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Retreatment With Epidermal Growth Factor Receptor(EGFR) Tyrosine Kinase Inhibitor in EGFR Mutation Positive Patients

Primary Purpose

EGFR Positive Non-small Cell Lung Cancer

Status
Unknown status
Phase
Phase 2
Locations
Korea, Republic of
Study Type
Interventional
Intervention
EGFR
Sponsored by
Korea University Guro Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for EGFR Positive Non-small Cell Lung Cancer focused on measuring Epidermal growth factor receptor tyrosine kinase inhibitor, Cytotoxic chemotherapy, Epidermal growth factor receptor mutation

Eligibility Criteria

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

Inclusion Criteria:

  1. Males or females ≥ 19 years of age
  2. Non Small Cell Lung Cancer(Non-Squamous Cell Carcinoma) patients who had shown clinical benefits (Complete response(CR) or Partial response(PR) or Stable disease(SD) ≥6 months) from EGFR-TKIs as first line treatment and developed progressive disease, and then received cytotoxic chemotherapy more than 4 cycles and developed progressive disease, and then confirmed T790 negative and sensitizing EGFR mutation(E19Del, L858R, L861Q, G719X, E19insertion) positive in Histologic, cytologic specimen or blood.
  3. Patient with at least one measurable lesions according to RECIST v 1.1
  4. Expected life expectancy ≥ 12 weeks
  5. Eastern Cooperative Oncology Group(ECOG) performance status ≤ 2
  6. Patients who have proper hematologic, renal and hepatic functions as follows:

    • Absolute neutrophil count(ANC) ≥ 1,500/mm³
    • platelets ≥ 100,000/mm³
    • Hemoglobin ≥ 9g/dL
    • Total bilirubin ≤ 1.25 X UNL
    • Aspartate aminotransferase(AST or SGOT) and alanine aminotransferase(ALT or SGPT) ≤ 3.0 X UNL (if liver metastasis ≤5.0 X UNL)
    • Alkaline phosphatase ≤ 2.5 X UNL (if liver metastasis ≤5.0 X UNL)
    • Serum creatinine ≤ 1.5mg/dL
  7. patients who are willing to comply with study procedure and voluntarily provide informed consent with signature

Exclusion Criteria:

  1. Patients who have preexisting or coexisting malignancies in other parts except for effectively treated non-melanoma skin cancer, cervical carcinoma in situ(CIS) cervical cancer within the last 5 years
  2. Patients with brain metastasis except for the followings:

    - Asymptomatic and stable brain metastases for which local treatment has been given: corticosteroids treatment isn't requiured for at least 2 weeks before starting the study treatment.

  3. Patients currently receiving palliative radiation therapy or have toxicities from radiation therapy at screening.
  4. Patients with clinically active history of interstitial lung disease(ILD), Drug induced ILD, Radiation pneumonitis
  5. Patients with clinically significant cardiovascular disease or myocardial infarction within the past 12 months.
  6. Patients with active infection or severe systemic disease that are difficult to include in this study
  7. Patients who received radiation therapy to target lesion of this study.
  8. Patients who had major operation within 4 weeks before starting the study treatment and were not fully recovered.
  9. Patients who were administered other study drugs within 4 weeks before starting the study treatment
  10. Males and females of reproductive potential who are not using an effective method of birth control and females who are pregnant or breastfeeding or have a positive pregnancy test prior to study entry
  11. Patients who are difficult to include in this study in accordance with the investigator's judgment
  12. Patients with histories of hypersensitivity to investigational product(IP) or any components of the agent
  13. Patients with any of the following genetic predispositions including galactose intolerance, Lapp lactase deficiency, lactose intolerance or glucose-galactose malabsorption
  14. Patient previously received cytotoxic chemotherapy within 2 weeks of IP administration
  15. Patient received Immunotherapy prior to the study participation
  16. Patients who are difficult to include in this study in accordance with the investigator's judgment due to severe adverse effects during previous EGFR TKI treatment

Sites / Locations

  • Hallym University Sacred Heart Hospital
  • Pusan National University Yangsan Hospital
  • Chonnam National University Hwasun Hospital
  • Chungnam National University Hospital
  • Yonsei University Severance Hospital
  • Konkuk University Medical Center
  • Asan Medical Center
  • Korea University Guro Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

EGFR retreat group

Arm Description

Outcomes

Primary Outcome Measures

Objective Response Rate(ORR) including rage of CR&PR
Assessed on based of RECIST 1.1.

Secondary Outcome Measures

Progression Free Survival, PFS
Progression-free survival (PFS) the time from first dose of the study drug until the date of disease progression or death by any cause
Overall Survival
Overall Survival (OR) the time from first dose of the study drug until the date of death by any cause
The incidence of Adverse Events(including Serious Adverse Events and Adverse Drug Reactions)
Assessment on the base of NCI-CTCAE (version 4.03)

Full Information

First Posted
December 19, 2017
Last Updated
July 13, 2021
Sponsor
Korea University Guro Hospital
Collaborators
Chong Kun Dang Pharmaceutical Corp.
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1. Study Identification

Unique Protocol Identification Number
NCT03382795
Brief Title
Retreatment With Epidermal Growth Factor Receptor(EGFR) Tyrosine Kinase Inhibitor in EGFR Mutation Positive Patients
Official Title
Retreatment With 1st Generation EGFR TKIs in Sensitizing EGFR Mutation Positive Non-Squamous Cell Carcinoma Patients Who Previously Treated With EGFR TKI and Cytotoxic Chemotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Unknown status
Study Start Date
January 3, 2018 (Actual)
Primary Completion Date
March 31, 2023 (Anticipated)
Study Completion Date
March 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Korea University Guro Hospital
Collaborators
Chong Kun Dang Pharmaceutical Corp.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
In this trial, treatment efficacy and safety of retreatment with 1st generation epidermal growth factor receptor(EGFR) tyrosine kinase inhibitor(TKI)s(Gefitinib/Erlotinib), will be assessed in patients with sensitizing EGFR mutation positive Non-Squamous Cell Carcinoma patients who previously treated with EGFR TKI and cytotoxic chemotherapy
Detailed Description
This study is designed to be multi-center, open-label, single-arm, prospective, phase II trial of patient with sensitizing EGFR mutation positive Non-Squamous Cell Carcinoma patients who previously treated with EGFR TKI and cytotoxic chemotherapy. Approximately 69 patients will be enrolled into the trial, and expected study duration is 48 months from Institutional Review Board(IRB) and Korea Ministry of Food and Drug Safety(MFDS) approval date. The study drug will be administered orally as one tablet(Gefitinib 250mg/ Erlotinib 150mg) once a day until disease progression or manifestation of unacceptable toxicity. The initial dose of the study drug daily can be reduced according to dose reduction criteria in protocol. A cycle of study treatment is defined as 28 days, and subjects will visit the site every 2 cycles(56 days).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
EGFR Positive Non-small Cell Lung Cancer
Keywords
Epidermal growth factor receptor tyrosine kinase inhibitor, Cytotoxic chemotherapy, Epidermal growth factor receptor mutation

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
EGFR retreat group
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
EGFR
Intervention Description
Gefitinib 250mg or Erlotinib 150mg medication, Once-Daily.
Primary Outcome Measure Information:
Title
Objective Response Rate(ORR) including rage of CR&PR
Description
Assessed on based of RECIST 1.1.
Time Frame
Through study completion (5 years)
Secondary Outcome Measure Information:
Title
Progression Free Survival, PFS
Description
Progression-free survival (PFS) the time from first dose of the study drug until the date of disease progression or death by any cause
Time Frame
Through study completion (5 years)
Title
Overall Survival
Description
Overall Survival (OR) the time from first dose of the study drug until the date of death by any cause
Time Frame
Through study completion (5 years)
Title
The incidence of Adverse Events(including Serious Adverse Events and Adverse Drug Reactions)
Description
Assessment on the base of NCI-CTCAE (version 4.03)
Time Frame
Through study completion (5 years)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males or females ≥ 19 years of age Non Small Cell Lung Cancer(Non-Squamous Cell Carcinoma) patients who had shown clinical benefits (Complete response(CR) or Partial response(PR) or Stable disease(SD) ≥6 months) from EGFR-TKIs as first line treatment and developed progressive disease, and then received cytotoxic chemotherapy more than 4 cycles and developed progressive disease, and then confirmed T790 negative and sensitizing EGFR mutation(E19Del, L858R, L861Q, G719X, E19insertion) positive in Histologic, cytologic specimen or blood. Patient with at least one measurable lesions according to RECIST v 1.1 Expected life expectancy ≥ 12 weeks Eastern Cooperative Oncology Group(ECOG) performance status ≤ 2 Patients who have proper hematologic, renal and hepatic functions as follows: Absolute neutrophil count(ANC) ≥ 1,500/mm³ platelets ≥ 100,000/mm³ Hemoglobin ≥ 9g/dL Total bilirubin ≤ 1.25 X UNL Aspartate aminotransferase(AST or SGOT) and alanine aminotransferase(ALT or SGPT) ≤ 3.0 X UNL (if liver metastasis ≤5.0 X UNL) Alkaline phosphatase ≤ 2.5 X UNL (if liver metastasis ≤5.0 X UNL) Serum creatinine ≤ 1.5mg/dL patients who are willing to comply with study procedure and voluntarily provide informed consent with signature Exclusion Criteria: Patients who have preexisting or coexisting malignancies in other parts except for effectively treated non-melanoma skin cancer, cervical carcinoma in situ(CIS) cervical cancer within the last 5 years Patients with brain metastasis except for the followings: - Asymptomatic and stable brain metastases for which local treatment has been given: corticosteroids treatment isn't requiured for at least 2 weeks before starting the study treatment. Patients currently receiving palliative radiation therapy or have toxicities from radiation therapy at screening. Patients with clinically active history of interstitial lung disease(ILD), Drug induced ILD, Radiation pneumonitis Patients with clinically significant cardiovascular disease or myocardial infarction within the past 12 months. Patients with active infection or severe systemic disease that are difficult to include in this study Patients who received radiation therapy to target lesion of this study. Patients who had major operation within 4 weeks before starting the study treatment and were not fully recovered. Patients who were administered other study drugs within 4 weeks before starting the study treatment Males and females of reproductive potential who are not using an effective method of birth control and females who are pregnant or breastfeeding or have a positive pregnancy test prior to study entry Patients who are difficult to include in this study in accordance with the investigator's judgment Patients with histories of hypersensitivity to investigational product(IP) or any components of the agent Patients with any of the following genetic predispositions including galactose intolerance, Lapp lactase deficiency, lactose intolerance or glucose-galactose malabsorption Patient previously received cytotoxic chemotherapy within 2 weeks of IP administration Patient received Immunotherapy prior to the study participation Patients who are difficult to include in this study in accordance with the investigator's judgment due to severe adverse effects during previous EGFR TKI treatment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sung Yong Lee, MD, Ph.D.
Organizational Affiliation
Professor
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hallym University Sacred Heart Hospital
City
Anyang
State/Province
Gyeonggi-do
ZIP/Postal Code
14068
Country
Korea, Republic of
Facility Name
Pusan National University Yangsan Hospital
City
Yangsan
State/Province
Gyeongsangnam-do
ZIP/Postal Code
50612
Country
Korea, Republic of
Facility Name
Chonnam National University Hwasun Hospital
City
Hwasun
State/Province
Jeollanam-do
ZIP/Postal Code
58128
Country
Korea, Republic of
Facility Name
Chungnam National University Hospital
City
Daejeon
ZIP/Postal Code
35015
Country
Korea, Republic of
Facility Name
Yonsei University Severance Hospital
City
Seoul
ZIP/Postal Code
03722
Country
Korea, Republic of
Facility Name
Konkuk University Medical Center
City
Seoul
ZIP/Postal Code
05030
Country
Korea, Republic of
Facility Name
Asan Medical Center
City
Seoul
ZIP/Postal Code
05505
Country
Korea, Republic of
Facility Name
Korea University Guro Hospital
City
Seoul
ZIP/Postal Code
08308
Country
Korea, Republic of

