Tucatinib Plus Trastuzumab in Patients With HER2+ Colorectal Cancer
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| ClinicalTrials.gov Identifier: NCT03043313 |
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Recruitment Status :
Completed
First Posted : February 6, 2017
Results First Posted : April 18, 2023
Last Update Posted : November 13, 2023
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Sponsor:
Seagen Inc.
Collaborators:
National Cancer Institute (NCI)
Academic and Community Cancer Research United
Information provided by (Responsible Party):
Seagen Inc.
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Brief Summary:
This trial studies how well the drug tucatinib works when given with trastuzumab and when given by itself. The participants in this trial have HER2-positive (HER2+) metastatic colorectal cancer (mCRC). 'Metastatic' means that the cancer has spread to other parts of the body.
In the first part of this study, participants enrolled into Cohort A and received both tucatinib and trastuzumab. In the second part of this study, participants are randomly assigned to either Cohort B or Cohort C. Participants in Cohort B will receive tucatinib and trastuzumab. Participants in Cohort C will receive tucatinib. Participants in Cohort C who do not respond to therapy may have an option to receive tucatinib plus trastuzumab.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Metastatic Colorectal Adenocarcinoma | Drug: Trastuzumab Drug: Tucatinib | Phase 2 |
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 117 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | MOUNTAINEER: A Phase II, Open Label Study of Tucatinib Combined With Trastuzumab in Patients With HER2+ Metastatic Colorectal Cancer |
| Actual Study Start Date : | June 23, 2017 |
| Actual Primary Completion Date : | March 28, 2022 |
| Actual Study Completion Date : | November 2, 2023 |
Resource links provided by the National Library of Medicine
| Arm | Intervention/treatment |
|---|---|
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Experimental: Cohort A: Tucatinib + Trastuzumab
Non-randomized cohort. Participants take tucatinib twice per day orally on Days 1-21 and trastuzumab intravenously (into the vein; IV) on Day 1. Cycles repeat every 21 days.
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Drug: Trastuzumab
Given intravenously (into the vein; IV)
Other Name: Herceptin Drug: Tucatinib Given orally
Other Names:
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Experimental: Cohort B: Tucatinib + Trastuzumab
Randomized cohort. Participants take tucatinib twice per day orally on Days 1-21 and trastuzumab intravenously (into the vein; IV) on Day 1. Cycles repeat every 21 days.
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Drug: Trastuzumab
Given intravenously (into the vein; IV)
Other Name: Herceptin Drug: Tucatinib Given orally
Other Names:
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Experimental: Cohort C: Tucatinib Monotherapy
Randomized cohort. Participants take tucatinib twice per orally every day. Participants who do not respond to therapy may have the option to receive tucatinib and trastuzumab.
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Drug: Tucatinib
Given orally
Other Names:
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Primary Outcome Measures :
- Confirmed Objective Response Rate (cORR) Per RECIST 1.1 Per Blinded Independent Central Review (BICR) in Pooled Cohorts A+B [ Time Frame: Up to 46.6 months ]cORR is defined as the percentage of participants with confirmed complete response (CR) or partial response (PR) according to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1).
Secondary Outcome Measures :
- ORR by 12 Weeks of Treatment Per RECIST 1.1 According to BICR Assessment [ Time Frame: Up to 3 months ]ORR per BICR by 12 Weeks is defined as the percentage of participants with CR or PR by 12 weeks of treatment, and before time of crossover (Cohort C), whichever comes earlier.
- Duration of Response (DOR) Per RECIST 1.1 According to BICR Assessment [ Time Frame: Up to 44.7 months ]DOR is defined as the time from the first objective response (CR or PR that is subsequently confirmed) to documented PD per RECIST 1.1 or death from any cause, whichever occurs first.
- Progression-Free Survival (PFS) Per RECIST 1.1 According to BICR Assessment for Pooled Cohorts A+B [ Time Frame: Up to 46.6 months ]PFS is defined as the time from start of study treatment (Cohort A) or date of randomization (Cohort B) to documented disease progression (as determined by BICR per RECIST 1.1) or death from any cause, whichever occurs first.
