Pembrolizumab in Treating Patients With EGFR Mutant, Tyrosine Kinase Inhibitor Naive Advanced Non-Small Cell Lung Cancer

• Sponsor: Jonsson Comprehensive Cancer Center (Other)
• Overall Status: Completed
• CT.gov ID: NCT02879994
• Collaborator: Merck Sharp & Dohme LLC (Industry)
• Enrollment: 11
• Location: 1
• Arm: 1
• Actual Duration (Months): 27.6
• Patients Per Site Per Month: 0.4

Study Details

Study Description

Brief Summary

This phase II trial studies how well pembrolizumab works in treating patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer that have not received prior tyrosine kinase inhibitor therapy and has spread to other places in the body. Monoclonal antibodies, such as pembrolizumab, may block growth in different ways by targeting certain cells.

Condition or Disease	Intervention/Treatment	Phase
Stage IIIA Non-Small Cell Lung Cancer; Stage IIIB Non-Small Cell Lung Cancer; Stage IV Non-Small Cell Lung Cancer	Other: Laboratory Biomarker Analysis; Biological: Pembrolizumab	Phase 2

Detailed Description

PRIMARY OBJECTIVES:

1. Determine efficacy (objective response rate (ORR)) of front-line pembrolizumab for metastatic EGFR mutation positive programmed cell death 1 ligand 1 (PD-L1)+ (> 1% by immunohistochemistry [IHC]) non-small cell lung cancer (NSCLC).

SECONDARY OBJECTIVES:

1. Determine safety (adverse event tabulation and grading) of front-line pembrolizumab for metastatic EGFR mutation positive PD-L1+ (> 1% by IHC) NSCLC.

2. Determine efficacy (progression free survival (PFS), overall survival (OS)) of front-line pembrolizumab for metastatic EGFR mutation positive PD-L1+ (>1% by IHC) NSCLC.

3. Determine ORR, PFS and OS of subsequent EGFR tyrosine kinase inhibitor (TKI) therapy in patients with EGFR-sensitizing mutation after pembrolizumab.

TERTIARY OBJECTIVE:

1. Analyze tumor tissue biomarkers for potential correlation with response.

OUTLINE:

Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for up at 3 and 6 months, and then every 9 weeks thereafter.

Study Design

• Study Type: Interventional
• Actual Enrollment: 11 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase II Study of Pembrolizumab in EGFR Mutant, Tyrosine Kinase Inhibitor Naïve Treatment Patients With Advanced Non-Small Cell Lung Cancer (NSCLC)
• Actual Study Start Date: Sep 15, 2016
• Actual Primary Completion Date: Nov 30, 2017
• Actual Study Completion Date: Jan 3, 2019

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Treatment (pembrolizumab) Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity.	Other: Laboratory Biomarker Analysis; Correlative studies; Biological: Pembrolizumab; Given IV; Other Names: Keytruda Lambrolizumab MK-3475 SCH 900475

Outcome Measures

Primary Outcome Measures

1. Overall Response Rate (ORR) Determined as the Percentage of Patients Achieving Complete Response or Partial Response as Respectively Defined in RECIST 1.1 [Up to 14 months]

   Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by accessed by radiographic imaging: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Secondary Outcome Measures

1. Number of Participants With Adverse Events According to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 [Up to 14 Months]

   Number of Participants with Adverse Events According to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0

2. Efficacy (Progression Free Survival (PFS) and Overall Survival (OS)) Assessed by RECIST 1.1 [assessed for up to 14 months]

   Will evaluate Progression Free Survival and Overall Survival. Average of Progression Free Survival recorded for limited number of subjects analyzed. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (PHI)

• Have a life expectancy of at least 3 months

• Have a histologically or cytologically confirmed diagnosis of non-small cell lung cancer (NSCLC) and have at least one measurable lesion as defined by modified Response Evaluation Criteria in Solid Tumors (RECIST) 1.1; the target lesion(s) should also have bi-dimensional measurability for RECIST 1.1 evaluation on study

• Have an EGFR mutation (sensitizing or non-sensitizing)

• Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) performance scale

• Absolute neutrophil count (ANC) >= 1,500 /microliters(mcL)

• Platelets >= 100,000 / mcL

• Hemoglobin >= 9 g/dL or >= 5.6 mmol/L without transfusion or erythropoietin (EPO) dependency (within 7 days of assessment)

• Serum creatinine =< 1.5 X upper limit of normal (ULN) OR measured or calculated creatinine clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance (CrCl)) >= 60 mL/min for subject with creatinine levels > 1.5 x institutional ULN

• Serum total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for subjects with total bilirubin levels > 1.5 ULN

• Aspartate transaminase (AST) (serum glutamic oxaloacetic transaminase (SGOT)) and alanine transferase (ALT) (serum glutamate pyruvate transaminase (SGPT)) =< 2.5 X ULN OR =< 5 X ULN for subjects with liver metastases

• Albumin >= 2.5 mg/dL

• International Normalized Ratio (INR) or Prothrombin Time (PT) =< 1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants

• Activated partial thromboplastin time (aPTT) =< 1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants

• Have provided tissue for PD-L1 biomarker analysis from a newly obtained formalin fixed tumor tissue from a biopsy of a tumor lesion not previously irradiated; the tissue sample must be received and evaluated by the study site prior to start of treatment; fine needle aspirates are not acceptable; needle or excisional biopsies, or resected tissue is required

• Have a PD-L1 positive (either strongly or weakly) tumor as determined by the IHC 22C3 pharmDx test at the study site; if a patient's initial tumor specimen is not classified as PD-L1 positive by the central laboratory, a newly obtained specimen (different from the sample previously submitted) may be submitted for testing; if the newer specimen is classified as PD-L1 positive by the study site, the patient meets this eligibility criterion

• Have resolution of toxic effect(s) of the most recent prior chemotherapy to grade 1 or less (except alopecia); if subject received major surgery or radiation therapy of > 30 Gy, they must have recovered from the toxicity and/or complications from the intervention

• Female subject of childbearing potential has a negative urine or serum pregnancy test; if the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required; the serum pregnancy test must be negative for the subject to be eligible

• Female subjects may be enrolled in the trial if they are:

• of non-childbearing potential which is defined as:

• of childbearing potential who are willing to use either 2 adequate barrier methods or a barrier method plus a hormonal method of contraception to prevent pregnancy, or to abstain from heterosexual activity throughout the trial, starting with the screening visit (visit 1) through 120 days after the last dose of MK-3475 (pembrolizumab)

• Male subjects should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy

Exclusion Criteria:

• Has received prior therapy with an EGFR tyrosine kinase inhibitor (such as erlotinib, gefitinib, afatinib, rociletinib, or AZD9291) for NSCLC

• Is currently participating or has participated in a study of an investigational agent or using an investigational device within 30 days of the first dose of trial treatment; the 30 day window should be applied to the last dose of an antineoplastic investigational agent or last use of an investigational device with antineoplastic intent

• Is receiving systemic steroid therapy within three days prior to the first dose of trial treatment or receiving any other form of immunosuppressive medication (corticosteroid use on study for management of early combined immunosuppression (ECIs) is allowed)

• Is expected to require any other form of systemic or localized antineoplastic therapy while on trial (including maintenance therapy with another agent for NSCLC or radiation therapy)

• Has received prior systemic cytotoxic chemotherapy, antineoplastic biological therapy (e.g., cetuximab), major surgery within 3 weeks of the first dose of trial treatment; received thoracic radiation therapy of > 30 Gy within 6 months of the first dose of trial treatment

• Has received prior therapy with an anti-programmed cell death protein 1 (PD-1), anti-PD-L1, anti-programmed cell death 1 ligand 2 (PD-L2), anti-cluster of differentiation 137 (CD137), or anti-cytotoxic t-lymphocyte-associated antigen-4 (CTLA-4) antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways); has participated in another MK-3475 clinical trial

• Has a known history of prior malignancy except if the patient has undergone potentially curative therapy with no evidence of that disease recurrence for 3 years since initiation of that therapy; Note: the time requirement for no evidence of disease for 3 years does not apply to the NSCLC tumor for which a subject is enrolled in this trial; the time requirement also does not apply to subjects who underwent successful definitive resection of basal cell carcinoma of the skin, superficial bladder cancer, squamous cell carcinoma of the skin, or in situ cervical cancer

• Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis; subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by magnetic resonance imaging [MRI] for at least two weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are using no steroids for at least three days prior to study medication

• Has an active autoimmune disease, or a documented history of autoimmune disease that required systemic steroids or immunosuppressive agents; subjects with vitiligo or resolved childhood asthma/atopy would be exception to this rule; subjects that require inhaled steroid or local steroid injections will not be excluded from the study; subjects with hypothyroidism not from autoimmune disease and stable on hormone replacement will not be excluded from the study

• Has had an allogeneic tissue/solid organ transplant

• Has interstitial lung disease or a history of pneumonitis that required oral or intravenous glucocorticoids to assist with management; lymphangitic spread of the NSCLC is not exclusionary

• Has received or will receive a live vaccine within 30 days prior to the first administration of study medication; seasonal flu vaccines that do not contain live virus are permitted

• Has an active infection requiring intravenous systemic therapy

• Has known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies)

• Has known active hepatitis B or C; active hepatitis B is defined as a known positive hepatitis B surface antigen (HBsAg) result; active hepatitis C is defined by a known positive hepatitis (Hep) C antibody (Ab) result and known quantitative hepatitis C virus (HCV) ribonucleic acid (RNA) results greater than the lower limits of detection of the assay

• Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator

• Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial

• Is, at the time of signing informed consent, a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol)

• Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit (visit 1) through 120 days after the last dose of MK-3475

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	UCLA / Jonsson Comprehensive Cancer Center	Los Angeles	California	United States	90095

Sponsors and Collaborators

• Jonsson Comprehensive Cancer Center
• Merck Sharp & Dohme LLC

Investigators

• Principal Investigator: Edward Garon, UCLA / Jonsson Comprehensive Cancer Center

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Dec 1, 2017
• Informed Consent Form - Feb 14, 2018

More Information

Publications

None provided.

• Responsible Party: Jonsson Comprehensive Cancer Center
• ClinicalTrials.gov Identifier: NCT02879994
• Other Study ID Numbers: 15-001818; NCI-2016-00861; Garon Pembrolizumab IST NSCLC; 15-001818
• First Posted: Aug 26, 2016
• Last Update Posted: Jul 14, 2021
• Last Verified: Sep 1, 2019

• Additional relevant MeSH terms: Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Pembrolizumab

Study Results

Participant Flow

Recruitment Details	September 15, 2016 - October 24, 2018 Recruitment Period

Arm/Group Title	Treatment (Pembrolizumab)
Arm/Group Description	Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity. Laboratory Biomarker Analysis: Correlative studies Pembrolizumab: Given IV
Period Title: Overall Study
STARTED	11
COMPLETED	0
NOT COMPLETED	11

Baseline Characteristics

Arm/Group Title	Treatment (Pembrolizumab)
Arm/Group Description	Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity. Laboratory Biomarker Analysis: Correlative studies Pembrolizumab: Given IV
Overall Participants	11
Age, Customized (Count of Participants)
18 - 21 years	0 0%
22 - 29 years	0 0%
30 - 39 years	1 9.1%
40 - 49 years	0 0%
50 - 59 years	3 27.3%
60 - 69 years	6 54.5%
70 - 79 years	1 9.1%
Sex: Female, Male (Count of Participants)
Female	7 63.6%
Male	4 36.4%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	0 0%
Not Hispanic or Latino	10 90.9%
Unknown or Not Reported	1 9.1%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%
Asian	5 45.5%
Native Hawaiian or Other Pacific Islander	0 0%
Black or African American	0 0%
White	6 54.5%
More than one race	0 0%
Unknown or Not Reported	0 0%
Region of Enrollment (participants) [Number]
United States	11 100%

Outcome Measures

1. Primary Outcome

Title	Overall Response Rate (ORR) Determined as the Percentage of Patients Achieving Complete Response or Partial Response as Respectively Defined in RECIST 1.1
Description	Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by accessed by radiographic imaging: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Time Frame	Up to 14 months

Outcome Measure Data

Analysis Population Description

Enrollment was ceased due to lack of efficacy after 11 of 25 planned patients were treated. Only 1 patient had an objective response, but repeat analysis of this patient's tumor definitively showed the original report of an epidermal growth factor receptor (EGFR) mutation to be erroneous.

Arm/Group Title	Treatment (Pembrolizumab)
Arm/Group Description	Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity. Laboratory Biomarker Analysis: Correlative studies Pembrolizumab: Given IV
Measure Participants	11
Count of Participants [Participants]	1 9.1%

2. Secondary Outcome

Title	Number of Participants With Adverse Events According to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0
Description	Number of Participants with Adverse Events According to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0
Time Frame	Up to 14 Months

Outcome Measure Data

Analysis Population Description

Enrollment was halted after 11 of 25 planned subjects due to lack of efficacy.

Arm/Group Title	Treatment (Pembrolizumab)
Arm/Group Description	Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity. Laboratory Biomarker Analysis: Correlative studies Pembrolizumab: Given IV
Measure Participants	11
Count of Participants [Participants]	11 100%

3. Secondary Outcome

Title	Efficacy (Progression Free Survival (PFS) and Overall Survival (OS)) Assessed by RECIST 1.1
Description	Will evaluate Progression Free Survival and Overall Survival. Average of Progression Free Survival recorded for limited number of subjects analyzed. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions
Time Frame	assessed for up to 14 months

Outcome Measure Data

Analysis Population Description

Participants analyzed is 10 because although 11 patients were treated, forensic analysis revealed that 1 subject did not have documented EGFR mutation. Regarding Overall Survival, median OS was not reached at time of data cutoff.

Arm/Group Title	Treatment (Pembrolizumab)
Arm/Group Description	Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity. Laboratory Biomarker Analysis: Correlative studies Pembrolizumab: Given IV
Measure Participants	10
Progression free survival	119

Adverse Events

Time Frame	Up to 14 months
Adverse Event Reporting Description	Period of active patient enrollment
Arm/Group Title	Treatment (Pembrolizumab)
Arm/Group Description	Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease progression or unacceptable toxicity. Laboratory Biomarker Analysis: Correlative studies Pembrolizumab: Given IV
All Cause Mortality
	Treatment (Pembrolizumab)
	Affected / at Risk (%)	# Events
Total	2/11 (18.2%)
Serious Adverse Events
	Treatment (Pembrolizumab)
	Affected / at Risk (%)	# Events
Total	6/11 (54.5%)
Blood and lymphatic system disorders
Hypercalcemia	1/11 (9.1%)	1
Hepatobiliary disorders
Elevated alanine aminotransferase	1/11 (9.1%)	1
Metabolism and nutrition disorders
Hypotension	1/11 (9.1%)	1
Musculoskeletal and connective tissue disorders
Back Pain	1/11 (9.1%)	1
Respiratory, thoracic and mediastinal disorders
Respiratory failure	1/11 (9.1%)	1
Pneumonitis	1/11 (9.1%)	1
Other (Not Including Serious) Adverse Events
	Treatment (Pembrolizumab)
	Affected / at Risk (%)	# Events
Total	6/11 (54.5%)
Blood and lymphatic system disorders
Alanine aminotransferase increased	1/11 (9.1%)	1
Aspartate aminotransferase increased	1/11 (9.1%)	1
Thyroid-stimulating hormone decreased	1/11 (9.1%)	1
Endocrine disorders
Adrenal insufficiency	1/11 (9.1%)	1
Gastrointestinal disorders
Diarrhea	2/11 (18.2%)	2
Hyperglycemia	1/11 (9.1%)	1
General disorders
Flu-like symptoms	2/11 (18.2%)	2
Chills	1/11 (9.1%)	1
Musculoskeletal and connective tissue disorders
Arthralgia	1/11 (9.1%)	1
Psychiatric disorders
Anorexia	1/11 (9.1%)	1
Skin and subcutaneous tissue disorders
Rash	3/11 (27.3%)	3
Pruritus	2/11 (18.2%)	2

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.