This phase Ib trial studies the side effects and best dose of telaglenastat hydrochloride when given together with osimertinib in treating patients with stage IV non-small cell lung cancer and a mutation in the EGFR gene. Telaglenastat hydrochloride and osimertinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVE: I.To assess the safety and tolerability of osimertinib (AZD9291) and telaglenastat (CB-839) hydrochloride (HCl) and determine the recommended phase II dose (RP2D) in patients with metastatic, EGFR activating mutation-positive non-small cell lung cancer (NSCLC). SECONDARY OBJECTIVES: I. To determine toxicity profile of the combination of osimertinib (AZD9291) and telaglenastat (CB-839) HCl in patients with metastatic EGFR activating mutation positive NSCLC. II. To assess the pharmacokinetics (PK) of telaglenastat (CB-839) HCl and osimertinib (AZD9291) in patients with metastatic EGFR activating mutation positive NSCLC. EXPLORATORY/CORRELATIVE OBJECTIVES: I. To determine the progression free survival (PFS) of osimertinib (AZD9291) and telaglenastat (CB-839) HCl in patients with EGFR mutation positive NSCLC who have developed progressive disease (PD) on front-line EGFR inhibitor therapy. II. To determine the overall survival (OS) of osimertinib (AZD9291) and telaglenastat (CB-839) HCl in patients with EGFR mutation positive NSCLC who have developed PD on front-line EGFR inhibitor therapy. III. To assess cell-free deoxyribonucleic acid (DNA) (cfDNA) and measure changes with response to treatment as well as disease progression (EGFR sensitizing mutations, T790M resistance mutation, recognized bypass mechanisms). IV. To assess circulating levels of glutamine, glutamate, aspartate and asparagine, and measure changes with response to treatment as well as disease progression. V. To assess 18F-fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET) parameters at baseline and after treatment to evaluate changes with response to treatment as well as emergence of disease resistance or progression. (Expansion cohort, select patients only) VI. To perform molecular profiling assays on malignant and normal tissues, including, but not limited to, whole exome sequencing (WES) and ribonucleic acid (RNA) sequencing (RNAseq), in order to: VIa. To identify potential predictive and prognostic biomarkers beyond any genomic alteration by which treatment may be assigned. VIb. To identify resistance mechanisms using genomic DNA- and RNA-based assessment platforms. OUTLINE: This is a phase I, dose-escalation study of telaglenastat hydrochloride followed by a dose-expansion study. Patients receive telaglenastat hydrochloride orally (PO) twice daily (BID) and osimertinib PO once daily (QD) (starting cycle 1 day 16 of phase I). Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and may undergo x-ray imaging, computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan throughout the study. After completion of study treatment, patients are followed up at 30 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Undergo blood sample collection
Undergo CT scan
Undergo MRI
Given PO
Undergo PET scan
Given PO
Undergo x-ray imaging
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables, Florida, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, United States
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation, Florida, United States
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, United States
Case Western Reserve University
Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, United States
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, United States
...and 1 more locations
Recommended Phase II Dose (RP2D)
Time frame: Up to 28 days
Dose Limiting Toxicities (DLT)
Will be assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Frequency and severity of adverse events and tolerability of the regimen will be collected and summarized by descriptive statistics. The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns.
Time frame: Up to 28 days
Progression-free Survival (PFS)
Survival will initially be modeled using Kaplan-Meier methods, resulting in median survival times with 95% CI, assuming sufficient events have occurred.
Time frame: From initiation of therapy to documented progression or death without progression, assessed up to 30 days after completion of therapy
Overall Survival (OS)
Survival will initially be modeled using Kaplan-Meier methods, resulting in median survival times with 95% CI, assuming sufficient events have occurred.
Time frame: From initiation of therapy to death from any cause, assessed up to 30 days after completion of therapy
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