12. IPD Sharing Statement

Citations:
PubMed Identifier
12928116
Citation
Janssen-Heijnen ML, Coebergh JW. The changing epidemiology of lung cancer in Europe. Lung Cancer. 2003 Sep;41(3):245-58. doi: 10.1016/s0169-5002(03)00230-7.
Results Reference
background
PubMed Identifier
11181774
Citation
Jemal A, Chu KC, Tarone RE. Recent trends in lung cancer mortality in the United States. J Natl Cancer Inst. 2001 Feb 21;93(4):277-83. doi: 10.1093/jnci/93.4.277.
Results Reference
background
PubMed Identifier
27150013
Citation
Kinoshita FL, Ito Y, Nakayama T. Trends in Lung Cancer Incidence Rates by Histological Type in 1975-2008: A Population-Based Study in Osaka, Japan. J Epidemiol. 2016 Nov 5;26(11):579-586. doi: 10.2188/jea.JE20150257. Epub 2016 Apr 30.
Results Reference
background
PubMed Identifier
22054876
Citation
Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med. 2011 Dec;32(4):605-44. doi: 10.1016/j.ccm.2011.09.001.
Results Reference
background
PubMed Identifier
27669705
Citation
Shin A, Oh CM, Kim BW, Woo H, Won YJ, Lee JS. Lung Cancer Epidemiology in Korea. Cancer Res Treat. 2017 Jul;49(3):616-626. doi: 10.4143/crt.2016.178. Epub 2016 Sep 23.
Results Reference
background
PubMed Identifier
19671843
Citation
Jackman DM, Miller VA, Cioffredi LA, Yeap BY, Janne PA, Riely GJ, Ruiz MG, Giaccone G, Sequist LV, Johnson BE. Impact of epidermal growth factor receptor and KRAS mutations on clinical outcomes in previously untreated non-small cell lung cancer patients: results of an online tumor registry of clinical trials. Clin Cancer Res. 2009 Aug 15;15(16):5267-73. doi: 10.1158/1078-0432.CCR-09-0888. Epub 2009 Aug 11.
Results Reference
background
PubMed Identifier
19692680
Citation
Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, Sunpaweravong P, Han B, Margono B, Ichinose Y, Nishiwaki Y, Ohe Y, Yang JJ, Chewaskulyong B, Jiang H, Duffield EL, Watkins CL, Armour AA, Fukuoka M. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009 Sep 3;361(10):947-57. doi: 10.1056/NEJMoa0810699. Epub 2009 Aug 19.
Results Reference
background
PubMed Identifier
20573926
Citation
Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, Gemma A, Harada M, Yoshizawa H, Kinoshita I, Fujita Y, Okinaga S, Hirano H, Yoshimori K, Harada T, Ogura T, Ando M, Miyazawa H, Tanaka T, Saijo Y, Hagiwara K, Morita S, Nukiwa T; North-East Japan Study Group. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 2010 Jun 24;362(25):2380-8. doi: 10.1056/NEJMoa0909530.
Results Reference
background
PubMed Identifier
22285168
Citation
Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, Palmero R, Garcia-Gomez R, Pallares C, Sanchez JM, Porta R, Cobo M, Garrido P, Longo F, Moran T, Insa A, De Marinis F, Corre R, Bover I, Illiano A, Dansin E, de Castro J, Milella M, Reguart N, Altavilla G, Jimenez U, Provencio M, Moreno MA, Terrasa J, Munoz-Langa J, Valdivia J, Isla D, Domine M, Molinier O, Mazieres J, Baize N, Garcia-Campelo R, Robinet G, Rodriguez-Abreu D, Lopez-Vivanco G, Gebbia V, Ferrera-Delgado L, Bombaron P, Bernabe R, Bearz A, Artal A, Cortesi E, Rolfo C, Sanchez-Ronco M, Drozdowskyj A, Queralt C, de Aguirre I, Ramirez JL, Sanchez JJ, Molina MA, Taron M, Paz-Ares L; Spanish Lung Cancer Group in collaboration with Groupe Francais de Pneumo-Cancerologie and Associazione Italiana Oncologia Toracica. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012 Mar;13(3):239-46. doi: 10.1016/S1470-2045(11)70393-X. Epub 2012 Jan 26.
Results Reference
background
PubMed Identifier
23816960
Citation
Sequist LV, Yang JC, Yamamoto N, O'Byrne K, Hirsh V, Mok T, Geater SL, Orlov S, Tsai CM, Boyer M, Su WC, Bennouna J, Kato T, Gorbunova V, Lee KH, Shah R, Massey D, Zazulina V, Shahidi M, Schuler M. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013 Sep 20;31(27):3327-34. doi: 10.1200/JCO.2012.44.2806. Epub 2013 Jul 1.
Results Reference
background
PubMed Identifier
23470965
Citation
Yu HA, Arcila ME, Rekhtman N, Sima CS, Zakowski MF, Pao W, Kris MG, Miller VA, Ladanyi M, Riely GJ. Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers. Clin Cancer Res. 2013 Apr 15;19(8):2240-7. doi: 10.1158/1078-0432.CCR-12-2246. Epub 2013 Mar 7.
Results Reference
background
PubMed Identifier
24669016
Citation
Besse B, Adjei A, Baas P, Meldgaard P, Nicolson M, Paz-Ares L, Reck M, Smit EF, Syrigos K, Stahel R, Felip E, Peters S; Panel Members; ESMO. 2nd ESMO Consensus Conference on Lung Cancer: non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease. Ann Oncol. 2014 Aug;25(8):1475-84. doi: 10.1093/annonc/mdu123. Epub 2014 Mar 25.
Results Reference
background
PubMed Identifier
21474967
Citation
Asahina H, Oizumi S, Inoue A, Kinoshita I, Ishida T, Fujita Y, Sukoh N, Harada M, Maemondo M, Saijo Y, Dosaka-Akita H, Isobe H, Nukiwa T, Nishimura M; Hokkaido Lung Cancer Clinical Study Group. Phase II study of gefitinib readministration in patients with advanced non-small cell lung cancer and previous response to gefitinib. Oncology. 2010;79(5-6):423-9. doi: 10.1159/000326488. Epub 2011 Apr 8.
Results Reference
background
PubMed Identifier
22402083
Citation
Koizumi T, Agatsuma T, Ikegami K, Suzuki T, Kobayashi T, Kanda S, Yoshikawa S, Kubo K, Shiina T, Takasuna K, Matsuo A, Hayasaka M, Morikawa M, Ameshima S. Prospective study of gefitinib readministration after chemotherapy in patients with advanced non-small-cell lung cancer who previously responded to gefitinib. Clin Lung Cancer. 2012 Nov;13(6):458-63. doi: 10.1016/j.cllc.2012.01.006. Epub 2012 Mar 7.
Results Reference
background
PubMed Identifier
22333554
Citation
Oh IJ, Ban HJ, Kim KS, Kim YC. Retreatment of gefitinib in patients with non-small-cell lung cancer who previously controlled to gefitinib: a single-arm, open-label, phase II study. Lung Cancer. 2012 Jul;77(1):121-7. doi: 10.1016/j.lungcan.2012.01.012. Epub 2012 Feb 12.
Results Reference
background
PubMed Identifier
21529987
Citation
Hata A, Katakami N, Yoshioka H, Fujita S, Kunimasa K, Nanjo S, Otsuka K, Kaji R, Tomii K, Iwasaku M, Nishiyama A, Hayashi H, Morita S, Ishida T. Erlotinib after gefitinib failure in relapsed non-small cell lung cancer: clinical benefit with optimal patient selection. Lung Cancer. 2011 Nov;74(2):268-73. doi: 10.1016/j.lungcan.2011.03.010. Epub 2011 May 6.
Results Reference
background
PubMed Identifier
19540616
Citation
Kaira K, Naito T, Takahashi T, Ayabe E, Shimoyama R, Kaira R, Ono A, Igawa S, Shukuya T, Murakami H, Tsuya A, Nakamura Y, Endo M, Yamamoto N. Pooled analysis of the reports of erlotinib after failure of gefitinib for non-small cell lung cancer. Lung Cancer. 2010 Apr;68(1):99-104. doi: 10.1016/j.lungcan.2009.05.006. Epub 2009 Jun 21.
Results Reference
background
PubMed Identifier
27959700
Citation
Mok TS, Wu Y-L, Ahn M-J, Garassino MC, Kim HR, Ramalingam SS, Shepherd FA, He Y, Akamatsu H, Theelen WS, Lee CK, Sebastian M, Templeton A, Mann H, Marotti M, Ghiorghiu S, Papadimitrakopoulou VA; AURA3 Investigators. Osimertinib or Platinum-Pemetrexed in EGFR T790M-Positive Lung Cancer. N Engl J Med. 2017 Feb 16;376(7):629-640. doi: 10.1056/NEJMoa1612674. Epub 2016 Dec 6.
Results Reference
background
Links:
URL
http://globocan.iarc.fr
Description
GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. All cancers (excluding nonmelanoma skin cancer) estimated incidence, mortality and prevalence worldwide in 2012 [Internet]. Geneva: World Health Organization
URL
http://www.nccn.org
Description
National Comprehensive Cancer Network: National Comprehensive Cancer Network(NCCN) Clinical Practice Guidelines in Oncology- Non-Small Cell Lung Cancer, Version 5.2017.

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Retreatment With Epidermal Growth Factor Receptor(EGFR) Tyrosine Kinase Inhibitor in EGFR Mutation Positive Patients

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