This phase III trial compares the effect of the combination of aglatimagene besadenovec and pembrolizumab versus standard of care docetaxel chemotherapy for the treatment of stage IV non-squamous, non-small cell lung cancer. Aglatimagene besadenovec is a replication-deficient adenoviral vector encoding the herpes simplex virus thymidine kinase (HSV-tk) gene. When combined with an oral prodrug (valacyclovir), injection of aglatimagene induces targeted tumor cell death and stimulates a systemic immune response. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. This trial may help doctors find out if giving aglatimagene with pembrolizumab is more effective at treating patients with stage IV non-squamous, non-small cell lung cancer than standard chemotherapy.
PRIMARY OBJECTIVE: I. To compare overall survival (OS) in participants previously treated with platinum-based chemotherapy and pembrolizumab-based immunotherapy for stage IV non-squamous, non-small cell lung cancer (NSCLC) randomized to pembrolizumab and aglatimagene plus prodrug (valacyclovir) versus standard of care docetaxel chemotherapy. SECONDARY OBJECTIVES: I. To compare patient-reported outcomes (PRO) between participants treated with aglatimagene besadenovec + prodrug in combination with pembrolizumab versus SoC docetaxel chemotherapy. II. To evaluate the safety of aglatimagene besadenovec + prodrug in combination with pembrolizumab versus SoC docetaxel chemotherapy. OUTLINE: Patients are randomized to 1 of 2 arms. ARM 1: Patients receive two aglatimagene intratumoral injections followed by oral prodrug and pembrolizumab IV on study. ARM 2: Patients receive docetaxel chemotherapy per standard of care on study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
500
via intratumoral injections into lung or lymph nodes at two timepoints
Oral, for14 days following each aglatimagene besadenovec injection
every 3 weeks (Q3W) or every 6 weeks (Q6W)
every 21 days with standard premedication
Laura & Isaac Perlmutter Cancer Center at NYU Langone Health
New York, New York, United States
RECRUITINGOverall Survival
To evaluate whether treatment with aglatimagene besadenovec (CAN-2409) plus valacyclovir and continued pembrolizumab improves overall survival (OS) compared to standard of care (SoC) docetaxel chemotherapy, in participants with Stage IV non-squamous non-small cell lung cancer (NSCLC) whose disease has progressed following prior pembrolizumab-based platinum chemoimmunotherapy
Time frame: From date of randomization until date of death from any cause, assessed for a minimum of 24 months
Time to meaningful deterioration based on the Non-Small Cell Lung Cancer Symptom Assessment Questionnaire (NSCLC-SAQ) Total Score
Defined as the time from randomization until a definitive clinically meaningful worsening in symptoms or in NSCLC-SAQ total score. The lowest score possible is 0, and the highest score possible is 20. Higher score indicates more severe symptoms.
Time frame: Baseline to Week 12
Change from baseline of Total Score of NSCLC-SAQ at Week 12
NSCLC-SAQ Total Score after Week 12 compared to baseline. The lowest score possible is 0, and the highest score possible is 20. Higher score indicates more severe symptoms.
Time frame: Baseline to Week 12
Change from baseline of Global Health Status/QoL Score of EORTC-QLQ-30 at Week 12
EORTC-QLQ-30 Global Health Status/QoL Score after Week 12 compared to baseline. The lowest score possible is 0, and the highest score possible is 100. Higher score indicates less severe symptoms.
Time frame: Baseline to Week 12
Frequency of Treatment Emergent Adverse Events (TEAEs) graded per National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE)
Treatment Emergent Adverse Events (TEAEs) graded per National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE)
Time frame: Baseline to 120 days after last administered dose of study drug
Change from baseline in clinical laboratory parameters
Observed values and changes from baseline for continuous clinical laboratory parameters will be summarized at each scheduled timepoint using descriptive statistics.
Time frame: Baseline to 120 days after last administered dose of study drug
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