This phase Ib trial studies the side effects and best dose of brigatinib and how well it works with bevacizumab in treating patients with ALK-rearranged non-small cell lung cancer that has spread to nearby tissues or lymph nodes (locally advanced) or other places in the body (metastatic) or has come back (recurrent). Brigatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. It is not yet known if brigatinib and bevacizumab will work better in treating patients with ALK-rearranged non-small cell lung cancer.
PRIMARY OBJECTIVE: I. To determine toxicity and tolerability, and the maximum tolerated dose (MTD) of brigatinib and bevacizumab in patients with ALK rearranged non-small cell lung cancer (NSCLC). SECONDARY OBJECTIVES: I. To describe the dose-limiting toxicities of brigatinib in combination with bevacizumab. II. To estimate overall response rate (ORR) to treatment with brigatinib and bevacizumab. III. To estimate the duration of response as defined by the time of first documented clinical benefit to the time of progression. IV. To estimate patient survival by measuring progression free survival (PFS) as defined by the time from treatment initiation to documented disease progression or death from any cause. Overall survival (OS) as defined by the time from treatment initiation until death due to any cause. EXPLORATORY OBJECTIVES: I. To identify predictive biomarkers using genetics and tumor immunology-based assessment platforms. Ia. Analysis with next-generation sequencing (NGS) to identify predictive biomarkers for response using tissue and cerebral spinal fluid (CSF) (optional for patients with brain metastases). Ib. Tumor tissue will be obtained at baseline, and cell free deoxyribonucleic acid (DNA) (cfDNA)/cell tumor DNA (ctDNA) obtained at baseline and the time of progression or study completion will be evaluated for genomic alterations and biomarkers. II. Evaluation of central nervous system (CNS) penetration through cerebral spinal fluid (CSF) obtained by lumbar puncture on cycle 2 day 1 (C2D1) (with time matched pharmacokinetic \[PK\] blood draw), and at progression or study completion for consenting patients (optional). OUTLINE: This is a dose-escalation study of brigatinib. Patients receive brigatinib orally (PO) once daily (QD) on days 1-28 of cycle 1 and days 1-21 of subsequent cycles. Patients also receive bevacizumab intravenously (IV) on day 8 of cycle 1 and day 1 of subsequent cycles. Starting cycle 2, cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 days, 3, 6, 9, and 12 months, then every 6 months for up to 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
5
Given IV
Given PO
City of Hope Medical Center
Duarte, California, United States
University of Colorado Cancer Center
Aurora, Colorado, United States
Northwestern University
Chicago, Illinois, United States
Rush University Medical Center
Chicago, Illinois, United States
Penn State Cancer Institute
Hershey, Pennsylvania, United States
University of Wisconsin Hospital and Clinics
Madison, Wisconsin, United States
Incidence of adverse events
Will be assessed using Common Terminology Criteria for Adverse Events (CTCAE) 5.0.
Time frame: Within 30 days of treatment discontinuation or prior to start of next treatment
Maximum tolerated dose
Will be determined by dose limiting toxicities and assessed using CTCAE 5.0.
Time frame: Up to 28 days
Dose-limiting toxicities
Will be evaluated in the first 28 days of treatment for the first 6-12 patients in the safety cohort to determine any dose limiting toxicities at this dose.
Time frame: Up to 28 days
Overall response rate
Will be defined as the overall number of patients with complete response plus partial response and assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. A proportion and exact 95% binomial confidence interval will be calculated.
Time frame: Up to 3 years
Duration of response
Will be analyzed using medians and ranges.
Time frame: From first documentation of clinical benefit from treatment to the time of documentation of progressive disease or death, whichever comes first, assessed up to 3 years
Progression-free survival (PFS)
Will be estimated using the Kaplan-Meier method. If there is a change of treatment in multiple patients, then a competing risk cumulative incidence for PFS will be calculated using the treatment change as a competing risk.
Time frame: From treatment initiation to the time of documented disease progression or death from any cause, whichever comes first, assessed up to 3 years
Overall survival (OS)
Will be estimated using the Kaplan-Meier method.
Time frame: From treatment initiation until death due to any cause, assessed up to 3 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.