臨床研究等提出・公開システム

A Phase 2, multicenter, randomized study of trastuzumab deruxtecan in subjects with HER2-mutated metastatic Non-Small Cell Lung Cancer (NSCLC) (DESTINY-LUNG02)

Trastuzumab deruxtecan for subjects with HER2-mutated metastatic NSCLC (DESTINY-LUNG02)

152

The median age was 59.4 years in T-DXd 5.4 mg/kg dose group, 61.3 years in T-DXd 6.4 mg/kg dose group. The proportion of females was 65 (63.7%) in T-DXd 5.4 mg/kg dose group, 34 (68.0%) in T-DXd 6.4 mg/kg dose group. The proportion of Asians was 65 (63.7%) in T-DXd 5.4 mg/kg dose group, 31 (62.0%) in T-DXd 6.4 mg/kg dose group. The proportion of non-smokers was 55 (53.9%) in T-DXd 5.4 mg/kg dose group, 29 (58.0%) in T-DXd 6.4 mg/kg dose group. HER2 mutation type (local testing) was kinase domain in 149 (98.0%) and extracellular domain in 3 (2.0%).

152 enrolled/151 treated at least one dose of study drug. 102 patients were enrolled in the T-DXd 5.4 mg/kg dose group and 50 patients were enrolled in the T-DXd 6.4 mg/kg dose group.

All subjects in the T-DXd 5.4 mg/kg dose group and in the T-DXd 6.4 mg/kg dose group reported at least 1 TEAE. Notable differences between the 2 dose groups included a lower proportion of subjects with TEAEs in the T-DXd 5.4 mg/kg dose group than in the T-DXd 6.4 mg/kg dose group for the following parameters: - Grade >=3 TEAEs (52.5% versus 66.0%) and drug-related Grade >=3 TEAEs (38.6% versus 58.0%) - TEAEs associated with study drug discontinuation (14.9% versus 26.0%) - TEAEs associated with study drug interruption (44.6% versus 62.0%) and drug-related TEAEs associated with study drug interruption (26.7% versus 48.0%) - TEAEs associated with dose reduction (17.8% versus 32.0%) and drug-related TEAEs associated with dose reduction (16.8% versus 32.0%) - Drug-related SAEs (13.9% versus 24.0%) - Drug-related SAEs Grade >=3 (8.9% versus 20.0%) 37/101 (36.6%) subjects in the T-DXd 5.4 mg/kg dose group and 20/50 (40.0%) subjects in the T-DXd 6.4 mg/kg dose group experienced serious TEAEs.

For subjects randomized to the T-DXd 5.4 mg/kg dose group, the confirmed ORR based on BICR was 49.0% (95% CI = 39.0, 59.1), with 1 (1.0%) subject achieving confirmed CR and 49 (48.0%) subjects achieving confirmed PR. In subjects randomized to the T-DXd 6.4 mg/kg dose group, the confirmed ORR based on BICR was 56.0% (95% CI = 41.3, 70.0), with 2 (4.0%) subjects achieving confirmed CR and 26 (52.0%) subjects achieving confirmed PR. DCR based on BICR was 93.1% (95% CI = 86.4, 97.2) in the T-DXd 5.4 mg/kg dose group and 92.0% (95% CI = 80.8, 97.8) in the T-DXd 6.4 mg/kg dose group. Median DoR based on BICR was 16.8 months (95% CI = 6.4, not estimable [NE]) in the T-DXd 5.4 mg/kg dose group and NE (95% CI = 8.3, NE) in the T-DXd 6.4 mg/kg dose group. Median PFS based on BICR was 9.9 months (95% CI = 7.4, NE) in the T-DXd 5.4 mg/kg dose group and 15.4 months (95% CI = 8.3, NE) in the T-DXd 6.4 mg/kg dose group. Median OS based on BICR was 19.5 months (95% CI = 13.6, NE) in the T-DXd 5.4 mg/kg dose group and NE (95% CI = 12.1, NE) in the T-DXd 6.4 mg/kg dose group. A dose-related increase in T-DXd, total anti-HER2 antibody, and DXd exposure parameter values was observed for the PK exposure parameters. 1 (1.0%) subject at the 5.4 mg/kg dose level and 1 (2.0%) subject at the 6.4 mg/kg dose level were identified as having treatment emergent anti drug antibodies. Change from baseline analyses in the EORTC QLQ-C30 scales suggested that, overall, subject HRQoL and symptoms remained stable with T-DXd at 5.4 mg/kg and 6.4 mg/kg treatment. Change from baseline analyses in the EORTC QLQ-LC13 scales suggested that, overall, subject lung cancer specific symptoms remained stable with T-DXd at 5.4 mg/kg and 6.4 mg/kg treatment.

