RecruitingPhase 2ACTRN12623000552684

OCEANiC: A Phase II, Open-label, Multi-centre Clinical Trial of Osimertinib With or Without Adjuvant Chemotherapy Guided by Tumour NGS Co-mutation Status and ctDNA Detection in Patients With Stage IIA-IIIA EGFR-Mutant Non Small Cell Lung Cancer Following Complete Surgical Resection

OCEANiC: A Phase II, Open-label, Multi-centre Clinical Trial on effect of Osimertinib, With or Without Adjuvant Chemotherapy, Guided by High-risk Tumour Next Generation Sequencing (NGS) Co-mutation Status and circulating tumour DNA (ctDNA) Detection on disease-free survival in Patients With Stage IIA-IIIA epidermal growth factor receptor (EGFR)-Mutant Non Small Cell Lung Cancer Following Complete Surgical Resection


Sponsor

The University of Sydney

Enrollment

100 participants

Start Date

Sep 22, 2023

Study Type

Interventional

Conditions

Summary

The purpose of this study is to investigate whether we can use co-mutation NGS profiling (looks for gene changes in your cancer tissue) and circulating tumour (ct) DNA (looks for fragments of the tumour moving through the blood stream. These fragments are known as circulating tumour DNA (ctDNA) and carry genetic information) to determine which patients with EGFR mutant non small-cell lung cancer can safely avoid chemotherapy. Who is it for? You may be eligible for this study if you are an adult with non small-cell lung cancer, with a mutation in epidermal growth factor receptor (referred to as EGFR mutation) that has had their tumour completely resected by surgery. Study details: During screening NGS profiling and ctDNA testing will be performed. The NGS and ctDNA results will be used to determine if your cancer is at higher or lower risk of returning. Participants with a higher risk of their cancer returning will have up to 4 cycles (over 12 weeks) of chemotherapy followed by up to 3 years of daily osimertinib. Participants with a lower risk of their cancer returning will have osimertinib daily for up to 3 years. The following assessments will be conducted throughout the trial: physical exam, CT scans, MRI, blood tests, pregnancy test, ECG and questionnaires. It is hoped that this study will help determine if osimertinib alone may provide similar benefits with less toxicity, improved quality of life and reduced health care costs, to chemotherapy and osimertinib.


Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Inclusion Criteria25

  • Adults, aged 18 years or older, with histological diagnosis of NSCLC. Patients with mixed small cell lung cancer histology are not eligible.
  • Stage IIA to IIIA NSCLC according to AJCC 8th edition.
  • Complete surgical resection of the primary NSCLC is mandatory.
  • 1. All gross tumour surgically removed at the end of surgery.
  • 2. All surgical resection margins must be microscopically negative.
  • 3. Resection may be accomplished by open or VATS techniques
  • 4. Surgery may consist of segmentectomies, lobectomy, sleeve resection, bi-lobectomy or pneumonectomy based on the intraoperative findings with appropriate lymph node sampling/mapping as determined by the surgeon. Patients who have only had wedge resections are not eligible.
  • Complete recovery from surgery at the time of registration. No more than 8 weeks may have elapsed between surgery and registration. Complete post-operative wound healing must have occurred following surgery.
  • Documented evidence of EGFR mutation (at any time since the initial diagnosis of NSCLC) known to be sensitive to osimertinib. These include exon 19 deletions, L858R (exon 21), G719X (exon 18), L861Q (exon 21), S768I (exon 20) and T790M (exon 20). Compound mutations involving any of the listed sensitising mutations are allowed.
  • ECOG Performance Status of 0 or 1 within 14 days prior to planned treatment start date.
  • Tumour tissue available from diagnostic biopsy or surgical specimen for co-mutation testing.
  • Adequate organ system function within 14 days prior to planned treatment start date:
  • Bone marrow function
  • i. Platelets more than or equal to 100 x 109/L
  • ii. Absolute neutrophil count (ANC) more than or equal to 1.5 x 109/L
  • iii. Haemoglobin more than or equal to 90 g/L
  • Liver function
  • i. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal to 2.5 x upper limit of normal (ULN)
  • ii. Total bilirubin less than or equal to 1.5 x ULN or 3 x ULN in the presence of documented Gilbert’s Syndrome (unconjugated hyperbilirubinaemia).
  • Renal function
  • i. Measured Creatinine clearance greater than or equal to 45 mL/min can be determined using any of the following: 51Cr-EDTA, 99mTc-DTPA renography, 24-hour urine collection for creatinine clearance, Calculated creatinine clearance greater than or equal to 45 mL/min by the Cockcroft-Gault formula or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.
  • MRI scan of the brain must be performed at any time between diagnosis and registration.
  • Baseline ECG with QTc <470ms and no clinically significant arrhythmias.
  • Willing and able to comply with all study requirements, including treatment, timing and/or nature of required assessments.
  • Signed, written informed consent.

