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Optimal Sequencing of Pembrolizumab (MK-3475) and Standard Platinum-based Chemotherapy in First-Line NSCLC

Primary Purpose

Non-Small Cell Lung Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
MK-3475
Carboplatin
Paclitaxel
Pemetrexed
Sponsored by
Alliance Foundation Trials, LLC.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-Small Cell Lung Cancer

Eligibility Criteria

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

Inclusion Criteria:

  1. Be ≥ 18 years of age on day of signing informed consent.
  2. Have a life expectancy of at least 3 months.
  3. Have a histologically or cytologically confirmed diagnosis of stage IV NSCLC.
  4. Have a performance status of 0 or 1 on the ECOG.
  5. Have a measurable disease based on RECIST 1.1.
  6. Have provided tissue from an archival tissue sample or newly obtained core or excisional biopsy of tumor lesion.
  7. In patients with non-squamous non-small cell lung cancer, investigators must be able to produce source documentation of the EGFR mutation status or ALK translocation status.
  8. Demonstrate adequate organ function.
  9. Female patient of childbearing potential should have a negative urine or serum pregnancy test within 72 hours.
  10. Female parents of childbearing potential must be willing to use 2 methods of birth control or be surgically sterile.
  11. Male patients must agree to use an adequate method of contraception.
  12. Patients with sensitizing EGFR mutation or ALK rearrangement must have progressed on an appropriate tyrosine kinase inhibitor (TKI)

Exclusion Criteria:

  1. Has received prior treatment with chemotherapy or biologic therapy for stage IV NSCLC.
  2. Is currently participating in or has participated in a study of an investigational agent or using an investigational device.
  3. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy.
  4. Has had a prior mAb within 4 weeks prior to study Day 1 or who has not recovered from adverse events due to agents administered more than 4 weeks earlier.
  5. Has had prior chemotherapy or radiation.
  6. Has a known additional malignancy that is progressing or requires active treatment.
  7. Has known active CNS metastases and/or carcinomatous meningitis.
  8. Has an active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents.
  9. Has evidence of interstitial lung disease or active, non-infectious pneumonitis.
  10. Has an active infection requiring systemic therapy.
  11. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial.
  12. Has known psychiatric or substance abuse disorders.
  13. Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial.
  14. Has received prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or CTLA-4 antibody.
  15. Has a known history of HIV.
  16. Has known active Hepatitis B or Hepatitis C.
  17. Has received a live vaccine within 30 days prior to the planned first dose of study therapy.
  18. Has a known history of active TB.
  19. Hypersensitivity to pembrolizumab or any of it's excipients.

Sites / Locations

  • UCSD Moores Cancer Center
  • The University of Chicago Medical Center
  • NorthShore University HealthSystem
  • Medical Oncology & Hematology Associates
  • EMMC Cancer Care
  • Metro MN Community Oncology Research Consortium
  • NH Oncology (Concord)
  • Dartmouth Hitchcock Medical Center
  • SUNY Upstate Medical University
  • The Ohio State University
  • University of Oklahoma Health Sciences Center Stephenson Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Arm A

Arm B

Arm Description

For Squamous Carcinoma Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Paclitaxel 200 mg/m2 IV day 1 every 21-days for up to 4 cycles OR For Non-squamous Carcinoma Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Pemetrexed 500 mg/m2 IV day 1 every 21-days for up to 4 cycles

MK-3475 200 mg/m2 IV every 21-days for up to 4 cycles Patients with CR, PR, or SD by irRC will then be treated with: For Squamous Carcinoma: Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Paclitaxel 200 mg/m2 IV day 1 every 21-days for up to 4 cycles OR For Non-squamous Carcinoma Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Pemetrexed 500 mg/m2 IV day 1 every 21-days for up to 4 cycles

Outcomes

Primary Outcome Measures

Overall Response Rate (ORR) Per RECIST 1.1
The primary objective of this randomized phase II trial to determine the overall response rate (ORR per RECIST 1.1) in Chemotherapy naive patients with stage IV NSCLC after the administration of standard platinum-based chemotherapy before MK-3475 (arm A) and administration of MK-3475 administered before standard platinum-based chemotherapy (arm B). Overall Response (OR) = CR + PR.

Secondary Outcome Measures

Compare Progression-Free Survival (PFS) Per RECIST 1.1
To compare the progression-free survival (PFS) per RECIST 1.1 in previously untreated patients with advanced NSCLC treated with first line carboplatin-based chemotherapy followed by MK-3475 to patients treated with MK-3475 prior to first-line carboplatin-based chemotherapy.
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
To characterize the adverse events related to MK-3475 by frequency, type and grade in patients with Chemotherapy naive advanced NSCLC based on the sequence of administration with first-line chemotherapy. A count of participants experiencing an adverse event is summarized here, the detailed summary is in the adverse events section of this report.

