A Trial to Learn How the Combination of Fianlimab With Cemiplimab and Chemotherapy Works Compared With Cemiplimab and Chemotherapy for Treating Adult Patients With Advanced Non-small Cell Lung Cancer

Phase 3Active Not RecruitingNCT05800015

Regeneron Pharmaceuticals950 enrolled

Overview

This study is researching an investigational drug called fianlimab (also called REGN3767) with two other medications called cemiplimab and chemotherapy, individually called a "study drug" or collectively called "study drugs". 'Investigational' means that the study drug is not approved for use outside of this study by any Health Authority. Examples of chemotherapy drugs include the following: Paclitaxel plus carboplatin, and Pemetrexed plus cisplatin. The study is being conducted in patients who have advanced non-small cell lung cancer (NSCLC). The aim of the study is to see how effective the combination of fianlimab, cemiplimab, and chemotherapy is for treating advanced NSCLC, in comparison with cemiplimab and chemotherapy. The study is looking at several other research questions, including: * What side effects may happen from taking the study drugs * How much of each study drug is in your blood at different times * Whether the body makes antibodies against the study drugs (which could make the drug less effective or could lead to side effects) * How administering the study drugs might improve your quality of life

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

950

Conditions

Non-small Cell Lung Cancer

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Key Inclusion Criteria: 1. Patients with non-squamous or squamous histology NSCLC with stage IIIB or stage IIIC disease who are not candidates for surgical resection or definitive chemoradiation per investigator assessment or stage IV (metastatic disease), who received no prior systemic treatment for recurrent or metastatic NSCLC. 2. Availability of an archival or on-study formalin-fixed, paraffin-embedded (FFPE) tumor tissue sample, without intervening therapy between biopsy collection and screening as described in the protocol 3. For enrollment in phase 2, patients should have PD-L1, expression results (regardless of expression level) determined by a College of American Pathologists (CAP)/Clinical Laboratory Improvement Amendments (CLIA) (or equivalently licensed, according to local regulations) accredited laboratory, as described in the protocol. For enrollment in phase 3, patients should have a valid PD-L1 result, regardless of expression level, using an assay as performed by a central laboratory, as described in the protocol. 4. At least 1 radiographically measurable lesion by computed tomography (CT) or magnetic resonance imaging (MRI) per RECIST 1.1 criteria. Target lesions may be located in a previously irradiated field if there is documented (radiographic) disease progression in that site. 5. Eastern Cooperative Oncology Group (ECOG) performance status of ≤1. 6. Adequate organ and bone marrow function as defined in the protocol. Key Exclusion Criteria: 1. Active or untreated brain metastases or spinal cord compression. Patients are eligible if central nervous system (CNS) metastases are adequately treated and patients have neurologically returned to baseline (except for residual signs or symptoms related to the CNS treatment) for at least 2 weeks prior to enrollment. Patients must be off (immunosuppressive doses of) corticosteroid therapy. 2. Patients with tumors tested positive for actionable epidermal growth factor receptor (EGFR) gene mutations, anaplastic lymphoma kinase (ALK) gene translocations, or ROS oncogene 1 (ROS1) fusions, as described in the protocol. 3. Encephalitis, meningitis, or uncontrolled seizures in the year prior to enrollment. 4. History of interstitial lung disease (eg, idiopathic pulmonary fibrosis or organizing pneumonia), of active, noninfectious pneumonitis that required immune-suppressive doses of glucocorticoids to assist with management, or of pneumonitis within the last 5 years. A history of radiation pneumonitis in the radiation field is permitted as long as pneumonitis resolved ≥6 months prior to enrollment. 5. Known primary immunodeficiencies, either cellular (eg, DiGeorge syndrome, T-cell-negative severe combined immunodeficiency \[SCID\]) or combined T- and B-cell immunodeficiencies (eg, T- and B-cell negative SCID, Wiskott Aldrich syndrome, ataxia telangiectasia, common variable immunodeficiency). 6. Ongoing or recent (within 2 years) evidence of significant autoimmune disease that required treatment with systemic immunosuppressive treatments, which may suggest risk of immune-mediated treatment-emergent adverse events (imTEAEs). Patients with uncontrolled type 1 diabetes mellitus or with uncontrolled adrenal insufficiency are excluded. The following are not exclusionary: vitiligo, childhood asthma that has resolved, residual hypothyroidism that required only hormone replacement, or psoriasis that does not require systemic treatment. 7. Patients with a condition requiring corticosteroid therapy (\>10 mg prednisone/day or equivalent) within 14 days of randomization. Physiologic replacement doses are allowed even if they are \>10 mg of prednisone/day or equivalent, as long as they are not being administered for immunosuppressive intent. Patients with clinically relevant systemic immune suppression within the last 3 months before trial enrollment are excluded. Inhaled or topical steroids are permitted, provided that they are not for treatment of an autoimmune disorder. 8. Patients who have received prior systemic therapies are excluded with the exception of the following: 1. Adjuvant or neoadjuvant platinum-based doublet chemotherapy (after surgery and/or radiation therapy) if recurrent or metastatic disease develops more than 6 months after completing therapy as long as toxicities have resolved to CTCAE grade ≤1 or baseline with the exception of alopecia and peripheral neuropathy. 2. Anti-PD-(L)1 with or without LAG-3 as an adjuvant or neoadjuvant therapy as long as the last dose is \>12 months prior to enrollment. 3. Prior exposure to other immunomodulatory or vaccine as an adjuvant or neoadjuvant therapy such as Cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) antibodies as long as the last dose is \>6 months prior to enrollment. Immune-mediated AEs must be resolved to CTCAE grade ≤1 or baseline by the time of enrollment. Endocrine immune-mediated AEs controlled with hormonal or other non-immunosuppressive therapies without resolution prior to enrollment are allowed. Note: Other protocol-defined Inclusion/ Exclusion Criteria apply

