A Phase 1 interventional study of selumetinib and gemcitabine in Locally Advanced or Metastatic NSCL Cancer Stage IIIB IV, sponsored by AstraZeneca. Completed at 4 sites in United Kingdom. Open to participants aged 18 Years to 99 Years. Per ClinicalTrials.gov, last updated 2018-03-13.
Sponsored by AstraZeneca · Phase 1, Interventional, and Treatment
This is a Phase I, open label multicentre study of selumetinib administered orally in combination with first line chemotherapy regimens to patients with advanced/metastatic NSCLC. The study has been designed to allow an investigation of the optimal dose of selumetinib in combination with various standard first line double-platinum chemotherapy regimens. Initial assessment will be based on tolerability of selumetinib in combination with one or more selected regimens that are considered to be tolerated also being assessed for preliminary evidence of activity.
This study is a dose finding and optional cohort expansion; In addition all patients will be assessed for anti-cancer efficacy of the combination of selumetinib and chemotherapy.
A Phase I, Open Label, Multicentre Study to Assess the Safety, Tolerability, Pharmacokinetics and Preliminary Efficacy of Selumetinib (AZD6244; ARRY-142886) in Combination with First Line Chemotherapy Regimens in Patients with Non-Small Cell Lung Cancer (NSCLC)
7,243 studies on the registry are indexed under Lung Neoplasms; 1,557 are open to participants now.
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Exclusion Criteria:
Selumetinib plus gemcitabine; or pemetrexed and cisplatin or carboplatin
Drug: selumetinib · Drug: gemcitabine · Drug: cisplatin · Drug: carboplatin · Drug: pemetrexed
2 x 25mg capsules bd continuously in cohort 1 (with gemcitabine and cisplatin). If tolerated - next cohort 3 x 25mg capsules bd continuously. if higher doses are explored, required number of capsules will be provided. Option to administer on D2-19 of each 21 day cycle if required to assess tolerability of combinations with chemotherapy
1250 mg/m2 iv on Day 1 and 8 of each 21 day cycle. If combination not tolerated, option to give 1000 mg/m2 iv on Day 1 and Day 8 of each 21 day cycle
75 mg/m2 iv on Day 1 of each 21 day cycle. If combination not tolerated, option to give 50 mg/m2 iv on Day 1 or 25mg/m2 iv on Day 1 and Day 8 of each 21 day cycle
If it is not possible to identify a tolerable combination of selumetinib, gemcitabine and cisplatin, cisplatin may be replaced with carboplatin (AUC5) iv on Day 1 of each 21 day cycle
Gemcitabine may be replaced with pemetrexed 500 mg/m2 iv on Day 1 of each 21 day cycle.
Dose Limiting Toxicity (DLT) Events in Chemotherapy in Combination With Selumetinib
Any toxicity not attributable to the disease or disease-related processess under investigation, considered related to the combination of chemotherapy plus selumetinib, which occurs within the timeframe and is dose limiting
Time frame: The first dose on Cycle 1 Day 1 up to the time before dosing on Cycle 2 Day 1, assessed up to 3 weeks
Best Objective Response
The best response a patient has had during their time in the study up until RECIST progression or last valuable assessment in the absence of RECIST progression. Per Response Evaluation Criteria In Solid Tumours (RECIST version 1.1) for target lesions (TL) and assessed by MRI or CT: Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Stable Disease (SD), neither sufficient shrinkage to qualify for a Partial Response nor sufficient increase to qualify for Progressive Disease (PD); Progressive Disease (PD), \>=20% increase in the sum of the longest diameter of target lesions, the sum must also demonstrate an absolute increase of \>=5mm; Complete Response (CR), disappearance of all target lesions, any pathological lymph nodes selected as TLs must have a reduction in short axis to \<10mm