Exclusion Criteria17

  • Previous diagnosis of another lung cancer within 5 years prior to registration.
  • Prior systemic treatment for NSCLC including prior EGFR pathway inhibitor treatment.
  • History of hypersensitivity to active or inactive excipients of osimertinib or drugs with a similar chemical structure or class to osimertinib.
  • Post-operative radiotherapy (PORT) planned.
  • Prior radiation to lung and/or mediastinum.
  • Known history of interstitial lung disease (ILD) or drug-induced pneumonitis requiring steroid treatment, or any evidence of clinically active ILD.
  • Treatment with an investigational drug within five half-lives of the compound or 3 months, whichever is greater.
  • Significant history of cardiovascular disease. Any clinically important abnormalities in rhythm conduction or morphology of resting ECG e.g. Complete left bundle branch block, third degree heart block and second degree heart block. Patient with any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, electrolyte abnormalities, Congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years of age in first degree relatives or any concomitant medication known to prolong the QT interval and cause Torsades de Pointes.
  • Significant history of peripheral vascular or cerebrovascular disease.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, active hepatitis B, hepatitis C, or HIV. Chronic hepatitis B carrier with undetectable hepatitis DNA level is allowed. Serological testing is not mandatory unless clinically indicated.
  • Significant gastrointestinal disorder that results in significant malabsorption, requirement for intravenous alimentation or inability to take oral medication as per investigator’s discretion.
  • History of another concurrent active malignancy that requires ongoing treatment.
  • Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results.
  • Treatment with prohibited medications which may interact with study treatment.
  • Serious medical or psychiatric conditions that might limit the ability of the patient to comply with the protocol.
  • Pregnancy, lactation, or inadequate contraception. Participants must be post-menopausal, infertile, or use a reliable means of contraception. Participants of childbearing potential must have a negative pregnancy test done within 7 days prior to registration. Participants who are having a sexual relationship in which their partner could become pregnant must have been surgically sterilised or use a (double if required) barrier method of contraception.
  • Involvement in the planning and/or conduct of the study (applies to both NHMRC CTC staff and/or staff at the study site).

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Interventions

During screening patients are divided into 2 noncomparative cohorts, (low vs higher risk cancer recurrence) which is based on tumour tissue co-mutation status and the detection of ctDNA in plasma coll

During screening patients are divided into 2 noncomparative cohorts, (low vs higher risk cancer recurrence) which is based on tumour tissue co-mutation status and the detection of ctDNA in plasma collected up to four weeks post-surgery. The tumour tissue used will be a sample from the surgical resection of the primary NSCLC the participant has already undergone. The plasma will be a blood test. Cohort 1 (low risk): Includes participants with absence of ctDNA and no co-mutations. Participants will receive osimertinib 80 mg orally, once daily, for up to 3 years or until disease recurrence, unacceptable toxicity. Participants will need to return osimertinib bottles at each visit to monitor treatment compliance. Cohort 2 (high risk): Includes participants with presence of ctDNA and/or presence of tumour co-mutations. Participants will receive 4 cycles of platimun doublet chemotherapy followed by osimertinib 80 mg orally, once daily, for up to 3 years or until disease recurrence, unacceptable toxicity or consent withdrawal, whichever is sooner. Participants will need to return osimertinib bottles at each visit to monitor treatment compliance. For participants in cohort 1, osimertinib should commence within 10 weeks following surgery. For participants in cohort 2, osimertinib should commence within 26 weeks following surgery.


Locations(11)

Peter MacCallum Cancer Centre - Melbourne

NSW,QLD,SA,WA,VIC, Australia

St Vincent's Hospital (Melbourne) Ltd - Fitzroy

NSW,QLD,SA,WA,VIC, Australia

Austin Health - Austin Hospital - Heidelberg

NSW,QLD,SA,WA,VIC, Australia

Monash Medical Centre - Clayton campus - Clayton

NSW,QLD,SA,WA,VIC, Australia

The Chris O’Brien Lifehouse - Camperdown

NSW,QLD,SA,WA,VIC, Australia

GenesisCare - St Leonards - St Leonards

NSW,QLD,SA,WA,VIC, Australia

Liverpool Hospital - Liverpool

NSW,QLD,SA,WA,VIC, Australia

The Prince Charles Hospital - Chermside

NSW,QLD,SA,WA,VIC, Australia

Fiona Stanley Hospital - Murdoch

NSW,QLD,SA,WA,VIC, Australia

Westmead Hospital - Westmead

NSW,QLD,SA,WA,VIC, Australia

Flinders Medical Centre - Bedford Park

NSW,QLD,SA,WA,VIC, Australia

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ACTRN12623000552684