This is a global, multicenter, randomized, double-blind, placebo-controlled Phase 3 study evaluating docetaxel plus plinabulin versus docetaxel plus placebo in participants with advanced or metastatic non-squamous non-small cell lung cancer (NSCLC) without EGFR, ALK, ROS1, or RET alterations who have experienced disease progression after prior anti-PD-1/PD-L1 immunotherapy and platinum-based chemotherapy. Approximately 442 participants will be randomized 1:1 to receive docetaxel (75 mg/m² IV on Day 1 of each 21-day cycle) in combination with plinabulin (30 mg/m² IV on Days 1 and 8) or matching placebo. Treatment will continue until disease progression, unacceptable toxicity, death, withdrawal of consent, or sponsor/investigator decision. Tumor assessments will be performed regularly per RECIST v1.1, and participants will be followed for survival after treatment discontinuation. The primary objective is to compare overall survival between treatment arms; secondary objectives include evaluation of progression-free survival, objective response rate, duration of response, disease control, incidence of Grade 4 neutropenia, quality of life, and safety/tolerability.
Participants with advanced or metastatic non-squamous non-small cell lung cancer (NSCLC) who have progressed following prior anti-PD-1/PD-L1 immunotherapy and platinum-based chemotherapy have limited treatment options and docetaxel remains a commonly used standard therapy in this setting. Plinabulin is a first-in-class small molecule with a distinct mechanism that may enhance anti-tumor activity and may mitigate chemotherapy-associated neutropenia. This study (DUBLIN-4) is designed to evaluate whether the addition of plinabulin to docetaxel improves clinical outcomes compared with docetaxel alone in this post-immunotherapy and post-platinum population without EGFR, ALK, ROS1, or RET alterations. This is a global, multicenter, randomized, double-blind, placebo-controlled Phase 3 study. Participants will be randomized in a 1:1 ratio to receive docetaxel in combination with plinabulin or matching placebo. Randomization will be stratified by geographic region (Asian countries vs Western countries), current line of therapy (2nd vs 3rd line), and prior progression-free survival duration on PD-1/PD-L1 inhibitor therapy (≥6 months vs \<6 months). Efficacy will be evaluated using standard radiographic tumor assessments and response criteria, with additional evaluation of clinically relevant outcomes in this treatment setting, including overall survival, progression-free survival, and objective response. Safety will be assessed throughout the study by monitoring adverse events, laboratory parameters, and other routine clinical assessments. The study also includes evaluation of patient-reported quality of life and the incidence of severe neutropenia as an important tolerability endpoint for docetaxel-based treatment. Participants who discontinue study treatment will enter follow-up, including a safety follow-up after treatment discontinuation and ongoing survival follow-up. Sparse pharmacokinetic samples will be collected to support population pharmacokinetic analyses of plinabulin.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
442
Plinabulin will be administered by IV infusion at 30 mg/m² over approximately 1 hour on Days 1 and 8 of each 21-day treatment cycle. On Day 1, plinabulin will be administered approximately 1 hour after completion of the docetaxel infusion.
Docetaxel will be administered by intravenous (IV) infusion at 75 mg/m² over approximately 1 hour on Day 1 of each 21-day treatment cycle.
Matching placebo will be administered by IV infusion over approximately 1 hour on Days 1 and 8 of each 21-day treatment cycle. On Day 1, placebo will be administered approximately 1 hour after completion of the docetaxel infusion.
Overall Survival (OS)
OS is defined as the time from randomization to death from any cause
Time frame: Approximately 2 years after study initiation.
Progression-Free Survival (PFS)
Time from randomization to the first documentation of disease progression per RECIST v1.1 or death from any cause, whichever occurs first.
Time frame: Approximately 2 years after study initiation.
Objective Response Rate (ORR)
Proportion of participants with best overall response of complete response (CR) or partial response (PR) per RECIST v1.1.
Time frame: Approximately 2 years after study initiation.
Incidence of Grade 4 Neutropenia (Cycle 1 Day 8 ANC)
Proportion of participants with Grade 4 neutropenia, defined as absolute neutrophil count (ANC) \<0.5 × 10\^9/L, based on ANC on Day 8 of Cycle 1.
Time frame: At Day 8 of Cycle 1 (approximately 1 week after the first dose; each treatment cycle is 21 days).
Overall Survival (OS) Rate at Month 24
Proportion of participants alive at 24 months after randomization.
Time frame: 24 months after randomization.
Overall Survival (OS) Rate at Month 36
Proportion of participants alive at 36 months after randomization.
Time frame: 36 months after randomization.
Duration of Response (DoR)
Time from first documented CR or PR (whichever occurs first) until disease progression per RECIST v1.1 or death from any cause.
Time frame: Approximately 2 years after study initiation.
Disease Control Rate (DCR)
Proportion of participants with CR, PR, or stable disease (SD) lasting ≥6 months per RECIST v1.1.
Time frame: Approximately 2 years after study initiation.
Incidence of New Brain Metastases
Incidence of new brain metastases based on brain imaging (MRI or head CT).
Time frame: Approximately 2 years after study initiation.
Quality of Life (QoL) - EORTC QLQ-LC13
Change from baseline in EORTC QLQ-LC13 scores. Quality of life will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer 13 (EORTC QLQ-LC13). Scores are transformed to a 0 to 100 scale. Higher scores indicate worse symptoms / greater symptom burden (worse outcome).
Time frame: Approximately 2 years after study initiation.
Incidence and Severity of Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)
TEAEs and SAEs will be assessed throughout the study and summarized by frequency, severity (per CTCAE), and relationship to study treatment.
Time frame: Approximately 2 years after study initiation.
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