CRAFT: The NCT-PMO-1602 Phase II Trial

Sponsor

German Cancer Research Center (Other)

Overall Status

Recruiting

CT.gov ID

NCT04551521

Collaborator

(none)

175

Enrollment

Locations

Arms

29.6

Anticipated Duration (Months)

29.2

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Whole-genome and transcriptome sequencing of patients with advanced solid tumors enrolled in the NCT/DKTK MASTER (Molecularly Aided Stratification for Tumor Eradication Research) program revealed genetic alterations in a substantial proportion of patients including (i) alterations that lead to aberrant activation of BRAF, ERBB2, ALK, and the PI3K-AKT and MAPK pathways and (ii) changes that predict sensitivity to immune checkpoint inhibition, such as high tumor mutational burden and specific alterations of the PD-L1 locus.

Within this seven-arm basket phase II clinical trial, we aim to investigate the efficacy of targeted-therapy plus immune checkpoint inhibition in patients with advanced tumors exhibiting one of the following genetic alterations detected within the NCT/DKTK MASTER study: (i) BRAF V600E/K, (ii)ERBB2 amplification and/or overexpression or activating ERBB2 mutation, (iii) ALK rearrangement or activating ALK mutation, (iv) activating PIK3CA or AKT mutations or other aberration predicting increased PI3K-AKT pathway activity, (v) abberations predicting increased RAF-MEK-ERK pathway activity; (vi) patients with high tumor mutational burden and/or specific alteration predicting sensitivity to PD-1/PD-L1 inhibition are eligible within this study for immune checkpoint inhibition. Recruitment of adequate patient numbers into these well-defined molecular subgroup is achieved in a multicenter approach including NCT Heidelberg and NCT Dresden as well as DKTK partner sites. Eligible patients will be identified by in-depth molecular characterization of tumors within the NCT/DKTK MASTER program. All study arms are based on similar biometrical assumptions, and sample size as well as power calculations are based on Simon's optimal two-stage design for each study arm separately. The overall aim is to reduce the cumulative hazard of progression-free survival observed within the study (PFS2) compared to the cumulative hazard of the progression-free time before inclusion into the study (PFS1) using a paired log-rank test. The sample size of the entire trial varies according to the performance of the individual study arms, ranging between 98 and 175 patients.

Condition or Disease	Intervention/Treatment	Phase
Metastatic or Locally Advanced Malignancies	Drug: Vemurafenib Drug: Cobimetinib Drug: Atezolizumab Drug: Trastuzumab Drug: Pertuzumab Drug: Alectinib Drug: Ipatasertib Drug: Cobimetinib Drug: Atezolizumab Drug: Atezolizumab Drug: Atezolizumab Drug: Ipatasertib Drug: Atezolizumab Drug: Atezolizumab	Phase 2

Study Design

Study Type:

Interventional

Anticipated Enrollment :

175 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Continuous ReAssessment With Flexible ExTension in Rare Malignancies - CRAFT: The NCT-PMO-1602 Phase II Trial

Actual Study Start Date :

Oct 12, 2021

Anticipated Primary Completion Date :

Apr 1, 2024

Anticipated Study Completion Date :

Apr 1, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: BRAF V600E/K	Drug: Vemurafenib 960 mg twice daily during run-in Phase, followed by 720 mg twice daily Drug: Cobimetinib 60 mg once daily Drug: Atezolizumab 840 mg every 2 weeks
Experimental: ERBB2	Drug: Trastuzumab 8 mg per kilogram of body weight as a loading dose, followed by 6 mg per kilogram every 3 weeks Drug: Pertuzumab 840 mg as a loading dose, followed by 420 mg intravenously every 3 weeks Drug: Atezolizumab 1200 mg every 3 weeks
Experimental: ALK	Drug: Alectinib 600 mg twice daily
Experimental: PI3K/AKT	Drug: Ipatasertib 400 mg once daily Drug: Atezolizumab 1200 mg in the first cycle, followed by 840 mg every 3 weeks
Experimental: PI3K-AKT-TAX	Drug: Atezolizumab 1200 mg in the first cycle, followed by 840 mg every 3 weeks Drug: Ipatasertib 400 mg once daily, combination with atezolizumab and taxane according to EMA approved indication only
Experimental: MAPK	Drug: Cobimetinib arm 6: 60 mg once daily Drug: Atezolizumab 840 mg every 2 weeks
Experimental: Immune evasion	Drug: Atezolizumab 1,200 mg every 3 weeks

Outcome Measures

Primary Outcome Measures

Disease Control Rate [Day 110 (+/- 5 days)]
Primary endpoint of the study is to DCR according to RECIST v1.1 including complete response (CR), partial response (PR) and stable disease (SD).