- Overall Survival (OS) in Pooled Cohorts A+B [ Time Frame: Up to 53 months ]OS is defined as the time from start of study treatment (Cohort A) or randomization (Cohort B) to date of death due to any cause.
- Number of Participants With Adverse Events (AEs) [ Time Frame: Up to 49.3 months ]An AE is any untoward medical occurrence in a patient or clinical investigational participant administered a medicinal product and which does not necessarily have a causal relationship with this treatment. Treatment emergent AEs (TEAEs) are defined as events that are new or worsened on or after receiving the first dose of study treatment (tucatinib or trastuzumab) and up through 30 days after the last dose of study treatment (tucatinib or trastuzumab).
- Number of Participants With AEs Resulting in Dose Modification [ Time Frame: Up to 49.3 months ]Dose modification included dose reduction and dose withheld by investigator due to AEs. Dose holds were defined as any instances where planned administration of the study drug was temporarily withheld or interrupted at the direction of the treating physician. Dose reductions of trastuzumab were not allowed; if trastuzumab could not be restarted after being held for a TEAE, it was discontinued.
- Number of Participants With Treatment-Emergent Laboratory Abnormalities (Hematology) [ Time Frame: Up to 49.3 months ]Treatment emergent laboratory abnormalities are defined as abnormalities that are new or worsened on or after receiving the first dose of study treatment and up through 30 days after the last dose of study treatment. NCI CTCAE v5.0 is used for creatinine increased. NCI CTCAE v4.03 is used for the other lab parameters.
- Number of Participants With Treatment-Emergent Laboratory Abnormalities (Chemistry) [ Time Frame: Up to 49.3 months ]Treatment emergent laboratory abnormalities are defined as abnormalities that are new or worsened on or after receiving the first dose of study treatment and up through 30 days after the last dose of study treatment. NCI CTCAE v5.0 is used for creatinine increased. NCI CTCAE v4.03 is used for the other lab parameters.
Information from the National Library of Medicine
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria
- Histologically and/or cytologically documented adenocarcinoma of the colon or rectum that is metastatic and/or unresectable
- Unless contraindicated, participants must have received and failed regimens containing the following agents: fluoropyrimidine (e.g., 5-fluorouracil or capecitabine), oxaliplatin, irinotecan, an anti-VEGF monoclonal antibody (bevacizumab, ramucirumab, or ziv-aflibercept), and an anti-PD-(L)1 therapy (nivolumab or pembrolizumab) if tumor has deficient mismatch repair proteins or is MSI-High.
- Have progression of unresectable or metastatic CRC after the last systemic therapy, or be intolerant of last systemic therapy
- Have RAS wild-type in primary or metastatic tumor tissue, based on expanded RAS testing
- Willing and able to provide the most recently available tissue blocks obtained prior to treatment initiation. If archival tissue is not available, then a newly-obtained baseline biopsy of an accessible tumor
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Have confirmed HER2-positive mCRC, as defined by having tumor tissue tested at a Clinical Laboratory Improvement Act (CLIA)-certified or International Organization for Standardization (ISO)-accredited laboratory, meeting at least one of the following criteria:
- HER2+ overexpression (3+ immunohistochemistry [IHC]) by an FDA-approved or Conformité Européene (CE)-marked HER2 ICH test
- HER2 2+ IHC is eligible if the tumor is amplified by an FDA-approved or CE-marked HER2 in situ hybridization assay (FISH or chromogenic in situ hybridization [CISH]))
- HER2 (ERBB2) amplification by CLIA-certified or ISO-accredited next generation sequencing (NGS) sequencing assay
- Have radiographically measurable disease assessable by RECIST 1.1, with at least one site of disease that is measurable and that has not been previously irradiated; or, if the participant has had previous radiation to the target lesion(s), there must be evidence of progression since the radiation
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, 1, or 2
- Life expectancy greater than 3 months
