An Open-label, Multicenter, Phase 1/2 Study of Radium-223 Dichloride in Combination With Pembrolizumab in Participants With Stage IV Non-small Cell Lung Cancer
试验速览
- 阶段
- 1 期
- 状态
- 终止
- 发起方
- Bayer
- 入组人数
- 8
- 试验地点
- 6
- 主要终点
- Number of Participants With Treatment-emergent Adverse Events in Phase 1
研究概览
简要总结
The purpose of the study was to determine the safety and test the efficacy of the combination of radium-223 dichloride and pembrolizumab in patients with stage IV non-small cell lung cancer (NSCLC) with bone metastases who either had not received any systemic therapy for their advanced disease or had progressed on prior immunologic checkpoint blockade with antibodies against the programmed cell death protein-(ligand) 1 (PD-1/PD-L1). In this study researchers wanted to measure tumor shrinkage in response to treatment and how long that shrinkage lasted and gathered information on safety. Pembrolizumab is an immunologic checkpoint blocker that promotes an immune response against the tumor. Radium-223 dichloride is an alpha particle-emitting radioactive agent which kills cancer cells.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Histologically or cytologically confirmed diagnosis of stage IV NSCLC.
- •Phase 2 Cohort 1: No Epidermal Growth Factor Receptor (EGFR) / v-Raf murine sarcoma viral oncogene homolog B (BRAF) mutation or anaplastic lymphoma kinase (ALK)/ROS1 rearrangement. Treatment naïve (no prior systemic therapy) for their metastatic NSCLC.
- •Phase 2 Cohort 2: progression on prior treatment with an immune checkpoint inhibitor inhibitor. Prior treatment with platinum-based chemotherapy in combination or in sequence in line with local standard of care.
- •Phase 1 includes participants meeting either Cohort 1 or Cohort 2 criteria.
- •Measurable disease per RECIST v1.
- •At least 2 skeletal metastases.
- •Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0 or
- •Adequate bone marrow and organ function.
- •Participants must be on a bone health agent (BHA) treatment, such as bisphosphonates or denosumab treatment unless such treatment is contraindicated or not recommended per investigator's judgement.
排除标准
- •Previous or concurrent cancer within 3 years prior to enrollment.
- •Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor. Phase 2 Cohort 2: was discontinued from that treatment due to a Grade 3 or higher immune-related AEs (irAEs).
- •Known active central nervous system metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable, clinically stable, and without requirement of steroid treatment for at least 14 days prior to first dose of study treatment.
- •Active autoimmune disease that has required systemic treatment in the past 2 years.
- •History of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
- •Known history or presence of osteonecrosis of jaw.
- •Ongoing infection >Grade 2 NCI-CTCAE v.5.0 requiring systemic therapy.
- •Significant acute GI disorders with diarrhea as a major symptom e.g., Crohn's disease, malabsorption, or ≥ NCI-CTCAE v.5.0 Grade 2 diarrhea of any etiology.
- •History of osteoporotic fracture.
- •Prior treatment with radium-223 dichloride or any therapeutic radiopharmaceutical.
- •Prior radiotherapy within 21 days of planned start of study treatment.
研究组 & 干预措施
Phase 1: Radium-223+Pembrolizumab
Participants received radium-223 dichloride at 55 kBq/kg every 6 weeks in combination with pembrolizumab every 3 weeks.
干预措施: Pembrolizumab (Drug)
Phase 1: Radium-223+Pembrolizumab
Participants received radium-223 dichloride at 55 kBq/kg every 6 weeks in combination with pembrolizumab every 3 weeks.
干预措施: Radium-223 dichloride (Xofigo, BAY 88-8223) (Drug)
Phase 2 Cohort 1: Radium-223+Pembrolizumab
Participants was planned to receive radium-223 dichloride at the maximum tolerated dose (MTD) to be determined in the Phase 1 part every 6 weeks in combination with 200 mg pembrolizumab every 3 weeks.
干预措施: Radium-223 dichloride (Xofigo, BAY 88-8223) (Drug)
Phase 2 Cohort 1: Radium-223+Pembrolizumab
Participants was planned to receive radium-223 dichloride at the maximum tolerated dose (MTD) to be determined in the Phase 1 part every 6 weeks in combination with 200 mg pembrolizumab every 3 weeks.
干预措施: Pembrolizumab (Drug)
Phase 2 Cohort 1: Pembrolizumab alone
Participants was planned to receive 200 mg pembrolizumab every 3 weeks.
干预措施: Pembrolizumab (Drug)
Phase 2 Cohort 2: Radium-223+Pembrolizumab
Participants was planned to receive radium-223 dichloride at the MTD to be determined in the Phase 1 part every 6 weeks in combination with 200 mg pembrolizumab every 3 weeks.
