Adjuvant Afatinib in Stage I-III NSCLC With EGFR Mutation

• ClinicalTrials.gov Identifier: NCT01746251
• Recruitment Status: Unknown
• First Posted: December 10, 2012
• Last Update Posted: July 7, 2020
• Sponsor: Massachusetts General Hospital
• Collaborator: National Comprehensive Cancer Network
• Information provided by (Responsible Party): Lecia V. Sequist, Massachusetts General Hospital

Study Description

Brief Summary:

This research study is a Phase II clinical trial, which tests the safety and effectiveness of an investigational drug to learn whether the drug works in treating a specific cancer. "Investigational" means that the drug is still being studied. It also means that the FDA has not yet approved afatinib for use in patients.

In this research study the investigators are looking to see if taking afatinib after surgery works better when taken over a short period of time, compared to a long period of time.

Condition or disease	Intervention/treatment	Phase
Non Small Cell Lung Cancer	Drug: Afatinib	Phase 2

Detailed Description:

In order to determine if one is eligible to participate in this study they would be asked to undergo some screening tests or procedures. Many of these tests and procedures are likely to be part of regular cancer care and may be done even if it turns out that one does not take part in the research study. If the patient has had some of these tests or procedures recently, they may or may not have to be repeated. These tests and procedures include: a medical history, performance status, physical exam and vital signs including height and weight, an assessment of your tumor, routine blood tests, pregnancy test, electrocardiogram, echocardiogram and/or multigated acquisition scan. If these tests show that a patient is eligible to participate in the research study, they will begin the study treatment. If one does not meet the eligibility criteria, they will not be able to participate in this research study.

Because no one knows which of the study options is best, the patients will be "randomized" into one of the study groups. They will take afatinib by mouth every day for either 3 months (short course) or for 2 years (long course). Randomization means that one is put into a group by chance. It is like flipping a coin. Neither the patient, nor the research doctor will choose what group the patient will be in. You will have a 50/50 chance of being placed in any group.

Regardless of which study group one is put in, all patients will take Afatinib by mouth every day. The first cycle will last 28 days. All cycles after that will last 25-31 days. Patients will take their medication (tablets) by mouth once a day, at about the same time each day. They should take Afatinib with a glass of water. Afatinib treatment will continue until the assigned course is completed, or until there are side effects that cannot be tolerated, or one decides to stop study treatment, of if the lung cancer returns.

Patients will be asked to come to the clinic at the following time points:

• Day 1 and 8 of Cycle 1
• Day 1 of Cycles 2, 3 and 4
• Off treatment visit-28 days after the last dose of study drug

If one is assigned to the long course, one will also need to come in for clinic visits on Day 1 of Cycles 7, 10, 13, 16, 19, 22 and 25. If one is assigned to the short course, one does not need to come in for these additional clinic visits.

The following tests and procedures will be done to monitor for side effects of afatinib.

• Routine blood tests-about 2 tablespoons of blood
• Performance status
• Physical exam and vital signs, including height and weight

The following tests and procedures will be done to monitor for recurrence of lung cancer. These visits are the same, regardless of whether one is taking a short course, or a long course of afatinib. There will be clinic visits once every 6 months for 3 years (months 7, 13, 19, 25, 31, 37 and 49), and then one more visit 1 year later. The following tests and procedures will be done at these follow up visits: a CT scan of the chest, routine blood tests, performance status and a physical exam, including height and weight.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 92 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Randomized Phase II Study Comparing Concise Versus Prolonged Afatinib as Adjuvant Therapy for Patients With Resected Stage I-III NSCLC With EGFR Mutation
• Study Start Date: January 2013
• Estimated Primary Completion Date: November 2020
• Estimated Study Completion Date: November 2021

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Concise Afatinib; Afatinib oral daily dose for 3 months	Drug: Afatinib
Active Comparator: Prolonged Afatinib; Afatinib oral daily dose for 2 years	Drug: Afatinib

Outcome Measures

Primary Outcome Measures :

1. Recurrence-free survival [ Time Frame: 2 years ]
   The primary objective of this study is to demonstrate that prolonged adjuvant therapy with afatinib will improve recurrence free survival (RFS) compared to a concise adjuvant course in patients with resected stage I-III non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation.

Secondary Outcome Measures :

1. Number of patients with adverse events [ Time Frame: 2 years ]
   To determine the safety and tolerability of adjuvant afatinib
2. Molecular genotype of recurrent cancers [ Time Frame: 2 years ]
   We aim to collect clinical data from patients with recurrent NSCLC after treatment with adjuvant afatinib, including molecular characteristics of recurrent cancer analyzed as part of routine care, and time to treatment failure for patients treated with alternative chemotherapies for recurrent lung cancer.
3. overall survival [ Time Frame: 2 years ]
   To estimate overall survival

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Pathologically confirmed diagnosis of non-small cell lung cancer with EGFR mutation
• Complete surgical resection, pathologic stage IA-B, IIA-B, IIIA-B by AJCC 7th Edition staging criteria
• Surgical resection with curative intent was at least 6 months prior to enrollment
• At least 3 weeks have passed since completion of adjuvant chemotherapy or radiotherapy

Exclusion Criteria:

• Pregnant or breastfeeding
• History of allergic reactions attributed to compounds of similar chemical composition to afatinib
• Prior exposure to EGFR tyrosine kinase inhibitor
• Evidence of clinically active interstitial lung disease
• Radiographic evidence of recurrent NSCLC prior to afatinib treatment
• Receipt of any experimental treatment within 30 days of start of treatment with afatinib until the end of treatment visit
• Use of potent P-gp inhibitors and potent P-gp inducers must be avoided during treatment with afatinib
• Individuals with a history of a different malignancy (except: synchronous or metachronous primary non-small cell lung cancers of lower stage than the cancer for which adjuvant treatment is currently being prescribed; disease free for at least 3 years; cervical cancer in situ; basal or squamous cell carcinoma of the skin)
• HIV positive on combination antiretroviral therapy
• Uncontrolled intercurrent illness

Contacts and Locations

Locations

United States, California

Stanford University

Palo Alto, California, United States, 94304

United States, Massachusetts

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States, 02115

Massachusetts General Hospital

Boston, Massachusetts, United States, 02115

United States, New York

Memorial Sloan Kettering

New York, New York, United States, 10065

Sponsors and Collaborators

Massachusetts General Hospital

National Comprehensive Cancer Network

Investigators

• Principal Investigator: Lecia Sequist, MD, MPH; Massachusetts General Hospital

More Information

• Responsible Party: Lecia V. Sequist, Principal Investigator, Massachusetts General Hospital
• ClinicalTrials.gov Identifier: NCT01746251
• Other Study ID Numbers: 12-504
• First Posted: December 10, 2012
• Last Update Posted: July 7, 2020
• Last Verified: July 2020

Keywords provided by Lecia V. Sequist, Massachusetts General Hospital:

EGFR mutation; Resected

Additional relevant MeSH terms:

Carcinoma, Non-Small-Cell Lung; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Neoplasms; Lung Diseases; Respiratory Tract Diseases; Afatinib; Antineoplastic Agents; Protein Kinase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action