Ramucirumab and Pembrolizumab Versus Standard of Care in Treating Patients With Stage IV or Recurrent Non-small Cell Lung Cancer (A Lung-MAP Non-Match Treatment Trial)

  • STATUS
    Recruiting
  • End date
    Feb 1, 2023
  • participants needed
    144
  • sponsor
    Southwest Oncology Group
Updated on 20 October 2021
ct scan
heparin
insulin
platelet count
corticosteroids
ascites
hysterectomy
monoclonal antibodies
nitrosoureas
prednisone
systemic therapy
measurable disease
warfarin
anticoagulants
HIV Infection
antiretroviral therapy
thyroxine
skin cancer
hepatitis b
lung cancer
oophorectomy
cardiac disease
unstable angina
pleural effusion
investigational drug
international normalized ratio
serum bilirubin
serum bilirubin level
major surgery
replacement therapy
MRI Scan
metastasis
pemetrexed
neutrophil count
liver metastasis
tumor cells
gemcitabine
pembrolizumab
monoclonal antibody therapy
brain metastases
liver metastases
mitomycin
pd-l1
docetaxel
positron emission tomography
hormonal therapy
ramucirumab
cancer treatment
concurrent chemotherapy
systemic chemotherapy
alopecia
targeted therapy
line of therapy
leptomeningeal disease
hepatitis c virus
chronic hepatitis b
hcv viral load
corticosteroid replacement therapy
platinum-based chemotherapy
pleural effusions
oral contraceptive pill
squamous cell skin cancer
recurrent non-small cell lung cancer
braf v600e mutation
egfr t790m

Summary

This phase II Lung-MAP non-Match treatment trial studies how well ramucirumab and pembrolizumab work versus standard of care in treating patients with non-small cell lung cancer that is stage IV or has come back. Immunotherapy with monoclonal antibodies, such as ramucirumab and pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Drugs used in standard of care chemotherapy for non-small cell lung cancer, such as docetaxel, gemcitabine hydrochloride, and pemetrexed, 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. Giving ramucirumab and pembrolizumab together may work better in treating patients with non-small lung cancer compared to standard of care.

Description

PRIMARY OBJECTIVES:

I. To compare overall survival between patients previously treated with platinum-based chemotherapy and immunotherapy for stage IV or recurrent non-small cell lung cancer randomized to ramucirumab and MK-3475 (pembrolizumab) versus standard of care (SoC).

SECONDARY OBJECTIVES:

I. To compare response rates between the arms, including complete response (CR) and partial response (PR) (confirmed and unconfirmed).

II. To compare the disease control rate (CR, PR, confirmed and unconfirmed and stable disease [SD]).

III. To evaluate the duration of response (DoR) among responders within each arm.

IV. To evaluate the frequency and severity of toxicities within each arm. V. To compare investigator assessed-progression-free survival (IA-PFS) between the arms.

VI. To evaluate the clinical outcomes (overall survival [OS], IA-PFS, response) by randomization stratification factors by comparing outcomes within the ramucirumab and MK-3475 (pembrolizumab) arm, performing a sub-group analysis of the arms, and by evaluating an interaction between the factors and treatment arm.

TRANSLATIONAL MEDICINE OBJECTIVES:

I. To evaluate if PD-L1 expression levels are associated with clinical outcomes (OS, IA-PFS, and response).

II. To evaluate if tumor mutation burden (TMB) as determined by the Foundation Medicine Inc (FMI) Foundation One panel is associated with clinical outcomes.

III. To collect, process, and bank cell-free (circulating cell-free deoxyribonucleic acid [cfDNA]) at baseline and progression for future development of a proposal to evaluate comprehensive next-generation sequencing of circulating tumor DNA (ctDNA).

IV. To establish a tissue/blood repository to pursue future studies.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A: Patients may receive docetaxel intravenously (IV) over 10-30 minutes on day 1, gemcitabine hydrochloride IV over 30 minutes on days 1 and 8, pemetrexed IV over 10 minutes on day 1 (non-squamous NSCLC patients only), or ramucirumab IV over 60 minutes combined with docetaxel IV over 10-30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM B: Patients receive ramucirumab IV over 60 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients also receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 21 days for up to 35 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment (prior to disease progression), patients are followed up every 3 months for the first year, and then every 6 months for up to 3 years from date of randomization. After completion of study treatment (after disease progression), patients are followed up every 6 months for 2 years, then at the end of year 3 from the date of randomization.

Details
Condition Stage IV Lung Cancer AJCC v8, Stage IVA Lung Cancer AJCC v8, Stage IVB Lung Cancer AJCC v8, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma, Recurrent Lung Non-Small Cell Carcinoma
Treatment gemcitabine hydrochloride, docetaxel, Gemcitabine, Pembrolizumab, Pemetrexed, pemetrexed disodium, Ramucirumab
Clinical Study IdentifierNCT03971474
SponsorSouthwest Oncology Group
Last Modified on20 October 2021

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