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Chemo-Immunotherapy Followed by Durvalumab and Ceralasertib in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer

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ClinicalTrials.gov Identifier: NCT04699838
Recruitment Status : Recruiting
First Posted : January 7, 2021
Last Update Posted : October 27, 2021
Sponsor:
Collaborator:
AstraZeneca
Information provided by (Responsible Party):
Muhammad Furqan, Big Ten Cancer Research Consortium

Brief Summary:
The primary objective of this single arm study is to estimate the progression free survival of previously-untreated patients with extensive stage small cell lung cancer. Patients will receive initial chemo-immunotherapy followed by maintenance therapy with durvalumab and oral ceralasertib.

Condition or disease Intervention/treatment Phase
Extensive Stage Small Cell Lung Cancer Drug: Cisplatin Drug: Carboplatin Drug: Etoposide Drug: Durvalumab Drug: Ceralasertib Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Study of Chemo-Immunotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer (ES-SCLC) Big Ten Cancer Research Consortium BTCRC-LUN18-363
Actual Study Start Date : April 20, 2021
Estimated Primary Completion Date : February 2023
Estimated Study Completion Date : February 2024

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Cisplatin or Carboplatin + Etoposide + Durvalumab + Ceralasertib

Initial Phase: Cycles 1-4 Cisplatin or Carboplatin: Day 1 Etoposide: Days 1-3 Durvalumab, 1500 mg: Day 1 q 3 weeks

Maintenance Phase, Cycles 5+ Durvalumab, 1500 mg: Day 1 q 4 wks. Ceralasertib at 240mg po BID: Days 15-28

Drug: Cisplatin
Cisplatin

Drug: Carboplatin
Carboplatin

Drug: Etoposide
Etoposide

Drug: Durvalumab
Durvalumab

Drug: Ceralasertib
Ceralasertib




Primary Outcome Measures :
  1. Progression Free Survival (PFS) [ Time Frame: From enrollment until the time of disease progression, assessed for a maximum of 24 months ]
    Progression free survival (PFS) is defined as the time from the initiation of treatment (C1D1) to the time when the criteria for disease progression is met as defined by RECIST v1.1 OR death due to any cause. The PFS is subject to right censoring due to loss to follow-up or at the end of study duration.


Secondary Outcome Measures :
  1. Time to disease progression [ Time Frame: From enrollment until the time of disease progression,assessed for a maximum of 24 months ]
    Time to disease progression: Will be measured from C1D1 of treatment until the criteria for disease progression is met as defined by RECIST 1.1

  2. Time to CNS Progression [ Time Frame: From enrollment until the time of cns progression, assessed for a maximum of 24 months ]
    Time to CNS progression: Will be measured from C1D1 of treatment until the criteria for disease progression is met in the CNS (intracranial) by RECIST 1.1 criteria. Patients with CNS -only progression or those with concurrent CNS and systemic progression will be included in this analysis.

  3. Time to Systemic Progression [ Time Frame: From enrollment until the time of systemic progression, assessed for a maximum of 24 months ]
    Time to Systemic progression: : Will be measured from C1D1 of treatment until the criteria for systemic disease (extracranial) progression is met by RECIST 1.1. Patients with systemic-only or those with concurrent CNS and systemic progression will be included in this analysis.

  4. Progression free survival for maintenance therapy [ Time Frame: From Cycle 5, Day 1 of maintenance therapy until disease progression, assessed for a maximum of 19 months ]
    Progression free survival for maintenance therapy: Will be measured from C5D1 of first maintenance therapy until the criteria for disease progression is met as defined by RECIST 1.1

  5. Objective response rate (ORR) [ Time Frame: 24 months ]
    Objective response rate (ORR): Will include complete response (CR) + partial response (PR) and will be determined as per RECIST1.1

  6. Duration of Response [ Time Frame: 24 months ]
    Duration of Response: The period measured from the time that measurement criteria are met for complete or partial response (whichever status is recorded first) until the date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since treatment started).

  7. Disease Control Rate [ Time Frame: 8 weeks from Cycle 1 Day 1 ]
    Disease control rate: The disease control rate is the proportion of all subjects with stable disease (SD) for 8 weeks, or partial response (PR), or complete response (CR) according to RECIST v1.1, from the start of treatment until disease progression/recurrence (taking as reference for progressive disease the smallest measurements recorded since the start of treatment).

  8. Overall Survival (OS) [ Time Frame: 24 months ]
    Overall survival: Will be measured from D1 to death from any cause

  9. Toxicity Profile [ Time Frame: 24 months ]
    Describe the toxicity profile of durvalumab and ceralasertib combination therapy by the NCI Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.



Information from the National Library of Medicine

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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:

  • Written informed consent and HIPAA authorization for release of personal health information. NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
  • Age >= 18 years at the time of consent.
  • ECOG Performance Status of 0-1 within 14 days prior to registration (Appendix A of Protocol).
  • Histological or cytological confirmed small cell lung carcinoma
  • Extensive stage disease
  • Patient must be considered suitable to receive a platinum-based chemotherapy as 1st line treatment for ES-SCLC. Chemotherapy must contain either Carboplatin or Cisplatin in combination with Etoposide.
  • Measurable disease according to RECIST v1.1 for solid tumors within 28 days prior to registration.
  • Prior treatment must be completed within the following number of days prior to registration:

    --Palliative radiation: for painful bony lesion must be completed prior to registration and any bone marrow toxicity recovered. For patients who received WBRT, 14 days washout is required prior to study therapy. Patient's must be off steroids without worsening of symptoms related to brain metastases. Patient should be on stable doses of anti-convulsant.

