Study of Durvalumab+Olaparib or Durvalumab After Treatment With Durvalumab and Chemotherapy in Patients With Lung Cancer (ORION)

Phase 2

Active, not recruiting

Conditions: Non-small Cell Lung Cancer NSCLC

Interventions: Drug: Durvalumab
Drug: Olaparib
Drug: Placebo for Olaparib
Drug: Nab-paclitaxel+carboplatin
Drug: Gemcitabine+carboplatin
Drug: Pemetrexed+carboplatin
Drug: Gemcitabine+cisplatin
Drug: Pemetrexed+cisplatin

Registration Number: NCT03775486

Lead Sponsor: AstraZeneca

Brief Summary: This is a randomized, double-blind, multi-center, global Phase II study to determine the efficacy and safety of Durvalumab plus Olaparib combination therapy compared with Durvalumab monotherapy as maintenance therapy in patients whose disease has not progressed following Standard of Care (SoC) platinum-based chemotherapy with Durvalumab as first-line treatment in patients with Stage IV non small-cell lung cancer (NSCLC) with tumors that lack activating epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) fusions.

Detailed Description: Adult patients with a histologically or cytologically documented advanced NSCLC not amenable to curative surgery or radiation with tumors that lack activation EGFR mutations and ALK fusions are eligible for enrollment. During the initial therapy phase, patients will receive treatment with Durvalumab along with the Investigator's choice of platinum-based doublet therapy for squamous NSCLC (nab-paclitaxel plus carboplatin or gemcitabine plus carboplatin/cisplatin) and non-squamous NSCLC (nab-paclitaxel plus carboplatin or pemetrexed plus carboplatin/cisplatin) for 4 cycles. Patients who have completed 4 cycles and not progressed throughout the initial therapy phase will be randomized in a 1:1 ratio into the maintenance phase of the study to receive either Durvalumab plus placebo or Durvalumab plus Olaparib maintenance therapy. Patients will receive maintenance treatment until specific discontinuation criteria are met, including clinical disease progression (as assessed by the Investigator) or RECIST 1.1-defined radiological Progressive Disease (PD), unacceptable toxicity, and withdrawal of consent. Tumor evaluation scans will be performed until objective disease progression as efficacy assessments. All patients will be followed for survival until the end of the study.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 401

Inclusion Criteria

Histologically or cytologically documented Stage IV NSCLC not amenable to curative surgery or radiation.

Patients must have tumors that lack activating EGFR mutations and ALK fusions.

(WHO)/(ECOG) performance status of 0 or 1
No prior chemotherapy or any other systemic therapy for Stage IV NSCLC
Adequate organ and marrow function without blood transfusions in the past 28 days,
At least 1 tumor lesion, not previously irradiated, that can be accurately measured as per RECIST 1.1.

Key Inclusion criteria for randomization to maintenance treatment:

Documented radiographic evidence of CR, PR, or Stable Disease (SD) as per Investigator-assessed RECIST 1.1 following 4 cycles of platinum-based chemotherapy.
Creatinine Clearance (CrCl) ≥51 mL/min calculated by the investigator or designee using the Cockcroft-Gault equation or measured by 24-hour urine collection.
Ability to swallow whole oral medications.
All patients must provide a formalin-fixed, paraffin embedded tumor sample for tissue-based immunohistochemistry staining and DNA sequencing to determine PD-L1 expression, HRRm status, and other correlatives: either newly acquired or archival tumor samples (<3 years old) are acceptable. If available, a newly acquired tumor biopsy, collected as part of routine clinical practice, is preferred. If not available, an archival sample taken <3 years prior to screening is acceptable. If both an archival sample and a fresh tumor biopsy sample are available, both samples should be submitted for analysis and must be submitted as different samples using different accession numbers. Slides from different blocks cannot be mixed and submitted with the same kit.

Exclusion criteria

Mixed small-cell lung cancer and sarcomatoid variant NSCLC histology.
Prior exposure to any chemotherapy agents (except chemotherapy or chemoradiation for non-metastatic disease), polyadenosine 5'diphosphoribose [poly (ADP ribose)] polymerase (PARP) therapy, or immunomediated therapy
Active or prior documented autoimmune or inflammatory disorders.
Any concurrent chemotherapy, IP, biologic, or hormonal therapy for cancer treatment.
Current or prior use of immunosuppressive medication within 14 days before the first dose of Investigational Product (IP)
untreated (CNS) metastases and/or carcinomatous meningitis
Active infection.

Exclusion criteria to be randomized to maintenance treatment:

• Inability to complete 4 cycles of platinum-based chemotherapy for any reason or discontinuation of Durvalumab during initial therapy.