Secondary Outcome Measures

Progression-free survival [24 months (median)]
Paired Progression-free Survival 2 (PFS2) and Progression-free Survival 1 (PFS1)

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Provision of written informed consent
Ability of patient to understand and comply with the protocol for the duration of the study, including treatment and scheduled visits and examinations
Diagnosis of a metastatic or locally advanced malignancy
Progressive disease
At least one measurable lesion that can be accurately assessed at baseline by computed tomography or magnetic resonance imaging and is suitable for repeated assessment
Prior administration of at least one standard chemotherapy for primary and/or relapsed malignancy according to current guidelines. Patients must have received standard therapy or have no standard therapy available. Or, in the opinion of investigator have been considered ineligible for a particular form of standard therapy on medical reasons.
ECOG Performance Status ≤2
Age ≥18 years, no upper age limit
Postmenopausal or evidence of non-childbearing status.
Female patients of childbearing potential and male patients with partners of childbearing potential who are sexually active must agree to the use of two highly effective forms of contraception. These should be started immediately after signing the informed consent form and continued throughout the period of study treatment plus at least seven months for both sexes after taking the last dose of study drug.
Availibility of complete information about the last medical treatment given before study participation, i.e. remission status before start of treatment, dosage and timing of drugs applicated, remission status and date of progression after treatment (in order to calculate PFS 1)
For patients included on the basis of molecular testing other than NCT/DKTK MASTER and for patients with an analysis in NCT/DKTK MASTER performed more than 3 months (date of tissue sampling) before planned study inclusion, a new tumor biopsy before start of study treatment is mandatory. However, patients may be included in the trial with archival tissue not older than 3 months on the basis of a case by case discussion with the PI.

Arm-specific Inclusion Criteria as determined by Whole Genome Sequencing and RNA Sequencing in NCT/DKTK MASTER or identification by gene panel performed in a certified lab Eligibility for the trial and the respective trial arms will be evaluated and determined exclusively by the NCT/DKTK molecular tumor board on the basis of results from NCT/DKTK MASTER (for all arms) or of results from other molecular studies, e.g. gene panel testing, performed in a certified laboratory (for arms 1-6). Trial participation is only possible with a report of the NCT/DKTK MASTER MTB confirming trial eligibility.

Arm 1 (BRAF V600E/K): BRAF V600E/K mutation
Arm 2 (ERBB2): ERBB2 amplification/overexpression, activating ERBB2 mutation
Arm 3 (ALK): ALK rearrangement or activating ALK mutations including alternative transcription initiation (ALK-ATI) or RET-fusions
Arm 4 (PI3K-AKT): Activating PIK3CA or AKT mutations; other aberrations predicting increased PI3K-AKT pathway activity, e.g. PTEN loss in entities with no approval for taxanes, i.e. nab-Paclitaxel, Paclitaxel or Docetaxel
Arm 5: (PI3K-AKT-TAX): Activating PIK3CA or AKT mutations; other aberrations predicting increased PI3K-AKT pathway activity, e.g. PTEN loss in entities with approval for taxanes, i.e. nab-Paclitaxel, Paclitaxel or Docetaxel
Arm 6 (MAPK): Aberrations other than BRAF V600E/K predicting increased RAF-MEK- ERK pathway activity
Arm 7 (Immune evasion): High tumor mutational burden and/or specific alterations predicting sensitivity to PD1/PDL1 inhibition (e.g. DNA mismatch repair deficiency or PDL1 amplification and/or overexpression), ineligibility for the six specific arms

Exclusion Criteria (general):

Other malignancy except for study indication within the last 5 years except: adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS), Stage 1, grade 1 endometrial carcinoma, or other malignancies curatively treated with no evidence of disease for ≥5 years
Concurrent or previous treatment within 30 days prior to C1D1 in another interventional clinical trial with an investigational anticancer therapy
Persistent toxicity (≥Grade 2 according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0) caused by previous cancer therapy, excluding alopecia
Clinical signs of active infection (>Grade 2 according to CTCAE version 5.0)
History of human immunodeficiency virus (HIV) infection and immunocompromised patients
Active Hepatitis A virus infection
Active hepatitis B virus (HBV) infection, defined as having a positive hepatitis B surface antigen (HBsAg) test at baseline patients with a past or resolved HBV infection, defined as having a negative HBsAg test and a positive total hepatitis B core antibody (HBcAb) test at baseline , are eligible for the study if active HBV infection is ruled out on the basis of HBV DNA viral load per local guidelines
Active hepatitis C virus (HCV) infection, defined as having a positive HCV antibody test at baseline confirmed by a polymerase chain reaction (PCR) positive for HCV RNA
Dementia or significant impairment of cognitive state
Epilepsy requiring pharmacologic treatment
Pregnancy or breastfeeding
Inability to take oral medication orgastrointestinal disorders likely to interfere with absorption of the study medication
Major surgery within four weeks of starting study treatment
Systemic chemotherapy or radiotherapy within two weeks prior to start of study treatment or a longer period depending on the characteristics of the agents used (at least five-half lives)
Heart failure New York Heart Association (NYHA) II/III/IV
Severe obstructive or restrictive ventilation disorder
Prior allogeneic bone marrow transplantation or solid organ transplant.
Administration of a live, attenuated vaccine within 4 weeks before initiation of study treatment or anticipation that such a live attenuated vaccine will be required during the study
Patients with clinical suspicion of active tuberculosis
Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug
Is taking or requiring the continued use of any of the prohibited concomitant medications listed in 5.10
Any concurrent antineoplastic therapy.
Known suspected active alcohol or drug abuse
Hematological malignancies and primary brain tumors. Patients with known progressive brain metastases determined by serial imaging or declining neurologic function in the opinion of the treating physician are not eligible. Patients with symptomatic uncontrolled brain metastases and patients with symptomatic uncontrolled spinal cord compression are not eligible. Patients with previously treated brain metastases are eligible, provided that the patient has not experienced a seizure or had a clinically significant change in neurological status within the three months prior to enrollment. All patients with previously treated brain metastases must be clinically stable for at least 1 month after completion of treatment and off steroid treatment for one month, both prior to study enrolment. Patients with asymptomatic untreated CNS disease may be enrolled, provided all of the following criteria are met:
Evaluable or measurable disease outside the CNS
No metastases to brain stem, midbrain, pons, medulla, cerebellum, or within 10 mm of the optic apparatus (optic nerves and chiasm)
No history of intracranial hemorrhage or spinal cord haemorrhage
No ongoing requirement for dexamethasone for CNS disease; patients on a stable dose of anticonvulsants are permitted
Immune disease as specified below (relevant for all patients at Baseline except arm 3 (Alectinib))
History of autoimmune disease, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis; autoimmune-related hypothyroidism (patients on a stable dose of thyroid replacement hormone are eligible for this study) and type I diabetes mellitus (patients on a stable dose of insulin regimen are eligible for this study).
History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or active pneumonitis; history of radiation pneumonitis in the radiation field (fibrosis) is permitted.
Psoriatic arthritis (however, patients with eczema, psoriasis, lichen simplex chronicus, or vitiligo with dermatologic manifestations only are permitted provided that they meet the following conditions:
Rash must cover less than 10% of body surface area (BSA)
Disease is well controlled at baseline and only requiring low potency topical steroids
No acute exacerbations of underlying condition within the previous 12 months (not requiring PUVA [psoralen plus ultraviolet A radiation], methotrexate, retinoids, biologic agents, oral calcineurin inhibitors, high potency or oral steroids]).

Contacts and Locations

Locations

	Site	City	Country	Postal Code
1	Charité - Universitätsmedizin Berlin	Berlin	Germany	12203
2	Nationales Centrum für Tumorerkrankungen (NCT)	Dresden	Germany	01307
3	Nationales Centrum für Tumorerkrankungen (NCT)	Heidelberg	Germany	69120
4	Universitätsmedizin der Johannes Gutenberg- Universität Mainz	Mainz	Germany	55131
5	Universitätsklinikum Tübingen, Medizinische Klinik I	Tübingen	Germany
6	Universitätsklinikum Würzburg, Interdisziplinäres Studienzentrum mit ECTU	Würzburg	Germany