EGFR mutation positive advanced NSCLC patients with uncleared ctDNA have poor prognosis, whether they can benefit from combination therapy has not been reported. This study aims to investigate the efficacy and safety of combination therapy compared with furmonertinib monotherapy in advanced EGFR mutant NSCLC with uncleared circulating tumor cell DNA.
This is a prospective, multicenter, randomized, open label, clinical study in China. In total the study aims to screen 720 patients and enroll approximately 280 advanced NSCLC patients with EGFR mutation positive circulating tumor cell DNA, consisting of 47 patients whose ctDNA is cleared after 3 weeks furmonertinib will receive furmonertinib monotherapy, and approximately 233 patients with uncleared ctDNA after 3weeks furmonertinib monotherapy will receive furmonertinib alone or furmonertinib in combination with chemotherapy or furmonertinib in combination with chemotherapy and bevacizumab in the main trial. In the main part of the trial, for the approximately 233 patients with uncleared ctDNA, there are 2 / 2 / 1 in 5 chances of receiving furmonertinib alone, furmonertinib plus chemotherapy, or furmonertinib plus chemotherapy and bevacizumab. The treatment is decided at random by a computer. The study involves a Screening Period, Induction treatment period, Treatment Period, and Follow up Period. Whilst receiving study medication, it is expected patients will attend, on average, approximately 9 visits. Each visit will last about 2 to 6 hours depending on the arrangement of medical assessments by the study site.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
280
Furmonertinib 80mg QD
Furmonertinib 80mg QD
Furmonertinib 80mg daily + Pemetrexed (500 mg/m2) plus carboplatin (AUC 5) on Day 1 of 21day cycles (every 3 weeks) for 4 cycles, followed by pemetrexed maintenance (500 mg/m2) every 3 weeks.
Progression-free survival (PFS)
Progression-free survival (PFS) using Investigator assessment as defined by Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). Progression-free survival (PFS) is defined as the time from beginning of study treatment until the date of objective disease progression or death (by any cause in the absence of progression), regardless of whether the patient withdraws from randomized therapy or receives another anti-cancer therapy prior to progression. Patients who have not progressed or died at the time of analysis will be censored at the time of the latest date of assessment from their last evaluable Response Evaluation Criteria in Solid Tumors (RECIST) assessment.
Time frame: The primary analysis of Progression-free survival (PFS) based on investigator assessment will occur when PFS maturity is observed at approximately 34 months after the first patient begin study treatment
Objective Response Rate (ORR)
Objective Response Rate (ORR) (per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) using Investigator assessments) is defined as the number (%) of patients with response
Time frame: Analysis will occur when PFS maturity is observed at approximately 34 months from the first patient begin study treatment
Disease Control Rate (DCR)
Disease control rate (DCR) is defined as the percentage of subjects who have a best overall response of Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) by Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by the Investigator.
Time frame: Analysis will occur when PFS maturity is observed at approximately 34 months from the first patient begin study treatment
Duration of Response (DoR)
Duration of Response is defined as the time from the date of first documented response until the date of documented progression or death in the absence of disease progression.
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Furmonertinib 80mg daily + Pemetrexed (500 mg/m2) plus carboplatin (AUC 5) plus bevacizumab (7.5mg/kg) on Day 1 of 21day cycles (every 3 weeks) for 4 cycles, followed by pemetrexed (500 mg/m2) with bevacizumab (7.5mg/kg) maintenance every 3 weeks.
The First Hospital of Jilin University
Changchun, China
NOT_YET_RECRUITINGSichuan Provincial People's Hospital
Chengdu, China
NOT_YET_RECRUITINGDongguan People's Hospital
Dongguan, China
NOT_YET_RECRUITINGAffiliated Dongyang Hospital of Wenzhou Medical University, Dongyang People's hospital
Dongyang, China
NOT_YET_RECRUITINGThe First People's Hospital of Foshan
Foshan, China
NOT_YET_RECRUITINGAffiliated Cancer Hospital and Institute of Guangzhou Medical University
Guangzhou, China
NOT_YET_RECRUITINGNanfang Hospital, Southern Medical University
Guangzhou, China
NOT_YET_RECRUITINGSun Yat-sen University cancer center
Guangzhou, China
RECRUITINGThe First Affiliated Hospital, Sun Yat-sen University
Guangzhou, China
NOT_YET_RECRUITINGThe First Affiliated Hospital, Zhejiang University School of Medicine
Hangzhou, China
NOT_YET_RECRUITING...and 16 more locations
Time frame: Duration of Response analysis will occur when Progression-free survival (PFS) maturity is observed at approximately 34 months from the first patient begin study treatment
Overall Survival (OS)
Overall survival is defined as the time from beginning of study treatment until death due to any cause.
Time frame: The analysis of OS will be conducted at 2 time points: when PFS maturity is observed at approximately 34 months after the first patient begin study treatment, and when OS maturity is observed at approximately 70 months after the first patient begin study
Landmark Overall Survival (LOS)
Landmark Overall Survival at 1, 3 and 5 years will look at the number of patients alive at 1-, 3- and 5-year time points.
Time frame: The analysis of Landmark Overall Survival will be conducted at 2 time points: when PFS maturity is observed at approximately 34 months after the first patient begin study treatment, and when Overall Survival maturity is observed at approximately 70 month
Adverse Events
The number of patients with adverse events and the severity according to CTCAE v5.0.
Time frame: From the start of study drug to 30 days after the last dose of study drug