  • Demonstrate adequate organ function as defined in the protocol; all screening labs to be obtained within 14 days prior to registration
  • Female subjects of childbearing potential and non-sterilized male subjects who intend to be sexually active during the study must agree to use a highly effective method of contraception from the time of screening, throughout the total duration of the drug treatment, and during the 90-day post-drug washout period. See section 5.6.2.3 of the protocol for full details.
  • Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:

    • Women <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 if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
    • Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).
  • As determined by the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study
  • Ability to swallow and retain oral medication
  • Must have a life expectancy of at least 12 weeks

Exclusion Criteria:

  • Prior systemic therapy for extensive stage or recurrent SCLC
  • Patients with recurrent SCLC, who received chemotherapy or definitive chest radiation in the past for limited-stage SCLC.
  • Clinically significant active infection requiring systemic therapy
  • Pregnant or breastfeeding (NOTE: breast milk cannot be stored for future use while the mother is being treated on study).
  • Participants who have undergone major surgery within 28 days before first dose of study drug
  • Participants who are currently receiving any other investigational agents
  • Active malignancy requiring therapy other than small cell lung cancer, excluding: non-melanoma skin cancer, noninvasive colonic polyps, superficial bladder tumors, cervical cancer in-situ, ductal carcinoma in situ of the breast, monoclonal B-cell lymphocytosis, or monoclonal gammopathy of undetermined significance.
  • Diagnosis of immunodeficiency or is receiving systemic steroid therapy (> 10 mg of prednisone or equivalent) or any other form of immunosuppressive therapy within 7 days prior to study enrolment. Patient's on physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Topical, inhaled or intra-articular steroids are not considered as systemic steroids. Steroids as premedication for hypersensitivity reaction (e.g. CT scan premedication) or prior to chemotherapy is allowed.
  • Active autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis or Crohn's disease], systemic lupus erythematosus, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion:

    • Patients with vitiligo or alopecia
    • Patients with hyperthyroidism or hypothyroidism (e.g., following Hashimoto syndrome) clinically stable on hormone replacement
    • Any chronic skin condition that does not require systemic immunosuppressive therapy
    • Patients with celiac disease controlled by diet alone
    • Diabetes mellitus with or without insulin replacement therapy
  • Has history of immune therapy related pneumonitis that required steroids
  • Patients with untreated or symptomatic central nervous system (CNS) metastases or leptomeningeal carcinomatosis will be excluded. Previously-treated CNS metastases and have no requirement for steroids for at least 2- week prior to study entry is allowed. Anticonvulsant therapy at a stable dose is permitted. May have residual symptoms as new baseline. Brain imaging with either MRI (preferred) or CT with contrast must be performed on all subjects at screening to evaluate brain metastases.
  • Known history of Hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA
  • Known history of active tuberculosis
  • History of allogeneic stem cell or solid organ transplant
  • History of Ataxia telangiectasia
  • Uncontrolled intercurrent illness including, but not limited to, serious and active uncontrolled infection, symptomatic congestive heart failure (NYHA class III-IV), active inflammatory bowel disease, unstable angina pectoris, uncontrolled seizures, or psychiatric illness/social situations that would limit compliance with study requirements
  • Participants with a known hypersensitivity to durvalumab, ceralasertib or any excipient of the product
  • Patients who have been vaccinated with live, attenuated vaccines within 4 weeks of first dose of study drug
  • Refractory nausea and vomiting, chronic gastrointestinal diseases or previous significant bowel resection, with clinically significant sequelae that would preclude adequate absorption of ceralasertib.
  • Patients weighing <= 30 Kg.
  • Participants may not be receiving any medications or substances that are potent inhibitors or inducers of CYP3A4 (Appendix B of the protocol).

    • There is a required wash-out period of 5 half-lives from such agents prior to starting ceralasertib, or three weeks for St. John's Wort.
    • For non-potent inhibitors or inducers of CYP3A4, the decision to allow a patient to enroll on the study is per investigator best judgement. Note these include common azole antifungals, macrolide antibiotics, and other medications listed in the concomitant medications section. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product.
    • Exposure of other drugs metabolized by CYP3A4 and/or CYP2B6 may be reduced and additional monitoring may be required.
    • The use of herbal supplements or 'folk remedies' (and medications and foods that significantly modulate CYP3A activity) should be discouraged. If deemed necessary, such products may be administered with caution and the reason for use documented in the CRF.

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): NCT04699838


Contacts
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Contact: Muhammad Furqan, MD 319-356-1527 muhammad-furqan@uiowa.edu
Contact: Milena Petkov, RN 317-634-5842 ext 40 mpetkov@hoosiercancer.org

Locations
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United States, Illinois
University of Illinois Medical Center Recruiting
Chicago, Illinois, United States, 60612
Contact: Lauren Talasnik    312-996-6275    talasnik@uic.edu   
Principal Investigator: Lawrence Feldman, MD         
United States, Iowa
University of Iowa Hospitals and Clinics Recruiting
Iowa City, Iowa, United States, 52242
Contact: Laura Dallas    319-353-0708    laura-dallas@uiowa.edu   
Principal Investigator: Muhammad Furgan, MD         
Sponsors and Collaborators
Muhammad Furqan
AstraZeneca
Investigators
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Principal Investigator: Muhammad Furqan, MD University of Iowa
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Responsible Party: Muhammad Furqan, Clinical Associate Professor., Big Ten Cancer Research Consortium
ClinicalTrials.gov Identifier: NCT04699838    
Other Study ID Numbers: BTCRC-LUN18-363
First Posted: January 7, 2021    Key Record Dates
Last Update Posted: October 27, 2021
Last Verified: October 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Lung Neoplasms
Small Cell Lung Carcinoma
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Carboplatin
Etoposide
Durvalumab
Antineoplastic Agents
Antineoplastic Agents, Phytogenic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents, Immunological