This is a multicenter, non-randomized, open-label, phase I/II study to evaluate the safety and tolerability of AMG 510 plus MVASI in subjects with advanced KRAS p.G12C mutant non-small cell lung cancer (NSCLC) with small, untreated brain metastases.
Each patient is scheduled to receive AMG 510 (KRASG12C inhibitor) in combination with MVASI (vascular endothelial growth factor \[VEGF\] inhibitor; bevacizumab biosimilar); both drugs will be provided by the study: AMG 510: Continuous once daily (QD) oral dosing (Days 1-21 each cycle) with or without food. MVASI: Intravenous (i.v.) infusion every 21 days (i.e. Day 1 of each 21-day cycle). The study will be conducted in 2 parts. The dose expansion part of the study (Part 2) can open once the maximum tolerated dose (MTD) and/or a biologically active dose (e.g. recommended phase 2 dose \[RP2D\]) using a 3+3 study design has been determined in Part 1. CNS response will be assessed using RANO-BM criteria, and non-CNS objective response will be based on Solid Tumor Response Criteria \[RECIST v1.1\] assessment of overall tumor burden at baseline versus that detected on subsequent CT/MRI re-scans. This includes a brain MRI on C2D1 (21 days) and a CT chest/abdomen/pelvis (C/A/P) at 6 weeks, then brain MRI at 15 weeks and CT C/A/P imaging at 12-16 weeks, and then every 4 cycles (every 12 weeks) while on study. It is intended that patients will be treated until disease progression or intolerable toxicity. Patients will be followed for survival for up to 18 months after ending study treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Vanderbilt Ingram Cancer Center
Nashville, Tennessee, United States
Dose Exploration
To determine the feasibility and safety of AMG 510 in combination with MVASI for the treatment of patients with KRAS G12C mutant NSCLC with asymptomatic, untreated brain metastases. For patients enrolled in the dose exploration part of the study (anticipated to be the initial 9-18 patients participating in the study), whose participation will establish the recommended phase 2 dose (RP2D), dedicated surveillance and expedited reporting of Dose Limiting Toxicity (DLT) required for 21 days after initiating protocol-indicated treatment. Satisfactory completion of the physical exam and safety labs is required to help detect evidence of past or present DLT as having occurred during the first 21 days of protocol-indicated treatment.
Time frame: 21 days
Dose Expansion
To determine the CNS objective response and rate of salvage radiation to the CNS 18 weeks after therapy initiation. The CNS objective response rate using Rando-BM will be evaluated at 18 weeks. Whether or not the patient requires salvage radiation therapy will be evaluated at 18 weeks
Time frame: 18 weeks
Dose Exploration
Safety and tolerability (phase I component). Dedicated surveillance and expedited reporting of Dose Limiting Toxicity (DLT) is required for 21 days after initiating protocol-indicated treatment A minimum of 6 patients will be treated at the Maximum tolerated dose on the phase I portion of the study in order to obtain sufficient toxicity data prior to proceeding to the phase II evaluation of this regimen
Time frame: 21 days
Dose Expansion
CNS objective response, assessed using RANO-BM.
Time frame: 18 weeks
Dose Expansion
Initiation of salvage radiation therapy to the CNS at 18 weeks (phase II component).
Time frame: 18 weeks
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Dose Expansion
To evaluate systemic disease control by progression free survival and overall survival.
Time frame: 18.5 months
Dose Expansion
Non-CNS overall response (ORR), assessed using RECIST v1.1.
Time frame: 18 weeks
Dose Expansion
Non-CNS progression-free survival (PFS).
Time frame: 18.5 months
Dose Expansion
Overall Survival (OS).
Time frame: 18.5 months