A Study of the Combination of Osimertinib, Platinum and Etoposide for Patients With Metastatic EGFR Mutant Lung Cancers

Memorial Sloan Kettering Cancer Center (MSK)

Status and phase: Active, not recruiting; Phase 1

Conditions: Lung Cancer

Treatments: Drug: Osimertinib; Drug: Etoposide; Drug: Platinum

Study type: Interventional

Funder types: Other

Identifiers

NCT03567642

18-211

Details and patient eligibility

About

The purpose of this study is to test the safety of combining Osimertinib with either Cisplatin or Carboplatin (at different dose levels) and Etoposide, to find out what effects, if any, this combination of drugs has on people with EGFR mutant lung cancer.

Enrollment: 11 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Written informed consent

• Advanced biopsy-proven metastatic non-small cell lung cancer

• Either have not started an EGFR TKI or may have started osimertinib within the last 9 weeks

• Somatic activating mutation in EGFR in pre-treatment tumor biopsy or cfDNA

• Evidence of a concurrent P53 alteration by IHC or NGS on pre-treatment tumor biopsy or cfDNA

• Evidence of a concurrent RB1 alteration by IHC or NGS on pre-treatment tumor biopsy or cfDNA

• Must have a site of disease amenable to repeat biopsy and be willing to undergo a biopsy during treatment

• Measurable (RECIST 1.1) indicator lesion not previously irradiated

• Karnofsky performance status (KPS) ≥ 70%

• Age >18 years old

• Ability to swallow oral medication

• Adequate organ function

  • AST, ALT ≤ 3 x ULN
  • Total bilirubin ≤ 1.5x ULN
  • Creatinine ≤ 1.5x ULN OR calculated creatinine clearance ≥ 60ml/min
  • Absolute neutrophil count (ANC) ≥ 1000 cells/mm^3
  • Hemoglobin≥8.0 g/dL
  • Platelets ≥100,000/mm^3

Exclusion criteria

• Pregnant or lactating women
• Started an EGFR TKI other than osimertinib or started osimertinib more than 9 weeks ago
• Any radiotherapy within 1 week of starting treatment on protocol.
• Any major surgery within 1 weeks of starting treatment on protocol.
• Any evidence of active clinically significant interstitial lung disease
• Continue to have unresolved > grade 1 toxicity from any previous treatment
• Have pure small cell histology
• Corrected QT interval using Fridericia's formula (QTcF)>475msec or any clinically significant (as deemed by the investigator) abnormalities in rhythm or conduction or morphology of the resting EKG.
• Patients are to be excluded from cisplatin treatment arm if they meet any of the following criteria:
• Creatinine clearance < 60 ml/min
• Hearing impairment requiring assistive device
• Neuropathy
• The treating provider does not feel as though the patient should receive cisplatin

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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11 participants in 1 patient group

Osimertinib, Platinum (cisplatin or carboplatin) and Etoposide

Experimental group

Description:

Initially, 6 patients will be enrolled and will begin treatment with osimertinib 80mg orally daily (3 who will be receiving cisplatin and 3 who will be receiving carboplatin). Cisplatin or carboplatin treatment will be decided by the treating physician prior to study registration. After 9 weeks (+/- 1 week)( 3 cycles) on osimertinib alone, carboplatin or cisplatin and etoposide will be added. Carboplatin is doses at an AUC of 5 or cisplatin at 60mg/m2 will be given on C4D1. Etoposide is dosed at 100mg/m2 given on Days 1-3 of C4. Only patients on osimertinib 80mg orally daily at the start of cycle 4 will be included in the 3+3 dose de-escalation portion of the study. Chemotherapy and osimertinib will be administered concurrently during cycles 4-7, and from cycle 8 onward, osimertinib monotherapy will be continued. Patients will present every 2 cycles post-chemo (Cycles 8, 10, 12, etc.)

Treatment:

Drug: Platinum

Drug: Etoposide

Drug: Osimertinib