids or local steroid injection therapy, or as preventive medication for hypersensitivity reactions (such as medication before CT examination, etc.), or to control central nervous system symptoms in patients with brain metastasis can be included in the study];
Subjects who had undergone major surgery within 4 weeks before the first dose or were expected to undergo major surgery during the study;
Bleeding symptoms with significant clinical significance or obvious bleeding tendency within 4 weeks before the first administration.
Severe gastrointestinal dysfunction is known.
Known or suspected allergy to the ingredients of the study drug or its analogues;
Pregnant or lactating women or female subjects who plan to become pregnant during the study or within 6 months after the last dose;
In the judgment of the investigator, the subject has other factors that may affect the results of the study or cause the forced termination of the study, such as alcohol abuse, drug abuse, suffering from other serious diseases (including mental diseases) requiring combined treatment, serious abnormal laboratory test values, family or social factors and other conditions that may affect the safety of the subject or the collection of test data.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Shanghai Allist Pharmaceuticals Co., Ltd Shanghai Allist Pharmaceuticals Co., Ltd | Contact | 021-80423288 | zhenhua.gong@allist.com.cn |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Guangdong Provincial People's Hospital | Recruiting | Guangdong | Guangzhou | China |
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| Carboplatin Injection | Drug | Usage and dosage: Administer via IV infusion, with a dosage of AUC5, not exceeding 750 mg. Medication schedule: every 3 weeks as a cycle, D1 administration per cycle, immediate administration of carboplatin upon completion of pemetrexed infusion, intravenous infusion, carboplatin can be used for up to 4 cycles. |
|
| Cisplatin for injection | Drug | Usage and dosage: Administer via IV infusion at a dose of 75 mg/m2. Medication schedule: Every 3 weeks as a cycle, with D1 administration per cycle. Cisplatin is administered approximately 30 minutes after the infusion of pemetrexed, via intravenous infusion. Adequate hydration therapy must be received before and after cisplatin treatment. Cisplatin can be used for up to 4 cycles. |
|
| Pemetrexed Disodium for Injection | Drug | Usage and dosage: Intravenous (IV) infusion administration, dosage of 500 mg/m2 Medication schedule: Administer on the first day of each cycle (21 days per cycle, i.e. every 3 weeks) until intolerable toxicity, disease progression, death, or initiation of new anti-tumor therapy occurs. |
|
| Osimertinib Mesylate Tablets | Drug | Usage and dosage: 80mg, QD administration Medication duration: A cycle of 21 days until intolerable toxicity, disease progression, death, or initiation of new anti-tumor therapy occurs |
|
Both the safe introduction period and randomized controlled trials require evaluation of objective response rate (ORR)
| Up to 4 years |
| Disease control rate (DCR) | Both the safe introduction period and randomized controlled trials require evaluation of disease control rate (DCR) | Up to 4 years |
| Duration of Relief (DOR) | Both the safe introduction period and randomized controlled trials require evaluation of Duration of Relief (DOR) | Up to 4 years |
| Overall survival (OS) | safe introduction period | Up to 4 years |
| InterPlanetary File System(iPFS) by researchers and BICR based on RECIST 1.1 evaluation | Randomized Controlled Phase | Up to 4 years |
| Depth of Response(DepOR) by researchers and BICR based on RECIST 1.1 evaluation | Randomized Controlled Phase | Up to 4 years |
| adverse events (AE) | Randomized Controlled Phase | Up to 4 years |
| serious adverse events (SAE) | Randomized Controlled Phase | Up to 4 years |
| Patient Reported Outcomes by EORTC QLQ LC13 questionnaire | Randomized Controlled Phase:To assess the impact of firmonertinib on patients' disease-related symptoms and health related quality of life (HRQoL). | Up to 4 years |
| Patient Reported Outcomes by EORTCQLQ-C30 questionnaire | Randomized Controlled Phase:To assess the impact of firmonertinib on patients' disease-related symptoms and health related quality of life (HRQoL). | Up to 4 years |
| Peak Plasma Concentration (Cmax) | Randomized Controlled Phase | Up to 4 years |
| Steady-state oral clearance(CLss/F) | Randomized Controlled Phase | Up to 4 years |
| Steady-state minimal concentration(Cmin,ss) | Randomized Controlled Phase | Up to 4 years |
| Steady-state area under the curve(AUCss) | Randomized Controlled Phase | Up to 4 years |
| ID | Term |
|---|---|
| D016190 | Carboplatin |
| D002945 | Cisplatin |
| D007267 | Injections |
| D000068437 | Pemetrexed |
| C000596361 | osimertinib |
| ID | Term |
|---|---|
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017672 | Nitrogen Compounds |
| D017671 | Platinum Compounds |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D006147 | Guanine |
| D007042 | Hypoxanthines |
| D011688 | Purinones |
| D011687 | Purines |
| D006574 | 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 |
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