LDK378 in Crizotinib naïve Adult Patients With ALK-activated Non-small Cell Lung Cancer
Basic Trial Information
|Phase II||Treatment||Closed||18 and over||Pharmaceutical / Industry||CLDK378A2203|
A single-arm, open-label, two-stage multicenter, phase II study. Patients will be pre-screened for ALK positive status. Treatment with LDK378 at 750 mg qd will continue until the patient experiences unacceptable toxicity that precludes further treatment, discontinues treatment at the discretion of the investigator or patient, starts a new anticancer therapy and/or dies. LDK378 may be continued beyond RECIST defined PD as assessed by the investigator, if in the judgment of the investigator, there is evidence of clinical benefit. Patients who discontinue the study medication in the absence of progression will continue to be followed for tumor assessment until the time of PD as assessed by the investigator. Male and female patients aged 18 or over with ALK-rearranged NSCLC will be screened for eligibility. Patients must have received no prior crizotinib, and must be chemotherapy-naïve or have been pretreated with cytotoxic chemotherapy (up to three prior lines)
Further Study Information
This is a single-arm, open-label, two-stage, multicenter, phase II study in which the efficacy and safety of LDK378 will be evaluated in patients with stage IIIB or IV NSCLC harboring a confirmed ALK rearrangement, defined as 15% or more positive tumor cells as assessed by the FDA-approved FISH test (Abbott Molecular Inc.) using Vysis breakapart probes.
Patients will be pre-screened to test for ALK positivity. The test to confirm ALK rearrangement must be performed either using archival tissue or, preferably, using a fresh biopsy prior to study entry according to the above criteria, i.e. with an FDA-approved assay. The test will be performed at a Novartis designated central laboratory.
After confirmation of ALK positivity, the study begins with a screening period to assess eligibility, up to and including 28 days prior to the first dose of LDK378.
Patients must not have received prior crizotinib. Patients must be chemotherapy-naïve or have been pretreated with cytotoxic chemotherapy (up to three prior lines)
The study will use a Simon's optimal two-stage design. Stage 1 will consist of 43 patients and their data up to 6 cycles of treatment unless a patient has discontinued treatment earlier or a confirmed response to treatment has been observed prior to completing 6 cycles. The trial will be stopped at Stage 1 for futility if 16 or fewer responses are observed. If at the time that the last patient is enrolled to Stage 1 a minimum of 17 responses have not yet been observed, accrual may be temporarily suspended during the analysis of Stage 1. The Data Monitoring Committee will periodically review response data and will make the appropriate recommendation regarding transition into Stage 2 or stopping enrollment. Stage 2 will include an additional 62 patients. The primary analysis will occur when all 105 patients have completed 6 cycles of treatment or discontinued treatment earlier.
The treatment period begins on Day 1 of Cycle 1. All patients will be treated with LDK378, administered orally, at a starting dose of 750 mg. A total of approximately 105 patients will be enrolled in the study. Patients will take LDK378 once daily, at approximately the same time each day. On days when a PK sample is obtained, the patient will take LDK378 during the clinic visit as instructed by the study staff. Treatment with LDK378 will continue until the patient experiences unacceptable toxicity that precludes further treatment, discontinues treatment at the discretion of the patient or investigator, starts a new anti-cancer therapy or dies. If the patient experiences RECIST-defined progressive disease (PD) on LDK378 as assessed by the investigator, treatment with the study drug may be continued if, in the judgment of the investigator, there is still evidence of clinical benefit. These patients will be counted as PD for ORR, DOR, DCR and PFS calculations.
Assessments of tumor response and progression will be performed every 8 weeks (i.e. every 2 cycles), starting from the first day of treatment with LDK378. This schedule of tumor assessment every 8 weeks must continue regardless of dose interruptions. Tumor assessment should continue until:
- For patients who experience PD as assessed by the investigator, tumor assessments should continue every 8 weeks until LDK378 is permanently discontinued (i.e. if the patient continues treatment with LDK378 after PD, tumor assessments should continue until LDK378 is permanently discontinued).
- For patients who discontinue treatment in the absence of PD, tumor assessments should continue every 8 weeks from the EOT visit until PD is assessed by the investigator.
Tumor evaluations will always cease if the patient starts a new anti-cancer therapy, withdraws consent (unless the patient agrees to continue efficacy assessments in absence of dosing with LDK378, or dies.
All tumor imaging assessments will be submitted for independent radiological assessment of response by a Blinded Independent Review Committee (BIRC).
Clinical and laboratory assessments will be performed.
When the patient discontinues from study treatment an End of Treatment (EOT) visit must be performed as soon as possible and within 7 days of the last dose of LDK378. Patients will be contacted for the safety follow-up 30 days after their last dose of LDK378 to determine if they have experienced any new AEs and/or to follow resolution of ongoing AEs.
Following the end of tumor assessments, the Study Phase Completion Disposition eCRF must be completed. Patients will be contacted every 3 months to obtain information pertaining to survival status until death, loss to follow-up, withdrawal of consent to survival follow-up, or the end of the study. Patients do not need to visit the clinic during the survival follow-up.
- Histologically or cytologically confirmed diagnosis of stage IIIB or IV NSCLC that carries an ALK rearrangement, as per the FDA-approved Vysis ALK break-apart FISH assay (Abbott Molecular Inc.)
- Age 18 years or older at the time of informed consent.
- Patients must have NSCLC that has progressed during or after the last chemotherapy regimen received prior to the first dose of LDK378, if chemotherapy was received
- Patients must be chemotherapy-naive or have received 1-3 lines of cytotoxic chemotherapy to treat their locally advanced or metastatic NSCLC
- Patients must have a tumor tissue sample available, collected either at the time of diagnosis of NSCLC or any time since.
- Patients must have recovered from all toxicities related to prior anticancer therapies to grade ≤ 2, except for patients with grade 2 nausea/vomiting and/or grade 2 diarrhea despite optimal supportive therapy who will not be allowed to participate in the study.
- Prior treatment with crizotinib, or any other ALK inhibitor investigational agent, for NSCLC
- Patients with known hypersensitivity to any of the excipients of LDK378.
- Patients with symptomatic central nervous system (CNS) metastases who are neurologically unstable or have required increasing doses of steroids within the 2 weeks prior to study entry to manage CNS symptoms.
- History of carcinomatous meningitis.
- Presence or history of a malignant disease other than NSCLC that has been diagnosed and/or required therapy within the past 3 years.
- Clinically significant, uncontrolled heart disease.
Trial Contact Information
Trial Lead Organizations/Sponsors
Novartis Pharmaceuticals Corporation
Link to the current ClinicalTrials.gov record.
NLM Identifier NCT01685138
ClinicalTrials.gov processed this data on May 21, 2015
Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.