Time frame: Screening, week 6 and week 12
Percentage Change From Baseline at 6 Weeks in Target Lesion Size
The percentage change in the sum of the diameters of target lesions
Time frame: Week 6
Best Percentage Change From Baseline in Target Lesion Size
The best percentage change in tumour size a patient has had during their time in the study up until RECIST progression or last valuable assessment in the absence of RECIST progression. Percentage change was derived at each visit by the percentage change in the sum of the diameters of target lesions
Time frame: Screening, week 6 and week 12
Objective Response Rate (ORR)
The number of patients who had at least 1 confirmed visit response of Complete Response (CR) or Partial Response (PR) prior to any evidence of progression. Per Response Evaluation Criteria In Solid Tumours (RECIST version 1.1) for target lesions (TL) and assessed by MRI or CT: Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Complete Response (CR), disappearance of all target lesions, any pathological lymph nodes selected as TLs must have a reduction in short axis to \<10mm; Objective Response Rate (ORR) = CR + PR
Time frame: Up until progression or last evaluable assessment in the absence of progression, up to 9 months
AUC (0-tau)
Area under the concentration time curve (AUC) over a dosing interval at steady state (0-tau)
Time frame: Cycle 2 Day1, pre-dose, 0.5, 1, 1.5, 2, 4, 8, 10 hours post dose
Cmax,ss
Maximum plasma concentration at steady state
Time frame: Cycle 2 Day1, pre-dose, 0.5, 1, 1.5, 2, 4, 8, 10 hours post dose
Tmax,ss
Time to reach maximum plasma concentration at steady state
Time frame: Cycle 2 Day1, pre-dose, 0.5, 1, 1.5, 2, 4, 8, 10 hours post dose
CL/F
Apparent oral plasma clearance
Time frame: Cycle 2 Day1, pre-dose, 0.5, 1, 1.5, 2, 4, 8, 10 hours post dose
Patients were enrolled into dose-finding cohorts to evaluate escalating doses of selumetinib (AZD6244; ARRY-142886) to determine the maximum tolerated dose in combination with standard first-line chemotherapy regimens. Chemotherapy was administered on Day 1 (and Day 8 for gemcitabine) of each 3-week cycle.
| Milestone | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Started | 3 | 9 | 7 | 3 | 6 | 15 | 12 |
| Completed | 2 | 8 | 4 | 2 | 4 | 12 | 7 |
| Not completed | 1 | 1 | 3 | 1 | 2 | 3 | 5 |
| Withdrew: Withdrawal by subject | 0 | 0 | 1 | 1 | 1 | 0 | 4 |
| Withdrew: Death | 1 | 1 | 2 | 0 | 1 | 3 | 1 |
Any toxicity not attributable to the disease or disease-related processess under investigation, considered related to the combination of chemotherapy plus selumetinib, which occurs within the timeframe and is dose limiting
| participants | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Evaluable patients | 3 | 7 | 4 | 3 | 6 | 12 | 6 |
| Evaluable patients with a DLT Event | 0 | 2 | 1 | 0 | 0 | 1 | 1 |
