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EUCROSS: European Trial on Crizotinib in ROS1 Translocated Lung Cancer (EUCROSS)

Primary Purpose

Lung Cancer, Adenocarcinoma, NSCLC

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Crizotinib
Sponsored by
University of Cologne
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring lung cancer, adenocarcinoma, NSCLC, ROS1, ROS1 translocation, crizotinib, phase II

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with adenocarcinoma of the lung that is locally advanced or metastatic independent from the number of prior lines of therapy, i.e. including non-pretreated patients (UICC stage IIIB or IV)
  • Positive for ROS1 translocation by central FISH-testing
  • Ability to swallow pills
  • Age > 18 years
  • ECOG performance status 0 to 2
  • Life expectancy of at least 12 weeks
  • Disease measurable per Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1)
  • Any prior treatment (chemotherapy, radiation or surgery) must have been completed at least 2 weeks prior to initiation of study medication
  • Adequate bone marrow, liver and renal function as assessed by the following laboratory requirements to be conducted within 14 days prior to screening:
  • Hemoglobin ≥ 8.0 g/dL
  • Absolute neutrophil count (ANC) ≥ 1,000 /mm3
  • Platelet count ≥ 50 000/µL
  • Total bilirubin ≤ 2 x upper limit of normal (ULN)
  • Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (AP) ≤ 2,5 x ULN or ≤ 5 x ULN in case of liver involvement
  • PT-INR/PTT ≤ 1.5 x ULN
  • Serum creatinine ≤ 2 times ULN
  • Calculated creatinine clearance (CLcr) ≥ 40 ml/min (Cockcroft-Gault formula)
  • Written informed consent
  • Negative serum pregnancy test within 3 days prior to start of dosing premenopausal women. Women of non-childbearing potential may be included without serum pregnancy test if they are either surgically sterile or have been postmenopausal for ≥ 1 year.

Fertile men and women must have an effective method of contraception during treatment and for at least 3 months after completion of treatment as directed by their physician. Effective methods of contraception result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly (for example implants, injectables, combined oral contraception or intra-uterine devices). At the discretion of the investigator, acceptable methods of contraception may include total abstinence where lifestyle of the patient ensures compliance (Periodic abstinence and withdrawal are not acceptable methods of contraception).

Exclusion Criteria:

  • Previous treatment with specific ALK or ROS1 inhibitors
  • Current treatment within another therapeutic clinical trial
  • Other history of ongoing malignancy that would potentially interfere with the interpretation of efficacy (early stage or chronic disease is allowed if not requiring active therapy or intervention and being under control)
  • Pregnancy or breastfeeding
  • Use of drugs or foods that are known potent CYP3A4 inhibitors, including but not limited to atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole and grapefruit or grapefruit juice
  • Use of drugs that are known potent CYP3A4 inducers, including but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, and St. John's wort
  • Use of drugs that are CYP3A4 substrates with narrow therapeutic indices, including but not limited to dihydroergotamine, ergotamine, pimozide, astemizole, cisapride, and terfenadine
  • Active CNS metastases. Patients with brain metastasis are eligible if asymptomatic for ≥ 14 days before starting study medication and off corticosteroids.
  • History of or known carcinomatous meningitis or leptomeningeal disease
  • Known diagnosis of HIV, active hepatitis B and/or C (testing is not mandatory)
  • Any person being in an institution on assignment of the respective authority against his/her own will
  • Any medical, mental or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or understand the patient information
  • Ongoing cardiac dysrhythmias of CTCAE grade ≥2, uncontrolled atrial fibrillation of any grade or QTcF interval > 470ms
  • Patients with known interstitial fibrosis or interstitial lung disease
  • Any of the following within 3 months prior to first crizotinib administration:

Myocardial infarction, severe/unstable angina, symptomatic congestive heart failure, cerebrovascular accident or transient ischemic attack

