Trastuzumab deruxtecan for subjects with HER2-mutated metastatic NSCLC

Phase 1

Conditions: HER2-mutated metastatic Non-Small Cell Lung Cancer (NSCLC)
MedDRA version: 20.0Level: LLTClassification code 10025044Term: Lung cancerSystem Organ Class: 100000004864
Therapeutic area: Diseases [C] - Cancer [C04]

Registration Number: EUCTR2020-003427-42-FR

Lead Sponsor: Daiichi Sankyo, Inc.

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: Authorised-recruitment may be ongoing or finished

Sex: All

Target Recruitment: 150

Inclusion Criteria

1. Must have provided informed consent for study participation (see Section 10.1.2) before performance of any study-specific procedure or test.
2. Men or women =18 years old. (Please follow local regulatory requirements if the legal age of consent for study participation is >18 years old).
3. Pathologically documented metastatic NSCLC with a known activating HER2 mutation (please refer to the list of HER2 mutations, Table 10.2). The HER2 mutation must be documented from an archival or fresh tumor tissue sample analyzed by Clinical Laboratory Improvement Amendments (CLIA) certified laboratory or equivalent laboratory performing testing to Good Laboratory Practice (GLP) standard.
Note: HER2 mutation documented only from a liquid biopsy sample cannot be used for enrollment.
4. Subjects who had previous treatment (2L+) including platinum therapy, not amenable to curative surgery or radiation.
5. Presence of at least 1 measurable lesion confirmed by BICR based on RECIST version 1.1.
6. Is willing and able to provide an adequate archival tumor tissue sample. A fresh biopsy is required if an archival tumor tissue sample cannot be supplied. Fine needle aspirates are not acceptable.
7. Has ECOG PS of 0 to 1.
8. Has LVEF = 50% within 28 days before randomization.
9. Has adequate organ function within 14 days before randomization, as defined in the protocol.
10. Has adequate treatment washout period before randomization, as defined in the protocol.
11. Male and female subjects of reproductive/childbearing potential must agree to use a highly effective form of contraception or avoid intercourse during and upon completion of the study and for at least 7 months for females and for 4 months for males after the last dose of study drug. Please refer protocol for more details.
12. Male subjects must not freeze or donate sperm starting at Screening and throughout the study period, and at least 4 months after the final study drug administration. Preservation of sperm should be considered prior to enrollment in this study.
13. Female subjects must not donate, or retrieve for their own use, ova from the time of Screening and throughout the study treatment period, and for at least 7 months after the final study drug administration.
14. Life expectancy of 3 months or more.

Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 135
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 15

Exclusion Criteria

1. Has a known driver mutation in the EGFR or BRAF gene or a known ALK or ROS1 fusion.
2. Medical history of myocardial infarction within 6 months before randomization, symptomatic congestive heart failure (CHF) (New York Heart Association Class II to IV). Subjects with troponin levels above ULN at screening (as defined by the manufacturer), and without any MI related symptoms should have a cardiologic consultation before enrollment to rule out MI.
3. Has a corrected QT interval (QTcF) prolongation > 470 msec (females) or >450 msec (males) based on average of the triplicate12-lead ECG at screening.
4. Has a history of (non-infectious) ILD/pneumonitis that required steroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening.
5. Has spinal cord compression or clinically active CNS metastases, defined as untreated and symptomatic, or requiring therapy with corticosteroids or anticonvulsants to control associated symptoms. Subjects with clinically inactive brain metastases may be included in the study. Subjects with treated brain metastases that are no longer symptomatic and who require no treatment with corticosteroids or anticonvulsants may be included in the study if they have recovered from the acute toxic effect of radiotherapy. A minimum of 2 weeks must have elapsed between the end of whole brain radiotherapy and study randomization.
6. Has multiple primary malignancies within 3 years, except adequately resected non melanoma skin cancer, curatively treated in-situ disease, or other solid tumors curatively treated.
7. Has a history of severe hypersensitivity reactions to either the drug substances or inactive ingredients in the drug product.
8. Has a history of severe hypersensitivity reactions to other monoclonal antibodies.
9. Has an uncontrolled infection requiring IV antibiotics, antivirals, or antifungals.
10. Has substance abuse or any other medical conditions such as clinically significant cardiac or psychological conditions, that may, in the opinion of the investigator, interfere with the subject’s participation in the clinical study or evaluation of the clinical study results.
11. Known human immunodeficiency virus (HIV) infection. Subjects should be tested for HIV prior to randomization if required by local regulations or institutional review board (IRB)/independent ethics committee (IEC).
12. Known active clinically relevant liver disease (eg, active hepatitis B, or active hepatitis C), based on available blood tests, liver ultrasound, or liver biopsy results. Subjects who are HBsAg +, with HBV infection for more than 6 months, have a HBV DNA viral load < 2000 IU/mL, have normal transaminase values prior to randomization, and are willing to start and maintain antiviral treatment for the duration of the study are allowed].
13. Unresolved toxicities from previous anticancer therapy, defined as toxicities (other than alopecia)not yet resolved to Grade = 1 or baseline. Note: Subjects may be enrolled with chronic Grade 2 toxicities (defined as no worsening to > Grade 2 for at least 3 months prior to randomization and managed with standard of care treatment) which the investigator deems related to previous nticancer therapy, comprised of:
a. Chemotherapy-induced neuropathy
b. Fatigue
c. Residual toxicities from prior IO treatment: Grade 1 or Grade 2 endocrinopathies which may include:
• Hypothyroidism/ hyperthyroidism
• Type I diabetes
• Hypergl

Study & Design

Study Type: Interventional clinical trial of medicinal product

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method

Secondary Outcome Measures

Name	Time	Method

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