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
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
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.
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
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
We'll reach out to this number within 24 hrs