| Eligibility |
Inclusion Criteria:
1. Written informed consent, according to local guidelines, signed and dated by the
participant or by a legal guardian prior to the performance of any study-specific
procedures, sampling, or analyses
2. At least 18 years-of-age at the time of signature of the informed consent form (ICF)
3. Metastatic ALK+ NSCLC
4. Clinical and/or radiological progressive disease while receiving lorlatinib
monotherapy or within 3 weeks of stopping lorlatinib monotherapy due to clinical
and/or radiological progressive disease
5. Adequate hematologic function defined as:
- Absolute neutrophil count (ANC) =1500/µL
- Hemoglobin (Hb) =9 g/dL
- Platelets =100,000/µL
6. Adequate liver function defined as:
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =2.5 × the
upper limit of normal (ULN)
- Total bilirubin =1.5 × ULN (Participants with known Gilbert disease: serum
bilirubin level = 3 × ULN)
7. Adequate renal function defined as calculated creatinine clearance =45 mL/min as
calculated by Cockcroft and Gault Formula
8. Male or female participants. Male participants with female partners of childbearing
potential and female participants of childbearing potential are required to use two
forms of acceptable contraception, including one barrier method, during their
participation in the study and for 90 days following last dose. Male participants must
also refrain from donating sperm during their participation in the study.
Exclusion Criteria:
1. Prior treatment with platinum-based standard of care doublet chemotherapy with
pemetrexed
2. ECOG Performance Status score =3
3. Current treatment with any of the following:
- Known strong CYP3A inhibitors (e.g., atazanavir, boceprevir, clarithromycin,
conivaptan, indinavir, itraconazole, ketoconazole, lopinavir, mibefradil,
nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir,
telithromycin, troleandomycin, voriconazole, grapefruit juice or
grapefruit/grapefruit-related citrus fruits [e.g., Seville oranges, pomelos]).
The topical use of these medications (if applicable), such as 2% ketoconazole
cream, is allowed.
- Known strong CYP3A inducers (e.g., avasimibe, carbamazepine, phenobarbital,
phenytoin, rifatutin, rifampin, St. John's Wort)
- CYP3A substrates with a narrow therapeutic index (e.g., alfentanil, cyclosporine,
dihydroergotamine, ergotamine, fentanyl including transdermal patch, pimozide,
quinidine, sirolimus, tacrolimus) within 12 days prior to the first dose of
lorlatinib
- Known P-gp substrates with a narrow therapeutic index (e.g., digoxin)
- Currently receiving treatment with therapeutic doses of warfarin sodium. Low-
molecular-weight heparin is allowed.
- Major surgery (excluding placement of vascular access) within 4 weeks of first
dose of study drug(s).
4. Has any history of ILD (including pulmonary fibrosis or radiation pneumonitis), has
clinically significant ILD, or is suspected to have such disease by imaging during
screening. If imaging findings are unlikely to indicate a history of pneumonitis, then
the Investigator should discuss the considerations with the Study Chair about
potential enrollment and record the reasoning in the source documentation.
5. Clinically severe pulmonary compromise (based on Investigator's assessment) resulting
from intercurrent pulmonary illnesses including, but not limited to:
- any underlying pulmonary disorder (e.g., severe asthma, severe chronic
obstructive pulmonary disease, restrictive lung disease)
- any autoimmune, connective tissue or inflammatory disorder with pulmonary
involvement (e.g., rheumatoid arthritis, Sjögren's syndrome, sarcoidosis) OR
prior pneumonectomy
6. Women who are pregnant, nursing, or plan to become pregnant while in the study and for
at least 6 months after the last administration of study treatment
7. Men who plan to father a child while in the study and for at least 3 months after the
last administration of study treatment
8. Presence of active gastrointestinal disease or other condition that will interfere
significantly with the absorption, distribution, metabolism, or excretion of
lorlatinib (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea Grade
=2, malabsorption syndrome)
9. Any of the following cardiac criteria:
- Any clinically important abnormalities (as assessed by the Investigator) in
rhythm, conduction, or morphology of resting electrocardiograms (ECGs), e.g.,
complete left bundle branch block, third-degree heart block
- Congestive heart failure (New York Heart Association = Grade 2)
- Any factors that increase the risk of QTc prolongation or risk of arrhythmic
events such as heart failure, hypokalemia, congenital long QT syndrome, family
history of long QT syndrome or unexplained sudden death under 40 years-of-age, or
any concomitant medication known to prolong the QT interval
- Second degree or third-degree AV block (unless paced) or any AV block with PR
>220 msec
10. As judged by the Investigator, any evidence of severe or uncontrolled systemic
diseases, including uncontrolled hypertension, uncontrolled diabetes mellitus, active
bleeding diatheses, or active infection, including hepatitis B, hepatitis C, and human
immunodeficiency virus. Screening for chronic conditions is not required.
11. Presence of other active invasive cancers other than the one treated in this study
within 5 years prior to screening, except appropriately treated basal cell carcinoma
of the skin, in situ carcinoma of uterine cervix, or other local tumors considered
cured by local treatment
|