Locations (76)

Arizona Clinical Research Center

Tucson, Arizona, United States

Yuma Regional Medical Center

Yuma, Arizona, United States

The Oncology Institute of Hope & Innovation

Cerritos, California, United States

Crosson Cancer Institute

Fullerton, California, United States

St. Joseph Hospital Orange

Orange, California, United States

Outcomes

Primary Outcomes

Objective response rate (ORR) as assessed by blinded independent review committee (BICR) using RECIST 1.1

Phase 2 ORR is defined as proportion of patients with a best overall response of confirmed complete response (CR) or partial response (PR).

Time frame: Up to 136 Weeks

Overall Survival (OS)

Phase 3 Defined as the time from randomization to the date of death due to any cause

Time frame: Up to 5 years

Secondary Outcomes

Incidence of treatment-emergent adverse event (TEAEs)

Phase 2 \& Phase 3 A TEAE is any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product, which does not necessarily have a causal relationship with this treatment

Time frame: Up to 108 weeks

Incidence of treatment-related TEAEs

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Incidence of serious adverse events (SAEs)

Phase 2 \& Phase 3 Any untoward medical occurrence that at any dose: * Results in death - includes all deaths, even those that appear to be completely unrelated to study drug (eg, a car accident in which a patient is a passenger) * Is life-threatening * Requires in-patient hospitalization or prolongation of existing hospitalization • Results in persistent or significant disability/incapacity * Is a congenital anomaly/birth defect * Is an important medical event

Time frame: Up to 108 weeks

Incidence of adverse events of special interest (AESIs)

Phase 2 \& Phase 3 Serious or non-serious; is one of scientific and medical concern specific to the sponsor's product or program, for which ongoing monitoring and rapid communication by the Investigator to the sponsor can be appropriate. Such an event might warrant further investigation in order to characterize and understand it.

Time frame: Up to 108 weeks

Incidence of immune-mediated adverse events (imAEs)

Phase 2 \& Phase 3 Immune-mediated AEs are thought to be caused by unrestrained cellular immune responses directed at normal host tissues. An imAE can occur shortly after the first dose or several months after the last dose of treatment. Early detection and management reduces the risk of severe drug induced toxicity

Time frame: Up to 108 weeks

Occurrence of interruption of study drug(s) due to AEs

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Occurrence of discontinuation of study drug(s) due to AEs

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Incidence of deaths due to TEAE

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Incidence of grade 3-4 laboratory abnormalities

Phase 2 \& Phase 3 ≥ grade 3 per National Cancer Institute-Common Terminology Criteria for Adverse Events \[NCI-CTCAE v5.0\]

Time frame: Up to 108 weeks

ORR by investigator assessment using RECIST 1.1

Phase 2 \& Phase 3

Time frame: Up to 136 Weeks

Disease control rate (DCR) by BICR

Phase 2 and Phase 3 DCR is defined as CR + PR + stable disease (SD)

Time frame: Up to 136 Weeks

DCR by investigator assessment

Phase 2 and Phase 3 DCR is defined as CR + PR + stable disease (SD)

Time frame: Up to 136 Weeks

Time to tumor response (TTR) by BICR

Phase 2 and Phase 3 TTR is defined as the time from randomization to the date of the first response of CR or PR (whichever is first recorded) for patients with confirmed CR or PR.