- Have adequate hematological, hepatic, renal, coagulation, and cardiac function
Exclusion Criteria
- Previous treatment with anti-HER2 targeting therapy
- Previous treatment with any systemic anticancer therapy, non-central nervous system radiation, or experimental agent within 3 weeks of first dose of study treatment
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Toxicity related to prior cancer therapies that has not resolved to ≤ Grade 1, with the following exceptions:
- Alopecia and neuropathy, which must have resolved to ≤ Grade 2
- Congestive heart failure (CHF), which must have been ≤ Grade 1 in severity at the time of occurrence, and must have resolved completely
- Anemia, which must have resolved to ≤ Grade 2
- Decreased ANC, which must have resolved to ≤ Grade 2
- Have clinically significant cardiopulmonary disease
- Have known myocardial infarction, unstable angina, cardiac or other vascular stenting, angioplasty, or cardiac surgery within 6 months prior to first dose of study treatment
- Major surgical procedure, open biopsy, or significant traumatic injury ≤28 days prior to enrollment (≤56 days for hepatectomy, open thoracotomy, or major neurosurgery) or anticipation of need for major surgical procedure during the study
- Serious, non-healing wound, ulcer, or bone fracture
- Known to be positive for hepatitis B by surface antigen expression
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Known to have active hepatitis C infection
- Exception for participants with a documented sustained virologic response of 12 weeks
- Known to be positive for human immunodeficiency virus (HIV)
- Subjects who are pregnant, breastfeeding, or planning a pregnancy
- Inability to swallow pills or any significant gastrointestinal disease which would preclude the adequate oral absorption of medications
- Have used strong CYP2C8 inhibitor within 5 half-lives of the inhibitor, or have used a strong CYP2C8 or CYP3A4 inducer within 5 days prior to first dose of study treatment
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History of another malignancy within 3 years before the first dose of study drug, or any evidence of residual disease from a previously diagnosed malignancy.
- Exceptions are malignancies with a negligible risk of metastasis or death
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Subjects with known active CNS metastasis
- Irradiated or resected lesions are permitted, provided the lesions are fully treated and inactive, subject is asymptomatic, and no steroids have been administered for at least 30 days
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03043313
Locations
Show 56 study locations
Sponsors and Collaborators
Seagen Inc.
National Cancer Institute (NCI)
Academic and Community Cancer Research United
Investigators
| Study Chair: | John H Strickler | Academic and Community Cancer Research United | |
| Study Director: | Jorge Ramos, DO | Seagen Inc. |
Study Documents (Full-Text)
Documents provided by Seagen Inc.:
Documents provided by Seagen Inc.:
Study Protocol [PDF] June 30, 2021
Statistical Analysis Plan [PDF] May 11, 2022
| Responsible Party: | Seagen Inc. |
| ClinicalTrials.gov Identifier: | NCT03043313 |
| Other Study ID Numbers: |
SGNTUC-017 NCI-2017-01107 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) ACCRU-GI-1617 ( Other Identifier: Academic and Community Cancer Research United ) P30CA015083 ( U.S. NIH Grant/Contract ) |
| First Posted: | February 6, 2017 Key Record Dates |
| Results First Posted: | April 18, 2023 |
| Last Update Posted: | November 13, 2023 |
| Last Verified: | November 2023 |
| Studies a U.S. FDA-regulated Drug Product: | Yes |
| Studies a U.S. FDA-regulated Device Product: | No |
Keywords provided by Seagen Inc.:
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HER2 ERBB2 Colorectal cancer Seattle Genetics |
Additional relevant MeSH terms:
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Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site Neoplasms Digestive System Diseases Gastrointestinal Diseases Colonic Diseases |
Intestinal Diseases Rectal Diseases Trastuzumab Tucatinib Antineoplastic Agents, Immunological Antineoplastic Agents Protein Kinase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |