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Atezolizumab and Bevacizumab in Epidermal Growth Factor Receptor (EGFR) Mutant Non-Small Cell Lung Cancer in Patients With Progressive Disease After Receiving Osimertinib

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: NCT04099836
Recruitment Status : Recruiting
First Posted : September 23, 2019
Last Update Posted : July 24, 2020
Sponsor:
Information provided by (Responsible Party):
Duke University

Brief Summary:
The purpose of this study is to investigate the safety and efficacy of giving atezolizumab combined with bevacizumab in patients with stage 4 epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) whose cancer has gotten worse while receiving osimertinib.

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

Detailed Description:

This study will be single arm, open label, phase 2 study which will include patients with stage 4 NSCLC patients with EGFR mutations and who have progressed on osimertinib.

Although both atezolizumab and bevacizumab are approved for the treatment of NSCLC, the combination of atezolizumab and bevacizumab has not been approved by the FDA for the treatment of specific non-small cell lung cancer (NSCLC).

Patients who have one of the following EGRF mutations: exon 19 or exon 21 L858R with progressive disease on osimertinib may be eligible to participate in this study. If enrolled into the study, the study team will give the patient atezolizumab (1200 mg) combined with bevacizumab (15 mg/kg) every 3 weeks intravenously. As part of this study, the patient will have blood samples, other tests, exams, and procedures done for study purposes and their standard of care. Patient participation in the study will last for up to 2 years after completion of the last dose of the study drug or until your condition worsens or intolerable adverse events as deemed by the study doctor.

There are possible patient risks to this study that include but are not limited to diarrhea, itching, rash, and a feeling of weakness.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 39 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Single Arm Phase 2 Trial of Atezolizumab and Bevacizumab in Epidermal Growth Factor Receptor (EGFR) Mutant Non-Small Cell Lung Cancer in Patients With Progressive Disease After Receiving Osimertinib (TOP 1901)
Actual Study Start Date : July 9, 2020
Estimated Primary Completion Date : November 10, 2023
Estimated Study Completion Date : November 10, 2025

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: atezolizumab and bevacizumab
Atezolizumab 1200 mg IV every 3 weeks and bevacizumab 15 mg/kg IV every 3 weeks (1 cycle=3 weeks)
Drug: Atezolizumab
1200 mg IV

Drug: Bevacizumab
15 mg/kg IV




Primary Outcome Measures :
  1. Objective response rate (ORR) as assessed by the investigator using Response Evaluation Criteria in Solid Tumors RECIST 1.1 (brand name) [ Time Frame: Up to 3 years ]
    RECIST 1.1 will be used to measure confirmed partial or complete responses to the study drug.


Secondary Outcome Measures :
  1. Progression free survival as measured by Response Evaluation Criteria In Solid Tumors RECIST 1.1 (brand name) as assessed by the investigator. [ Time Frame: Up to 5 years ]
    Progression will be defined as time from start of study therapy to disease progression or death

  2. Overall survival as noted by follow-up via composite of telephone or medical record review. [ Time Frame: Up to 3 years ]
    Overall survival (OS) is defined as the time from start of study therapy to death from any cause, and patients who are alive at the time of analysis will be censored at the last date of contact.

  3. AEs as measured by Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 [ Time Frame: Up to 5 years] ]
    Evaluation of safety using the National Cancer Institute (NCI) CTCAE version 4.03



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 and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age ≥18 years
  2. Histologic documentation of primary lung carcinoma, non-squamous histology with EGFR exon deletion 19 or exon 21 L858R mutation
  3. Stage IV disease according to the 8th Edition of the American Joint Committee on Cancer staging system
  4. Disease progression on osimertinib
  5. Eastern Cooperative Oncology Group (ECOG) Performance Status 0 or 1 (appendix 1)
  6. Measureable disease as defined by RECIST 1.1 (appendix 2)
  7. The following laboratory values obtained ≤ 30 days prior to starting study therapy

    1. ANC ≥ 1, 500 / mm3
    2. Platelet count, ≥ 100,000 / mm3
    3. Hemoglobin ≥ 9.0 g / dL
    4. Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
    5. Serum Glutamic Oxaloacetic Transaminase (SGOT) (Aspartate Aminotransferase, AST) and Serum Glutamic Pyruvic Transaminase (SGPT) (Alanine Aminotransferase, ALT) ≤2.5 x ULN in patients without liver or bone metastases; < 5 x ULN in patients with liver or bone metastases.
    6. Cockcroft-Gault calculated creatinine clearance of ≥ 45 ml/min (appendix 3) or creatinine ≤1.5 x ULN
    7. Urine protein/creatinine (UPC) ratio ≤1.
  8. Negative pregnancy test done ≤7 days (or per institutional policy) prior to start of study therapy, for women of childbearing potential only. Female subjects should be using highly effective contraceptive measures, and must have a negative pregnancy test of must have evidence of non-child bearing potential by fulfilling one of the following criteria at screening:

