PACIFIC-4: Durvalumab vs Placebo With Stereotactic Body Radiation Therapy in Early Stage Unresected Non-small Cell Lung Cancer (NSCLC) Patients / Osimertinib Following SBRT in Patients With Early Stage Unresected NSCLC Harboring an EGFR Mutation
Study Details
Study Description
Brief Summary
This is a Phase III, randomized, placebo-controlled, double-blind, multi-center study assessing the efficacy and safety of durvalumab with SoC SBRT versus placebo with SoC SBRT in patients with unresected clinical Stage I/II lymph node-negative (T1 to T3N0M0) NSCLC.
An additional cohort will assess Osimertinib following SBRT in patients with early stage unresected T1 to T3N0M0 NSCLC harbouring an EGFR mutation.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Detailed Description
Patients who are to receive SoC SBRT as definitive treatment of Stage I/II lymph node-negative NSCLC and confirmed to meet all eligibility criteria will be randomized 1:1 to Durvalumab or placebo.
The primary objective of main cohort is to assess the efficacy of Durvalumab with SoC SBRT compared to placebo with SoC SBRT in terms of PFS. Key secondary is to assess the efficacy of Durvalumab with SoC SBRT compared to placebo with SoC SBRT in terms of Overall Survival (OS).
In addition, a study cohort with a sufficient number of patients harboring an EGFR mutation, will receive Osimertinib treatment after completion of SoC SBRT as definitive treatment of Stage I/II lymph node-negative NSCLC. The primary objective of Osimertinib cohort is to assess efficacy of Osimertinib following SoC SBRT in terms of 4years-PFS. Key secondary objectives include safety, OS and efficacy of Osimertininb treatment with SBRT.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: SoC SBRT + Durvalumab Therapy (Main Cohort) SBRT - delivered in 3, 4, 5 or 8 fractions. Durvalumab (PD-L1 monoclonal antibody) 1500 mg every 4 weeks [q4w] intravenously [iv] for up to 24 months or until progression or other discontinuation criteria are met. |
Drug: Durvalumab
Durvalumab 1500 mg every 4 weeks [q4w] intravenously [iv] for up to 24 months or until progression or other discontinuation criteria are met.
Other Names:
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Placebo Comparator: SoC SBRT + Placebo Therapy (Main Cohort) SBRT - delivered in 3, 4, 5 or 8 fractions. Placebo (matching placebo for infusion every 4 weeks iv for up to 24 months or until progression or other discontinuation criteria are met. |
Other: Placebo
Matching placebo for infusion every 4 weeks iv for up to 24 months or until progression or other discontinuation criteria are met.
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Experimental: SoC SBRT + Osimertinib Therapy (Osimertinib cohort, single-arm, separate cohort) SBRT delivered in 3, 4, 5 or 8 fractions Osimertinib 80mg every day [qd] for oral administration up to 36 months or until progression. Osimertinib treatment should start within 7 to 14 days after completion of SBRT |
Drug: Osimertinib (single-arm, open-label)
Osimertinib 80 mg every day [qd] orally for up to 36 months or until progression or other discontinuation criteria are met. Osimertinib treatment should start from 7 to 14 days after completion of SBRT
|
Outcome Measures
Primary Outcome Measures
- Progression-Free Survival (PFS) assessed by Blinded Independent Central Review (BICR) according to RECIST 1.1 in subpopulation of patients with Stage I/II NSCLC [from randomization up to 6 years]
Main Cohort
- 4-year Progression-Free Survival (4y-PFS) by ICR according to RECIST 1.1 criteria [from randomization up to 5 years]
Osimertinib Cohort
Secondary Outcome Measures
- Progression-Free Survival (PFS) assessed by BICR per RECIST 1.1 in all randomised patients with Stage I/II NSCLC [from randomization up to 6 years]
Main Cohort
- Overall Survival (OS) [from randomization up to 7 years]
Main Cohort
- Lung cancer-specific mortality [from randomization up to 7 years]
Main Cohort
- Maximum Plasma concentration (Cmax) [12 weeks after last dose]
Main Cohort
- Detection of ADA neutralising antibodies titers [up to 6 months after last dose]
Main Cohort
- Health-related quality of life in patients treated with durvalumab with SoC SBRT compared to placebo with SoC SBRT using the EORTC QLQ-C30 [from randomization up to 7 years]
Main Cohort
- Proportion of patients alive and progression free at 24 months from randomisation (PFS24) assessed by BICR according to RECIST 1.1 [at 24 months following randomization]
Main Cohort
- Time to progression (TTP) assessed by BICR according to RECIST 1.1 [from randomization up to 6 years]
Main Cohort
- Time to death or distant metastasis (TTDM) assessed by BICR according to RECIST 1.1 [from randomization up to 6 years]
Main Cohort
- Time from randomisation to second progression (PFS2) as defined by local standard clinical practice [from randomization up to 7 years]
Main Cohort
- Trough Concentration (Ctrough) [up to 3 months after last dose]
Main Cohort
- Assessment of AEs by CTCAE v 5.0 as measures of the safety and tolerability of Durvalumab with SoC SBRT compared to placebo with SoC SBRT [up to 3 months after last dose]
Main Cohort
- Assessment of AEs by CTCAE v 5.0 as measures of the safety, tolerability and compliance of osimertinib with SoC SBRT therapy [Up to 35 days after last dose]
Osimertinib Cohort
- WHO performance status [from randomization Up to 5 years]
Osimertinib Cohort
- ECG QT interval [Up to 156 weeks of treatment or treatment discontinuation]
Osimertinib Cohort
- Overall Survival [from randomization Up to 5 years]
Osimertinib Cohort
- Lung cancer mortality [from randomization Up to 5 years]
Osimertinib Cohort
- Time To Progression (TTP) [from randomization Up to 5 years]
Osimertinib Cohort
- Time to CNS progression [from randomization Up to 5 years]
Osimertinib Cohort
- PFS2 [from randomization up to 5 years]
Osimertinib Cohort
- Site(s) of disease progression [from randomization up to 5 years]
Osimertinib Cohort
- PFS by ICR using RECIST 1.1 [from randomization up to 5 years]
Osimertinib Cohort
Eligibility Criteria
Criteria
Main Cohort Key Inclusion Criteria:
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Age ≥18 years
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Planned SoC SBRT as definitive treatment
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WHO/ECOG PS of 0, 1 or 2
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Life expectancy of at least 12 weeks
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Body weight >30 kg
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Submission of tumor tissue sample if available
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Adequate organ and marrow function required
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Patients with central or peripheral lesions are eligible
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Staging studies must be done during screening (PET-CT within 10 weeks)
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Patients with a history of metachronous NSCLC and synchronous lesions are eligible with some exceptions
Main Cohort Key Exclusion Criteria:
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Mixed small cell and non-small cell cancer
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History of allogeneic organ transplantation
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History of another primary malignancy with exceptions
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History of active primary immunodeficiency
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Epidermal growth factor receptor local testing is strongly recommended prior to enrollment. Patients with a tumor harboring an EGFRm per local testing will be excluded from the main cohort
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Prior exposure to immune-mediated therapy with exceptions
Osimertinib Cohort Key Inclusion Criteria
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Age ≥18 years
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Planned SoC SBRT as definitive treatment
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World Health Organization (WHO)/ECOG PS of 0, 1, or 2
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Patients with central or peripheral lesions are eligible
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Patients with a history of metachronous NSCLC and synchronous lesions are eligible with some exceptions
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Staging studies must be done during screening (PET-CT within 10 weeks)
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Submission of available tumor tissue sample
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Confirmation by local laboratory that the tumor harbors one of the 2 common EGFR mutations known to be associated with EGFR-TKI sensitivity (Ex19del, L858R)
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Adequate bone marrow reserve or organ function required
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Female patients should be using highly effective contraceptive measures
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Male patients should be asked to use barrier contraceptives (ie, condoms) during sex with all partners during the trial and avoid procreation
Osimertinib Cohort Key Exclusion Criteria
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Mixed small cell and non-small cell cancer
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Patients currently receiving potent inducers of CYP3A4
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Patients with known or increased risk factor for QTc prolongation
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Treatment with any of the following:
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Preoperative or adjuvant platinum-based or other chemotherapy for the disease under investigation
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Prior treatment with neoadjuvant or adjuvant EGFR TKI
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Patients currently receiving (or unable to stop use prior to receiving the first dose of study treatment) medications or herbal supplements known to be potent inducers of CYP3A4
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Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product, or previous significant bowel resection that would preclude adequate absorption of osimertinib
- Any of the following cardiac criteria
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Mean resting corrected QT interval >470 msec, obtained from 3 ECGs
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Any clinically important abnormalities in rhythm, conduction, or morphology of resting ECG.
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Any factors that increase the risk of QTc prolongation or risk of arrhythmic events, or unexplained -sudden death under 40 years of age in first-degree relatives or any concomitant medication known to prolong the QT interval
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Past medical history of ILD, drug-induced ILD, radiation pneumonitis which required steroid treatment, or any evidence of clinically active ILD
Contacts and Locations
Locations
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1 | Research Site | Tuscaloosa | Alabama | United States | 35401 |
2 | Research Site | Chandler | Arizona | United States | 85224 |
3 | Research Site | Goodyear | Arizona | United States | 85338 |
4 | Research Site | Phoenix | Arizona | United States | 85004 |
5 | Research Site | Tucson | Arizona | United States | 85719 |
6 | Research Site | Arroyo Grande | California | United States | 93420 |
7 | Research Site | Duarte | California | United States | 91010 |
8 | Research Site | La Jolla | California | United States | 92037 |
9 | Research Site | Long Beach | California | United States | 90806 |
10 | Research Site | Los Angeles | California | United States | 90073 |
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175 | Research Site | Firenze | Italy | 50134 | |
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182 | Research Site | Akashi-shi | Japan | 673-8558 | |
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184 | Research Site | Chuo-ku | Japan | 104-0045 | |
185 | Research Site | Fukuoka-shi | Japan | 812-8582 | |
186 | Research Site | Hirosaki-shi | Japan | 036-8563 | |
187 | Research Site | Hiroshima-shi | Japan | 734-8551 | |
188 | Research Site | Kashiwa | Japan | 277-8577 | |
189 | Research Site | Kobe-shi | Japan | 650-0047 | |
190 | Research Site | Kyoto-shi | Japan | 606-8507 | |
191 | Research Site | Niigata-shi | Japan | 951-8566 | |
192 | Research Site | Osaka-shi | Japan | 541-8567 | |
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198 | Research Site | Cheongju-si | Korea, Republic of | 28644 | |
199 | Research Site | Goyang-si | Korea, Republic of | 10408 | |
200 | Research Site | Gyeonggi-do | Korea, Republic of | 13620 | |
201 | Research Site | Seoul | Korea, Republic of | 03722 | |
202 | Research Site | Seoul | Korea, Republic of | 05505 | |
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204 | Research Site | Amsterdam | Netherlands | 1081 HV | |
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210 | Research Site | Białystok | Poland | 15-044 | |
211 | Research Site | Elbląg | Poland | 02-300 | |
212 | Research Site | Gdańsk | Poland | 80-214 | |
213 | Research Site | Katowice | Poland | 40-514 | |
214 | Research Site | Warszawa | Poland | 02-781 | |
215 | Research Site | Łódź | Poland | 93-513 | |
216 | Research Site | Hato Rey | Puerto Rico | 00917 | |
217 | Research Site | San Juan | Puerto Rico | 00927 | |
218 | Research Site | Ekaterinburg | Russian Federation | 620905 | |
219 | Research Site | Kazan, Tatarstan | Russian Federation | 420029 | |
220 | Research Site | Moscow | Russian Federation | 105229 | |
221 | Research Site | Moscow | Russian Federation | 115478 | |
222 | Research Site | Moscow | Russian Federation | 119421 | |
223 | Research Site | Saint Petersburg | Russian Federation | 197758 | |
224 | Research Site | Saint-Petersburg | Russian Federation | 197758 | |
225 | Research Site | St. Petersburg | Russian Federation | 197758 | |
226 | Research Site | Ufa | Russian Federation | 450054 | |
227 | Research Site | Badajoz | Spain | 6006 | |
228 | Research Site | Barcelona | Spain | 08041 | |
229 | Research Site | L'Hospitalet de Llobregat | Spain | 08907 | |
230 | Research Site | Madrid | Spain | 28034 | |
231 | Research Site | Madrid | Spain | 28041 | |
232 | Research Site | Madrid | Spain | 28046 | |
233 | Research Site | Malaga | Spain | 29010 | |
234 | Research Site | San Sebastián | Spain | 20014 | |
235 | Research Site | Santiago de Compostela | Spain | 15706 | |
236 | Research Site | Sevilla | Spain | 41009 | |
237 | Research Site | Valencia | Spain | 46010 | |
238 | Research Site | Zaragoza | Spain | 50009 | |
239 | Research Site | Ankara | Turkey | 06520 | |
240 | Research Site | Istanbul | Turkey | 34214 | |
241 | Research Site | Izmir | Turkey | 35340 | |
242 | Research Site | Birmingham | United Kingdom | B9 5SS | |
243 | Research Site | Leeds | United Kingdom | LS9 7TF | |
244 | Research Site | London | United Kingdom | EC1A 7BE | |
245 | Research Site | Manchester | United Kingdom | M20 4BX |
Sponsors and Collaborators
- AstraZeneca
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- D9103C00001
- 2018-002572-41