The goal of this clinical trial is to learn whether amivantamab combined with intrathecal pemetrexed is safe and may help treat leptomeningeal metastasis in adults with EGFR-mutant lung adenocarcinoma. Leptomeningeal metastasis occurs when cancer cells spread to the membranes surrounding the brain and spinal cord or to the cerebrospinal fluid. It is a serious complication of advanced lung cancer and is difficult to treat because many systemic drugs do not reach high enough levels in the cerebrospinal fluid.
The main questions this study aims to answer are:
What medical problems do participants have when receiving amivantamab combined with intrathecal pemetrexed? How long do participants live without their disease getting worse after receiving this treatment? How long do participants survive after starting this treatment?
Participants will:
Receive amivantamab by intravenous infusion according to the study schedule. Receive intrathecal pemetrexed, together with dexamethasone and normal saline, once every week.
Continue their original EGFR tyrosine kinase inhibitor treatment as determined by the study doctor.
Have cerebrospinal fluid pressure measured and cerebrospinal fluid samples collected before each intrathecal treatment.
Have tests of cerebrospinal fluid, including routine tests, biochemical tests, tumor markers, albumin, IgG, and cytology.
Have imaging tests, including enhanced MRI, about every 3 months to check the disease.
Be followed by clinic visits and/or telephone calls to collect information about survival, disease status, side effects, and any later cancer treatments.
Inclusion Criteria:
Voluntary participation in the clinical study: fully understands and is informed of this study and signs the written informed consent form; is willing and able to complete all trial procedures.
Age: >=18 years; male or female.
Patients with EGFR-mutated lung adenocarcinoma with leptomeningeal metastasis diagnosed according to the EANO-ESMO guidelines.
Expected survival of at least 3 months.
Adequate organ and bone marrow function, with no severe hematopoietic abnormality and no severe cardiac, pulmonary, hepatic or renal dysfunction or immunodeficiency (within 14 days before use of study drug, no blood transfusion, granulocyte colony-stimulating factor or other relevant medical support):
Left ventricular ejection fraction (LVEF) in cardiac function examination >=50%.
Negative serum pregnancy test, and effective contraception from signing the informed consent form until 6 months after the last chemotherapy dose.
Thyroid-stimulating hormone (TSH), free thyroxine (FT4) or free triiodothyronine (FT3) within +/-10% of the normal range.
Ophthalmic examination, including dilated fundus examination, slit-lamp examination and color fundus photography.
Exclusion Criteria:
bicheng_zhang@zju.edu.cn
Subjects will receive a comprehensive treatment regimen of amivantamab combined with systemic pemetrexed chemotherapy + intrathecal pemetrexed. Amivantamab dosing regimen: once weekly in the first month, 350 mg each time; no dosing is required in weeks 5 and 6. Starting from week 7, 700 mg each time once every 3 weeks. Systemic pemetrexed dosing regimen: day 1 of week 1, week 4, week 7 and once every 3 weeks thereafter, 500 mg/m2. Intrathecal injection shall be performed by personnel qualified to perform intrathecal injection (personnel of the Department of Radiation Oncology of our hospital holding standardized residency training certificates).
zezht@zju.edu.cn86+15157125533
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