DS8201a and Pembrolizumab in Participants With Locally Advanced/Metastatic Breast or Non-Small Cell Lung Cancer
- Conditions
- Breast CancerNon-small Cell Lung Carcinoma
- Interventions
- Registration Number
- NCT04042701
- Lead Sponsor
- Daiichi Sankyo
- Brief Summary
This two-part study will include a dose escalation part to determine the recommended dose for expansion of DS8201a and pembrolizumab and a dose expansion part to evaluate efficacy, safety, and tolerability of the combination.
- Detailed Description
This phase 1b, open-label, 2-part, multicenter, non-randomized, multiple-dose study will evaluate DS-8201a in combination with pembrolizumab in participants with advanced/metastatic breast cancer or non-small cell lung cancer (NSCLC).
In the dose escalation part of the study, escalating doses of DS-8201a in combination with pembrolizumab will be assessed. DS-8201a and pembrolizumab 200 mg will be administered on Day 1 of every 21-day cycle. The initial dose administered for DS8201a will be 3.2 mg/kg Q3W. Escalation to the next dose (5.4 mg/kg Q3W) will be based on acceptable safety signals based on the earlier dose cohort.
Upon completion of dose escalation with the recommended dose of escalation (RDE) established, the dose expansion part of the study will begin. The dose expansion part will include 4 cohorts: Human epidermal growth factor receptor 2 (HER2+) breast cancer participants with prior ado-trastuzumab emtansine (T-DM1), HER2 low breast cancer participants with prior failed standard treatments, HER2-expressing NSCLC participants who have not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents, and HER2-mutant NSCLC participants who have not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 115
- Written informed consent
- Adults ≥18 years
- Eastern Cooperative Oncology Group performance status (ECOG PS) 0 to 1
- Pathologically documented HER2-expressing locally advanced/metastatic breast cancer, and HER2-expressing or HER2-mutant locally advanced/metastatic NSCLC
- Willing to provide a tumor biopsy during screening and during treatment
- Have at least 1 measurable lesion per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 as assessed by the Investigator
- Adequate cardiac function, as defined by left ventricular ejection fraction (LVEF) ≥50% within 28 days before enrollment.
- Adequate organ function
- Adequate treatment washout period before enrollment
Inclusion Criteria Specific to Part 1
- Participants in Part 1 should meet the additional inclusion criteria listed for 1 of the 4 cohorts in Part 2.
Inclusion Criteria Specific to Part 2
Inclusion Criteria for Cohort 1
- Pathologically documented, locally advanced/metastatic breast cancer that has centrally determined HER2-positive expression as per American Society of Clinical Oncology-College of American Pathologists (ASCO-CAP) Guidelines
- Received prior trastuzumab emtansine (T-DM1) therapy with documented progression
Inclusion Criteria for Cohort 2
- Pathologically documented, locally advanced/metastatic breast cancer that has centrally determined HER2-low expression (immunohistochemistry [IHC] 1+ or IHC 2+/in situ hybridization [ISH-])
- Participants must have exhausted treatments that can confer any clinically meaningful benefit (eg, other therapies such as hormonal therapy for participants who are hormone receptor positive)
Inclusion Criteria for Cohort 3
- Pathologically documented, locally advanced/metastatic NSCLC that has centrally or locally determined HER2-expression (IHC 1+, 2+, or 3+)
- Participants who have known epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK), BRAF V600E mutation, or ROS1 fusion should have disease progression after treatment with at least one genomically-targeted therapy for metastatic disease that are known to confer clinical benefit, or are intolerant to treatment, or refuse standard treatment
Inclusion Criteria for Cohort 4
- Pathologically documented, locally advanced/metastatic HER2-mutant NSCLC
- Participants who have known EGFR mutation, ALK, BRAF V600E mutation, or ROS1 fusion should have disease progression after treatment with at least one genomically-targeted therapy for metastatic disease that are known to confer clinical benefit, or are intolerant to treatment, or refuse standard treatment
- Prior treatment with pembrolizumab or DS-8201a
- Medical history of myocardial infarction (MI) within 6 months before enrollment, symptomatic congestive heart failure (New York Heart Association Class II to IV). Participants with troponin levels above the upper limit of normal at Screening (as defined by the manufacturer), and without any MI-related symptoms, should have a cardiologic consultation before enrollment to rule out MI
- Corrected QT interval (QTc) prolongation to >470 ms (females) or >450 ms (males)
- History of (non-infectious) interstitial lung disease (ILD)/pneumonitis that required steroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening
- Spinal cord compression or clinically active central nervous system metastases
- Active, known or suspected autoimmune disease
- Condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of start of study treatment
- Prior therapy with an anti-PD-1 or anti-PD-L1 agent
- Prior therapy with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX 40, CD137) and was discontinued from that treatment due to a Grade 3 or higher immune-related adverse event (irAE)
- Prior anti-HER2 therapy is not allowed for participants with HER2 low-expressing breast cancer or participants with NSCLC (Cohorts 2, 3, or 4). Prior treatment with pan-HER tyrosine kinase inhibitor is allowed.
