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Phase II Study of Pembrolizumab (Keytruda®) and Trifluridine/Tipiracil (Lonsurf®) With Previously Treated Advanced Gastric Cancer

Primary Purpose

Gastric and Gastroesophageal Junction Adenocarcinoma

Status
Not yet recruiting
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Pembrolizumab (Keytruda®), Trifluridine/Tipiracil (Lonsurf®)
Sponsored by
Yonsei University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastric and Gastroesophageal Junction Adenocarcinoma focused on measuring Pembrolizumab(Keytruda®), Trifluridine/Tipiracil (Lonsurf®)

Eligibility Criteria

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

Inclusion Criteria:

  1. Has provided written informed consent fo the trial.
  2. Is male or female at least 18 years of age.
  3. Has a histologically or cytologically confirmed diagnosis of advanced or metastatic gastric/gastroesophageal junction (GEJ) adenocarcinoma.
  4. Has previously received at least 2 prior regiments.
  5. Has a life expectancy of at least 3 months.
  6. Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  7. Have 1 or more measurable disease as determined by RECIST 1.1.
  8. Is able to take medications orally.
  9. Has adequate organ function as defined by the following criteria.
  10. Is willing to follow and follow research procedures.
  11. A male participant must agree to use a contraception of this protocol during the treatment period and for at least 120 days post TAS-102.
  12. A female participant is eligible to participate if she is not pregnant or breastfeeding.

Exclusion Criteria:

  1. Has other concurrently active malignancies.
  2. Has received prior therapy with TAS-102.
  3. Is contraindicated for pembrolizumab and/or TAS-102, or have severe hypersensitivity to any of those drugs and/or their excipients.
  4. Has any unresolved ≥Grade 2 toxicity (per CTCAE v5.0) attributed to any prior therapies at the time of enrollment.
  5. Has had major surgery within 2 weeks prior to first dose of study interventions.
  6. Has known active central nervous system (CNS) metastases.
  7. Has received radiotherapy for gastric cancer treatment within 2 weeks prior to the first dose of study drugs.
  8. Has received a live vaccine or live-attenuated vaccine within 30 days prior to the first dose of study drug.
  9. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug.
  10. Has participated has used an investigational device within 4 weeks prior to the first dose of study intervention.
  11. Has a history of uncontrollable or significant cardiovascular disease.
  12. Has active (significant or uncontrolled) gastrointestinal bleeding.
  13. Has active autoimmune disease that has required systemic treatment in the past 2 years.
  14. Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
  15. Has an active, unresolved infection requiring systemic therapy.
  16. Has a known history of Human Immunodeficiency Virus (HIV) infection.
  17. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg] reactive) or known active Hepatitis C virus infection.
  18. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  19. Has had an allogenic tissue/solid organ transplant.
  20. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Single arm, Pembrolizumab, trifluridine/tipiracil

    Arm Description

    Outcomes

    Primary Outcome Measures

    Phase Ib (Lead-in safety cohort): Dose-limiting toxicity (DLT)
    Phase Ib (Lead-in safety cohort): Recommended Phase 2 dose (RP2D)
    Objective response rate (ORR)
    The proportion of patients in complete remission (CR) or partial remission (PR) among the best response (BOR) assessed by the investigator according to RECIST 1.1.

    Secondary Outcome Measures

    Overall survival (OS)
    Defined as the time start of study treatment until death by cause. Any subject not known to have died at the time of the analysis will be censored on the last recorded date on which the subject was known to be alive.
    Progression-free survival (PFS) as assessed per RECIST 1.1
    Defined as the time from start of study treatment until the date of objective disease progression or death. Progression is defined in accordance with RECIST v1.1 criteria.
    Disease control rate (DCR) as assessed per RECIST 1.1
    Defined as the proportion of subjects with a best objective response (BOR) of complete response (CR) or Partial response (PR), or stable disease maintained for a minium of twelve weeks from start of treatment, as defined by the RECIST 1.1.
    Duration of response (DOR) as assessed per RECIST 1.1
    Defined as the time from the investigator's first determination of objective response to the first of disease progression or death according to RECIST 1.1.
    Number of participants with Adverse Events that are related to treatment
    Safety and tolerability of the pembrolizumab and TAS-120 combination therapy as determined by adverse events categorized in accordance with CTCAE 5.0 Criteria.

    Full Information

    First Posted
    July 7, 2022
    Last Updated
    August 17, 2022
    Sponsor
    Yonsei University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05508737
    Brief Title
    Phase II Study of Pembrolizumab (Keytruda®) and Trifluridine/Tipiracil (Lonsurf®) With Previously Treated Advanced Gastric Cancer
    Official Title
    Open-label Phase II Study With Lead-in Safety Cohort of Pembrolizumab (Keytruda®) and Trifluridine/Tipiracil (Lonsurf®) Combination Treatment in Patients With Previously Treated Advanced Gastric Cancer
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    August 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    December 1, 2022 (Anticipated)
    Primary Completion Date
    May 2, 2025 (Anticipated)
    Study Completion Date
    December 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Yonsei University

    4. Oversight

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

    5. Study Description

    Brief Summary
    This is a two-part, Phase II, open-label, single arm, multi-center study to determine the efficacy of pembrolizumab in combination with TAS-102 (trifluridine/tipiracil) in patients with advanced gastric cancer who have progressed after prior treatment with or without anti-PD-1/PD-L1 agent, and to further assess the safety and tolerability of this combination treatment.
    Detailed Description
    This is a two-part, Phase II, open-label, single arm, multi-center study to determine the efficacy of pembrolizumab in combination with TAS-102 (trifluridine/tipiracil) in patients with advanced gastric cancer who have progressed after prior treatment with or without anti-PD-1/PD-L1 agent, and to further assess the safety and tolerability of this combination treatment. In lead-in-safety cohort, recommended dose of trifluridine/tipiracil combined with pembrolizumab will be determined with dose-limiting toxicity (DLT) and safety. Pembrolizumab dose will be fixed with current recommended dose of 400mg IV every 6 weeks (Q6W). There will be 2 dose cohort for trifluridine/tipiracil; dose level 1 is trifluridine/tipiracil 35mg/m2 BID, D1-5, D8-12, every 4 weeks (Q4W) and dose level 0 is trifluridine/tipiracil 30mg/m2 BID, D1-5, D8-12, every 4 weeks (Q4W). DLT will be evaluated during first 6 weeks. In the subsequent expansion Phase II part, patients will be recruited from four sites to evaluate the efficacy and safety of the combination therapy in 2 cohorts, anti-PD-1/PD-L1 inhibitor naive and exposure cohorts.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Gastric and Gastroesophageal Junction Adenocarcinoma
    Keywords
    Pembrolizumab(Keytruda®), Trifluridine/Tipiracil (Lonsurf®)

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1, Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    75 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Single arm, Pembrolizumab, trifluridine/tipiracil
    Arm Type
    Experimental
    Intervention Type
    Drug
    Intervention Name(s)
    Pembrolizumab (Keytruda®), Trifluridine/Tipiracil (Lonsurf®)
    Intervention Description
    Single arm: Pembrolizumab 400 mg every 6 weeks (Q6W), trifluridine/tipiracil at 35 or 30 mg/m2 twice daily (BID) for 5 days a week (D1-5, D8-12) with 2 days rest for 2 weeks, followed by a 14-day rest, repeated every 4 weeks (Q4W)
    Primary Outcome Measure Information:
    Title
    Phase Ib (Lead-in safety cohort): Dose-limiting toxicity (DLT)
    Time Frame
    within first 6weeks
    Title
    Phase Ib (Lead-in safety cohort): Recommended Phase 2 dose (RP2D)
    Time Frame
    within first 6weeks
    Title
    Objective response rate (ORR)
    Description
    The proportion of patients in complete remission (CR) or partial remission (PR) among the best response (BOR) assessed by the investigator according to RECIST 1.1.
    Time Frame
    6months after the last treatment of the last subject
    Secondary Outcome Measure Information:
    Title
    Overall survival (OS)
    Description
    Defined as the time start of study treatment until death by cause. Any subject not known to have died at the time of the analysis will be censored on the last recorded date on which the subject was known to be alive.
    Time Frame
    6months after the last treatment of the last subject
    Title
    Progression-free survival (PFS) as assessed per RECIST 1.1
    Description
    Defined as the time from start of study treatment until the date of objective disease progression or death. Progression is defined in accordance with RECIST v1.1 criteria.
    Time Frame
    6months after the last treatment of the last subject
    Title
    Disease control rate (DCR) as assessed per RECIST 1.1
    Description
    Defined as the proportion of subjects with a best objective response (BOR) of complete response (CR) or Partial response (PR), or stable disease maintained for a minium of twelve weeks from start of treatment, as defined by the RECIST 1.1.
    Time Frame
    6months after the last treatment of the last subject
    Title
    Duration of response (DOR) as assessed per RECIST 1.1
    Description
    Defined as the time from the investigator's first determination of objective response to the first of disease progression or death according to RECIST 1.1.
    Time Frame
    6months after the last treatment of the last subject
    Title
    Number of participants with Adverse Events that are related to treatment
    Description
    Safety and tolerability of the pembrolizumab and TAS-120 combination therapy as determined by adverse events categorized in accordance with CTCAE 5.0 Criteria.
    Time Frame
    Throughout the overall trial period as well as up to 3months after the last dose study treatment for each subject

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    19 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Has provided written informed consent fo the trial. Is male or female at least 18 years of age. Has a histologically or cytologically confirmed diagnosis of advanced or metastatic gastric/gastroesophageal junction (GEJ) adenocarcinoma. Has previously received at least 2 prior regiments. Has a life expectancy of at least 3 months. Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Have 1 or more measurable disease as determined by RECIST 1.1. Is able to take medications orally. Has adequate organ function as defined by the following criteria. Is willing to follow and follow research procedures. A male participant must agree to use a contraception of this protocol during the treatment period and for at least 120 days post TAS-102. A female participant is eligible to participate if she is not pregnant or breastfeeding. Exclusion Criteria: Has other concurrently active malignancies. Has received prior therapy with TAS-102. Is contraindicated for pembrolizumab and/or TAS-102, or have severe hypersensitivity to any of those drugs and/or their excipients. Has any unresolved ≥Grade 2 toxicity (per CTCAE v5.0) attributed to any prior therapies at the time of enrollment. Has had major surgery within 2 weeks prior to first dose of study interventions. Has known active central nervous system (CNS) metastases. Has received radiotherapy for gastric cancer treatment within 2 weeks prior to the first dose of study drugs. Has received a live vaccine or live-attenuated vaccine within 30 days prior to the first dose of study drug. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug. Has participated has used an investigational device within 4 weeks prior to the first dose of study intervention. Has a history of uncontrollable or significant cardiovascular disease. Has active (significant or uncontrolled) gastrointestinal bleeding. Has active autoimmune disease that has required systemic treatment in the past 2 years. Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease. Has an active, unresolved infection requiring systemic therapy. Has a known history of Human Immunodeficiency Virus (HIV) infection. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg] reactive) or known active Hepatitis C virus infection. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial. Has had an allogenic tissue/solid organ transplant. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    SUN YOUNG SUN YOUNG
    Phone
    SUN YOUNG
    Email
    rha7655@yuhs.ac
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    SUN YOUNG SUN YOUNG
    Organizational Affiliation
    Yonsei Cancer Center, Yonsei University College of Medicine
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    Phase II Study of Pembrolizumab (Keytruda®) and Trifluridine/Tipiracil (Lonsurf®) With Previously Treated Advanced Gastric Cancer

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