An Efficacy Study Comparing Brigatinib Versus Alectinib in Advanced Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer Participants Who Have Progressed on Crizotinib
The purpose of this study is to compare the efficacy of brigatinib versus alectinib in participants with anaplastic lymphoma kinase-positive (ALK+) locally advanced or metastatic non-small-cell lung cancer (NSCLC) who have progressed on crizotinib as evidenced by progression free survival as assessed by a blinded independent review committee (BIRC) utilizing response evaluation criteria in solid tumors (RECIST) v1.1.
- Have Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.
- Have histologically or cytologically confirmed stage IIIB (locally advanced or recurrent) or stage IV non-small cell lung cancer (NSCLC).
- Must meet one of the following criteria:
- Have documentation of anaplastic lymphoma kinase (ALK) rearrangement by a positive result from the Vysis ALK Break-Apart fluorescence in situ hybridization (FISH) Probe Kit or the Ventana ALK (D5F3) CDx Assay or Foundation Medicine's FoundationOne CDx.
- Have documented ALK rearrangement by a different test and be able to provide tumor sample to the central laboratory. (Note: central laboratory ALK rearrangement testing results are not required to be obtained before randomization).
- Had progressive disease (PD) while on crizotinib, as assessed by the investigator or treating physician. (Note: crizotinib does not need to be the last therapy a participant received. The participant may have received chemotherapy as his/her last therapy).
- Treatment with crizotinib for at least 4 weeks before progression.
- Have had no other ALK inhibitor other than crizotinib.
- Have had no more than 2 prior regimens of systemic anticancer therapy in the locally advanced or metastatic setting. Note: a systemic anticancer therapy regimen will be counted if it is administered over at least 1 cycle. A new antineoplastic agent used as maintenance therapy will be counted as a new regimen. Neoadjuvant or adjuvant systemic anticancer therapy will be counted as a prior regimen if disease progression/recurrence occurred within 12 months upon completion of this neoadjuvant or adjuvant therapy.
- Have at least 1 measurable (ie, target) lesion per response evaluation criteria in solid tumors (RECIST) v1.1.
- Have recovered from toxicities related to prior anticancer therapy to national cancer institute common terminology criteria for adverse events (NCI CTCAE) v4.03 grade ≤1. (Note: treatment-related alopecia or peripheral neuropathy that are grade >1 are allowed, if deemed irreversible).
- Have adequate organ function, as determined by:
- Total bilirubin ≤1.5 times the upper limit of normal (ULN).
- Estimated glomerular filtration rate ≥30 mL/minute/1.73 m2, using the modification of diet in renal disease equation.
- Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ≤2.5 × ULN; ≤5 × ULN is acceptable if liver metastases are present.
- Serum lipase ≤1.5 × ULN.
- Platelet count ≥75 ×109/L.
- Hemoglobin ≥9 g/dL.
- Absolute neutrophil count ≥1.5 × 109/L.
- Suitable venous access for study-required blood sampling (ie, including PK and laboratory safety tests).
- Had participated in the control (crizotinib) arm of Study AP26113-13-301 (ALTA 1L).
- Had received crizotinib within 7 days of randomization.
- Have a history or presence at baseline of pulmonary interstitial disease, drug related pneumonitis, or radiation pneumonitis.
- Have uncontrolled hypertension. Participants with hypertension should be under treatment for control of blood pressure upon study entry.
- Had Received systemic treatment with strong cytochrome P-450 (CYP) 3A inhibitors, strong CYP3A inducers, or moderate CYP3A inducers within 14 days before randomization.
- Treatment with any investigational systemic anticancer agents within 14 days or 5 half-lives, whichever is longer, before randomization.
- Had received chemotherapy or radiation therapy within 14 days of randomization except for stereotactic radiosurgery (SRS) or stereotactic body radiation therapy.
- Had received antineoplastic monoclonal antibodies within 30 days of randomization.
- Had major surgery within 30 days of randomization. Minor surgical procedures, such as catheter placement or minimally invasive biopsies, are allowed.
- Have symptomatic CNS metastases (parenchymal or leptomeningeal) at screening (participants with asymptomatic brain metastases or participants who have stable symptoms and did not require an increased dose of corticosteroids to control symptoms within 7 days before randomization will be enrolled). Note: If a participant has worsening neurological symptoms or signs due to CNS metastasis, the participant needs to complete local therapy and be neurologically stable (with no requirement for an increasing dose of corticosteroids or use of anticonvulsants) for 7 days before randomization.
- Have current spinal cord compression (symptomatic or asymptomatic and detected by radiographic imaging). Participants with leptomeningeal disease and without cord compression are allowed.
- Have significant, uncontrolled, or active cardiovascular disease, specifically including, but not restricted to the following:
- Myocardial infarction within 6 months before randomization.
- Unstable angina within 6 months before randomization.
- New York Heart Association Class III or IV heart failure within 6 months before randomization.
- History of clinically significant atrial arrhythmia (including clinically significant bradyarrhythmia), as determined by the treating physician.
- Any history of clinically significant ventricular arrhythmia.
- Had cerebrovascular accident or transient ischemic attack within 6 months before first dose of study drug.
- Have malabsorption syndrome or other gastrointestinal illness or condition that could affect oral absorption of the study drug.
- Have an ongoing or active infection, including but not limited to, the requirement for intravenous antibiotics.
- Have a known history of HIV infection. Testing is not required in the absence of history.
- Known hepatitis B surface antigen-positive, or known or suspected active hepatitis C infection.
- Have a known or suspected hypersensitivity to brigatinib or alectinib or their excipients.
- Life-threatening illness unrelated to cancer.
Locations & Contacts
Status: In review
Name Not Available
Trial Objectives and Outline
The drug being tested in this study is called brigatinib. Brigatinib has been demonstrated to benefit people with ALK-positive NSCLC. The comparator drug is called alectinib. Alectinib has been demonstrated to benefit people with ALK-positive NSCLC. Both drugs belong to a class of drugs called ALK inhibitors. Both drugs are taken by mouth. Both drugs are approved by the US FDA. The study will enroll approximately 246 patients. Participants will be randomly assigned (by chance, like flipping a coin) in 1:1 ratio to one of the two treatment groups: Brigatinib Alectinib All participants will be asked to take brigatinib or alectinib at the same time each day throughout the study. This multi-center trial will be conducted worldwide. The overall time to participate in this study is 5 years. Participants will make multiple visits to the clinic, and 30 days after last dose of study drug for a follow-up assessment.
Trial Phase & Type
Secondary IDs NCI-2018-03420, 2018-001957-29
Clinicaltrials.gov ID NCT03596866