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Lorlatinib in Combination With Chemotherapy in Participants With Metastatic Anaplastic Lymphoma Kinase Positive (ALK+) Non-small Cell Lung Cancer (NSCLC) Who Progressed on Single-agent Lorlatinib (NSCLC)

Primary Purpose

Lung Cancer, Non-small Cell Lung Cancer

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Lorlatinib
Cisplatin or Carboplatin
Pemetrexed
Sponsored by
SCRI Development Innovations, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring ALK positive, ALK+, Metastatic, Lung, NSCLC, Non-small cell lung cancer, Lorlatinib, Small molecule kinase inhibitor, Pemetrexed, Carboplatin, Cisplatin

Eligibility Criteria

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

Inclusion Criteria: Written informed consent, according to local guidelines, signed and dated by the participant or by a legal guardian prior to the performance of any study-specific procedures, sampling, or analyses At least 18 years-of-age at the time of signature of the informed consent form (ICF) Metastatic ALK+ NSCLC Clinical and/or radiological progressive disease while receiving lorlatinib monotherapy or within 3 weeks of stopping lorlatinib monotherapy due to clinical and/or radiological progressive disease Adequate hematologic function defined as: Absolute neutrophil count (ANC) ≥1500/μL Hemoglobin (Hb) ≥9 g/dL Platelets ≥100,000/μL Adequate liver function defined as: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × the upper limit of normal (ULN) Total bilirubin ≤1.5 × ULN (Participants with known Gilbert disease: serum bilirubin level ≤ 3 × ULN) Adequate renal function defined as calculated creatinine clearance ≥45 mL/min as calculated by Cockcroft and Gault Formula Male or female participants. Male participants with female partners of childbearing potential and female participants of childbearing potential are required to use two forms of acceptable contraception, including one barrier method, during their participation in the study and for 90 days following last dose. Male participants must also refrain from donating sperm during their participation in the study. Exclusion Criteria: Prior treatment with platinum-based standard of care doublet chemotherapy with pemetrexed ECOG Performance Status score ≥3 Current treatment with any of the following: Known strong CYP3A inhibitors (e.g., atazanavir, boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, lopinavir, mibefradil, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, troleandomycin, voriconazole, grapefruit juice or grapefruit/grapefruit-related citrus fruits [e.g., Seville oranges, pomelos]). The topical use of these medications (if applicable), such as 2% ketoconazole cream, is allowed. Known strong CYP3A inducers (e.g., avasimibe, carbamazepine, phenobarbital, phenytoin, rifatutin, rifampin, St. John's Wort) CYP3A substrates with a narrow therapeutic index (e.g., alfentanil, cyclosporine, dihydroergotamine, ergotamine, fentanyl including transdermal patch, pimozide, quinidine, sirolimus, tacrolimus) within 12 days prior to the first dose of lorlatinib Known P-gp substrates with a narrow therapeutic index (e.g., digoxin) Currently receiving treatment with therapeutic doses of warfarin sodium. Low- molecular-weight heparin is allowed. Major surgery (excluding placement of vascular access) within 4 weeks of first dose of study drug(s). Has any history of ILD (including pulmonary fibrosis or radiation pneumonitis), has clinically significant ILD, or is suspected to have such disease by imaging during screening. If imaging findings are unlikely to indicate a history of pneumonitis, then the Investigator should discuss the considerations with the Study Chair about potential enrollment and record the reasoning in the source documentation. Clinically severe pulmonary compromise (based on Investigator's assessment) resulting from intercurrent pulmonary illnesses including, but not limited to: any underlying pulmonary disorder (e.g., severe asthma, severe chronic obstructive pulmonary disease, restrictive lung disease) any autoimmune, connective tissue or inflammatory disorder with pulmonary involvement (e.g., rheumatoid arthritis, Sjögren's syndrome, sarcoidosis) OR prior pneumonectomy Women who are pregnant, nursing, or plan to become pregnant while in the study and for at least 6 months after the last administration of study treatment Men who plan to father a child while in the study and for at least 3 months after the last administration of study treatment Presence of active gastrointestinal disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of lorlatinib (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea Grade ≥2, malabsorption syndrome) Any of the following cardiac criteria: Any clinically important abnormalities (as assessed by the Investigator) in rhythm, conduction, or morphology of resting electrocardiograms (ECGs), e.g., complete left bundle branch block, third-degree heart block Congestive heart failure (New York Heart Association ≥ Grade 2) Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalemia, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years-of-age, or any concomitant medication known to prolong the QT interval Second degree or third-degree AV block (unless paced) or any AV block with PR >220 msec As judged by the Investigator, any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, uncontrolled diabetes mellitus, active bleeding diatheses, or active infection, including hepatitis B, hepatitis C, and human immunodeficiency virus. Screening for chronic conditions is not required. Presence of other active invasive cancers other than the one treated in this study within 5 years prior to screening, except appropriately treated basal cell carcinoma of the skin, in situ carcinoma of uterine cervix, or other local tumors considered cured by local treatment

Sites / Locations

  • Sarah Cannon Research Institute at HealthONERecruiting
  • Messino Cancer CenterRecruiting
  • Tennessee OncologyRecruiting
  • Texas OncologyRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lorlatinib and Platinum and Pemetrexed

Arm Description

Lorlatinib will be administered by mouth daily plus Pemetrexed by IV infusion every 3 weeks until progression or intolerable toxicity. Platinum-based standard of care chemotherapy by IV infusion will also be given every 3 weeks for the first 4 cycles; carboplatin or cisplatin are the platinum agents that may be selected based on physician discretion. One cycle is defined as 3 weeks.

Outcomes

Primary Outcome Measures

Incidence of adverse and serious adverse events of lorlatinib in combination with standard of care platinum-based chemotherapy and pemetrexed as assessed by CTCAE v5.0.

Secondary Outcome Measures

Pharmacokinetic (PK) analysis: lowest concentration with steady state dosing interval (Css, min) of lorlatinib in combination with standard of care platinum-based chemotherapy and pemetrexed.
Objective Response Rate (ORR) to assess the anti-tumor activity of treatment with lorlatinib in combination with standard of care platinum-based chemotherapy and pemetrexed.
Percentage of participants demonstrating a Complete Response (CR) or Partial Response (PR) according to RECIST v1.1 criteria

Full Information

First Posted
June 27, 2023
Last Updated
October 23, 2023
Sponsor
SCRI Development Innovations, LLC
Collaborators
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT05948462
Brief Title
Lorlatinib in Combination With Chemotherapy in Participants With Metastatic Anaplastic Lymphoma Kinase Positive (ALK+) Non-small Cell Lung Cancer (NSCLC) Who Progressed on Single-agent Lorlatinib
Acronym
NSCLC
Official Title
Phase II Study of Lorlatinib in Combination With Chemotherapy in Participants With Metastatic Anaplastic Lymphoma Kinase Positive (ALK+) Non-small Cell Lung Cancer (NSCLC) Who Progressed on Single-agent Lorlatinib
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 2023 (Anticipated)
Primary Completion Date
March 2025 (Anticipated)
Study Completion Date
September 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
SCRI Development Innovations, LLC
Collaborators
Pfizer

4. Oversight

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

5. Study Description

Brief Summary
This clinical trial is an open-label, single arm study evaluating the safest dose of lorlatinib in combination with standard of care chemotherapy in participants with metastatic anaplastic lymphoma kinase positive (ALK+) NSCLC who progressed on prior therapy of lorlatinib alone. The main goals of this study are to: Evaluate the safety and tolerability of lorlatinib in combination with standard of care chemotherapy. Evaluate how well the combination of lorlatinib and standard of care chemotherapy works to treat metastatic anaplastic lymphoma kinase positive (ALK+) NSCLC. Evaluate the pharmacokinetics (PK) of lorlatinib when given in combination with standard of care chemotherapy.
Detailed Description
Lorlatinib is a kinase inhibitor with in vitro activity against ALK and ROS1. This study's aim is to evaluate the safety of lorlatinib given in combination with platinum-based standard of care chemotherapy in participants with metastatic anaplastic lymphoma kinase positive (ALK+) non-small-cell lung cancer who progressed after receiving lorlatinib alone. There will be a lead-in portion for the first six participants treated. Lead-in participants will receive an assigned starting dose of lorlatinib by mouth once daily throughout each cycle. In addition, a platinum-based standard of care chemotherapy regimen, to include carboplatin or cisplatin as well as pemetrexed, will be given intravenously every 3 weeks. A cycle is defined as 3 weeks. After tolerability is confirmed in the lead-in with the first 6 participants on trial, the next 9 participants may begin at an increased starting dose of lorlatinib by mouth once daily. After 4 cycles of oral lorlatinib and intravenous platinum-based standard of care chemotherapy and intravenous pemetrexed, the participant will move into the maintenance regimen. The maintenance regimen will include continuing on daily oral lorlatinib plus intravenous pemetrexed every 3 weeks until disease progression or intolerable toxicity or other reason for discontinuation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer, Non-small Cell Lung Cancer
Keywords
ALK positive, ALK+, Metastatic, Lung, NSCLC, Non-small cell lung cancer, Lorlatinib, Small molecule kinase inhibitor, Pemetrexed, Carboplatin, Cisplatin

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Lorlatinib and Platinum and Pemetrexed
Arm Type
Experimental
Arm Description
Lorlatinib will be administered by mouth daily plus Pemetrexed by IV infusion every 3 weeks until progression or intolerable toxicity. Platinum-based standard of care chemotherapy by IV infusion will also be given every 3 weeks for the first 4 cycles; carboplatin or cisplatin are the platinum agents that may be selected based on physician discretion. One cycle is defined as 3 weeks.
Intervention Type
Drug
Intervention Name(s)
Lorlatinib
Other Intervention Name(s)
Lorbrena, Lorviqua
Intervention Description
Participants will receive assigned dose of daily oral lorlatinib continuously for each cycle. Each cycle is 3 weeks.
Intervention Type
Drug
Intervention Name(s)
Cisplatin or Carboplatin
Other Intervention Name(s)
Platinol (Cisplatin), Paraplatin (Carboplatin)
Intervention Description
Participants will receive standard of care intravenous Cisplatin or Carboplatin, both chemotherapy medications, on day 1 of each cycle every 3 weeks, for Cycles 1-4. Each cycle is 3 weeks.
Intervention Type
Drug
Intervention Name(s)
Pemetrexed
Other Intervention Name(s)
Alimta, Pemfexy, Ciambra
Intervention Description
Participants will receive intravenous Pemetrexed, a chemotherapy medication, on day 1 of each cycle. Each cycle is 3 weeks.
Primary Outcome Measure Information:
Title
Incidence of adverse and serious adverse events of lorlatinib in combination with standard of care platinum-based chemotherapy and pemetrexed as assessed by CTCAE v5.0.
Time Frame
From Cycle 1 Day 1 to 30 days after treatment discontinuation, up to approximately 1 year. Each cycle is 3 weeks.
Secondary Outcome Measure Information:
Title
Pharmacokinetic (PK) analysis: lowest concentration with steady state dosing interval (Css, min) of lorlatinib in combination with standard of care platinum-based chemotherapy and pemetrexed.
Time Frame
Cycle 1, Day 1; Cycle 2, Day 1; Cycle 4, Day 1 (each cycle is 3 weeks) and at time of treatment discontinuation, up to approximately 1 year.
Title
Objective Response Rate (ORR) to assess the anti-tumor activity of treatment with lorlatinib in combination with standard of care platinum-based chemotherapy and pemetrexed.
Description
Percentage of participants demonstrating a Complete Response (CR) or Partial Response (PR) according to RECIST v1.1 criteria
Time Frame
Up to approximately 26 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent, according to local guidelines, signed and dated by the participant or by a legal guardian prior to the performance of any study-specific procedures, sampling, or analyses At least 18 years-of-age at the time of signature of the informed consent form (ICF) Metastatic ALK+ NSCLC Clinical and/or radiological progressive disease while receiving lorlatinib monotherapy or within 3 weeks of stopping lorlatinib monotherapy due to clinical and/or radiological progressive disease Adequate hematologic function defined as: Absolute neutrophil count (ANC) ≥1500/μL Hemoglobin (Hb) ≥9 g/dL Platelets ≥100,000/μL Adequate liver function defined as: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × the upper limit of normal (ULN) Total bilirubin ≤1.5 × ULN (Participants with known Gilbert disease: serum bilirubin level ≤ 3 × ULN) Adequate renal function defined as calculated creatinine clearance ≥45 mL/min as calculated by Cockcroft and Gault Formula Male or female participants. Male participants with female partners of childbearing potential and female participants of childbearing potential are required to use two forms of acceptable contraception, including one barrier method, during their participation in the study and for 90 days following last dose. Male participants must also refrain from donating sperm during their participation in the study. Exclusion Criteria: Prior treatment with platinum-based standard of care doublet chemotherapy with pemetrexed ECOG Performance Status score ≥3 Current treatment with any of the following: Known strong CYP3A inhibitors (e.g., atazanavir, boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, lopinavir, mibefradil, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, troleandomycin, voriconazole, grapefruit juice or grapefruit/grapefruit-related citrus fruits [e.g., Seville oranges, pomelos]). The topical use of these medications (if applicable), such as 2% ketoconazole cream, is allowed. Known strong CYP3A inducers (e.g., avasimibe, carbamazepine, phenobarbital, phenytoin, rifatutin, rifampin, St. John's Wort) CYP3A substrates with a narrow therapeutic index (e.g., alfentanil, cyclosporine, dihydroergotamine, ergotamine, fentanyl including transdermal patch, pimozide, quinidine, sirolimus, tacrolimus) within 12 days prior to the first dose of lorlatinib Known P-gp substrates with a narrow therapeutic index (e.g., digoxin) Currently receiving treatment with therapeutic doses of warfarin sodium. Low- molecular-weight heparin is allowed. Major surgery (excluding placement of vascular access) within 4 weeks of first dose of study drug(s). Has any history of ILD (including pulmonary fibrosis or radiation pneumonitis), has clinically significant ILD, or is suspected to have such disease by imaging during screening. If imaging findings are unlikely to indicate a history of pneumonitis, then the Investigator should discuss the considerations with the Study Chair about potential enrollment and record the reasoning in the source documentation. Clinically severe pulmonary compromise (based on Investigator's assessment) resulting from intercurrent pulmonary illnesses including, but not limited to: any underlying pulmonary disorder (e.g., severe asthma, severe chronic obstructive pulmonary disease, restrictive lung disease) any autoimmune, connective tissue or inflammatory disorder with pulmonary involvement (e.g., rheumatoid arthritis, Sjögren's syndrome, sarcoidosis) OR prior pneumonectomy Women who are pregnant, nursing, or plan to become pregnant while in the study and for at least 6 months after the last administration of study treatment Men who plan to father a child while in the study and for at least 3 months after the last administration of study treatment Presence of active gastrointestinal disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of lorlatinib (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea Grade ≥2, malabsorption syndrome) Any of the following cardiac criteria: Any clinically important abnormalities (as assessed by the Investigator) in rhythm, conduction, or morphology of resting electrocardiograms (ECGs), e.g., complete left bundle branch block, third-degree heart block Congestive heart failure (New York Heart Association ≥ Grade 2) Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalemia, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years-of-age, or any concomitant medication known to prolong the QT interval Second degree or third-degree AV block (unless paced) or any AV block with PR >220 msec As judged by the Investigator, any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, uncontrolled diabetes mellitus, active bleeding diatheses, or active infection, including hepatitis B, hepatitis C, and human immunodeficiency virus. Screening for chronic conditions is not required. Presence of other active invasive cancers other than the one treated in this study within 5 years prior to screening, except appropriately treated basal cell carcinoma of the skin, in situ carcinoma of uterine cervix, or other local tumors considered cured by local treatment
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sarah Cannon Research Institute Development Innovations, LLC
Phone
615-329-7274
Email
CANN.SCRIInnovationsEnr@scri-innovations.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Melissa Johnson, MD
Organizational Affiliation
SCRI Development Innovations, LLC
Official's Role
Study Chair
Facility Information:
Facility Name
Sarah Cannon Research Institute at HealthONE
City
Denver
State/Province
Colorado
ZIP/Postal Code
80218
Country
United States
Individual Site Status
Recruiting
Facility Name
Messino Cancer Center
City
Asheville
State/Province
North Carolina
ZIP/Postal Code
28806
Country
United States
Individual Site Status
Recruiting
Facility Name
Tennessee Oncology
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37203
Country
United States
Individual Site Status
Recruiting
Facility Name
Texas Oncology
City
Dallas
State/Province
Texas
ZIP/Postal Code
75246
Country
United States
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Lorlatinib in Combination With Chemotherapy in Participants With Metastatic Anaplastic Lymphoma Kinase Positive (ALK+) Non-small Cell Lung Cancer (NSCLC) Who Progressed on Single-agent Lorlatinib

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