Almonertinib With Bevacizumab for EGFR-Mutant NSCLC Patients With Leptomeningeal Metastasis

NSCLC Clinical Trial

— ATTRACT  

Official title:

Almonertinib Combined With Bevacizumab for EGFR-Mutant NSCLC Patients With Leptomeningeal Metastasis: A Prospective, Open-label, Multi-center, Single-arm Study

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04944069
• Other study ID #: HSM-10296-A016
• Status: Not yet recruiting
• Phase: N/A
• Start date: July 2021
• Est. completion date: March 2025

Study information

• Verified date: May 2021
• Source: Second Affiliated Hospital of Nanchang University
• Contact: Liu Anwen, PhD
• Phone: +8613767120022
• Email: awliu666[@]163.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A prospective, open-label, multi-center, single-arm study of Almonertinib combined With Bevacizumab for EGFR-mutant NSCLC patients with leptomeningeal metastasis.

Description:

This is a prospective, open-label, multi-center, single-arm study to evaluate the efficacy and safety of Almonertinib combined with Bevacizumab for EGFR-mutant NSCLC patients with leptomeningeal metastasis. ALL patients were treated with Almonertinib 110mg oral daily and Bevacizumab 15mg/kg intravenous every 3 weeks. Study therapy continued until disease progression, unacceptable adverse event, or withdrawal of consent.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 69
• Est. completion date: March 2025
• Est. primary completion date: March 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

1. Male or female, age in 18-75 years.

2. The Eastern Cooperative Oncology Group (ECOG) physical status score is 0-2 and has not deteriorated in the previous 2 weeks, with a minimum expected survival of 12 weeks.

3. Histologically confirmed patients with NSCLC leptomeningeal metastasis by positive cerebrospinal fluid cytological examination.

4. Tumor tissue samples or blood are confirmed to be EGFR sensitive mutations (including exon 19 deletion or L858R).

5. There must be at least one measurable extracranial lesion that has not been locally treated at the time of enrollment.

6. Females should be using adequate contraceptive measures throughout the study; should not be breastfeeding at the time of screening, during the study and until 3 months after completion of the study; and must have a negative pregnancy test prior to start of dosing if of childbearing potential or must have evidence of non-childbearing potential by fulfilling 1 of the following criteria at Screening: a) Postmenopausal defined as age more than 50 years and amenorrheic for at least 12 months following cessation of all exogenous hormonal treatments. b) Women under 50 years old would be considered postmenopausal if they have been amenorrheic for 12 months or more, following cessation of exogenous hormonal treatments, and with luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the postmenopausal range for the laboratory. c) Documentation of irreversible surgical sterilization by hysterectomy, bilateral oophorectomy, or bilateral salpingectomy, but not by tubal ligation.

7. Male patients should be willing to use barrier contraception (i.e., condoms).

8. For inclusion in study, patient must provide a written informed consent.

Exclusion Criteria:

1. Treatment with any of the following: a) Prior treatment with systemic anti-cancer therapy for locally advancer or metastatic NSCLC including chemotherapy, biologic therapy, immunotherapy, or any investigational drug. b) Prior treatment with an EGFR TKI. c) Major surgery (excluding placement of vascular access) within 4 weeks of the first dose of study drug. d) Radiotherapy with a limited field of radiation for palliation within 4 week of the first dose of study drug, with the exception of patients receiving radiation to > 30% of the bone marrow or with a wide field of radiation within 4 weeks of the first dose of study drug. e) Medications that are predominantly CYP3A4 strong inhibitors or inducers or sensitive substrates of CYP3A4 with a narrow therapeutic range within 7 days of the first dose of study drug.

2. Patients with other malignancies, except basal cell carcinoma and carcinoma in situ.

3. Any unresolved toxicities from prior therapy greater than Common Terminology Criteria for Adverse Events (CTCAE) Grade 1 at the time of starting study treatment, with the exception of alopecia and Grade 2, prior platinum-therapy related neuropathy.

4. Any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension or active bleeding diatheses, which, in the Investigator's opinion, makes it undesirable for the patient to participate in the trial OR which would jeopardize compliance with the protocol such as active infection. Screening for chronic conditions is not required..

5. Refractory nausea, vomiting, or chronic gastrointestinal diseases, inability to swallow the study drug, or previous significant bowel resection that would preclude adequate absorption of Almonertinib.

6. Any of the following cardiac criteria: a) Mean resting corrected QT interval (QTc) > 470 ms obtained from 3 electrocardiograms (ECGs), using the screening clinic's ECG machine and Fridericia's formula for QT interval correction (QTcF). b) Any clinically important abnormalities in rhythm, conduction, or morphology of the resting ECG (e.g., complete left bundle branch block, third-degree heart block, second-degree heart block, PR interval > 250 ms). c) 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 in first degree relatives or any concomitant medication known to prolong the QT interval. d) Left ventricular ejection fraction (LVEF)< 50%.