The best response a patient has had during their time in the study up until RECIST progression or last valuable assessment in the absence of RECIST progression. Per Response Evaluation Criteria In Solid Tumours (RECIST version 1.1) for target lesions (TL) and assessed by MRI or CT: Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Stable Disease (SD), neither sufficient shrinkage to qualify for a Partial Response nor sufficient increase to qualify for Progressive Disease (PD); Progressive Disease (PD), \>=20% increase in the sum of the longest diameter of target lesions, the sum must also demonstrate an absolute increase of \>=5mm; Complete Response (CR), disappearance of all target lesions, any pathological lymph nodes selected as TLs must have a reduction in short axis to \<10mm
| participants | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Complete response | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Partial response | 1 | 2 | 2 | 1 | 1 | 2 | 2 |
| Unconfirmed complete or partial response | 0 | 3 | 0 | 0 | 2 | 2 | 2 |
| Stable disease | 0 | 1 | 2 | 2 | 3 | 7 | 6 |
| RECIST progression | 2 | 0 | 1 | 0 | 0 | 1 | 1 |
| Death | 0 | 0 | 0 | 0 | 0 | 1 | 0 |
| Incomplete post-baseline assessments | 0 | 3 | 2 | 0 | 0 | 2 | 1 |
The percentage change in the sum of the diameters of target lesions
| % change | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Percentage Change From Baseline at 6 Weeks in Target Lesion Size | -7.5 ± 19.79 | -29.3 ± 11.15 | -10.4 ± 24.45 | -14.7 ± 1.91 | -24.4 ± 32.60 | -18.9 ± 10.55 | -18.4 ± 19.58 |
The best percentage change in tumour size a patient has had during their time in the study up until RECIST progression or last valuable assessment in the absence of RECIST progression. Percentage change was derived at each visit by the percentage change in the sum of the diameters of target lesions
| % change | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Best Percentage Change From Baseline in Target Lesion Size | -11.9 ± 26.52 | -34.6 ± 8.11 | -41.3 ± 21.25 | -28.3 ± 15.25 | -34.7 ± 33.30 | -24.4 ± 14.71 | -25.4 ± 20.51 |
The number of patients who had at least 1 confirmed visit response of Complete Response (CR) or Partial Response (PR) prior to any evidence of progression. Per Response Evaluation Criteria In Solid Tumours (RECIST version 1.1) for target lesions (TL) and assessed by MRI or CT: Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Complete Response (CR), disappearance of all target lesions, any pathological lymph nodes selected as TLs must have a reduction in short axis to \<10mm; Objective Response Rate (ORR) = CR + PR
| participants | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Objective Response Rate (ORR) | 1 ± 26.52 | 2 ± 8.11 | 2 ± 21.25 | 1 ± 15.25 | 1 ± 33.30 | 2 ± 14.71 | 2 ± 20.51 |
Area under the concentration time curve (AUC) over a dosing interval at steady state (0-tau)
| h*ng/mL | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| AUC (0-tau) | NA ± NA | 3571 ± 42.13 | 3339 ± 15.08 | 4813 ± 30.93 | 4366 ± 48.14 | 4116 ± 33.92 | 5202 ± 52.94 |
Maximum plasma concentration at steady state
| ng/mL | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Cmax,ss | 476.7 ± 51.12 | 1222 ± 59.86 | 1487 ± 23.09 | 1615 ± 27.71 | 1375 ± 40.21 | 1364 ± 57.78 | 2309 ± 35.99 |
Time to reach maximum plasma concentration at steady state
| h | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| Tmax,ss | 1.00 ± 51.12 | 1.25 ± 23.09 | 1.00 ± 57.78 | 1.00 ± 59.86 | 1.75 ± 27.71 | 1.48 ± 40.21 | 1.50 ± 35.99 |
Apparent oral plasma clearance
| L/h | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| CL/F | NA ± NA | 14.72 ± 5.156 | 22.64 ± 3.521 | 10.72 ± 3.328 | 18.82 ± 9.777 | 19.08 ± 5.881 | 21.02 ± 9.857 |
Collected over Adverse Events are collected throughout the study, from informed consent until the end of follow-up, which is defined as 28 +/- 7 days after selumetinib is discontinued. Patients were expected to receive up to 6 cycles (18 wks) of chemotherapy.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cohort 1 sel50, Gem, Cis | — | 1/3 (33.3%) | 3/3 (100%) |
| Cohort 2 sel50, Gem, Carb | — | 6/9 (66.7%) | 9/9 (100%) |
| Cohort 3 sel75, Gem, Cis | — | 3/7 (42.9%) | 7/7 (100%) |
| Cohort 4 sel150, Pem, Carb | — | 2/3 (66.7%) | 3/3 (100%) |
| Cohort 5 sel75, Pem, Carb | — | 3/6 (50%) | 6/6 (100%) |
| Cohort 6 sel75, Pem, Cis | — | 9/15 (60%) | 15/15 (100%) |
| Cohort 7 sel100, Pem, Carb | — | 9/12 (75%) | 12/12 (100%) |
| Event | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| ThrombocytopeniaBlood and lymphatic system disorders | 0/3 | 4/9 | 0/7 | 0/3 | 0/6 | 0/15 | 4/12 |
| Large intestine perforationGastrointestinal disorders | 1/3 | 0/9 | 1/7 | 0/3 | 0/6 | 0/15 | 0/12 |
| Musculoskeletal chest painMusculoskeletal and connective tissue disorders | 0/3 | 0/9 | 0/7 | 1/3 | 0/6 | 0/15 | 0/12 |
| Pain in extremityMusculoskeletal and connective tissue disorders | 0/3 | 0/9 | 0/7 | 1/3 | 0/6 | 0/15 | 0/12 |
| Urinary retentionRenal and urinary disorders | 0/3 | 0/9 | 0/7 | 1/3 | 0/6 | 0/15 | 0/12 |
| Pulmonary embolismRespiratory, thoracic and mediastinal disorders | 1/3 | 0/9 | 1/7 | 0/3 | 0/6 | 0/15 | 0/12 |
| NauseaGastrointestinal disorders | 0/3 | 0/9 | 2/7 | 0/3 | 0/6 | 1/15 | 0/12 |
| AnaemiaBlood and lymphatic system disorders | 0/3 | 0/9 | 1/7 | 0/3 | 0/6 | 0/15 | 2/12 |
| PyrexiaGeneral disorders | 0/3 | 1/9 | 0/7 | 0/3 | 1/6 | 0/15 | 0/12 |
| Neutropenic sepsisInfections and infestations | 0/3 | 0/9 | 0/7 | 0/3 | 1/6 | 0/15 | 0/12 |
| Event | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb |
|---|---|---|---|---|---|---|---|
| NauseaGastrointestinal disorders | 3/3 | 5/9 | 5/7 | 3/3 | 5/6 | 8/15 | 10/12 |
| VomitingGastrointestinal disorders | 3/3 | 4/9 | 4/7 | 1/3 | 4/6 | 6/15 | 7/12 |
| ConstipationGastrointestinal disorders | 1/3 | 5/9 | 4/7 | 2/3 | 2/6 | 6/15 | 9/12 |
| RashSkin and subcutaneous tissue disorders | 0/3 | 3/9 | 5/7 | 2/3 | 1/6 | 8/15 | 6/12 |
| Periorbital oedemaEye disorders | 0/3 | 3/9 | 2/7 | 2/3 | 1/6 | 2/15 | 6/12 |
| DiarrhoeaGastrointestinal disorders | 2/3 | 5/9 | 4/7 | 1/3 | 3/6 | 9/15 | 6/12 |
| FatigueGeneral disorders | 2/3 | 6/9 | 3/7 | 1/3 | 2/6 | 9/15 | 7/12 |
| Lower respiratory tract infectionInfections and infestations | 0/3 | 4/9 | 1/7 | 2/3 | 0/6 | 2/15 | 0/12 |
| HypomagnesaemiaMetabolism and nutrition disorders | 0/3 | 0/9 | 0/7 | 2/3 | 0/6 | 0/15 | 0/12 |
| AnaemiaBlood and lymphatic system disorders | 1/3 | 5/9 | 0/7 | 1/3 | 1/6 | 0/15 | 4/12 |
| Age, Continuous(Years) | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb | Total |
|---|---|---|---|---|---|---|---|---|
| Mean | 58.7 ± 3.79 | 69.2 ± 3.53 | 55.1 ± 8.65 | 64.7 ± 7.23 | 59.5 ± 5.28 | 61.8 ± 5.86 | 60.2 ± 8.39 | 61.5 ± 7.45 |
| Sex: Female, Male(Participants) | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb | Total |
|---|---|---|---|---|---|---|---|---|
| Female | 1 | 5 | 3 | 1 | 4 | 5 | 7 | 26 |
| Male | 2 | 4 | 4 | 2 | 2 | 10 | 5 | 29 |
| Race/Ethnicity, Customized(Participants) | Cohort 1 sel50, Gem, Cis | Cohort 2 sel50, Gem, Carb | Cohort 3 sel75, Gem, Cis | Cohort 4 sel150, Pem, Carb | Cohort 5 sel75, Pem, Carb | Cohort 6 sel75, Pem, Cis | Cohort 7 sel100, Pem, Carb | Total |
|---|---|---|---|---|---|---|---|---|
| Black Or African American | 1 | 0 | 0 | 0 | 1 | 1 | 0 | 3 |
| Other | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 2 |
| White | 2 | 9 | 7 | 3 | 5 | 13 | 11 | 50 |
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