Time frame: Up to 136 Weeks

TTR by investigator assessment

Phase 2 and Phase 3 TTR is defined as the time from randomization to the date of the first response of CR or PR (whichever is first recorded) for patients with confirmed CR or PR

Time frame: Up to 136 Weeks

Duration of response (DOR) by BICR

Phase 2 and Phase 3 DOR is defined as the time from first response of CR or PR to first radiographic progression or death due to any cause for patients with confirmed CR or PR

Time frame: Up to 5 Years

DOR by investigator assessment

Phase 2 and Phase 3 DOR is defined as the time from first response of CR or PR to first radiographic progression or death due to any cause for patients with confirmed CR or PR

Time frame: Up to 5 Years

Progression free survival (PFS) by BICR

Phase 2 and Phase 3 PFS is defined as the time from randomization to the date of the first radiographic progression or death due to any cause, whichever occurred earlier

Time frame: Up to 5 Years

PFS by investigator assessment

Phase 2 and Phase 3 PFS is defined as the time from randomization to the date of the first radiographic progression or death due to any cause, whichever occurred earlier

Time frame: Up to 5 Years

Phase 2 Defined as the time from randomization to the date of death due to any cause

Time frame: Up to 5 Years

Change from baseline in patient-reported global health status/quality of life (GHS/QoL) per European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)

Phase 2 \& Phase 3 EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a GHS/QoL scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.

Time frame: Up to 108 weeks

Change from baseline in physical functioning per EORTC QLQ-C30

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Change from baseline in patient-reported chest pain per European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Lung Cancer 13 (EORTC QLQ-LC13)

Phase 2 \& Phase 3 EORTC QLQ-LC 13 is a lung cancer specific module developed to assess lung cancer-associated symptoms and treatment-related side effects among lung cancer patients

Time frame: Up to 108 weeks

Change from baseline in patient-reported dyspnea per EORTC QLQ-LC13

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Change from baseline in patient-reported cough per EORTC QLQ-LC13

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Time until definitive deterioration in patient-reported global health status/QoL per EORTC QLQ-C30

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Time until definitive deterioration in patient-reported physical functioning per EORTC QLQ-C30

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Time until definitive deterioration in patient-reported chest pain per EORTC QLQ-LC13

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Time until definitive deterioration in patient-reported dyspnea per EORTC QLQ-LC13

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Time until definitive deterioration in patient-reported cough per EORTC QLQ-LC13

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Time until definitive deterioration in a composite of these three symptoms: patient-reported chest pain, dyspnea and cough per EORTC QLQ-LC13

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Change from baseline in patient-reported general health status per EuroQoL 5-Dimensional 5-Level Scale (EQ-5D-5L) VAS

Phase 2 \& Phase 3 The EQ-5D-5L VAS records the respondent's self-rated health on a 10 centimeter (cm) vertical, visual analogue scale. It is rated by the respondent on a scale 0 to 100, with 0 being "the worst health you can imagine" and 100 being "the best health you can imagine".

Time frame: Up to 108 weeks

Change from baseline in patient-reported severity with usual or daily activities due to fatigue per the Patient Reported Outcomes for Common Terminology Criteria for Adverse Events (PRO-CTCAE)

Phase 2 \& Phase 3 PRO-CTCAE questionnaire assesses side effect symptoms in cancer clinical trials using a PRO-CTCAE score. The PRO-CTCAE includes an item library of 124 items representing 78 symptomatic toxicities drawn from the CTCAE.

Time frame: Up to 108 weeks

Change from baseline in patient-reported interference with usual or daily activities due to fatigue per the PRO-CTCAE

Phase 2 \& Phase 3

Time frame: Up to 108 weeks

Concentrations of cemiplimab in serum

Phase 2 \& Phase 3

Time frame: Up to 136 weeks

Concentrations of fianlimab in serum

Phase 2 \& Phase 3

Time frame: Up to 136 weeks

Immunogenicity, as measured by anti-drug antibodies (ADA) to fianlimab

Phase 2 \& Phase 3

Time frame: Up to 136 weeks

Immunogenicity, as measured by ADA to cemiplimab

Phase 2 \& Phase 3

Time frame: Up to 136 weeks

Immunogenicity, as measured by neutralizing antibodies (NAb) to fianlimab

Phase 2 \& Phase 3

Time frame: Up to 136 weeks

Immunogenicity, as measured by NAb to cemiplimab

Phase 2 \& Phase 3

Time frame: Up to 136 weeks