Sites / Locations

  • Thoraxklinik Heidelberg
  • Universitätsklinikum Frankfurt - Medizinische Klinik II
  • LungenClinic Großhansdorf
  • Evangelische Lungenklinik Berlin
  • University of Cologne / LCGC
  • Universitätsklinikum Tübingen
  • Maria Rosaria Garcia Campelo
  • CEIC Hospital General Universitario de Alicante
  • CEIC Hopsital Vall d'Hebron
  • Institut Catala D'Oncologia
  • Hospital Universitario Materno-Infantil de Canarias
  • CEIC Área 2 - Hospital Universitario de La Princesa
  • CEIC Área 6 - Hospital Universitario Puerta de Hierro de Majadahonda
  • CEIC Malaga Nordeste - Hospital Regional Universitario Carlos Haya
  • Hospital Son Llatzer
  • CEIC Hospital Universitario Virgen del Rocio
  • CEIC Hospital Clínico Universitario de Valencia
  • Universitätsspital Basel

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Crizotinib

Arm Description

Patients are treated in this single-arm trial with oral crizotinib 250 mg b.i.d.. Treatment dose will be adjusted according to the protocol if indicated. Treatment will be conducted until disease progression or beyond disease progression according to the protocol if clinically indicated.

Outcomes

Primary Outcome Measures

Objective Response Rate (ORR); evaluation criteria: investigator assessed RECIST v.1.1 analysis
CT/MRI scans will be performed to evaluate the efficacy of crizotinib treatment in advanced adenocarcinoma of the lung harbouring ROS1 fusion genes (primary outcome measure: objective response rate (ORR) according to RECIST v.1.1)

Secondary Outcome Measures

Progression Free Survival (PFS) according to RECIST v1.1; evaluation criteria: investigator assessed RECIST v.1.1 analysis
CT/MRI scans will be performed to assess the PFS during treatment period.
Overall Survival (OS); evaluation criteria: investigator assessed RECIST v.1.1 analysis
OS will be assessed by telephone calls every 3 months after the safety follow-up visit.
Duration of Response (DR); evaluation criteria: investigator assessed RECIST v.1.1 analysis
CT/MRI scans will be performed to asses the DR.
Time to Tumor Response; evaluation criteria: investigator assessed RECIST v.1.1 analysis
CT/MRI scans will be performed to assess the Time to Tumor Response.
Disease Control Rate (DCR); evaluation criteria: investigator assessed RECIST v.1.1 analysis
CT/MRI scans will be performed at weeks 6, 12, 24 to assess the DCR.
Safety/Adverse Events and tolerability in all patients treated with crizotinib assessed by number and severity of adverse events as recorded on the case report form, vital signs, laboratory variables, physical examination, electrocardiogram and RECIST1.1
Safety and tolerability will be assessed on every study visit and for 28 days after end of treatment.
Patient Reported Outcomes (PRO) (EORTC QLQ-C30, EORTC QLQ-LC13)
Patient reported outcomes (PRO) of health-related quality of life (HRQoL), disease/treatment related symptoms of lung cancer and general health status
To evaluate the efficacy of crizotinib treatment in the patient subgroup with ROS1 translocation confirmed by the CAGE technology regarding the objective response rate (ORR) (evaluation criteria: investigator assessed RECIST v1.1)
CT/MRI scans will be performed to evaluate the efficacy of crizotinib treatment in advanced adenocarcinoma of the lung harbouring ROS1 fusion genes as confirmed by CAGE sequencing
Objective Response Rate (ORR), Overall Survival (OS), Progression Free Survival (PFS), Duration of Response (DR), Time to Tumor Response, Disease Control Rate (DCR); evaluation criteria: RECIST v1.1 by independent radiologic review
CT/MRI scans will be performed to evaluate the efficacy of crizotinib treatment

Full Information

First Posted
June 25, 2014
Last Updated
June 15, 2022
Sponsor
University of Cologne
Collaborators
Spanish Lung Cancer Group, Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT02183870
Brief Title
EUCROSS: European Trial on Crizotinib in ROS1 Translocated Lung Cancer
Acronym
EUCROSS
Official Title
EUCROSS: A Phase II Trial to Evaluate Efficacy and Safety of Crizotinib Treatment in Advanced Adenocarcinoma of the Lung Harbouring ROS1 Translocations
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Completed
Study Start Date
May 2014 (undefined)
Primary Completion Date
July 24, 2018 (Actual)
Study Completion Date
February 29, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Cologne
Collaborators
Spanish Lung Cancer Group, Pfizer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
EUCROSS is a phase II trial to evaluate the efficacy and safety of crizotinib in patients with adenocarcinoma of the lung harbouring ROS1 translocations. Patients will be treated with 250mg crizotinib bid until progression or intolerable toxicity.
Detailed Description
EUCROSS is a phase II trial to evaluate the efficacy and safety of crizotinib in patients with adenocarcinoma of the lung harbouring ROS1 translocations. In individual treatment attempts and an ongoing phase I trial crizotinib has shown remarkable effects on this selected subgroup of lung cancer patients. Crizotinib is a tyrosine kinase inhibitor, blocking the catalytic activity of rearranged ALK and ROS1 as well as MET. The patients eligible for the trial will be treated with 250mg crizotinib twice-daily. Tumor response to treatment will be assessed every 6 weeks by CT or MRI scans. In case of progression treatment beyond may be conducted if clinically indicated. To identify mechanisms of resistance to crizotinib treatment, an optional re-biopsy may be performed in these cases and fresh frozen tumor material will analyzed at the University of Cologne.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer, Adenocarcinoma, NSCLC
Keywords
lung cancer, adenocarcinoma, NSCLC, ROS1, ROS1 translocation, crizotinib, phase II