干预措施: Radium-223 dichloride (Xofigo, BAY 88-8223) (Drug)
Phase 2 Cohort 2: Radium-223+Pembrolizumab
Participants was planned to receive radium-223 dichloride at the MTD to be determined in the Phase 1 part every 6 weeks in combination with 200 mg pembrolizumab every 3 weeks.
干预措施: Pembrolizumab (Drug)
结局指标
主要结局
Number of Participants With Treatment-emergent Adverse Events in Phase 1
时间窗: Up to 218 days
A treatment-emergent adverse event (TEAE) was any untoward medical occurrence in a participant, whether or not related to the treatment, arising or worsening after start of study treatment administration until the end of treatment visit (EoT visit, i.e. 30 \[+7\] days after last dose of study treatment). Severities of the TEAEs are summarized overall and by the maximum grade experienced by the participants for any TEAEs according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v.5.0.
Number of Participants With Treatment-emergent Serious Adverse Events in Phase 1
时间窗: Up to 278 days
A treatment-emergent serious adverse event (TESAE) was any untoward medical occurrence that resulting in death, initial or prolonged inpatient hospitalization, life-threatening, persistent disability/incapacity, congenital anomaly/birth defect, another medical important serious event as judged by the investigator arising or worsening after start of study treatment administration until 90 days after the cessation of study treatment for serious AE (regardless of causality) or until the end of treatment visit (EoT visit, i.e. 30 \[+7\] days after last dose of study treatment) visit if the participant initiated new anti-cancer therapy, whichever was earlier.
Number of Participants With Dose Limiting Toxicities (DLTs) in Phase 1
时间窗: Within 6 weeks after the first administration of pembrolizumab
Any of following toxicities (exceptions as in protocol) during DLT window was considered a DLT if assessed by investigator to be possibly, probably or definitely related to study treatment: 1.Grade 4 non-hematologic toxicity. 2.Grade 4 hematologic toxicity ≥7 days. 3.Any non-hematologic AE (excl. lab) ≥Grade 3. 4.Any Grade 3 non-hematologic lab value if clinically significant medical intervention required, or the abnormality led to hospitalization, or the abnormality persisted for \>1 week. 5.Grade 3 abnormality in AST, ALT, or bilirubin without liver metastases at screening; The abnormality results in a Drug-induced Liver Injury. 6.Febrile neutropenia Grade 3 or 4. 7.Prolonged delay (\>2 weeks) in initiating Cycle 2 of pembrolizumab due to treatment-related toxicity 8.Any treatment-related toxicity that caused the participant to discontinue treatment during Cycle 1 or 2. 9.Missing \>25% of pembrolizumab doses as a result of drug-related AE(s) during the first cycle. 10.Grade 5 toxicity.
Objective Response Rate (ORR) Per RECIST v1.1 in Phase 2
时间窗: 0 day as Phase 2 never started due to the early termination of the study
ORR was defined as the percentage of participants with best overall response of complete response (CR) or partial response (PR) during the course of the study. It was evaluated per Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST V1.1). Complete Response (CR): Disappearance of all clinical and radiological evidence of tumor (both target and non-target). Any pathological lymph nodes (whether target or non-target) must have a reduction in short axis to \< 10mm. Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions taking as reference the baseline sum, no unequivocal progression of existing non target lesions and no appearance of new lesions.
次要结局
- Progression Free Survival (PFS) Per RECIST v1.1 in Phase 2(0 day as Phase 2 never started due to the early termination of the study)
- Number of Participants Categorized by Best Tumor Responses Per RECIST v1.1 in Phase 1(Up to 188 days)
- Objective Response Rate (ORR) Per RECIST v1.1 in Phase 1(Up to 188 days)
- Duration of Response (DoR) Per RECIST v1.1 in Phase 1(Up to 188 days)
- Disease Control Rate (DCR) Per RECIST v1.1 in Phase 1(Up to 188 days)
- Duration of Response (DoR) Per RECIST v1.1 in Phase 2(0 day as Phase 2 never started due to the early termination of the study)
- Disease Control Rate (DCR) Per RECIST v1.1 in Phase 2(0 day as Phase 2 never started due to the early termination of the study)
- Overall Survival (OS) in Phase 2(0 day as Phase 2 never started due to the early termination of the study)
- Number of Participants With Treatment-emergent Adverse Events in Phase 2(0 day as Phase 2 never started due to the early termination of the study)
- Number of Participants With Treatment-emergent Serious Adverse Events in Phase 2(0 day as Phase 2 never started due to the early termination of the study)