Lurbinectedin Monotherapy in Patients With Progressive Malignant Pleural Mesothelioma.
Aim of this study is to provide the "proof of concept" of efficacy and tolerability of lurbinectedin monotherapy in progressive malignant mesotheliomas.
|Condition or Disease
Malignant mesothelioma arises from the mesothelial cells of the pleural, peritoneal or pericardial lining and is often associated with asbestos exposition. There is no cure for most malignant mesotheliomas and the scope of all three major oncological therapeutic procedures (surgery, radiotherapy and chemotherapy) is to reduce/eliminate symptoms as well as to prolong progression free survival (PFS) and/or overall survival (OS). While progressive patients are still in good health able to undertake a second-line treatment, there is no standard treatment for progressive disease.
Lurbinectedin is a novel compound structurally related to trabectedin and with similar mode of action. Pre-clinical data showed a better safety profile than trabectedin. Lurbinectedin has been already tested in different Phase I-II trials showing promising activity in ovarian, pancreatic, breast, small and non-small cell lung cancer as well as in other tumor types, with objective responses averaging 30%, disease stabilization up to 75% and having manageable toxicity. Although lurbinectedin has not been widely tested in mesotheliomas, some mesothelioma patients have been already treated with lurbinectedin where again promising activity has been observed.
Arms and Interventions
Lurbinectedin 3.2 mg/m2 i.v. every 3 weeks (one cycle) until progression, unacceptable toxicity or patient's withdrawal.
3.2 mg/m2 i.v. every 3 weeks
Primary Outcome Measures
- Progression free survival (PFS) at 12 weeks [at 12 weeks]
PFS at 12 weeks is defined as absence of progression or death due to any cause during 12 weeks (±2 weeks) after registration. Patients with no tumor assessment at 12 weeks (±2 weeks) will be considered: Progressed at 12 weeks, if they have no following tumor assessment within the trial (patient died, refused, started a new treatment or was lost to follow-up) or if they progress at the following tumor assessment after 12 weeks (±2 weeks). Progression-free at 12 weeks, if they do not progress at the following tumor assessment after 12 weeks (±2 weeks).
Secondary Outcome Measures
- Progression-free survival (PFS) [From date of registration until the date of first documented relapse or progression according to the modified RECIST criteria for malignant pleural mesothelioma or date of death from any cause, whichever came first, assessed up to 30 months.]
PFS is defined as time from registration to one of the following events, whichever occurs first: Relapse or progression according to the modified RECIST criteria for malignant pleural mesothelioma Death due to any cause Patients not experiencing an event will be censored at the date of last evaluable tumor assessment before starting a subsequent treatment, if any.
- Objective response (OR) [From date of registration until the date of treatment discontinuation for any cause, assessed up to 30 months.]
OR is defined as complete response (CR) or partial response (PR) achieved by the patient during trial treatment. Tumor response will be evaluated according to the modified RECIST criteria for malignant pleural mesothelioma. Patients without any tumor assessment during trial treatment will be regarded as having a non-evaluable response (NE) and shall be considered as failures for this endpoint.
- Disease control (DC) at 12 weeks [at 12 weeks: From date of registration until 14 weeks after.]
DC is defined as CR, PR or stable disease (SD) for at least 12 weeks achieved by the patient during trial treatment. Tumor response will be evaluated according to the modified RECIST criteria for malignant pleural mesothelioma.
- Overall survival (OS) [From date of registration until the date of death from any cause, assessed up to 30 months.]
OS is defined as time from registration until death due to any cause. Patients alive or lost to follow-up will be censored at the last date they were known to be alive.
- Time to treatment failure (TTF) [From date of registration until the date of treatment discontinuation for any cause, assessed up to 30 months.]
TTF is defined as time from registration until treatment discontinuation due to any reason (unacceptable toxicity, patient refusal, progression, death or any other event that determines the termination of the trial treatment). Patients not experiencing an event will be censored at the date of their last available assessment or visit.