7. Inadequate bone marrow reserve or organ function, as demonstrated by any of the following laboratory values: a) Absolute neutrophil count (ANC) <1.5×10^9 / L. b) Platelet count <100×10^9 / L. c) Hemoglobin <90 g/L (<9 g/dL). d) Alanine aminotransferase > 2.5 × upper limit of normal (ULN) if no demonstrable liver metastases or > 5 × ULN in the presence of liver metastases. e) Aspartate aminotransferase (AST) > 2.5 × ULN if no demonstrable liver metastases or > 5 × ULN in the presence of liver metastases. f) Total bilirubin (TBL) > 1.5 × ULN if no liver metastases or > 3 × ULN in the presence of documented Gilbert's Syndrome (unconjugated hyperbilirubinemia) or liver metastases. g) Creatinine > 1.5 × ULN concurrent with creatinine clearance < 50 mL/min (measured or calculated by the Cockcroft-Gault equation); confirmation of creatinine clearance is only required when creatinine is > 1.5 × ULN. h) ALB <28 g/L.

8. Past medical history of interstitial lung disease, drug-induced interstitial lung disease, radiation pneumonitis that required steroid treatment, or any evidence of clinically active interstitial lung disease.

9. Women who are breastfeeding or have a positive urine or serum pregnancy test at the Screening Visit.

10. History of hypersensitivity to any active or inactive ingredient of Almonertinib, or to drugs with a similar chemical structure or class to Almonertinib.

11. Judgment by the Investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions, and requirements.

12. Any severe and uncontrolled ocular disease that may, in the ophthalmologist's opinion, present a specific risk to the patient's safety.

13. Any disease or condition that, in the opinion of the Investigator, would compromise the safety of the patient or interfere with study assessments.

Related Conditions & MeSH terms

• EGFR Activating Mutation
• Leptomeningeal Metastasis
• Meningeal Carcinomatosis
• Neoplasm Metastasis
• Neoplasms, Second Primary
• NSCLC

Intervention

Drug:
• Almonertinib
110 mg oral once daily
• Bevacizumab
15 mg/kg intravenous on Day 1 of 21 day cycles (every 3 weeks)

Locations

Country	Name	City	State
China	The Second Afiliated Hospital of Nanchang University	Nanchang	Jiangxi

Sponsors (2)

Lead Sponsor	Collaborator
Second Affiliated Hospital of Nanchang University	Jiangsu Hansoh Pharmaceutical Co., Ltd.

Country where clinical trial is conducted

China, 

References & Publications (19)

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* Note: There are 19 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Evaluate the correlation between the results of CSF genetic testing and drug resistance mechanisms	Evaluate the correlation between the results of CSF genetic testing and drug resistance mechanisms	CSF samples will be collected on Cycle 1 Day 1, Cycle 2 Day 1 and within one week after disease progression (each cycle is 21 days)
Primary	Overall Survival (OS)	OS is the time from the date of enrollment until death due to any cause	From date of enrollment until the date of death, up to 2 years
Secondary	Time to Symptom Resolution	Time to symptom resolution is the time from first drug dosage date (C1D1) until the date of symptom resolution	From baseline, then every 3 weeks, up to 2 years
Secondary	Progression Free Survival (PFS)	PFS is the time from date of enrollment until the date of PD (by investigator assessment) or death	From baseline, then every 6 weeks, up to 2 years
Secondary	Objective Response Rate (ORR)	ORR is the proportion of patients with a best overall response of complete response or partial response (CR+PR)	From baseline, then every 6 weeks, up to 2 years
Secondary	Disease Control Rate (DCR)	DCR is the proportion of patients with a best overall response of complete response, partial response or stable disease(CR+PR+SD)	From baseline, then every 6 weeks, up to 2 years
Secondary	Duration of Response (DoR)	DoR is the time from date of first documented response until the date of PD (by investigator assessment) or death	From baseline, then every 6 weeks, up to 2 years
Secondary	Intracranial Progression Free Survival (iPFS)	Intracranial progression-free survival	From baseline, then every 6 weeks, up to 2 years
Secondary	Intracranial Objective Response Rate (iORR)	Intracranial objective response rate	From baseline, then every 6 weeks, up to 2 years
Secondary	Intracranial Disease Control Rate (iDCR)	Intracranial disease control rate	From baseline, then every 6 weeks, up to 2 years
Secondary	Intracranial Duration of Response (iDoR)	Intracranial duration of response	From baseline, then every 6 weeks, up to 2 years
Secondary	Extracranial Progression Free Survival (ePFS)	Extracranial progression-free survival	From baseline, then every 6 weeks, up to 2 years
Secondary	Extracranial Objective Response Rate (eORR)	Extracranial objective response rate	From baseline, then every 6 weeks, up to 2 years
Secondary	Extracranial Disease Control Rate (eDCR)	Extracranial disease control rate	From baseline, then every 6 weeks, up to 2 years
Secondary	Extracranial Duration of Response (eDoR)	Extracranial duration of response	From baseline, then every 6 weeks, up to 2 years
Secondary	Assess the safety of Almonertinib Combined With Bevacizumab	Number of adverse events (AEs)/serious adverse events (SAEs)	From baseline, then every 3 weeks, up to 2 years