This is a prospective, single arm, phase Ib/IIa study. Up to 25 patients will be enrolled into the study (Part A: 2-18; Part B: 7-19). The study has been designed to allow an investigation of the optimal combination dose and schedule whilst of Osimertinib plus Anlotinib in patients with EGFRm+, treatment-naïve IIIb/IV Non-Small Cell Lung Cancer (NSCLC) ensuring the safety of patients with intensive safety monitoring. There are two main parts to this study; Part A, Combination dose finding and Parts B, Dose expansion.
Part A has been designed to identify the recommended dose of the combination of Osimertinib plus Anlotinib for further clinical evaluation based upon assessment of the safety and tolerability data collected during the first 21 days (cycle 1, 21 days per cycle). A cycle of study treatment will be defined as 21 days. Dosing will begin at Osimertinib 80mg QD continuously and Anlotinib 8mg QD from day1 to 14 of a 21-day cycle. In the first 6 patients, a delay of at least 21 days (the first group of 3 patients) and a delay of at least 7 days (the second group of 3 patients) will be mandatory between the administration of the first dose to the first patient and administration of first dose to subsequent patients. Patients will be enrolled to ensure a minimum of 3 and a maximum of 6 evaluable patients per cohort. Dose escalation and de-escalation will follow the scheme below, according to the following logic:If no dose-limiting toxicity (DLT) is observed (for definition see Section 4.1.3) in a cohort of 3 evaluable patients then dose escalation may occur. Dose increases will be permitted after review of data from a minimum of 3 evaluable patients has been performed. * If one patient experiences a DLT in a group of 3 evaluable patients then the cohort will be expanded to include 6 evaluable patients. If only one DLT is observed in the complete cohort of 6 evaluable patients then dose escalation may occur. * If 2 or more patients experience a DLT in a group of up to 6 patients, irrespective of the number of patients enrolled, the dose will be considered not tolerated and recruitment to the cohort and dose escalation will cease. Safety will be intensively monitored in part A. If RP2D was not reached in Part A, Part B would not be initiated. If RP2D was reached in Part A, eligible patients in part B will be enrolled and receive Osimertinib (80mg QD, continuously) plus Anlotinib (RP2D, QD from day 1 to 14 of a 21-day cycle) till disease progression (PD) or unacceptable toxicity, with the aim to further evaluate the safety, tolerability and efficacy in terms of ORR, DCR, DOR, PFS, overall survival at 12 months. For all eligible patients (Part A and Part B), tissue and/or blood samples at baseline and PD will be collected to understand the resistance profile.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Osimertinib, 80mg, QD, p.o.
(Phase Ib) Anlotinib, from 8mg to10mg to 12mg, QD, p.o. from day 1 to 14 of a 21-day cycle. (Phase IIa)Anlotinib, given at RP2D dose QD, p.o. from day 1 to 14 of a 21-day cycle.
Shanghai Chest hospital
Shanghai, Shanghai Municipality, China
Recommended Phase II Dose(RP2D)
RP2D is defined as the dose cohort as follows: (1). If 2 or more of 6 patients in cohort 1 experienced a DLT, the combination would not be considered tolerable. There would be no RP2D and no dose expansion. (2). If none of the first 3 patients or 1 of 6 patients in starting dose cohort 1 experienced a DLT, dose escalation to cohort 2 would be done in the next 3 to 6 patients. If 2 or more patients experienced a DLT in up to 6 patients in cohort 2, the RP2D will defined as Osimertinib 80mg and Anlotinib 8mg. (3).If none of the first 3 patients or 1 of 6 patients in cohort 2 experienced a DLT, dose escalation to cohort 3 would be done in the next 3 to 6 patients. If 2 or more patients experience a DLT in up to 6 patients in cohort 3, the RP2D will defined as Osimertinib 80mg and Anlotinib 10mg. (4). If none of the first 3 patients or 1 out of 6 patients experienced a DLT in cohort 3, the RP2D would be Osimertinib 80mg and Anlotinib 12mg.
Time frame: Up to approximately 6 months
ORR according to RECIST Version 1.1
According to RECIST 1.1, the proportion of subjects whose tumors were assessed as CR+PR by subcenter imaging evaluation was recorded from the time they were first treated until disease progression or initiation of a new anticancer treatment.
Time frame: Up to approximately 3 years following the first dose of study drug
Dose-limiting toxicity (DLT)
A DLT is defined as any toxicity not attributable to the disease or disease-related processed under investigation.
Time frame: occurs from the first dose of study drug (Day 1, Cycle 0) up to the last day of Cycle 1 (21 days after start of dosing)
Disease Control Rate (DCR)
Proportion of patients whose tumors shrink or remain stable for a certain period of time, including CR, PR, and SD;
Time frame: Up to approximately 3 years following the first dose of study drug
Duration of disease remission (DOR)
The time from objective tumor remission (CR or PR) to objective tumor progression or death for any reason (whichever occurs first) was recorded for the first time.
Time frame: Up to approximately 3 years following the first dose of study drug
Disease progression-free survival(PFS)
The time from the first use of the drug into the group to the progression of the disease or death (in terms of the first appearance)
Time frame: Up to approximately 3 years following the first dose of study drug
Overall Survival(OS)
The time from the first use of the drug into the group to the time of all-cause death. For the subjects who were still alive at the last follow-up, the OS was deleted according to the time of the last follow-up. For the subjects who lost the follow-up, their OS was counted as data deletion according to the last confirmed survival time before the loss of follow-up.
Time frame: Up to approximately 5 years following the first dose of study drug
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