- Prior systemic anticancer therapy, including investigational agents within 2 to 6 weeks prior to treatment
- Unresolved toxicities from previous anticancer therapy
- Live vaccine within 30 days prior to the first dose of study drug
- Currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment
- Multiple primary malignancies within 3 years, except adequately resected non-melanoma skin cancer, curatively treated in situ disease, other solid tumors curatively treated, or contralateral breast cancer
- History of severe hypersensitivity reactions to other monoclonal antibodies and/or any of the study drug components
- Active infection requiring systemic therapy
- Known history of human immunodeficiency virus (HIV) infection
- Active hepatitis B or C virus infection
- History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, or any other reason the participant is found not appropriate to participate in the opinion of the treating Investigator
- Known psychiatric or substance abuse disorders
- Prior organ transplantation, including allogeneic stem cell transplantation
- Pregnant, breastfeeding, or planning to become pregnant
- Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses
- Uncontrolled infection requiring IV antibiotics, anti-virals, or anti-fungals
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description HER2-mutant NSCLC (Part 2 Dose Expansion) Trastuzumab deruxtecan (DS-8201a) HER2-mutant NSCLC participants who had not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents and received DS8201a at the RDE in combination with pembrolizumab 200 mg. Part 1 (Dose Escalation) Trastuzumab deruxtecan (DS-8201a) HER2-positive breast cancer, HER2-low expressing breast cancer, HER2-expressing NSCLC, and HER2-mutant NSCLC participants who received escalating doses of DS8201a (initial dose 3.2 mg/kg Q3W) and pembrolizumab 200 mg. HER2-positive breast cancer (Part 2 Dose Expansion) Trastuzumab deruxtecan (DS-8201a) HER2-positive breast cancer participants with prior ado-trastuzumab emtansine (T-DM1) with disease progression and who received DS8201a at the RDE in combination with pembrolizumab 200 mg. HER2-low breast cancer (Part 2 Dose Expansion) Trastuzumab deruxtecan (DS-8201a) HER2 low breast cancer participants with prior failed standard treatments who received DS8201a at the RDE in combination with pembrolizumab 200 mg. HER2-expressing NSCLC (Part 2 Dose Expansion) Trastuzumab deruxtecan (DS-8201a) HER2-expressing NSCLC participants who had not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents and received DS8201a at the RDE in combination with pembrolizumab 200 mg. Part 1 (Dose Escalation) Pembrolizumab HER2-positive breast cancer, HER2-low expressing breast cancer, HER2-expressing NSCLC, and HER2-mutant NSCLC participants who received escalating doses of DS8201a (initial dose 3.2 mg/kg Q3W) and pembrolizumab 200 mg. HER2-positive breast cancer (Part 2 Dose Expansion) Pembrolizumab HER2-positive breast cancer participants with prior ado-trastuzumab emtansine (T-DM1) with disease progression and who received DS8201a at the RDE in combination with pembrolizumab 200 mg. HER2-low breast cancer (Part 2 Dose Expansion) Pembrolizumab HER2 low breast cancer participants with prior failed standard treatments who received DS8201a at the RDE in combination with pembrolizumab 200 mg. HER2-mutant NSCLC (Part 2 Dose Expansion) Pembrolizumab HER2-mutant NSCLC participants who had not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents and received DS8201a at the RDE in combination with pembrolizumab 200 mg. HER2-expressing NSCLC (Part 2 Dose Expansion) Pembrolizumab HER2-expressing NSCLC participants who had not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents and received DS8201a at the RDE in combination with pembrolizumab 200 mg.
