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Phase 2 Platform Study in Patients With Advanced Non-Small Lung Cancer Who Progressed on First-Line Osimertinib Therapy (ORCHARD) (ORCHARD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03944772
Recruitment Status : Recruiting
First Posted : May 10, 2019
Last Update Posted : December 20, 2021
Sponsor:
Information provided by (Responsible Party):
AstraZeneca

Brief Summary:
Phase 2 Platform Study in Patients with Advanced Non-Small Lung Cancer who progressed on First-Line Osimertinib Therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments.

Condition or disease Intervention/treatment Phase
Non-Small Cell Lung Cancer Drug: Osimertinib Drug: Savolitinib Drug: Gefitinib Drug: Necitumumab Drug: Durvalumab Drug: Carboplatin Drug: Pemetrexed Drug: Alectinib Drug: Selpercatinib Drug: Selumetinib Drug: Etoposide Drug: Cisplatin Phase 2

Detailed Description:

This is an open-label, multicentre, multi-drug, biomarker-directed Phase 2 platform study in patients with advanced non-small cell lung cancer (NSCLC) harbouring an epidermal growth factor receptor (EGFR)-sensitizing mutation whose disease has progressed on first-line monotherapy with osimertinib.Treatment options for these patients are limited. Novel treatments for these patients are urgently required.

This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 210 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Phase 2 platform study in patients with advanced Non-Small Lung Cancer harbouring an epidermal growth factor receptor (EGFR)-sensitizing mutation with evidence of radiological progression following first-Line osimertinib therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments. The study will be conducted in three groups (Groups A, B and C). Patient allocation to a study treatment within each group will be based on tumour molecular profile. Biomarker positive patients or patients with histologically identifiable neuroendocrine transformation to small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (NEC) will be allocated to a biomarker-matched study treatment in Group A, patients without a biomarker will be allocated to a study treatment in Group B and patients with a biomarker amenable to therapies not currently available in ORCHARD will be allocated to Group C.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Biomarker-directed Phase 2 Platform Study in Patients With Advanced Non-Small Lung Cancer Whose Disease Has Progressed on First-Line Osimertinib Therapy.
Actual Study Start Date : June 25, 2019
Estimated Primary Completion Date : November 28, 2025
Estimated Study Completion Date : November 28, 2025

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lung Cancer
Drug Information available for: Osimertinib

Arm Intervention/treatment
Experimental: Module 1: Osimertinib + Savolitinib
The patients in this group will receive osimertinib taken in combination with savolitinib
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Savolitinib
Savolitinib will be given orally at 300 mg or 600mg once daily

Experimental: Module 2: Osimertinib + Gefitinib
The patients in this group will receive osimertinib taken in combination with gefitinib
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Gefitinib
Gefitinib given orally at 250 mg once daily
Other Name: Iressa

Experimental: Module 3: Osimertinib + Necitumumab
The patients in this group will receive osimertinib taken in combination with necitumumab
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Necitumumab
Necitumumab given IV at 800 mg on Day 1 and Day 8 of every 3-week cycle
Other Name: Portrazza

Experimental: Module 4: Carboplatin + Pemetrexed + Durvalumab)
The patients in this group will receive platinum-containing doublet (carboplatin + pemetrexed) taken in combination with durvalumab.
Drug: Durvalumab
Durvalumab given IV at 1500 mg on Day 1 of every cycle
Other Name: IMFINZI

Drug: Carboplatin
Carboplatin given IV on Day 1 of every 21-day cycle for up to 6 cycles

Drug: Pemetrexed
Pemetrexed given IV at 500 mg/m2 body BSA on Day 1 of every cycle

No Intervention: Observational Cohort: No study drug

Patients in this group will not receive study treatment but receive further anticancer care (Standard of Care therapy or other experimental therapies) or supportive care, as clinically indicated, in accordance with local practice.

With Group C, the aim is to understand the clinical course and/or outcome for the overall clinical population after progression on first-line monotherapy with osimertinib.

Experimental: Module 5: Osimertinib + Alectinib
The patients in this group will receive osimertinib taken in combination with alectinib
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Alectinib
Alectinib given orally at 600mg twice daily and for Japanese patients at 300mg twice daily.
Other Name: Alecensa

Experimental: Module 6: Osimertinib + Selpercatinib
The patients in this group will receive osimertinib taken in combination with selpercatinib
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Selpercatinib
Selpercatinib given orally at 160mg twice daily
Other Name: Loxo-292, Retevmo, Retsevmo

Experimental: Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin
The patients in this group will receive platinum-containing doublet (etoposide + carboplatin or cisplatin) taken in combination with durvalumab.
Drug: Durvalumab
Durvalumab given IV at 1500 mg on Day 1 of every cycle
Other Name: IMFINZI

Drug: Carboplatin
Carboplatin given IV on Day 1 of every 21-day cycle for up to 6 cycles

Drug: Etoposide
Etoposide 80-100 mg/m2 given IV on day 1, 2 and 3 of every 21-day cycle for up to 4 cycles.

Drug: Cisplatin
Cisplatin 75-80 mg/m2 given IV on days 1, 2, and 3 of each cycle

Experimental: Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin.
The patients in this group will receive Osimertinib plus platinum-containing doublet (pemetrexed + carboplatin or cisplatin).
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Carboplatin
Carboplatin given IV on Day 1 of every 21-day cycle for up to 6 cycles

Drug: Pemetrexed
Pemetrexed given IV at 500 mg/m2 body BSA on Day 1 of every cycle

Drug: Cisplatin
Cisplatin 75-80 mg/m2 given IV on days 1, 2, and 3 of each cycle

Experimental: Module 9: Osimertinib + Selumetinib
The patients in this group will receive osimertinib taken in combination with selumetinib
Drug: Osimertinib
Osimertinib given orally at 80 mg once daily
Other Name: TAGRISSO

Drug: Selumetinib
Selumetinib given orally at 75 mg twice daily for 4 days, followed by 3 days off treatment
Other Name: Koselugo




Primary Outcome Measures :
  1. Objective response rate (ORR) [ Time Frame: Measured from first dose until confirmed response or progression. For each patient this is expected to be 3 months on average ]
    The percentage of patients with a confirmed investigator-assessed complete or partial response according to Response Evaluation Criteria In Solid Tumours (RECIST) 1.1. Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond progression).


Secondary Outcome Measures :
  1. Progression-free survival (PFS) [ Time Frame: Measured from first dose until progression. For each patient this is expected to be 6 months on average ]
    The time from first dose until the date of objective disease progression or death (by any cause in the absence of progression). Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST (Response Evaluation Criteria In Solid Tumours)1.1 defined disease progression or cessation of study treatment (if treating beyond progression).

  2. Duration of response (DoR) [ Time Frame: Measured from response until progression. For each patient this is expected to be 6 months on average ]
    The time from the date of first response until date of disease progression or death in the absence of disease progression. Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond progression).

  3. Overall survival (OS) [ Time Frame: Measured from first dose until death or final cohort data cut-off. For each patient this is expected to be 20 months on average ]
    The time from the date of the first dose of study treatment until death due to any cause.

  4. Plasma concentrations of therapeutic agents [ Time Frame: Pre-dose and 1 hour post-dose blood samples on Day 1 of Cycles 1, 3 (Cycle 2 for durvalumab), 6 for all therapeutic agents and a sample at the 90-day safety follow up for durvalumab only. (One Cycle = 21 or 28 days, depending on treatment). ]
    Blood samples will be collected at various timepoints to evaluate the sparse pharmacokinetics of study therapeutic agents.

  5. Plasma concentrations of therapeutic agents [ Time Frame: Pre-dose and serial post-dose blood samples (1 hour, 2 hours, 4 hours, 6 hours, 8 hours) on Day 15 of Cycle 1 for alectinib and selpercatinib only. ]
    Blood samples will be collected at various timepoints to evaluate the serial pharmacokinetics of study therapeutic agents

  6. Incidence of Treatment-emergent adverse events (AEs) and serious adverse events (SAEs) as characterized and graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event [CTCAE] v5 [ Time Frame: Continuously from first dose to end of safety follow up after study treatment discontinuation (approximately up to 21 Months) ]
    To evaluate safety and tolerability of each study treatment



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 130 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria applicable to all study treatment modules (Group A & B)

  1. NSCLC with the following features:

    1. Locally advanced or metastatic disease (ie, advanced NSCLC) not amenable to curative surgery or radiotherapy at study entry.
    2. Histologically or cytologically confirmed adenocarcinoma of the lung (patients with mixed histology are eligible if adenocarcinoma is the predominant histology) harboring EGFR mutation(s) known to be associated with EGFR TKI sensitivity at diagnosis. Any histologically identifiable component of neuroendocrine transformation to SCLC or large cell NEC is required for treatment under Module 7.
    3. Received only one line of therapy, with single-agent osimertinib, for advanced NSCLC, with clinical benefit as judged by investigator discretion.

      (Note: a 'line' of therapy is defined as a daily anti-cancer treatment administered for >14 days, or a single infusion of an intravenous anti-cancer treatment. For instance, patients who have had <14 days of a first- or second- generation TKI prior to osimertinib, and stopped due to adverse events, would be eligible to enter this study, see also exclusion criteria 5).

      Patients previously treated adjuvantly or neo-adjuvantly are eligible per exclusion criterion 5.

    4. Evidence of radiological disease progression on first-line monotherapy with osimertinib 80 mg po QD.
  2. Suitable for a mandatory biopsy defined as having an accessible tumor; by whichever modality the site uses and, ideally, confirmed by the person who will perform the procedure; and a stable clinical condition that will allow the patient to tolerate the procedure. The biopsy should be performed within 60 days of the planned first dose of study treatment.
  3. Patients must have measurable disease per RECIST 1.1, as defined by at least 1 lesion that can be accurately measured at baseline as ≥ 10 mm at the longest diameter (except lymph nodes which must have a short axis ≥ 15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI), which is suitable for accurate repeated measurements. Previously irradiated lesions or a lesion in the field of radiation should not be used as measurable disease unless the lesion(s) has/have demonstrated unequivocal disease progression by RECIST 1.1. Target lesions should not be used for the baseline tumour biopsy, unless there are no other lesions suitable for biopsy and they fulfil requirements.
  4. Adequate coagulation parameters, defined as:

International Normalisation Ratio (INR) < 1.5 × upper limit of normal (ULN) and activated partial thromboplastin time < 1.5 × ULN unless patients are receiving therapeutic anti-coagulation which affects these parameters.

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Exclusion Criteria applicable to all study treatment modules (Groups A/B):

  1. Patients whose disease has progressed within the first 3 months of osimertinib treatment (refractory to osimertinib treatment).
  2. Patients must not have experienced a toxicity(-ies) that led to permanent discontinuation or dose reduction of prior osimertinib.

    (a) Patients who had dose reductions in the past, but were receiving a full dose of osimertinib at the time of pre-screening should be discussed with the Study Physician.

  3. Any unresolved toxicities from prior osimertinib treatment greater than CTCAE Grade 1 at the time of starting study treatment.
  4. Patients should not have discontinued osimertinib >60 days prior to the first dose of study treatment.
  5. Inadequate bone marrow reserve or organ function as demonstrated by any of the following laboratory values:

    1. Absolute neutrophil count < 1.5 × 109/L.
    2. Platelet count < 100 × 109/L.
    3. Haemoglobin < 9 g/dL.
    4. Alanine transaminase (ALT) > 2.5 × ULN.
    5. Aspartate aminotransferase (AST) > 2.5 × ULN.
    6. Total bilirubin (TBL) > 1.5 × ULN, or > 3 × ULN in the presence of documented Gilbert's Syndrome (unconjugated hyperbilirubinaemia).
  6. Creatinine clearance (CrCl) < 50 mL/min, calculated using Cockcroft-Gault equation (Cockcroft and Gault 1976) or 24-hour urine collection.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03944772


Contacts
Layout table for location contacts
Contact: AstraZeneca Clinical Study Information Center 1-877-240-9479 information.center@astrazeneca.com
Contact: Cancer Study Locator (For US sites only) 1-877-400-4656 astrazeneca@emergingmed.com

Locations
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United States, California
Research Site Recruiting
Duarte, California, United States, 91010
Research Site Not yet recruiting
La Jolla, California, United States, 92093
Research Site Recruiting
Los Angeles, California, United States, 90048
Research Site Recruiting
Sacramento, California, United States, 95817
Research Site Recruiting
Santa Monica, California, United States, 90404
United States, Connecticut
Research Site Recruiting
New Haven, Connecticut, United States, 06510
United States, Georgia
Research Site Withdrawn
Atlanta, Georgia, United States, 30318
United States, Illinois
Research Site Recruiting
Chicago, Illinois, United States, 60612
United States, Maryland
Research Site Recruiting
Baltimore, Maryland, United States, 21224
United States, Massachusetts
Research Site Recruiting
Boston, Massachusetts, United States, 02114
Research Site Recruiting
Boston, Massachusetts, United States, 02215
United States, Michigan
Research Site Not yet recruiting
Grand Rapids, Michigan, United States, 49503
United States, New York
Research Site Recruiting
New York, New York, United States, 10017
Research Site Recruiting
New York, New York, United States, 10032
United States, Oregon
Research Site Not yet recruiting
Portland, Oregon, United States, 97239
United States, Pennsylvania
Research Site Not yet recruiting
Pittsburgh, Pennsylvania, United States, 15232
United States, Texas
Research Site Recruiting
Houston, Texas, United States, 77030
United States, Washington
Research Site Recruiting
Seattle, Washington, United States, 98109
Denmark
Research Site Completed
Herlev, Denmark, 2730
Research Site Completed
Odense C, Denmark, 5000
Research Site Completed
Vejle, Denmark, 7100
Japan
Research Site Recruiting
Chuo-ku, Japan, 104-0045
Research Site Recruiting
Fukuoka-shi, Japan, 812-8582
Research Site Recruiting
Koto-ku, Japan, 135-8550
Research Site Recruiting
Nagoya-shi, Japan, 464-8681
Research Site Recruiting
Osaka-shi, Japan, 541-8567
Research Site Recruiting
Wakayama-shi, Japan, 641-8510
Korea, Republic of
Research Site Recruiting
Seongnam-si, Korea, Republic of, 13620
Research Site Recruiting
Seoul, Korea, Republic of, 03722
Research Site Recruiting
Seoul, Korea, Republic of, 05505
Research Site Recruiting
Seoul, Korea, Republic of, 06351
Netherlands
Research Site Recruiting
Amsterdam, Netherlands, 1066 CX
Research Site Recruiting
Amsterdam, Netherlands, 1081 HV
Research Site Recruiting
Maastricht, Netherlands, 6229 HX
Research Site Recruiting
Nijmegen, Netherlands, 6525 GA
Research Site Recruiting
Rotterdam, Netherlands, 3015GD
Norway
Research Site Recruiting
Drammen, Norway, 3004
Research Site Recruiting
Oslo, Norway, N-0310
Research Site Recruiting
Trondheim, Norway, 7030
Spain
Research Site Recruiting
A Coruña, Spain, 15006
Research Site Recruiting
Barcelona, Spain, 08025
Research Site Recruiting
Barcelona, Spain, 08036
Research Site Recruiting
Madrid, Spain, 28041
Research Site Recruiting
Madrid, Spain, 28046
Research Site Recruiting
Sevilla, Spain, 41009
Sweden
Research Site Recruiting
Stockholm, Sweden, 171 76
Research Site Recruiting
Uppsala, Sweden, SE-751 85
Sponsors and Collaborators
AstraZeneca
Investigators
Layout table for investigator information
Principal Investigator: Helena A Yu, MD Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: AstraZeneca
ClinicalTrials.gov Identifier: NCT03944772    
Other Study ID Numbers: D6186C00001
First Posted: May 10, 2019    Key Record Dates
Last Update Posted: December 20, 2021
Last Verified: December 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Access Criteria: When a request has been approved AstraZeneca will provide access to the de-identified individual patient-level data in an approved sponsored tool . Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
URL: https://astrazenecagroup-dt.pharmacm.com/DT/Home

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by AstraZeneca:
Non-small cell lung cancer
NSCLC
tSCLC
NEC
Phase II
Platform study
Biomarker-directed
Durvalumab
Osimertinib
Savolitinib
Selumetinib
Etoposide
Gefitinib
Necitumumab
Platinum-containing doublet
Pemetrexed
EGFR positive
Carboplatin
Alectinib
Selpercatinib
Cisplatin
TKI-resistant
MET amplification
MET exon 14 skipping
EGFR
EGFR C797X
EGFR G724X
EGFR L718X
EGFR exon 20 insertion
EGFR amplification
Additional relevant MeSH terms:
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Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Carboplatin
Etoposide
Pemetrexed
Durvalumab
Gefitinib
Osimertinib
Necitumumab
Antineoplastic Agents
Antineoplastic Agents, Phytogenic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Folic Acid Antagonists
Nucleic Acid Synthesis Inhibitors
Antineoplastic Agents, Immunological
Protein Kinase Inhibitors