| Eligibility |
Inclusion Criteria:
- Patients must be assigned to S1900D. Assignment to S1900D is determined by the S1400
or LUNGMAP protocol genomic profiling using the FoundationOne assay. Biomarker
eligibility for S1900D is based on the identification of an NFE2L2 mutation or KEAP1
alteration
- Patients must have a histologically or cytologically confirmed stage IV or recurrent
pure squamous cell lung cancer
- Patients must have measurable disease documented by computed tomography (CT) or
magnetic resonance imaging (MRI). The CT from a combined positron emission tomography
(PET)/CT may be used to document only non-measurable disease unless it is of
diagnostic quality. Measurable disease must be assessed within 28 days prior to
sub-study randomization. Pleural effusions, ascites and laboratory parameters are not
acceptable as the only evidence of disease. Non-measurable disease must be assessed
within 42 days prior to sub-study randomization. All disease must be assessed and
documented on the Baseline Tumor Assessment Form. Patients whose only measurable
disease is within a previous radiation therapy port must demonstrate clearly
progressive disease (in the opinion of the treating investigator) prior to
randomization. CT and MRI scans must be submitted for central review via transfer of
images and data (TRIAD)
- Patients must have a CT or MRI scan of the brain to evaluate for central nervous
system (CNS) disease within 42 days prior to sub-study randomization
- Patients with evidence of chronic hepatitis B virus (HBV) infection must have
undetectable HBV viral load on suppressive therapy within 28 days prior to sub-study
randomization
- Patients with a history of hepatitis C virus (HCV) infection must have been treated
and cured. Patients with HCV infection who are currently on treatment must have an
undetectable HCV viral load within 28 days prior to sub-study randomization
- Patients with a known history of human immunodeficiency virus (HIV) seropositivity:
- Must have undetectable viral load using standard HIV assays in clinical practice
- Must have CD4 count >= 400/mcL
- Must not require prophylaxis for any opportunistic infections (i.e., fungal,
mycobacterium avium complex [MAC], or pneumocystis pneumonia [PCP] prophylaxis)
- Must not be newly diagnosed within 12 months prior to sub-study randomization
- Patients must be able to swallow oral medications. Patients must not have any
impairment of gastrointestinal function or gastrointestinal disease that may
significantly alter the absorption of TAK228 (MLN0128, sapanisertib) (e.g. ulcerative
disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small
bowel resection, or enteric stomata)
- Patients must be able to safely receive at least one of the investigator's choice of
standard of care regimens
- Patients must have progressed (in the opinion of the treating physician) following the
most recent line of therapy
- Patients must have recovered (=< grade 1) from any side effects of prior therapy
- Absolute neutrophil count (ANC) >= 1,500/mcl (obtained within 28 days prior to
sub-study randomization)
- Platelet count >= 100,000 mcl (obtained within 28 days prior to sub-study
randomization)
- Hemoglobin >= 9 g/dL (obtained within 28 days prior to sub-study randomization).
Transfusion to obtain a hemoglobin (Hb) of >= 9 g/dl is acceptable
- Patients must have fasting triglycerides =< 300 mg/dL within 28 days prior to
sub-study randomization
- Serum bilirubin =< Institutional upper limit of normal (IULN) (within 28 days prior to
sub-study randomization. For patients with liver metastases, serum bilirubin must be
=< 2 x IULN
- Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) =< 2 x IULN (within
28 days prior to sub-study randomization) (if both ALT and AST are done, both must be
< 2 IULN). For patients with liver metastases, ALT or AST must be =< 5 x IULN (if both
ALT and AST are done, both must be =< 5 x IULN)
- Patients must have a serum creatinine =< the IULN or calculated creatinine clearance
>= 40 mL/min using the following Cockcroft-Gault formula. This specimen must have been
drawn and processed within 28 days prior to sub-study randomization
- Patients must have Zubrod performance status 0-1 documented within 28 days prior to
sub-study randomization
- Pre-study history and physical exam must be obtained within 28 days prior to
randomization
- No other prior malignancy is allowed except for the following: adequately treated
basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated
stage I or II cancer from which the patient is currently in complete remission, or any
other cancer from which the patient has been disease free for two years. In addition,
indolent or low-grade malignancies which are not expected to interfere with assessment
of the primary or toxicity endpoints are permissible (e.g. localized well
differentiated prostate cancer). These cases should be discussed with a study chair
prior to enrollment
- Patients must agree to have blood specimens submitted for circulating tumor DNA
(ctDNA)
- Patients must also be offered participation in banking and in the correlative studies
for collection and future use of specimens
- Patients must be informed of the investigational nature of this study and must sign
and give written informed consent in accordance with institutional and federal
