DESTINY-Lung03 will investigate the safety and tolerability of trastuzumab deruxtecan in combination with Immunotherapy Agents with and without chemotherapy in patients with HER2 over-expressing non-small cell lung cancer. The efficacy will be also analyzed as a secondary endpoint.
Part 1 is a dose escalation study by design, allowing the assessment of safety, tolerability, and recommended dose levels of the combination of T-DXd and durvalumab plus cisplatin, carboplatin, or pemetrexed. No more patients will be enrolled in this part of the study. Part 2, expansions in the treatment-naïve setting on any recommended dose level, will not be initiated. The evaluation of T-DXd combination treatment with immunotherapy continues in Part 3, Part 4, and Part 5. In Part 3, T-DXd is assessed in combination with volrustomig, with carboplatin (Arm 3B) or without carboplatin (Arm 3A). Part 4 examines T-DXd with rilvegostomig, either with carboplatin (Arm 4B) or without carboplatin (Arm 4A). In Part 5, T-DXd is evaluated with volrustomig, given with or without a priming dose followed by a fixed dose in Arm 5A. There is also an optional Arm 5B at the Sponsor's discretion. These parts focus on further dose optimization for first-line HER2-overexpressing NSCLC. For Part 3, patients will be randomized to Arms 3A and 3B, beginning with the cohorts receiving the volrustomig starting dose (SD). A total of 6 DLT-evaluable patients will be enrolled to the SD cohorts in each arm. If the combination of T-DXd with volrustomig at the starting dose is deemed safe, a dose escalation (E1) cohort will be opened for 6 DLT-evaluable patients. Once all open dose confirmation cohorts have 6 DLT-evaluable patients, the SRC will convene to select the volrustomig RP2D to be used in the dose-expansion (DE) cohorts of each arm (n=34). Part 3 is now permanently closed to recruitment; no further patients will be enrolled. In Part 4, once a total of 6 DLT-evaluable patients/arm have been enrolled into Arm 4A and Arm 4B safety-run in (SR) cohorts and deemed safe, an additional 34 patients per arm will be enrolled in Arms 4A and 4B in dose expansion cohorts. Part 5 involves additional dosing regimens of T-DXd in combination with volrustomig. The objective of Part 5 is to evaluate the safety and efficacy of priming and flat dosing regimens in 2 different cohorts of up to 30 patients per arm. The target population of interest (for Part 3, 4 and 5) are patients with advanced or metastatic non-small cell lung cancer measurable disease by RECIST 1.1 criteria, HER2 overexpression, ECOG PS of 0 to 1, patients who are treatment naïve for recurrent, unresectable or metastatic disease. Patients with tumors that harbor a known genomic alteration or driver for which approved therapies are available are excluded.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
244
T-DXd: administered as an IV infusion
Durvalumab: administered as an IV infusion
Cisplatin: administered as an IV infusion
Frequency of AEs and SAEs
Occurrence of AEs and SAEs graded according to NCI CTCAE v5.0
Time frame: Safety and tolerability (and to determine RP2D) will be assessed for approximately 20 months from informed consent
Confirmed Objective Response Rate (ORR)
Confirmed ORR per RECIST 1.1 is the percentage of patients with Complete Response or Partial Response that is subsequently confirmed, based on investigator assessment
Time frame: An average of approximately 12 months
Duration of Response (DoR)
DOR is defined as the time from the date of first documented response until the date of documented progression or death, based on RECIST 1.1 assessment
Time frame: An average of approximately 20 months
Disease Control Rate (DCR)
DCR is the percentage of patients who have a best overall response of complete response (CR) or partial response (PR) or stable disease (SD), based on RECIST 1.1 assessment. DCR is assessed at 6 and 12 weeks
Time frame: An average of approximately 12 months
Progression-free survival (PFS)
PFS is the time from first dose of study treatment until the date of objective disease progression or death, based on RECIST 1.1 assessment
Time frame: An average of approximately 20 months
Overall survival (OS)
OS is the time form the date of first dose of study treatment until death due to any cause
Time frame: An average of approximately 20 months
Pharmacokinetics (PK) assessed by the serum concentration of T-DXd, total anti-HER2 antibody, and MAAA-1181 in all arms
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Carboplatin: administered as an IV infusion
Pemetrexed: administered as an IV infusion (drug not used)
Volrustomig: administered as an IV infusion
Rilvegostomig: administered as an IV infusion
Research Site
Duarte, California, United States
WITHDRAWNResearch Site
Newport Beach, California, United States
WITHDRAWNResearch Site
Orange, California, United States
RECRUITINGResearch Site
Santa Rosa, California, United States
WITHDRAWNResearch Site
Westwood, Kansas, United States
WITHDRAWNResearch Site
Baltimore, Maryland, United States
RECRUITINGResearch Site
Detroit, Michigan, United States
WITHDRAWNResearch Site
Buffalo, New York, United States
WITHDRAWNResearch Site
New York, New York, United States
WITHDRAWNResearch Site
The Bronx, New York, United States
WITHDRAWN...and 76 more locations
Individual patient data and descriptive statistics will be provided for serum concentration data at each time point for T-DXd, total anti-HER2 antibody and MAAA-1181a
Time frame: An average of approximately 20 months
Pharmacokinetics (PK) assessed by the serum concentration of durvalumab in study arms including T-DXd in combination with durvalumab
Individual patient data and descriptive statistics will be provided for serum concentration data at each time point for durvalumab, including T-DXd in combination with durvalumab
Time frame: An average of approximately 20 months
Pharmacokinetics (PK) assessed by the serum concentration of volrustomig in study arms including T-DXd in combination with volrustomig
Individual patient data and descriptive statistics will be provided for serum concentration data at each time point for volrustomig, including T-DXd in combination with volrustomig
Time frame: An average of approximately 20 months
Pharmacokinetics (PK) assessed by the serum concentration of rilvegostomig in study arms including T-DXd in combination with rilvegostomig
Individual patient data and descriptive statistics will be provided for serum concentration data at each time point for rilvegostomig, including T- DXd in combination with rilvegostomig
Time frame: An average of approximately 20 months
The immunogenicity of T-DXd, durvalumab, volrustomig and rilvegostomig assessed by the presence of ADAs for T-DXd, durvalumab, volrustomig, or rilvegostomig
Individual participant data and descriptive statistics will be provided for data at each time point for each dose level for T-DXd, durvalumab or volrustomig, or rilvegostomig
Time frame: An average of approximately 20 months