Written informed consent according to ICH/GCP regulations before registration and prior to any trial specific procedures
Histologically confirmed malignant mesothelioma (all histologies are eligible)
Progression on or after one line of platinum-based combination chemotherapy. Any previous treatment with surgery or radiotherapy is allowed
≤ 1 line of treatment with an immune checkpoint inhibitor
Prior systemic treatment stopped at least 4 weeks before registration
Measurable or evaluable disease according to the modified RECIST criteria for malignant pleural mesothelioma
Age ≥ 18 years
ECOG performance status ≤ 1
Adequate bone marrow function: hemoglobin ≥ 90 g/L; absolute neutrophil count ≥ 2 x 109/L, platelet count ≥ 100 x 109/L
Adequate hepatic function: total bilirubin ≤ 1.5 ULN (except for patients with Gilbert's disease ≤ 3.0 x ULN); aspartate aminotransferase and alanine aminotransferase ≤ 3.0 x ULN; albumin ≥ 30 g/L
Adequate renal function: creatinine clearance ≥ 30 mL/min/1.73, calculated according to the corrected formula of Cockcroft-Gault
Women with child-bearing potential are using effective contraception, are not pregnant or lactating and agree not to become pregnant during trial treatment and during 6 months thereafter. A negative pregnancy test before registration (within 7 days) into the trial is required for all women with child-bearing potential
Men agree not to father a child during trial treatment and during 6 months after last treatment infusion.
Known brain or leptomeningeal metastases
History of another hematologic or primary solid tumor (except for curatively treated basal or squamous cell carcinoma of the skin, properly treated in situ malignant melanoma, in situ carcinoma of the uterine cervix or pT1-2 prostate cancer with Gleason score ≤6) within five years prior to registration
More than one previous line of chemotherapy. Re-challenge is not allowed
Prior treatment with lurbinectedin or trabectedin
Treatment with any other experimental drug within 4 weeks before registration
Concomitant use of other anti-cancer drugs, anti-cancer surgical intervention or radiotherapy except for local pain control and/or other local symptoms (e.g. pleurodesis due to dyspnea)
Grade > 1 from any AE derived from previous treatment; alopecia any grade, grade ≤ 2 peripheral neuropathy and clinically not significant elevation of GGT grade ≤ 2 (according to the NCI-CTCAE v4.03) are allowed
Treatment with cortisone (prednisolone > 10 mg or equivalent) for immune-mediated side effects from previous immunotherapy (if applicable)
Severe or uncontrolled cardiovascular disease (congestive heart failure NYHA III or IV), unstable angina pectoris, history of myocardial infarction within the last six months, serious arrhythmias requiring medication (with exception of atrial fibrillation or paroxysmal supraventricular tachycardia)
Severe or uncontrolled endocrinopathy due to previous immune checkpoint inhibitor treatment (if applicable)
Known history of human immunodeficiency virus or active chronic hepatitis C or hepatitis B virus infection or any uncontrolled active systemic infection requiring intravenous antimicrobial treatment
Known hypersensitivity to the trial drug or to any component of the trial drug
Any other serious underlying medical, psychiatric, psychological, familial or geographical condition, which in the judgment of the investigator may interfere with the planned staging, treatment and follow-up, affect patient compliance or place the patient at high risk from treatment-related complications.
Contacts and Locations
|A.O. SS. Antonio e Biagio e Cesare Arrigo
|Istituto Clinico Humanitas
|IOSI Ospedale Regionale di Bellinzona e Valli
Sponsors and Collaborators
- Swiss Group for Clinical Cancer Research
- Study Director: Yannis Metaxas, MD, Kantonsspital Graubünden, Chur
- Study Chair: Roger von Moos, Prof, Kantonsspital Graubünden, Chur
- Study Chair: Miklos Pless, MD, Kantonsspital Winterthur KSW
- Study Chair: Federica Grosso, MD, SS. Antonio e C. Arrigo Hospital Alessandria (Italy)
Study Documents (Full-Text)None provided.
- SAKK 17/16