guidelines
- As a part of the OPEN registration process the treating institution's identity is
provided in order to ensure that the current (within 365 days) date of institutional
review board approval for this study has been entered in the system
- Patients with impaired decision-making capacity are eligible as long as their
neurological or psychological condition does not preclude their safe participation in
the study (e.g., tracking pill consumption and reporting adverse events to the
investigator)
Exclusion Criteria:
- Patients must not have EGFR sensitizing mutations, EGFR T790M mutation, ALK gene
fusion, ROS 1 gene rearrangement, and BRAF V600E mutation unless they have progressed
following all standard of care targeted therapy
- Patient must not have leptomeningeal disease, spinal cord compression or brain
metastases unless: (1) metastases have been locally treated and have remained
clinically controlled and asymptomatic for at least 14 days following treatment, and
prior to sub-study randomization, AND (2) patient has no residual neurological
dysfunction and has been off corticosteroids for at least 14 days prior to sub-study
randomization. Patients with brain metastases that have not been treated may be
registered if the metastases are:
- < 2 mm OR deemed clinically equivocal, AND
- No evidence of shift, AND
- No focal or other neurologic deficits, AND
- No requirement for steroids, anti-seizure medications
- Patients must not have uncontrolled illnesses within 28 days prior to sub-study
randomization including:
- Uncontrolled asthma is defined as: oxygen (O2) saturation < 90% by arterial blood
gas analysis or pulse oximetry on room air
- Medically significant (symptomatic) bradycardia
- History of arrhythmia requiring an implantable cardiac defibrillator
- Symptomatic pulmonary hypertension
- Uncontrolled hypertension (use of anti-hypertensive agents to control
hypertension before cycle 1 day 1 [C1D1] is allowed)
- Clinically significant valvular disease
- Patients must not have received any radiation therapy within 14 days prior to
randomization
- Patients must not be planning to receive any concurrent chemotherapy, immunotherapy,
biologic or hormonal therapy for cancer treatment while receiving treatment on this
study. Concurrent use of hormones for non-cancer-related conditions (e.g. insulin for
diabetes and hormone replacement therapy) is acceptable
- Patient must not have had a major surgery within 14 days prior to sub-study
randomization. Patient must have fully recovered from the effects of prior surgery in
the opinion of the treating investigator
- Patients must not have previously received treatment with PI3K, AKT, PI3K/mTOR
inhibitors, TORC1/2 inhibitors or TORC1 inhibitors
- Patients must not have uncontrolled diabetes within 28 days prior to sub-study
randomization
- Definition of uncontrolled diabetes: Glycosylated hemoglobin (HbA1c) >= 8.0% and
fasting serum glucose (> 130 mg/dL) within 28 days prior to sub-study
randomization
- Patients must not have any grade III/IV cardiac disease as defined by the New York
Heart Association Criteria (i.e., patients with cardiac disease resulting in marked
limitation of physical activity or resulting in inability to carry on any physical
activity without discomfort), unstable angina pectoris, myocardial infarction within 6
months, or serious uncontrolled cardiac arrhythmia
- Patients must not have had an ischemic cerebrovascular event or pulmonary embolism
within 6 months
- Patients must not have a rate-corrected QT interval > 480 msec based on the 12-lead
electrocardiography (ECG) within 28 days prior to sub-study randomization (i.e.,
repeated demonstration of corrected QT [QTc] interval > 480 milliseconds, or history
of congenital long QT syndrome, or torsades de pointes). It is suggested that a local
cardiologist review the QTc intervals
- Patients must not have received any live attenuated vaccinations or been in close
contact with those who have received live vaccines within 28 days prior to sub-study
registration and throughout protocol treatment
- Patients must not be planning to use proton pump inhibitors (PPIs) at least one week
prior to sub-study randomization and throughout protocol treatment
- Patients must not be pregnant or nursing. Women of reproductive potential must have
agreed to use an effective contraceptive method and must not donate eggs during
protocol treatment and for 90 days after the last protocol treatment. Men of
reproductive potential must have agreed to use an effective contraceptive method and
must not donate sperm during protocol treatment and for 120 days after the last
protocol treatment. A woman is considered to be of "reproductive potential" if she has
had menses at any time in the preceding 12 consecutive months. In addition to routine
contraceptive methods, "effective contraception" also includes heterosexual celibacy
and surgery intended to prevent pregnancy (or with a side-effect of pregnancy
prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal
ligation. However, if at any point a previously celibate patient chooses to become
heterosexually active during the time period for use of contraceptive measures
outlined in the protocol, he/she is responsible for beginning contraceptive measures
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