E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with KRASG12C-mutant stage IV NSCLC that had prior chemotherapy and/or immune-checkpoint inhibition or both. |
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E.1.1.1 | Medical condition in easily understood language |
Patients with ‘non-small cell lung cancer’ (NSCLC) that has grown again during/after previous treatment. A change (mutation) in a gene called KRAS was found, which causes the lung cancer to grow.
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10029515 |
E.1.2 | Term | Non-small cell lung cancer recurrent |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this trial is to assess the clinical efficacy of adagrasib treatment, in terms of objective response, in patients with KRASG12C-mutant NSCLC, including the elderly (≥70 years) or patients with poor performance status (ECOG PS=2). |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives refer to the evaluation of measures of clinical efficacy including durable clinical benefit (DCB), time-to-progression (TTP), progression-free survival (PFS), overall survival (OS), overall safety and patient-related outcomes. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Histologically or cytologically confirmed stage IV NSCLC - KRASG12C-mutation by local testing (by tissue or ctDNA) - Prior treatment with at least one line of systemic therapy for NSCLC (e.g., platinum-based doublet chemotherapy and/or immune-checkpoint inhibition or both). - Life expectancy ≥12 weeks - Measurable disease according to RECIST v1.1 - Age ≥18 years with ECOG PS 2 (cohort 1), or age ≥70 years with ECOG PS 0-1 (cohort 2) - Adequate haematological, renal and liver function - Negative pregnancy test for patients of childbearing potential - Ability to comply with the trial protocol, in the investigator's judgment. - Written informed consent for protocol treatment must be signed and dated by the patient and the investigator prior to any trial-related intervention, including the submission of mandatory biomaterial. |
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E.4 | Principal exclusion criteria |
-Prior investigational therapy within 28 days or at least 5 half-lives before enrolment -Prior treatment with an agent targeting KRASG12C -Leptomeningeal disease or untreated brain metastases: - Patient should be neurologically stable for at least 2 weeks before enrolment, without the need for corticosteroids, except for prednisone (or its equivalent) at a dose of ≤10 mg daily - For patients with definitively treated brain metastases, a minimum of 2 weeks must have elapsed from the last day of radiotherapy - History of intestinal disease or major gastric surgery likely to alter absorption of study treatment or inability to swallow oral medications. - Any of the following cardiac abnormalities: - Unstable angina pectoris or myocardial infarction within 6 months prior to enrolment. - Symptomatic or uncontrolled atrial fibrillation within 6 months prior to enrolment. - Congestive heart failure ≥NYHA Class 3 within 6 months prior to enrolment. - Prolonged QTc interval >480 ms or family or medical history of congenital Long QT Syndrome - History of stroke or transient ischemic attack within 6 months prior to enrolment - Ongoing need for treatment with concomitant medication with any of the following characteristics: known risk of Torsades de Pointes; substrate of CYP3A with narrow therapeutic index; strong inducer of CYP3A and/or P-gp; strong inhibitor of BCRP; and proton pump inhibitors that cannot be switched to alternative treatment prior to enrolment - Known human immunodeficiency virus (HIV) infection - Acute or chronic hepatitis B or C infection. Note that the following are permitted: a. Patients treated for hepatitis C (HCV) with no detectable viral load at screening; b. Patients treated for HIV with no detectable viral load for at least 1 month prior to enrolment; and c. Patients with hepatitis B (HBV) receiving prophylaxis against reactivation of hepatitis B (either [HBsAg-positive with normal ALT and HBV DNA <2,000 IU/mL or <10,000 copies/mL] or [HBsAg-negative and anti-HBcAg-positive]) - Women who are pregnant or in the period of lactation - Sexually active men and women of childbearing potential who are not willing to use an effective contraceptive method during the study - Judgement by the investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Objective Response Rate (ORR) per RECIST v1.1, assessed at 12 weeks. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
- Durable clinical benefit (DCB) - Time to progression (TTP) - Progression-free Survival (PFS) - Overall Survival (OS) - Safety - Patient-related outcomes |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- DCB: final analysis - TTP: final analysis - PFS: final analysis - OS: final analysis - Safety: every 3 month and at final analysis -Patient-related outcomes: final analysis
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 23 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
France |
Spain |
Italy |
Belgium |
Ireland |
United Kingdom |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |