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FGFR Inhibitor in FGFR Dysregulated Cancer (FIND)

Primary Purpose

Lung Cancer, NSCLC, Pulmonary Neoplasm

Status
Terminated
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
ERDAFITINIB
Sponsored by
Lung Cancer Group Cologne
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring sqNSCLC, FGFR Mutations

Eligibility Criteria

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

Inclusion Criteria:

  • Age > 18 years
  • Stage IIIB/IV NSCLC patients with activating FGFR alteration after the failure on any prior line of standard treatment, or in the opinion of the investigator no effective standard therapy exists, is appropriate, tolerated or is considered equivalent to study treatment
  • Activating FGFR alteration as approved by FIND Molecular Board
  • Must sign an informed consent form (ICF) (or their legally acceptable representative must sign) indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study.
  • ECOG performance status score 0, 1, or 2.
  • Clinical laboratory values and cardiovascular measurements at screening as defined in protocol
  • Disease measurable per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) for cohort 1 and 2. or evaluable disease.
  • A woman of childbearing potential who is sexually active must have a negative pregnancy test (human chorionic gonadotropin [hCG]) at Screening (urine or serum, minimum sensitivity 25 IU/L or equivalent units of b-HCG) within 24 hours prior to the start of erdafitinib
  • Women of childbearing potential (WOCBP) and men who are sexually active with WOCBP must use appropriate method(s) of contraception with a failure rate of less than 1% per year before study entry, during the study and until 5 months after taking the last dose of study drug. And other Criteria

Exclusion Criteria:

  • Pathogenic somatic alterations in the following genes: EGFR, BRAF, ALK ROS1 and NTRK (Please note that molecular testing might be reduced in heavy smokers with NSCLC
  • Treatment with any other investigational agent or participation in another clinical trial with therapeutic intent within 28 days prior to recruitment
  • Treatment with small molecules or chemotherapy within 7 days prior C1D1
  • Treatment with monoclonal antibodies within 28 days prior C1D1 if related to the underlying malignancy
  • Any other history of ongoing malignancy that would potentially interfere with the interpretation of erdafitinib efficacy
  • Symptomatic central nervous system metastases.
  • Received prior FGFR inhibitor treatment or if the patient has known allergies, hypersensitivity, or intolerance to erdafitinib or its excipients
  • Any corneal or retinal abnormality likely to increase the risk of eye toxicity, i.e.:
  • History of or current evidence of CeSR or retinal vascular occlusion (RVO)
  • Active wet, age-related macular degeneration (AMD)
  • Diabetic retinopathy with macular edema (non-proliferative)
  • Uncontrolled glaucoma (per local standard of care)
  • Corneal pathology such as keratitis, keratoconjunctivitis, keratopathy, corneal abrasion, inflammation or ulceration.
  • Has persistent phosphate level >ULN during screening (on 2 consecutive assessments at least 1 week apart, within 14 days prior to Cycle 1 Day 1) and despite medical management
  • Has a history of or current uncontrolled cardiovascular disease as defined in protocol
  • Known human immunodeficiency virus (HIV) infection, testing is mandatory (a-HIV 1/2)
  • Patients with acute or chronic Hepatitis B infection (tests should include assessment of HBsAg and HBc IgG antibody. If one parameter is positive, determine HBV-DNA to confirm acute infection. Patients with positive results for HBsAg and/or HBV-DNA are considered positive for acute or chronic infection.
  • Patients with acute or chronic Hepatitis C infection (determine HCV-RNA. Patients with positive result for HCV-RNA are considered positive for acute or chronic infection).
  • Has not recovered from reversible toxicity of prior anticancer therapy (except toxicities which are not clinically significant such as alopecia, skin discoloration, Grade 1 neuropathy, Grade 1-2 hearing loss)
  • Has impaired wound healing capacity defined as skin/decubitus ulcers, chronic leg ulcers, known gastric ulcers, or unhealed incisions
  • Major surgery within 2 weeks of the first dose, or will not have fully recovered from surgery, or has surgery planned during the time the patient is expected to participate in the study or within 2 weeks after the last dose of study drug administration. (patients with planned surgical procedures to be conducted under local anesthesia may participate).
  • Any serious underlying medical condition, such as:

    • Evidence of serious active viral, bacterial, or uncontrolled systemic fungal infection requiring current systemic treatment
    • Psychiatric conditions (eg, alcohol or drug abuse), dementia, or altered mental status

Sites / Locations

  • Asklepios Klinik München Gauting
  • Uniklinik Frankfurt
  • Städtisches Klinikum Braunschweig
  • Pius Hospital Oldenburg
  • Uniklinik RWTH Aachen - Klinik für Hämotologie, Onkologie
  • University Hospital of Cologne
  • Universitätsklinikum Würzburg Comprehensive Cancer center
  • Uniklinik Carl Gustav Carus Dresden
  • Evangelische Lungenklink Berlin
  • Universitätsklinik Freiburg
  • Universitätsklinik des Saarlandes Homburg

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Active Comparator

Arm Label

Cohort 1 FGFR trans

Cohort 2 FGFR mut

Cohort 3 FGFR other

Arm Description

Cohort 1: Activating (high confidence) FGFR translocations (max. 15 patients) under daily Erdaifitinib treatment

Cohort 2: Activating (high confidence) hotspot FGFR mutations (max. 15 patients) under daily Erdafitinib treatment

Cohort 3: Activating (low confidence) FGFR alteration (max. 20 patients)

Outcomes

Primary Outcome Measures

Overall Response Rate
Overall response rate (ORR) per RECIST 1.1 under erdafitinib treatment in sqNSCLC with genetic alteration in FGFR

Secondary Outcome Measures

number of adverse events per patient
assessment of adverse events according to CTC-AE
time length of progression free survival
assessment of progression free survival
time length of overall survival
assessment of overall survival

Full Information

First Posted
January 22, 2019
Last Updated
June 7, 2023
Sponsor
Lung Cancer Group Cologne
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1. Study Identification

Unique Protocol Identification Number
NCT03827850
Brief Title
FGFR Inhibitor in FGFR Dysregulated Cancer
Acronym
FIND
Official Title
A Phase II Trial to Evaluate Efficacy and Safety of Erdafitinib in Patients With Advanced Non Small Cell Lung Carcinoma (NSCLC) Harboring Fibroblast Growth Factor Receptor (FGFR) Genetic Alterations After Relapse of Standard Therapy.
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Terminated
Why Stopped
Study-related difficulties faced with patient enrolment, no safety-related reasons
Study Start Date
March 25, 2019 (Actual)
Primary Completion Date
September 30, 2022 (Actual)
Study Completion Date
October 14, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Lung Cancer Group Cologne

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
In the FIND trial, Non Small Cell Lung Carcinoma (NSCLC) patients with Fibroblast Growth Factor Receptor (FGFR) genetic alteration will be treated with the selective FGFR1-4 inhibitor erdafitinib. Archival samples, fresh frozen tumor samples and blood for circulating tumor DNA (ctDNA) will be collected before treatment. Patients will be treated until disease progression or unacceptable toxicity. In case of progression, fresh frozen tumor biopsies and ctDNA analyses will be performed to assess resistance mechanisms. The primary objective of the trial is to analyze the efficacy of erdafitinib in NSCLC patients with FGFR genetic alterations. NSCLC patient number will be based on a statistical hypothesis aiming at increasing the response rate comparing to chemotherapy/immunotherapy after standard treatment.
Detailed Description
Downstream signaling of fibroblast growth factor receptors 1-4 (FGFR 1-4) regulates cell proliferation, migration, differentiation and survival in healthy cells. Genetic alterations (amplifications, point-mutations and translocations) in FGFR1-4 genes cause altered signaling and oncogenic transformation. FGFR-alterations with sensitivity to kinase inhibition have been identified in a variety of tumors such as breast-, bladder- and endometrial-cancer, squamous cell lung and head and neck cancer, cholangiocarcinoma and glioblastoma. First-in-man/phase-I clinical trials with erdafitinib and BGJ398 - both selective FGFR inhibitors - enrolled patients with any genetic alterations in FGFR. The trials showed clinical responses with differences according to the type of FGFR alterations and histological subtypes. In the BGJ398 trial, the partial response rate was 11% (4/36) in patients with FGFR1 amplified squamous NSCLC (sqNSCLC) and 38% (3/8) in patients with FGFR3-mutant bladder cancer. No PR was observed in patients with FGFR1/2 amplified (n=25) and FGFR3 mutant (n=1) breast cancer. All patients with FGFR2-translocated (n=2) and FGFR2-mutated cholangiocarcinoma (n=1) showed reduced tumor burden of 20% and 10%, respectively. In the erdafitinib trial, 5 partial responses were seen in FGFR translocated tumors: 3/8 (37.5%) patients with urothelial carcinoma, 1/3 (33%) patients with glioblastoma and 1 patient with endometrial cancer reached PR. Summing up the results of the phase-I trials, the inhibition of FGFR downstream pathways in FGFR translocated and mutated solid tumors exerted clinical activity. Thus, focusing treatment with FGFR inhibitors on FGFR mutated and translocated solid tumors may increase response rates, progression free and overall survival in these tumors with otherwise adverse prognosis. In NSCLC patients without druggable alterations in genes as EGFR, ALK or ROS1 and without high PD-L1 (Programmed cell death 1 ligand 1) expression, prognosis remains adverse with a median survival time of about 18 months. Particularly in sqNSCLC, only few driver mutations have been identified yet. Of these, solely mutations of the KRAS gene (although observed at low frequency in sqNSCLC) were explored in large clinical studies targeting KRAS downstream signaling with no survival benefit comparing to chemotherapy. Immunotherapy with PD-1 antibodies such as nivolumab and pembrolizumab showed benefit in patients with high PD-L1 expression mainly. The frequency of somatic FGFR1-3 mutations in lung cancer is about 4% (Helsten et al., 2016). Translocations occur with a similar frequency of about 4% in lung cancer. Multiple of these FGFR alterations are shown to have oncogenic potential as demonstrated in multiple in vitro, in vivo and first-in-man studies. Preclinical models in NSCLC cell lines and xenografts showed oncogenic activity of FGFR2/3 mutations with consecutive sensitivity to FGFR inhibitors. Similarly, FGFR3-TACC translocation exerted kinase activation in sqNSCLC cell lines and other tumor types. Furthermore, patient derived FGFR3-fusion lung xenograft model showed responses to FGFR targeted treatment. In summary, on the basis of genetically and phenotypically validated cell-line panels, in vivo and particularly on the basis of clinical data, there is strong evidence for a clinical benefit from FGFR inhibition for patients with FGFR altered NSCLC. The primary objective of the trial is to analyze the efficacy of erdafitinib in NSCLC patients with FGFR genetic alterations. NSCLC patient number will be based on a statistical hypothesis aiming at increasing the response rate comparing to chemotherapy/immunotherapy after standard treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer, NSCLC, Pulmonary Neoplasm, Squamous Cell Lung Cancer, NSCLC Stage IV
Keywords
sqNSCLC, FGFR Mutations

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Patients with NSCLC and FGFR alteration with high evidence on oncogenic transformation according to FIND molecular board will be included to cohort 1 (FGFR translocated NSCLC patients) and cohort 2 (FGFR mutated NSCLC patients). Patients with NSCLC and FGFR alterations without enough evidence (intermediate / low evidence according to FIND molecular tumor board) for recruitment into cohorts 1 or 2, will be treated in cohort 3. Overall response rate under Erdafitinib treatment will be the primary endpoint.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1 FGFR trans
Arm Type
Active Comparator
Arm Description
Cohort 1: Activating (high confidence) FGFR translocations (max. 15 patients) under daily Erdaifitinib treatment
Arm Title
Cohort 2 FGFR mut
Arm Type
Active Comparator
Arm Description
Cohort 2: Activating (high confidence) hotspot FGFR mutations (max. 15 patients) under daily Erdafitinib treatment
Arm Title
Cohort 3 FGFR other
Arm Type
Active Comparator
Arm Description
Cohort 3: Activating (low confidence) FGFR alteration (max. 20 patients)
Intervention Type
Drug
Intervention Name(s)
ERDAFITINIB
Other Intervention Name(s)
JNJ -42756493, WHO NUMBER 10147
Intervention Description
Daily in a range from 3 mg to 9 mg
Primary Outcome Measure Information:
Title
Overall Response Rate
Description
Overall response rate (ORR) per RECIST 1.1 under erdafitinib treatment in sqNSCLC with genetic alteration in FGFR
Time Frame
3 years
Secondary Outcome Measure Information:
Title
number of adverse events per patient
Description
assessment of adverse events according to CTC-AE
Time Frame
3 years
Title
time length of progression free survival
Description
assessment of progression free survival
Time Frame
3 years
Title
time length of overall survival
Description
assessment of overall survival
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age > 18 years Stage IIIB/IV NSCLC patients with activating FGFR alteration after the failure on any prior line of standard treatment, or in the opinion of the investigator no effective standard therapy exists, is appropriate, tolerated or is considered equivalent to study treatment Activating FGFR alteration as approved by FIND Molecular Board Must sign an informed consent form (ICF) (or their legally acceptable representative must sign) indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study. ECOG performance status score 0, 1, or 2. Clinical laboratory values and cardiovascular measurements at screening as defined in protocol Disease measurable per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) for cohort 1 and 2. or evaluable disease. A woman of childbearing potential who is sexually active must have a negative pregnancy test (human chorionic gonadotropin [hCG]) at Screening (urine or serum, minimum sensitivity 25 IU/L or equivalent units of b-HCG) within 24 hours prior to the start of erdafitinib Women of childbearing potential (WOCBP) and men who are sexually active with WOCBP must use appropriate method(s) of contraception with a failure rate of less than 1% per year before study entry, during the study and until 5 months after taking the last dose of study drug. And other Criteria Exclusion Criteria: Pathogenic somatic alterations in the following genes: EGFR, BRAF, ALK, ROS1 and NTRK (Please note that molecular testing might be reduced in heavy smokers with NSCLC) Treatment with any other investigational agent or participation in another clinical trial with therapeutic intent within 28 days prior to recruitment Treatment with small molecules or chemotherapy within 7 days prior C1D1 Treatment with monoclonal antibodies within 28 days prior C1D1 if related to the underlying malignancy Any other history of ongoing malignancy that would potentially interfere with the interpretation of erdafitinib efficacy Symptomatic central nervous system metastases. Received prior FGFR inhibitor treatment or if the patient has known allergies, hypersensitivity, or intolerance to erdafitinib or its excipients Any corneal or retinal abnormality likely to increase the risk of eye toxicity, i.e.: History of or current evidence of CeSR or retinal vascular occlusion (RVO) Active wet, age-related macular degeneration (AMD) Diabetic retinopathy with macular edema (non-proliferative) Uncontrolled glaucoma (per local standard of care) Corneal pathology such as keratitis, keratoconjunctivitis, keratopathy, corneal abrasion, inflammation or ulceration. Has persistent phosphate level >ULN during screening (on 2 consecutive assessments at least 1 week apart, within 14 days prior to Cycle 1 Day 1) and despite medical management Has a history of or current uncontrolled cardiovascular disease as defined in protocol Known human immunodeficiency virus (HIV) infection, testing is mandatory (a-HIV 1/2) Patients with acute or chronic Hepatitis B infection (tests should include assessment of HBsAg and HBc IgG antibody. If one parameter is positive, determine HBV-DNA to confirm acute infection. Patients with positive results for HBsAg and/or HBV-DNA are considered positive for acute or chronic infection. Patients with acute or chronic Hepatitis C infection (determine HCV-RNA. Patients with positive result for HCV-RNA are considered positive for acute or chronic infection). Has not recovered from reversible toxicity of prior anticancer therapy (except toxicities which are not clinically significant such as alopecia, skin discoloration, Grade 1 neuropathy, Grade 1-2 hearing loss) Has impaired wound healing capacity defined as skin/decubitus ulcers, chronic leg ulcers, known gastric ulcers, or unhealed incisions Major surgery within 2 weeks of the first dose, or will not have fully recovered from surgery, or has surgery planned during the time the patient is expected to participate in the study or within 2 weeks after the last dose of study drug administration. (patients with planned surgical procedures to be conducted under local anesthesia may participate). Any serious underlying medical condition, such as: Evidence of serious active viral, bacterial, or uncontrolled systemic fungal infection requiring current systemic treatment Psychiatric conditions (eg, alcohol or drug abuse), dementia, or altered mental status
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lucia Nogova, MD
Organizational Affiliation
University Clinic Cologne
Official's Role
Principal Investigator
Facility Information:
Facility Name
Asklepios Klinik München Gauting
City
Gauting
State/Province
Bavaria
ZIP/Postal Code
82131
Country
Germany
Facility Name
Uniklinik Frankfurt
City
Frankfurt
State/Province
Hessen
ZIP/Postal Code
60590
Country
Germany
Facility Name
Städtisches Klinikum Braunschweig
City
Braunschweig
State/Province
Niedersachsen
ZIP/Postal Code
38114
Country
Germany
Facility Name
Pius Hospital Oldenburg
City
Oldenburg
State/Province
Niedersachsen
ZIP/Postal Code
26121
Country
Germany
Facility Name
Uniklinik RWTH Aachen - Klinik für Hämotologie, Onkologie
City
Aachen
State/Province
NRW
ZIP/Postal Code
52074
Country
Germany
Facility Name
University Hospital of Cologne
City
Cologne
State/Province
NRW
ZIP/Postal Code
50937
Country
Germany
Facility Name
Universitätsklinikum Würzburg Comprehensive Cancer center
City
Würzburg
State/Province
NRW
ZIP/Postal Code
97080
Country
Germany
Facility Name
Uniklinik Carl Gustav Carus Dresden
City
Dresden
State/Province
Sachsen
ZIP/Postal Code
01307
Country
Germany
Facility Name
Evangelische Lungenklink Berlin
City
Berlin
ZIP/Postal Code
13125
Country
Germany
Facility Name
Universitätsklinik Freiburg
City
Freiburg
ZIP/Postal Code
79106
Country
Germany
Facility Name
Universitätsklinik des Saarlandes Homburg
City
Homburg
ZIP/Postal Code
66421
Country
Germany

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
27870574
Citation
Nogova L, Sequist LV, Perez Garcia JM, Andre F, Delord JP, Hidalgo M, Schellens JH, Cassier PA, Camidge DR, Schuler M, Vaishampayan U, Burris H, Tian GG, Campone M, Wainberg ZA, Lim WT, LoRusso P, Shapiro GI, Parker K, Chen X, Choudhury S, Ringeisen F, Graus-Porta D, Porter D, Isaacs R, Buettner R, Wolf J. Evaluation of BGJ398, a Fibroblast Growth Factor Receptor 1-3 Kinase Inhibitor, in Patients With Advanced Solid Tumors Harboring Genetic Alterations in Fibroblast Growth Factor Receptors: Results of a Global Phase I, Dose-Escalation and Dose-Expansion Study. J Clin Oncol. 2017 Jan 10;35(2):157-165. doi: 10.1200/JCO.2016.67.2048. Epub 2016 Nov 21. Erratum In: J Clin Oncol. 2017 Mar 10;35(8):926. J Clin Oncol. 2019 Feb 1;37(4):358.
Results Reference
background
PubMed Identifier
26615127
Citation
Hierro C, Rodon J, Tabernero J. Fibroblast Growth Factor (FGF) Receptor/FGF Inhibitors: Novel Targets and Strategies for Optimization of Response of Solid Tumors. Semin Oncol. 2015 Dec;42(6):801-19. doi: 10.1053/j.seminoncol.2015.09.027. Epub 2015 Sep 24.
Results Reference
background
PubMed Identifier
25806220
Citation
Schildhaus HU, Nogova L, Wolf J, Buettner R. FGFR1 amplifications in squamous cell carcinomas of the lung: diagnostic and therapeutic implications. Transl Lung Cancer Res. 2013 Apr;2(2):92-100. doi: 10.3978/j.issn.2218-6751.2013.03.03.
Results Reference
background

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FGFR Inhibitor in FGFR Dysregulated Cancer

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