This is a phase 2 study to investigate NC318 alone or in combination with Pembrolizumab in patients with advanced non-small cell lung cancer.
This is a non-randomized, three-arm trial. Arm 1a and 1b will enroll patients with advanced NSCLC regardless of tumor PD-L1 expression who have experienced disease progression on or after PD-1 axis inhibitor therapy, given alone or in combination with other systemic anti-cancer therapy. Patients will be assigned to arm 1a or 1b at the discretion of the treating physician. Patients on arm 1a will receive NC318 alone; those on arm 1b, combination therapy with NC318 and pembrolizumab. Arm 1a will be based on a Simon two-stage minimax design. In the first stage, 18 patients will be accrued. If tumor response per RECIST v1.1 is achieved in 2 or fewer patients, arm 1a will be closed to further enrollment. If tumor response is demonstrated in 3 or more patients, then 25 additional patients will be accrued (stage 2), for a total of 43 patients. Arm 1a and 1b will start with a safety run-in portion consisting of 6 patients (see 4.1.1). If deemed safe, each arm will continue to accrue and follow the Simon two-stage design outlined above. Patients in the run-in portion will be included in stage 1 of the Simon two-stage design. Arm 2 will enroll patients with advanced NSCLC and tumor PD-L1 expression less than 50% who are naïve to PD-1 axis inhibitor therapy. Patients on arm 2 will receive combination therapy with NC318 and pembrolizumab. Arm 2 will also start with a safety run-in portion identical to that of arms 1a and 1b (see 4.1.1). If deemed safe, accrual will continue following a Simon two-stage minimax design. In the first stage, 19 patients will be accrued. If tumor response per RECIST v1.1 is achieved in 3 or fewer patients, arm 2 will be closed to further enrollment. If tumor response is demonstrated in 4 or more patients, then 36 additional patients will be accrued (stage 2), for a total of 54 patients. Patients in the run-in portion will be included in stage 1 of the Simon two-stage design. The study protocol was amended to add 2 additional arms 5/2023. Arms 1c and 2a will receive NC318 800 mg, IV weekly for 8 doses, followed by every 2 week dosing. They both follow the same procedures as the earlier arms in the study. Arm 2 has essentially been removed from the study- but remains included in the protocol registration. In addition, patients treated on arm 1a will be allowed to receive combination therapy with NC318 and pembrolizumab at the time of progression, after a mandatory tumor biopsy. They will be considered separately from arm 1c.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
159
NC318 will be given intravenously (IV) weekly for 8 doses and then every 2 weeks for patients receiving combination therapy treatment or weekly for patient receiving NC318 in monotherapy.
NC318 will be given intravenously (IV) every 2 weeks.
Pembrolizumab 200 mg will be given IV every 3 weeks
Yale University
New Haven, Connecticut, United States
Objective response rate (ORR) in Arm 1a
To determine the objective response rate (ORR) using RECIST v1.1 to NC318 in arm 1a
Time frame: Tumor response will be based on tumor assessments at screening, every 8 weeks from the first dose (for the first 24 weeks) and thereafter every 12 weeks until investigator-assessed initial disease progression, up to 4 years
Objective response rate (ORR) in Arm 1b
To determine the objective response rate (ORR) using RECIST v1.1 to NC318 combined with pembrolizumab in arm 1b
Time frame: Tumor response will be based on tumor assessments at screening, every 8 weeks from the first dose (for the first 24 weeks) and thereafter every 12 weeks until investigator-assessed initial disease progression, up to 4 years
Objective response rate (ORR) in Arm 1c
To determine the objective response rate (ORR) using RECIST v1.1 to NC318 combined with pembrolizumab in arm 1b
Time frame: Tumor response will be based on tumor assessments at screening, every 8 weeks from the first dose (for the first 24 weeks) and thereafter every 12 weeks until investigator-assessed initial disease progression, up to 4 years
Number of participants on Arm 1b with treatment related adverse events as assessed by CTCAE v5
To determine the safety of NC318 when administered in combination with pembrolizumab in arm 1b
Time frame: Safety run in of 6 weeks
Number of participants on Arm 1c with treatment related adverse events as assessed by CTCAE v5
To determine the safety of NC318 when administered in combination with pembrolizumab in arm 1b
Time frame: Safety run in of 6 weeks
Objective response rate (ORR) in Arm 2
To determine the objective response rate (ORR) using RECIST v1.1 to NC318 combined with pembrolizumab in arm 2
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Time frame: Tumor response will be based on tumor assessments at screening, every 8 weeks from the first dose (for the first 24 weeks) and thereafter every 12 weeks until investigator-assessed initial disease progression, up to 4 years
Objective response rate (ORR) in Arm 2a
To determine the objective response rate (ORR) using RECIST v1.1 to NC318 combined with pembrolizumab in arm 2
Time frame: Tumor response will be based on tumor assessments at screening, every 8 weeks from the first dose (for the first 24 weeks) and thereafter every 12 weeks until investigator-assessed initial disease progression, up to 4 years
Number of participants in arm 2 with treatment related adverse events as assessed by CTCAE v5
To determine the safety of NC318 when administered in combination with pembrolizumab in arm 2
Time frame: Safety run in of 6 weeks
Number of participants in arm 2a with treatment related adverse events as assessed by CTCAE v5
To determine the safety of NC318 when administered in combination with pembrolizumab in arm 2
Time frame: Safety run in of 6 weeks
Progression-free survival (RECIST v1.1) Arm 1a
To determine progression-free survival (RECIST v1.1) with NC318 in patients with pre-treated advanced NSCLC who have experienced disease progression on or after anti-PD-1 axis therapy.
Time frame: Until disease progression or death, up to 4 years
Overall Survival (RECIST v1.1) Arm 1a
To determine overall survival with NC318 in patients with pre-treated advanced NSCLC who have experienced disease progression on or after anti-PD-1 axis therapy.
Time frame: Until death, up to 5 years
Progression-free survival (RECIST v1.1) Arm 1B
To determine progression-free survival (RECIST v1.1) with NC318 combined with pembrolizumab in patients with pre- treated advanced NSCLC who have experienced disease progression on or after anti-PD-1 axis therapy.
Time frame: Until disease progression or death, up to 4 years
Overall survival (RECIST v1.1) Arm 1B
To determine overall survival (RECIST v1.1) with NC318 combined with pembrolizumab in patients with pre- treated advanced NSCLC who have experienced disease progression on or after anti-PD-1 axis therapy.
Time frame: Until death, up to 5 years
Progression-free survival (RECIST v1.1) Arm 2
To determine progression-free survival (RECIST v1.1) with NC318 and pembrolizumab when administered in combination to patients with PD-1 inhibitor naïve advanced NSCLC with tumor PD-L1 expression less than 50 percent.
Time frame: Until disease progression or death, up to 4 years
Overall survival (RECIST v1.1) Arm 2
To determine overall survival (RECIST v1.1) with NC318 and pembrolizumab when administered in combination to patients with PD-1 inhibitor naïve advanced NSCLC with tumor PD-L1 expression less than 50 percent.
Time frame: Until death, up to 5 years