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Crizotinib
Arm Type
Experimental
Arm Description
Patients are treated in this single-arm trial with oral crizotinib 250 mg b.i.d.. Treatment dose will be adjusted according to the protocol if indicated. Treatment will be conducted until disease progression or beyond disease progression according to the protocol if clinically indicated.
Intervention Type
Drug
Intervention Name(s)
Crizotinib
Other Intervention Name(s)
Xalkori
Intervention Description
250mg crizotinib bid until end of treatment
Primary Outcome Measure Information:
Title
Objective Response Rate (ORR); evaluation criteria: investigator assessed RECIST v.1.1 analysis
Description
CT/MRI scans will be performed to evaluate the efficacy of crizotinib treatment in advanced adenocarcinoma of the lung harbouring ROS1 fusion genes (primary outcome measure: objective response rate (ORR) according to RECIST v.1.1)
Time Frame
From time of beginning of treatment until the documention of response according to RECIST v1.1 (expected average 12 months) .
Secondary Outcome Measure Information:
Title
Progression Free Survival (PFS) according to RECIST v1.1; evaluation criteria: investigator assessed RECIST v.1.1 analysis
Description
CT/MRI scans will be performed to assess the PFS during treatment period.
Time Frame
From time of beginning of treatment until the first documented event of progression according to RECIST v1.1 (expected average 12 months).
Title
Overall Survival (OS); evaluation criteria: investigator assessed RECIST v.1.1 analysis
Description
OS will be assessed by telephone calls every 3 months after the safety follow-up visit.
Time Frame
From beginning to end of study (Last subject last visit (LSLV)) (up to approximately 24 months).
Title
Duration of Response (DR); evaluation criteria: investigator assessed RECIST v.1.1 analysis
Description
CT/MRI scans will be performed to asses the DR.
Time Frame
From time of beginning of treatment until the documention of progression according to RECIST v1.1 (expected average 12 months).
Title
Time to Tumor Response; evaluation criteria: investigator assessed RECIST v.1.1 analysis
Description
CT/MRI scans will be performed to assess the Time to Tumor Response.
Time Frame
From time of beginning of treatment until the first documented event of response according to RECIST v1.1 (expected average 3 months).
Title
Disease Control Rate (DCR); evaluation criteria: investigator assessed RECIST v.1.1 analysis
Description
CT/MRI scans will be performed at weeks 6, 12, 24 to assess the DCR.
Time Frame
From beginning of treatment to week 6, 12 and 24 according to RECIST v1.1 (expected average 3 months).
Title
Safety/Adverse Events and tolerability in all patients treated with crizotinib assessed by number and severity of adverse events as recorded on the case report form, vital signs, laboratory variables, physical examination, electrocardiogram and RECIST1.1
Description
Safety and tolerability will be assessed on every study visit and for 28 days after end of treatment.
Time Frame
From beginning of treatment until 28 days post treatment (expected average 12 months).
Title
Patient Reported Outcomes (PRO) (EORTC QLQ-C30, EORTC QLQ-LC13)
Description
Patient reported outcomes (PRO) of health-related quality of life (HRQoL), disease/treatment related symptoms of lung cancer and general health status
Time Frame
Questionnaires (EORTC QLQ-LC13, EORTC QLQ-C30) completed at baseline and every 4 weeks from beginning of treatment until end of study.
Title
To evaluate the efficacy of crizotinib treatment in the patient subgroup with ROS1 translocation confirmed by the CAGE technology regarding the objective response rate (ORR) (evaluation criteria: investigator assessed RECIST v1.1)
Description
CT/MRI scans will be performed to evaluate the efficacy of crizotinib treatment in advanced adenocarcinoma of the lung harbouring ROS1 fusion genes as confirmed by CAGE sequencing
Time Frame
From time of beginning of treatment until the documention of response according to RECIST v1.1 (expected average 12 months) .
Title
Objective Response Rate (ORR), Overall Survival (OS), Progression Free Survival (PFS), Duration of Response (DR), Time to Tumor Response, Disease Control Rate (DCR); evaluation criteria: RECIST v1.1 by independent radiologic review
Description
CT/MRI scans will be performed to evaluate the efficacy of crizotinib treatment
Time Frame
From time of beginning of treatment until the documention of response according to RECIST v1.1 (expected average 12 months) .
Other Pre-specified Outcome Measures:
Title
Characterization of ROS1 fusion gene on a genomic level by CAGE Technology to identify the exact break-apart point as well as the involved fusion genes.
Description
CAGE technology (Cap Analysis of Gene Expression) is an RNA based sequencing technology to identify the exact break-apart point as well as the fusion genes.
Time Frame
From beginning of screening of first patient to screening of last patient (expected average 24 months).
Title
Characterization of molecular and genetic mechanisms of resistance to crizotinib treatment in patients showing disease progression.
Description
Mechanisms of resistance to crizotinib will be analysed by molecular pathologic analyses, e.g. NGS and FISH.
Time Frame
At time of disease progression (expected average 12 months).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with adenocarcinoma of the lung that is locally advanced or metastatic independent from the number of prior lines of therapy, i.e. including non-pretreated patients (UICC stage IIIB or IV) Positive for ROS1 translocation by central FISH-testing Ability to swallow pills Age > 18 years ECOG performance status 0 to 2 Life expectancy of at least 12 weeks Disease measurable per Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) Any prior treatment (chemotherapy, radiation or surgery) must have been completed at least 2 weeks prior to initiation of study medication Adequate bone marrow, liver and renal function as assessed by the following laboratory requirements to be conducted within 14 days prior to screening: Hemoglobin ≥ 8.0 g/dL Absolute neutrophil count (ANC) ≥ 1,000 /mm3 Platelet count ≥ 50 000/µL Total bilirubin ≤ 2 x upper limit of normal (ULN) Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (AP) ≤ 2,5 x ULN or ≤ 5 x ULN in case of liver involvement PT-INR/PTT ≤ 1.5 x ULN Serum creatinine ≤ 2 times ULN Calculated creatinine clearance (CLcr) ≥ 40 ml/min (Cockcroft-Gault formula) Written informed consent Negative serum pregnancy test within 3 days prior to start of dosing premenopausal women. Women of non-childbearing potential may be included without serum pregnancy test if they are either surgically sterile or have been postmenopausal for ≥ 1 year. Fertile men and women must have an effective method of contraception during treatment and for at least 3 months after completion of treatment as directed by their physician. Effective methods of contraception result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly (for example implants, injectables, combined oral contraception or intra-uterine devices). At the discretion of the investigator, acceptable methods of contraception may include total abstinence where lifestyle of the patient ensures compliance (Periodic abstinence and withdrawal are not acceptable methods of contraception). Exclusion Criteria: Previous treatment with specific ALK or ROS1 inhibitors Current treatment within another therapeutic clinical trial Other history of ongoing malignancy that would potentially interfere with the interpretation of efficacy (early stage or chronic disease is allowed if not requiring active therapy or intervention and being under control) Pregnancy or breastfeeding Use of drugs or foods that are known potent CYP3A4 inhibitors, including but not limited to atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole and grapefruit or grapefruit juice Use of drugs that are known potent CYP3A4 inducers, including but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, and St. John's wort Use of drugs that are CYP3A4 substrates with narrow therapeutic indices, including but not limited to dihydroergotamine, ergotamine, pimozide, astemizole, cisapride, and terfenadine Active CNS metastases. Patients with brain metastasis are eligible if asymptomatic for ≥ 14 days before starting study medication and off corticosteroids. History of or known carcinomatous meningitis or leptomeningeal disease Known diagnosis of HIV, active hepatitis B and/or C (testing is not mandatory) Any person being in an institution on assignment of the respective authority against his/her own will Any medical, mental or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or understand the patient information Ongoing cardiac dysrhythmias of CTCAE grade ≥2, uncontrolled atrial fibrillation of any grade or QTcF interval > 470ms Patients with known interstitial fibrosis or interstitial lung disease Any of the following within 3 months prior to first crizotinib administration: Myocardial infarction, severe/unstable angina, symptomatic congestive heart failure, cerebrovascular accident or transient ischemic attack
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Juergen Wolf, Prof. Dr. med.
Organizational Affiliation
Uniklinik Köln, Department I for Internal Medicine, LCGC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Thoraxklinik Heidelberg
City
Heidelberg
State/Province
Baden-Würtemberg
ZIP/Postal Code
69126
Country
Germany
Facility Name
Universitätsklinikum Frankfurt - Medizinische Klinik II
City
Frankfurt a.M.
State/Province
Hessen
ZIP/Postal Code
60590
Country
Germany
Facility Name
LungenClinic Großhansdorf
City
Großhansdorf
State/Province
Schleswig-Holstein
ZIP/Postal Code
22927
Country
Germany
Facility Name
Evangelische Lungenklinik Berlin
City
Berlin
ZIP/Postal Code
13125
Country
Germany
Facility Name
University of Cologne / LCGC
City
Cologne
ZIP/Postal Code
50937
Country
Germany
Facility Name
Universitätsklinikum Tübingen
City
Tübingen
Country
Germany
Facility Name
Maria Rosaria Garcia Campelo
City
A Coruna
Country
Spain
Facility Name
CEIC Hospital General Universitario de Alicante
City
Alicante
Country
Spain
Facility Name
CEIC Hopsital Vall d'Hebron
City
Barcelona
Country
Spain
Facility Name
Institut Catala D'Oncologia
City
Barcelona
Country
Spain
Facility Name
Hospital Universitario Materno-Infantil de Canarias
City
Las Palmas de Gran Canaria
Country
Spain
Facility Name
CEIC Área 2 - Hospital Universitario de La Princesa
City
Madrid
Country
Spain
Facility Name
CEIC Área 6 - Hospital Universitario Puerta de Hierro de Majadahonda
City
Majadahonda
Country
Spain
Facility Name
CEIC Malaga Nordeste - Hospital Regional Universitario Carlos Haya
City
Malaga
Country
Spain
Facility Name
Hospital Son Llatzer
City
Palma de Mallorca
Country
Spain
Facility Name
CEIC Hospital Universitario Virgen del Rocio
City
Sevilla
Country
Spain
Facility Name
CEIC Hospital Clínico Universitario de Valencia
City
Valencia
Country
Spain
Facility Name
Universitätsspital Basel
City
Basel
Country
Switzerland

12. IPD Sharing Statement

Citations:
PubMed Identifier
23558310
Citation
Bos M, Gardizi M, Schildhaus HU, Heukamp LC, Geist T, Kaminsky B, Zander T, Nogova L, Scheffler M, Dietlein M, Kobe C, Holstein A, Maintz D, Buttner R, Wolf J. Complete metabolic response in a patient with repeatedly relapsed non-small cell lung cancer harboring ROS1 gene rearrangement after treatment with crizotinib. Lung Cancer. 2013 Jul;81(1):142-3. doi: 10.1016/j.lungcan.2013.02.018. Epub 2013 Apr 1.
Results Reference
background
PubMed Identifier
22327623
Citation
Takeuchi K, Soda M, Togashi Y, Suzuki R, Sakata S, Hatano S, Asaka R, Hamanaka W, Ninomiya H, Uehara H, Lim Choi Y, Satoh Y, Okumura S, Nakagawa K, Mano H, Ishikawa Y. RET, ROS1 and ALK fusions in lung cancer. Nat Med. 2012 Feb 12;18(3):378-81. doi: 10.1038/nm.2658.
Results Reference
background

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EUCROSS: European Trial on Crizotinib in ROS1 Translocated Lung Cancer

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