    1. Post-menopausal defined as aged more than 50 years and amenorrheic for at least 12 months following cessation of all exogenous hormonal treatments;
    2. Women under 50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the post-menopausal range for the institution;
    3. Documentation of irreversible surgical sterilization by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation.
  9. Male subjects should be willing to use barrier contraception.
  10. Provide informed written consent

Exclusion Criteria:

  1. Mixed, non-small cell and small cell tumors or mixed adenosquamous carcinomas with a predominant squamous component.
  2. Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown: pregnant women, nursing women, men or women of childbearing potential who are unwilling to employ adequate contraception
  3. Other active malignancy ≤ 2 years prior to study cycle 1 day 1 of study therapy. EXCEPTIONS: Nonmelanotic skin cancer or carcinoma-in-situ of the cervix, or adequately treated stage I or II cancer. NOTE: If there is a history of prior malignancy, they must not be receiving other specific treatment (i.e. hormonal therapy) for their cancer.
  4. History of myocardial infarction or other evidence of arterial thrombotic disease (angina), symptomatic congestive heart failure (New York Heart Association ≥ grade 2), unstable angina pectoris, or ventricular arrhythmia with ≤ 6 months
  5. History of cerebral vascular accident (CVA) or transient ischemic attack (TIA) ≤ 6 months prior to study cycle 1 day 1 of study therapy.
  6. History of bleeding diathesis or coagulopathy.
  7. Inadequately controlled hypertension (systolic blood pressure of >160 mmHg or diastolic pressure >100 mmHg on anti-hypertensive medications). Note: History of hypertensive crisis or hypertensive encephalopathy not allowed.
  8. Serious non-healing wound, ulcer, bone fracture, or have undergone a major surgical procedure, open biopsy, or significant traumatic injury ≤ 28 days or core biopsy ≤ 7 days prior to starting therapy
  9. History of abdominal fistula, gastrointestinal perforation, or intraabdominal abscess ≤6 months prior to study cycle 1 day 1 of study therapy.
  10. Known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies.
  11. History of hemoptysis ≥ grade 2 (defined as bright red blood of at least 2.5 mL) ≤ 3 months prior to cycle 1 day 1 of study therapy.
  12. Symptomatic untreated brain metastases which is defined as persistent neurological symptoms or requiring ongoing use of steroids. Asymptomatic untreated brain metastases are allowed if ≤ 1 cm
  13. Significant vascular disease (e.g. aortic aneurysm surgical repair or recent peripheral arterial thrombosis) ≤6 months prior to starting study therapy
  14. Radiotherapy to any site for any reason ≤ 14 days prior to study cycle 1 day 1 of study therapy.
  15. Pre-existing and clinically active interstitial lung disease
  16. Autoimmune condition requiring ongoing or intermittent systemic treatment. Participants with a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of study treatment initiation. Inhaled or topical steroids, and adrenal replacement steroid > 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.

    Participants with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.

  17. Prior therapy with anti-PD-1 or anti-PD-L1 immunotherapy,
  18. Prisoners, participants who are involuntarily incarcerated, or participants who are compulsorily detained for treatment of either a psychiatric or physical (e.g., infectious disease) illness

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): NCT04099836


Contacts
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Contact: Carol Alonso 919-681-4768 carol.alonso@duke.edu
Contact: Debra Shoemaker 919-687-4768 Debra.shoemaker@duke.edu

Locations
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United States, North Carolina
Duke University Medical Center Recruiting
Durham, North Carolina, United States, 27710
Contact: Carol Alonso    919-681-4768    carol.alonso@duke.edu   
Contact: Debra Shoemaker    919-681-4768    Debra.shoemaker@duke.edu   
Sponsors and Collaborators
Duke University
Investigators
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Principal Investigator: Thomas Stinchcombe, MD Duke University
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Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT04099836    
Other Study ID Numbers: Pro00103723
First Posted: September 23, 2019    Key Record Dates
Last Update Posted: July 24, 2020
Last Verified: March 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: There is no plan to share participant level data.

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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 Duke University:
EGFR Mutation
Atezolizumab
Bevacizumab
exon L858R
exon 21 L858R
Additional relevant MeSH terms:
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Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Disease Progression
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Disease Attributes
Pathologic Processes
Bevacizumab
Atezolizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors