This phase II trial tests how well zipalertinib with carboplatin and pemetrexed works in treating stage II-IIIB non small cell lung cancer. that can be removed by surgery (resectable). Zipalertinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Carboplatin is in a class of medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of tumor cells. Pemetrexed is in a class of medications called antifolate antineoplastic agents. It works by stopping cells from using folic acid to make DNA and may kill tumor cells. Giving zipalertinib with carboplatin and pemetrexed may kill more tumor cells in patients with resectable, stage II-IIIB non-small cell lung cancer.
PRIMARY OBJECTIVE: I. To evaluate the major pathologic response (MPR) rate of neoadjuvant zipalertinib plus carboplatin and pemetrexed chemotherapy at time of surgery in patients with resectable EGFR Ex20ins-mutated or uncommon/compound EGFR-mutated non-squamous non small cell lung cancer (NSCLC). SECONDARY OBJECTIVES: I. To evaluate the efficacy of zipalertinib plus chemotherapy as measured by overall response rate (ORR), pathologic complete response (pCR), event-free survival (EFS), and nodal downstaging. II. To evaluate the safety and tolerability of zipalertinib plus chemotherapy. EXPLORATORY OBJECTIVE: I. To assess potential prognostic and predictive biomarkers using circulating tumor deoxyribonucleic acid (DNA) dynamics through next-generation sequencing using the Tempus platform. OUTLINE: NEOADJUVANT: Patients receive zipalertinib orally (PO) twice daily (BID) on days 1-21, and carboplatin intravenously (IV), over 15-60 minutes, and pemetrexed IV, over 10 minutes, on day 1 of each cycle. Cycles repeat every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. Within 30 days patients undergo standard of care resection surgery. ADJUVANT: Between 4 and 12 weeks after surgery patients receive zipalertinib PO BID on days 1-21 of each cycle. Cycles repeat every 21 days for 13 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo positron emission tomography (PET)/computed tomography (CT) scan and/or magnetic resonance imaging (MRI) during screening and CT scan and blood and urine sample collection throughout the study. After completion of study treatment, patients are followed up at 30 days and every 12 weeks for up to 1 year or until cancer progression or initiation of a new cancer therapy, whichever occurs first.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16
Undergo blood and urine sample collection
Given IV
Undergo CT scan
Undergo MRI
Given IV
Undergo PET scan
Given PO
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, United States
Major pathologic response
Defined as ≤10% viable tumor present histologically in the resected tumor specimen after neoadjuvant treatment. A 95% confidence interval for the MPR rate will be calculated using the Clopper-Pearson (exact binomial) method.
Time frame: At time of surgery
Overall response rate (ORR)
Defined as complete response or partial response by Response Evaluation Criteria in Solid Tumors 1.1 criteria. ORR estimate and its associated 95% confidence interval will be calculated. Will compute the proportion of participants achieving complete response (CR) or partial response (PR) and compute 95% confidence intervals using the exact (Clopper-Pearson) confidence intervals.
Time frame: Up to 2 years
Pathologic complete response
Defined as no viable tumor present histologically in the resected tumor specimen. Will compute the proportion of participants achieving CR or PR and compute 95% confidence intervals using the exact (Clopper-Pearson) confidence intervals.
Time frame: Up to 2 years
Event free survival (EFS)
Will be analyzed using the Kaplan-Meier method. Median EFS and corresponding 95% confidence intervals will be reported.
Time frame: From cycle 1 day 1 to the earliest date of radiographic progression or recurrence, decision to forgo surgery, or death due to any cause, up to 2 years. Each cycle is 21 days
Nodal downstaging
Defined as having N2 or N1 disease prior to the initiation of neoadjuvant treatment with subsequent nodal downstaging to N1 or N0 disease at time or surgery. Will be reported as a percentage of participants who achieve histological downstaging at time of surgery.
Time frame: From baseline to surgery
Incidence of adverse events
Will be assessed using Common Terminology Criteria for Adverse Events version 5.0.
Time frame: Up to 2 years
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