Data in HER2 mutant NSCLC demonstrate compelling treatment benefit of T-DXd along with generally manageable safety that is consistent with the established safety profile of T-DXd. Both the T-DXd 5.4 mg/kg and the T-DXd 6.4 mg/kg doses show a positive benefit-risk profile in HER2-mutant NSCLC, though a better safety profile was observed with the 5.4 mg/kg dose.

Sept. 11, 2023

https://ascopubs.org/doi/10.1200/JCO.23.01361?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Yes

De-identified individual participant data (IPD) on completed studies and applicable supporting clinical trial documents may be available upon request at https://vivli.org/. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. Details on data sharing criteria and the procedure for requesting access can be found at this web address: https://vivli.org/ourmember/daiichi-sankyo/ Supporting Information: - Study Protocol - Statistical Analysis Plan (SAP) - Informed Consent Form (ICF) Time Frame: Completed studies that has reached a global end or completion with all data set collected and analyzed, and for which the medicine and indication have received European Union (EU) and United States (US), and/or Japan (JP) marketing approval on or after 01 January 2014 or by the US or EU or JP Health Authorities when regulatory submissions in all regions are not planned and after the primary study results have been accepted for publication. Access Criteria: Formal request from qualified scientific and medical researchers on IPD and clinical study documents on completed clinical trials supporting products submitted and licensed in the United States, the European Union and/or Japan from 01 January 2014 and beyond for the purpose of conducting legitimate research. This must be consistent with the principle of safeguarding study participants' privacy and consistent with provision of informed consent. URL: https://vivli.org/ourmember/daiichi-sankyo/

https://jrct.mhlw.go.jp/latest-detail/jRCT2061200038

Inoguchi Akihiro

DAIICHI SANKYO Co.,Ltd.

1-2-58, Hiromachi, Shinagawa-ku, Tokyo

dsclinicaltrial_jp@daiichisankyo.com

Contact for Clinical Trial Information

DAIICHI SANKYO Co.,Ltd.

1-2-58, Hiromachi, Shinagawa-ku, Tokyo

+81-3-6225-1111

dsclinicaltrial_jp@daiichisankyo.com

Complete

Feb. 01, 2021

Interventional

randomized controlled trial

double blind

dose comparison control

parallel assignment

treatment purpose

- Written informed consent
- Men or women >=18 years, follow local regulatory requirements if the legal age of the consent for study participation is >18 years
- Pathologically documented metastatic NSCLC with a known activating HER2 mutation. Note: A HER2 mutation documented only from a liquid biopsy samples cannot be used for enrollment.
- Had previous treatment (second line or later [2L+], including platinum therapy), not amenable to curative surgery or radiation
- Presence of at least 1 measurable lesion confirmed by the Blinded Independent Central Review based on RECIST version 1.1
- Willing and able to provide an archival tumor tissue sample. A fresh biopsy is required if an archival tumor tissue sample cannot be supplied. Fine needle aspirates are not acceptable.
- Eastern Cooperative Oncology Group performance status 0 to 1
- Left ventricular ejection fraction >= 50% within 28 days before randomization
- Adequate organ function as specified in protocol within 14 days before randomization
- Adequate treatment washout period before randomization
- Participants of reproductive/childbearing potential agree to use a highly effective form of contraception (or avoid intercourse) during study period and up to 7 months (females) and 4 months (males) after last study dose
- Males should not freeze or donate sperm throughout the study period up to at least 4 months after last study dose; females should not donate or retrieve ova for their own use throughout the study period and up to at least 7 months after last study dose
- Life expectancy 3 months or more

- Known driver mutation in the epidermal growth factor receptor (EGFR) or BRAF gene or a known anaplastic lymphoma kinase (ALK) or ROS1 fusion
- Medical history of myocardial infarction within 6 months before randomization, symptomatic congestive heart failure (CHF) (New York Heart Association Class II to IV). Participants with troponin levels above upper limit of normal at screening (as defined by the manufacturer) and
without any myocardial infarction (MI)-related symptoms should have a cardiologic consultation before enrollment to rule out MI
- Corrected QT interval (QTcF) prolongation > 470 msec (females) or >450 msec (males) based on average of the triplicate12-lead electrocardiogram at screening
- History of non-infectious interstitial lung disease (ILD)/pneumonitis that required steroids, current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening
- Spinal cord compression or clinically active central nervous system metastases, defined as untreated and symptomatic, or requiring therapy with corticosteroids or anticonvulsants to control associated symptoms
- Multiple primary malignancies within 3 years, except adequately resected non-melanoma skin cancer, curatively treated in-situ disease, or other solid tumors curatively treated
- History of severe hypersensitivity reactions to either the drug substances or inactive ingredients in the drug product
- History of severe hypersensitivity reactions to other monoclonal antibodies
- Uncontrolled infection requiring IV antibiotics, antivirals, or antifungals
- Substance abuse or any other medical conditions such as clinically significant cardiac or psychological conditions, that may, in the opinion of the investigator, interfere with the participant's participation in the clinical study or evaluation of the clinical study results
- Known human immunodeficiency virus (HIV) infection
- Known active, clinically relevant liver disease (eg, active hepatitis B, or active hepatitis C), based on available blood tests, liver ultrasound, or liver biopsy results
- Unresolved toxicities from previous anticancer therapy, defined as toxicities (other than alopecia) not yet resolved to Grade <= 1 or baseline
- Pregnant, breastfeeding, or planning to become pregnant
- Otherwise considered inappropriate for the study by the Investigator
- Lung-specific intercurrent clinically significant illnesses including, but not limited to, any underlying pulmonary disorder (eg. pulmonary emboli within three months of the study randomization, severe asthma, severe COPD, restrictive lung disease, pleural effusion, etc.)
- Any autoimmune, connective tissue or inflammatory disorders (e.g., Rheumatoid arthritis, Sjogren's, sarcoidosis etc.) where there is documented, or a suspicion of pulmonary involvement at the time of screening
- Prior complete pneumonectomy

Both

Non-Small Cell Lung Cancer

Trastuzumab deruxtecan will be administered at either 5.4 or 6.4 mg/kg by intravenous infusion every 3 weeks.

Objective Response Rate by Blinded Independent Central Review Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors

- Objective Response Rate by Investigator Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
- Duration of Response Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer
- Disease Control Rate Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer
- Progression-free Survival Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer
- Overall Survival Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Nonsmall Cell Lung Cancer Tumors
- The Percentage of Participants Reporting Treatment-emergent Adverse Events Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
- Pharmacokinetic Parameter Maximum Serum Concentration (Cmax) for Trastuzumab Deruxtecan, Total Anti-HER2 Antibody, and Active Metabolite MAAA-1181a
- Pharmacokinetic Parameter Minimum Observed Concentration (Ctrough) for Trastuzumab Deruxtecan, Total Anti- HER2 Antibody, and Active Metabolite MAAA-1181a
- Pharmacokinetic Parameter Area Under the Serum Concentration-Time Curve (AUC) for Trastuzumab Deruxtecan, Total Anti-HER2 Antibody, and Active Metabolite MAAA-1181a
- Incidence of Anti-Drug Antibodies (ADA) Following Intravenous Administration of Trastuzumab Deruxtecan in Participants With Metastatic Non-small Cell Lung Cancer Tumors
- Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and EORTC Quality of Life Questionnaire for Lung Cancer Trials (QLQ-LC13) Scores
- Time to deterioration in European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life
- Questionnaire (QLQ-C30) scores

+81-86-235-7534

Jan. 26, 2021

Australia/Canada/France/Italy/Netherlands/South Korea/Spain/Taiwan/US