A Study of Adagrasib Plus Pembrolizumab Plus Chemotherapy vs. Placebo Plus Pembrolizumab Plus Chemotherapy in Participants With Previously Untreated Non-squamous Non-small Cell Lung Cancer With KRAS G12C Mutation (KRYSTAL-4)

Mirati Therapeutics

Status and phase: Enrolling; Phase 3

Conditions: Carcinoma, Non-Small-Cell Lung

Treatments: Drug: Placebo; Drug: Pemetrexed; Drug: Pembrolizumab; Drug: Adagrasib; Drug: Cisplatin; Drug: Carboplatin

Study type: Interventional

Funder types: Industry

Identifiers

NCT06875310

CA2390004 (Other Identifier)

CA239-0004

Details and patient eligibility

About

This is a trial to evaluate the efficacy, safety, and tolerability of adagrasib plus pembrolizumab plus platinum-doublet chemotherapy versus placebo plus pembrolizumab plus platinum-doublet chemotherapy in participants with previously untreated, locally advanced or metastatic NSCLC with KRAS G12C mutation

Enrollment: 630 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histologically or cytologically confirmed diagnosis of non-squamous NSCLC with evidence of KRAS G12C mutation via tumor sample and/or circulating tumor deoxyribonucleic acid (ctDNA).
• Locally advanced or metastatic disease.
• Measurable disease via computed tomography (CT) or magnetic resonance imaging (MRI) per RECIST v1.1 criteria of at least 1 lesion.
• No prior systemic anti-cancer therapy given for advanced or metastatic disease.
• Not a candidate for definitive therapy (eg, chemoradiation or complete surgical resection).
• Participants with brain metastases are eligible for enrollment, including those with untreated brain metastases. Brain metastases must be asymptomatic and not in need of immediate local therapy. Any untreated brain metastases must be ≤ 20 mm in diameter.
• Any PD-L1 expression (0 to 100%) as determined by VENTANA PD-L1 (SP263) assay, Agilent PD-L1 IHC 22C3 pharmDx, or Agilent PD-L1 IHC 28-8 pharmDx.

Exclusion criteria

• Participants with an active autoimmune or inflammatory disease requiring systemic treatment within 2 years.
• Uncontrolled or significant cardiovascular conditions within 6 months prior to enrollment that are ongoing or with risk of recurrence.
• Inadequate bone marrow or liver function or electrocardiogram (ECG) abnormalities.
• Ongoing treatment with concomitant medication known to cause prolonged QTc interval and that cannot be switched to alternative treatment prior to study entry.
• Treatment targeting KRAS G12C mutation (eg, sotorasib, adagrasib) in any setting.
• Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration.
• Other protocol-defined Inclusion/Exclusion criteria apply.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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630 participants in 2 patient groups, including a placebo group

Adagrasib

Experimental group

Treatment:

Drug: Carboplatin

Drug: Cisplatin

Drug: Pembrolizumab

Drug: Adagrasib

Drug: Pemetrexed

Placebo

Placebo Comparator group

Treatment:

Drug: Carboplatin

Drug: Cisplatin

Drug: Pembrolizumab

Drug: Pemetrexed

Drug: Placebo