Full Information

First Posted
October 20, 2015
Last Updated
November 28, 2022
Sponsor
Alliance Foundation Trials, LLC.
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02591615
Brief Title
Optimal Sequencing of Pembrolizumab (MK-3475) and Standard Platinum-based Chemotherapy in First-Line NSCLC
Official Title
Randomized Phase II Trial Evaluating the Optimal Sequencing of PD-1 Inhibition With Pembrolizumab (MK-3475) and Standard Platinum-based Chemotherapy in Patients With Chemotherapy Naive Stage IV Non-small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
March 2016 (Actual)
Primary Completion Date
January 4, 2019 (Actual)
Study Completion Date
July 4, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Alliance Foundation Trials, LLC.
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a multicenter randomized phase II to determine if the administration of standard platinum-based chemotherapy before MK-3475 in with Chemotherapy naive stage IV Non-small Cell Lung Cancer (NSCLC) will improve the overall response rate (ORR) compared to MK-3475 administered before chemotherapy. Patients will be given Pembrolizumab as maintenance up to 2 years: Carboplatin and paclitaxel or pemetrexed every 3 weeks x 4 cycles followed by pembrolizumab every 3 weeks for up to 2 years. Pembrolizumab every 3 weeks x 4 cycles followed by carboplatin and paclitaxel or pemetrexed every 3 weeks x 4 cycles followed by pembrolizumab every 3 weeks for up to 2 years.
Detailed Description
While a genotype-directed strategy has been established as effective in treatment selection for patients with advanced NSCLC, only a minority of patients at this time will have a readily identifiable actionable molecular target. Furthermore, genotype-directed therapy has not been validated for patients with squamous cell carcinoma of the lung. Therefore, the majority of patients with advanced NSCLC will continue to rely on standard platinum-based doublet chemotherapy. Given the plateau in effectiveness of this approach, novel treatment strategies are clearly warranted.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-Small Cell Lung Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
91 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Active Comparator
Arm Description
For Squamous Carcinoma Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Paclitaxel 200 mg/m2 IV day 1 every 21-days for up to 4 cycles OR For Non-squamous Carcinoma Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Pemetrexed 500 mg/m2 IV day 1 every 21-days for up to 4 cycles
Arm Title
Arm B
Arm Type
Active Comparator
Arm Description
MK-3475 200 mg/m2 IV every 21-days for up to 4 cycles Patients with CR, PR, or SD by irRC will then be treated with: For Squamous Carcinoma: Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Paclitaxel 200 mg/m2 IV day 1 every 21-days for up to 4 cycles OR For Non-squamous Carcinoma Carboplatin AUC = 6 IV day 1 every 21-days for up to 4 cycles Pemetrexed 500 mg/m2 IV day 1 every 21-days for up to 4 cycles
Intervention Type
Drug
Intervention Name(s)
MK-3475
Other Intervention Name(s)
Pembrolizumab
Intervention Description
Dose frequency of Q3W, Day 1 of each cycle
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Other Intervention Name(s)
Paraplat, Paraplatin
Intervention Description
Dose frequency of Q3W, Day 1 of each cycle (standard Chemotherapy)
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Other Intervention Name(s)
Taxol
Intervention Description
Dose frequency of Q3W, Day 1 of each cycle (standard Chemotherapy)
Intervention Type
Drug
Intervention Name(s)
Pemetrexed
Other Intervention Name(s)
Alimta
Intervention Description
Dose frequency of Q3W, Day 1 of each cycle (standard Chemotherapy)
Primary Outcome Measure Information:
Title
Overall Response Rate (ORR) Per RECIST 1.1
Description
The primary objective of this randomized phase II trial to determine the overall response rate (ORR per RECIST 1.1) in Chemotherapy naive patients with stage IV NSCLC after the administration of standard platinum-based chemotherapy before MK-3475 (arm A) and administration of MK-3475 administered before standard platinum-based chemotherapy (arm B). Overall Response (OR) = CR + PR.
Time Frame
18 Months
Secondary Outcome Measure Information:
Title
Compare Progression-Free Survival (PFS) Per RECIST 1.1
Description
To compare the progression-free survival (PFS) per RECIST 1.1 in previously untreated patients with advanced NSCLC treated with first line carboplatin-based chemotherapy followed by MK-3475 to patients treated with MK-3475 prior to first-line carboplatin-based chemotherapy.
Time Frame
24 Months
Title
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Description
To characterize the adverse events related to MK-3475 by frequency, type and grade in patients with Chemotherapy naive advanced NSCLC based on the sequence of administration with first-line chemotherapy. A count of participants experiencing an adverse event is summarized here, the detailed summary is in the adverse events section of this report.
Time Frame
24 Months
Other Pre-specified Outcome Measures:
Title
Evaluate the ORR Per irRC
Description
To evaluate the ORR per irRC of MK-3475 administered prior to or after treatment with first-line carboplatin-based chemotherapy in patients with previously untreated NSCLC.
Time Frame
24 Months
Title
Evaluate PFS Per irRC
Description
To evaluate the PFS per irRC of previously untreated patients with advanced NSCLC who are treated with MK-3475 administered prior to or after first-line carboplatin-based chemotherapy.
Time Frame
24 Months
Title
Evaluate Response Duration of MK-3475
Description
To evaluate the response duration of MK-3475 based on schedule of administration with standard platinum-based chemotherapy in patients with previously untreated advanced NSCLC.
Time Frame
24 Months
Title
Evaluate the Overall Survival (OS)
Description
To evaluate the overall survival (OS) of patients with previously untreated advanced NSCLC who received MK-3475 administered prior to or after treatment with first line carboplatin-based chemotherapy.
Time Frame
24 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be ≥ 18 years of age on day of signing informed consent. Have a life expectancy of at least 3 months. Have a histologically or cytologically confirmed diagnosis of stage IV NSCLC. Have a performance status of 0 or 1 on the ECOG. Have a measurable disease based on RECIST 1.1. Have provided tissue from an archival tissue sample or newly obtained core or excisional biopsy of tumor lesion. In patients with non-squamous non-small cell lung cancer, investigators must be able to produce source documentation of the EGFR mutation status or ALK translocation status. Demonstrate adequate organ function. Female patient of childbearing potential should have a negative urine or serum pregnancy test within 72 hours. Female parents of childbearing potential must be willing to use 2 methods of birth control or be surgically sterile. Male patients must agree to use an adequate method of contraception. Patients with sensitizing EGFR mutation or ALK rearrangement must have progressed on an appropriate tyrosine kinase inhibitor (TKI) Exclusion Criteria: Has received prior treatment with chemotherapy or biologic therapy for stage IV NSCLC. Is currently participating in or has participated in a study of an investigational agent or using an investigational device. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy. Has had a prior mAb within 4 weeks prior to study Day 1 or who has not recovered from adverse events due to agents administered more than 4 weeks earlier. Has had prior chemotherapy or radiation. Has a known additional malignancy that is progressing or requires active treatment. Has known active CNS metastases and/or carcinomatous meningitis. Has an active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. Has evidence of interstitial lung disease or active, non-infectious pneumonitis. Has an active infection requiring systemic therapy. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial. Has known psychiatric or substance abuse disorders. Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial. Has received prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or CTLA-4 antibody. Has a known history of HIV. Has known active Hepatitis B or Hepatitis C. Has received a live vaccine within 30 days prior to the planned first dose of study therapy. Has a known history of active TB. Hypersensitivity to pembrolizumab or any of it's excipients.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Monica Bertagnolli, MD
Organizational Affiliation
Alliance Foundation Trials, LLC.
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Thomas Hensing, MD
Organizational Affiliation
NorthShore University HealthSystem
Official's Role
Study Chair
Facility Information:
Facility Name
UCSD Moores Cancer Center
City
La Jolla
State/Province
California
ZIP/Postal Code
92093
Country
United States
Facility Name
The University of Chicago Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
NorthShore University HealthSystem
City
Evanston
State/Province
Illinois
ZIP/Postal Code
60201
Country
United States
Facility Name
Medical Oncology & Hematology Associates
City
Des Moines
State/Province
Iowa
ZIP/Postal Code
50309
Country
United States
Facility Name
EMMC Cancer Care
City
Brewer
State/Province
Maine
ZIP/Postal Code
04412
Country
United States
Facility Name
Metro MN Community Oncology Research Consortium
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55416
Country
United States
Facility Name
NH Oncology (Concord)
City
Concord
State/Province
New Hampshire
ZIP/Postal Code
03301
Country
United States
Facility Name
Dartmouth Hitchcock Medical Center
City
Lebanon
State/Province
New Hampshire
ZIP/Postal Code
03756
Country
United States
Facility Name
SUNY Upstate Medical University
City
Syracuse
State/Province
New York
ZIP/Postal Code
13210
Country
United States
Facility Name
The Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
University of Oklahoma Health Sciences Center Stephenson Cancer Center
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73104
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
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Optimal Sequencing of Pembrolizumab (MK-3475) and Standard Platinum-based Chemotherapy in First-Line NSCLC

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