- Primary Outcome Measures
Name Time Method Dose-limiting toxicities (DLTs), Part 1 Within two 3-week cycles (6 weeks) Maximum Tolerated Dose (MTD) or recommended dose expansion (RDE) of DS-8201a (Part1) are based on the occurrence of DLTs.
Objective Response Rate (ORR), Confirmed by Independent Central Review, Part 2 Within approximately 30 months
- Secondary Outcome Measures
Name Time Method Pharmacokinetic Parameter Maximum Serum Concentration (Cmax) Cycle 1, Day 1: predose and postdose, Day 8, and Day 15; Cycle 2, Day 1 predose and postdose, and Cycle 3, Day 1 (each cycle is 21 days) Cmax of trastuzumab deruxtecan, MAAA-118A, and total anti-HER2 antibody will be assessed.
Treatment-emergent adverse events Within approximately 30 months Pharmacokinetic Parameter Area Under the Concentration-time Curve (AUC) Cycle 1, Day 1: predose and postdose, Day 8, and Day 15; Cycle 2, Day 1 predose and postdose, and Cycle 3, Day 1 (each cycle is 21 days) Area under the concentration-time curve of trastuzumab deruxtecan, MAAA-118A, and total anti-HER2 antibody will be assessed.
Progression-Free Survival (PFS), based on Independent Central Review using RECIST v1.1 Within approximately 30 months Duration of Response (DoR) Within approximately 30 months Disease Control Rate (DCR) Within approximately 30 months Overall survival (OS) Within approximately 30 months Time to Response (TTR), based on Independent Central Review using RECIST v1.1 Within approximately 30 months
Trial Locations
- Locations (31)
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Univ. of Cali. San Francisco Medical Center
🇺🇸San Francisco, California, United States
Yale Cancer Center
🇺🇸New Haven, Connecticut, United States
Cancer Specialists of North Florida (Cbo)
🇺🇸Jacksonville, Florida, United States
Moffit Cancer Center
🇺🇸Tampa, Florida, United States
Center for Cancer & Blood Disorders
🇺🇸Bethesda, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Siteman Cancer Center-Washington University
🇺🇸Saint Louis, Missouri, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Hope Cancer Center of East Texas
🇺🇸Tyler, Texas, United States
Institut Bergonie
🇫🇷Bordeaux, France
Centre Hospitalier Intercommunal de Créteil
🇫🇷Créteil, France
CHUTimone
🇫🇷Marseille, France
Institut PAOLI-CALMETTES
🇫🇷Marsielle, France
CHU de Poitiers
🇫🇷Poitiers, France
Univ. du Cancer de Toulouse
🇫🇷Toulouse, France
Institut Gustave Roussy
🇫🇷Villejuif, France
Hospital Teresa Herrera (C.H.U.A.C)
🇪🇸A Coruña, Spain
Inst. Oncologico Baselga Hospital Quiron
🇪🇸Barcelona, Spain
Hospital de la Santa Creu i de Sant Pau
🇪🇸Barcelona, Spain
Hopital Universitario Insular de Gran Canaria
🇪🇸Las Palmas de Gran Canaria, Spain
Hospital General Univ. Gregorio Marañon
🇪🇸Madrid, Spain
MD Anderson Cancer Center
🇪🇸Madrid, Spain
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
Hospital Universitario Virgen Macarena
🇪🇸Sevilla, Spain
Hospital Universitario Miguel Servet
🇪🇸Zaragoza, Spain
The Royal Marsden NHS Foundation Trust
🇬🇧London, United Kingdom
Sarah Cannon Research Institute (SCRI)
🇬🇧London, United Kingdom
The Christie NHS Fond. Trust
🇬🇧Manchester, United Kingdom
Royal Marsden Hosptial
🇬🇧Sutton, United Kingdom
Clatterbridge Cancer Centre
🇬🇧Wirral, United Kingdom
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