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Durvalumab/Olaparib Combination Therapy	Nab-paclitaxel+carboplatin	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab/Olaparib Combination Therapy	Durvalumab	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab/Olaparib Combination Therapy	Olaparib	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab Monotherapy	Nab-paclitaxel+carboplatin	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Durvalumab Monotherapy	Gemcitabine+carboplatin	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Durvalumab Monotherapy	Pemetrexed+carboplatin	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Durvalumab Monotherapy	Gemcitabine+cisplatin	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Durvalumab Monotherapy	Pemetrexed+cisplatin	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Durvalumab/Olaparib Combination Therapy	Gemcitabine+carboplatin	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab/Olaparib Combination Therapy	Pemetrexed+carboplatin	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab/Olaparib Combination Therapy	Gemcitabine+cisplatin	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab/Olaparib Combination Therapy	Pemetrexed+cisplatin	Durvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab Monotherapy	Durvalumab	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Durvalumab Monotherapy	Placebo for Olaparib	Durvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)

Primary Outcome Measures

Name	Time	Method
Progression-free Survival	From randomization until date of objective radiological disease progression or death, or last evaluable assessment in the absence of progression, up to 18 months	Progression-free survival (PFS) based on investigator assessments according to Response Evaluation Criteria in Solid Tumours version 1.1. PFS is defined as time from date of randomization until the date of objective radiological disease progression using Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1) or death (by any cause in the absence of progression).

Secondary Outcome Measures

Name	Time	Method
Overall Survival	From randomization until the date of death due to any cause, up to 18 months.	Overall survival (OS) across the maintenance phase. OS is defined as time from date of randomization until the date of death by any cause
Objective Response Rate	From randomization until date of objective radiological disease progression or death, or last evaluable assessment in the absence of progression, up to 18 months	Objective response rate (ORR) defined as number of participants with complete response (CR) or partial response (PR) after randomization
Duration of Response	From date of first documented response until objective radiological disease progression or death, up to 18 months.	Duration of response (DoR) defined as time from the date of first documented response following randomization until the first date of documented progression or death in the absence of disease progression. Percentage of participants remaining in response at 3, 6, 9 and 12 months estimated using the Kaplan-Meier method.
Progression-free Survival in Homologous Recombination Repair Related Gene Mutation (HRRm) Population	From randomization until date of objective radiological disease progression or death, or last evaluable assessment in the absence of progression, up to 18 months	Progression-free survival in homologous recombination repair related gene mutation (HRRm) population defined as time from date of randomization until the date of objective radiological disease progression in HRRm population using Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1) or death (by any cause in the absence of progression).
Change From Baseline in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-Lung Cancer (LC)13	From randomization until date of objective radiological disease progression or death, or last evaluable assessment in the absence of progression, up to 18 months	Disease-related symptoms assessed by change from baseline (for maintenance phase) in EORTC QLQ-LC13. Average adjusted mean over first 11 cycles is presented. The EORTC QLQ-LC13 was scored according to the published scoring manual. An outcome variable consisting of a score from 0 to 100 was derived for each of the symptom scales in the EORTC QLQ-LC13. Higher scores on symptom scales represent greater symptom severity.
Concentration of Durvalumab	Assessed from start of initial therapy up to 2 years.	Concentration (pharmacokinetics) of durvalumab
Time to Deterioration in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-Lung Cancer (LC)13	From randomization until date of objective radiological disease progression or death, or last evaluable assessment in the absence of progression, up to 18 months	Disease-related symptoms assessed by time to deterioration (for maintenance phase) in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-Lung Cancer (LC)13. Symptom deterioration is defined as an increase in the score from baseline of less than or equal to 10) that is confirmed at a subsequent assessment, or death (by any cause) in the absence of a clinically meaningful symptom deterioration. NA is "not applicable". The upper confidence limit was not calculable because of an insufficient number of participants with events.
Change From Baseline in EORTC Quality of Life Questionnaire (QLQ) QLQ-C30	Includes all assessments occurring within the first 12 months of randomization or until disease progression, up to 18 months.	Disease-related symptoms and health-related quality of life (HRQoL) assessed by change from baseline (for maintenance phase) in EORTC QLQ-C30. Average adjusted mean over first 11 cycles is presented. The EORTC QLQ-C30 was scored according to the published scoring manual. An outcome variable consisting of a score from 0 to 100 was derived for each of the symptom scales, each of the function scales, and the global health status/QoL scale in the EORTC QLQ-C30. Higher scores on the global health status and function scales indicate better health status/function. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / quality of life (QoL) represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems.
Time to Deterioration in EORTC Quality of Life Questionnaire (QLQ) QLQ-C30	From randomization until date of first symptom deterioration that is confirmed, up to 18 months.	Disease-related symptoms and health-related quality of life (HRQoL) assessed by time to deterioration (for maintenance phase) in EORTC QLQ-C30. NA is "not applicable". The upper confidence limit was not calculable because of an insufficient number of participants with events.
Presence of Anti-drug Antibodies (ADAs) for Durvalumab	Assessed from start of initial therapy up to 2 years.	Presence of anti-drug antibodies (ADAs) for durvalumab, as assessed at 3, 6, 12, 16 and 20 weeks after start of treatment and every 12 weeks thereafter until 3 and 6 months after last dose of durvalumab
Number of Participants With Treatment-Related Adverse Events	From randomization until date of objective radiological disease progression or death, or last evaluable assessment in the absence of progression, up to 18 months	Number of Participants with Treatment-Related Adverse Events as Assessed by Common Terminology Criteria for Adverse Events (CTCAE)