Datopotamab Deruxtecan + Immunotherapy for Non-Small Cell Lung Cancer

(TROPION-Lung04 Trial)

Not currently recruiting at 75 trial locations

Overseen By AstraZeneca Lung Cancer Study Locator Service

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: AstraZeneca

Disqualifiers: Autoimmune disorders, Cardiac disease, Hepatitis, HIV, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4 cycles of carboplatin (approximately 12 weeks)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore the safety and effectiveness of combining datopotamab deruxtecan (a TROP2-directed antibody-drug conjugate) with various immunotherapies, such as durvalumab, and possibly carboplatin, to treat advanced non-small cell lung cancer (NSCLC). Researchers seek to identify the best treatment combinations for patients who are either new to treatment or have had limited prior chemotherapy. The trial is recruiting participants diagnosed with advanced or metastatic NSCLC, particularly those without specific genetic changes, who may have tried one type of chemotherapy before. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering participants the opportunity to be among the first to receive this new treatment.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that datopotamab deruxtecan (Dato-DXd) is generally safe for patients with advanced non-small cell lung cancer. In one study, 35% of patients responded positively to the treatment, and 78% had their disease controlled, indicating significant patient benefit.

When combined with durvalumab, research has found Dato-DXd to be safe and effective. Durvalumab's existing approval for some cancers adds confidence in its safety.

For the combination of Dato-DXd with AZD2936, safety information is still being gathered. However, early results from other studies suggest it is generally safe.

Similarly, combining Dato-DXd with AZD7789 and MEDI5752 has shown safety for patients with non-small cell lung cancer.

While these combinations are still under study, current evidence supports their safety, with most side effects being manageable. This trial is in an early phase and aims to confirm these safety results further. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments because Datopotamab deruxtecan (Dato-DXd), combined with various agents like Durvalumab, AZD2936, and AZD7789, offers a novel approach to treating non-small cell lung cancer (NSCLC). Unlike standard chemotherapy that targets all rapidly dividing cells, Dato-DXd is an antibody-drug conjugate that specifically targets cancer cells, potentially reducing side effects and improving treatment precision. Additionally, the combinations with immune checkpoint inhibitors like Durvalumab aim to enhance the immune system's ability to fight cancer, which is a promising strategy not fully utilized in current standard treatments. These innovative combinations have the potential to overcome resistance seen with existing therapies and provide new hope for patients with NSCLC.

What evidence suggests that this trial's treatments could be effective for non-small cell lung cancer?

Research has shown that datopotamab deruxtecan (Dato-DXd) may effectively treat non-small cell lung cancer (NSCLC). In earlier studies, patients with advanced NSCLC who received Dato-DXd lived for a median of 14.6 months. In this trial, some participants will receive Dato-DXd combined with durvalumab, an immunotherapy drug. Previous studies have shown that combining Dato-DXd with durvalumab led to tumor shrinkage in 35% of patients, while 78% experienced stable disease without worsening. These findings suggest that Dato-DXd, especially when used with immunotherapy, could be a promising treatment option for NSCLC. ^{3 4 5 6 7}

Who Is on the Research Team?

Global Clinical Leader

Principal Investigator

Daiichi Sankyo, Inc.

Are You a Good Fit for This Trial?

Adults with advanced or metastatic non-small cell lung cancer (NSCLC) who are either treatment-naïve or have had one prior chemotherapy without immune checkpoint inhibitors. Participants must have good organ function, measurable disease, no severe illnesses, and an ECOG performance status of 0 or 1. Those with certain genetic alterations in NSCLC or a history of other cancers are excluded.

Inclusion Criteria

You have a disease that can be measured according to specific guidelines within the 28 days before starting treatment.

My advanced lung cancer does not have EGFR or ALK mutations.

My cancer shows PD-L1 presence as tested by specific assays.

Exclusion Criteria

I have severe lung problems due to a recent illness.

I do not have active brain metastases or spinal cord compression.

I do not have an infection needing IV drugs.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Dato-DXd in combination with immunotherapy with or without carboplatin. Part 1 involves dose escalation or confirmation, and Part 2 involves dose expansion.

4 cycles of carboplatin (approximately 12 weeks)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of disease control rate and pharmacokinetic parameters.

9 months

Long-term follow-up

Participants are monitored for overall survival and other secondary outcomes.

Approximately 60 months

What Are the Treatments Tested in This Trial?

Interventions

• Carboplatin
• Datopotamab deruxtecan
• Durvalumab

Trial Overview

The trial is testing the combination of Datopotamab deruxtecan (Dato-DXd), a new drug, with immunotherapy agents MEDI5752/AZD2936 and Durvalumab, plus Carboplatin for some groups. It aims to evaluate safety and how well these treatments work together in patients.

How Is the Trial Designed?

Group I: Cohort 9 Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + MEDI5752 + Carboplatin in participants with treatment-naïve NSCLC

Group II: Cohort 8 Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD2936 + Carboplatin in participants with treatment-naïve NSCLC

Group III: Cohort 7 Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD2936 + Carboplatin in participants with treatment-naïve NSCLC

Group IV: Cohort 6 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD2936 in participants with treatment-naïve NSCLC

Group V: Cohort 5 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD2936 in participants with treatment-naïve NSCLC

Group VI: Cohort 4A Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + Durvalumab + carboplatin in participants with treatment-naïve NSCLC

Group VII: Cohort 4 Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + Durvalumab + Carboplatin in NSCLC participants who are either treatment-naïve or have received only 1 prior line of systemic chemotherapy without concomitant ICI therapy

Group VIII: Cohort 3 Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + Durvalumab + Carboplatin in NSCLC participants who are either treatment-naïve or have received only 1 prior line of systemic chemotherapy without concomitant ICI therapy

Group IX: Cohort 2 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + Durvalumab in NSCLC participants who are either treatment-naïve or have received only 1 prior line of systemic chemotherapy without concomitant ICI therapy

Group X: Cohort 14 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD7789 in participants with treatment-naïve NSCLC

Group XI: Cohort 13 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD7789 in participants with CPI acquired resistant NSCLC

Group XII: Cohort 12 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + AZD7789 in participants with CPI acquired resistant NSCLC

Group XIII: Cohort 11 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + MEDI5752 in participants with treatment-naïve NSCLC

Group XIV: Cohort 10 Experimental Treatment 3 Interventions

Datopotamab deruxtecan (Dato-DXd) + MEDI5752 + Carboplatin in participants with treatment-naïve NSCLC

Group XV: Cohort 1 Experimental Treatment 2 Interventions

Datopotamab deruxtecan (Dato-DXd) + Durvalumab in NSCLC participants who are either treatment-naïve or have received only 1 prior line of systemic chemotherapy without concomitant ICI therapy

Datopotamab deruxtecan is already approved in Japan for the following indications:

Approved in Japan as Dato-DXd for:

• HER2-negative breast cancer

Who Is Running the Clinical Trial?

AstraZeneca

Lead Sponsor

Trials

4,491

Recruited

290,540,000+

Sir Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Dr. Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Medical Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Daiichi Sankyo

Industry Sponsor

Trials

443

Recruited

493,000+

Hiroyuki Okuzawa

Daiichi Sankyo

Chief Executive Officer

Degree in Social Sciences from Hitotsubashi University

Yuki Abe

Daiichi Sankyo

Chief Medical Officer since 2023

MD

Daiichi Sankyo, Inc.

Industry Sponsor

Trials

390

Recruited

442,000+

Yuki Abe

Daiichi Sankyo, Inc.

Chief Medical Officer since 2022

MD

Hiroyuki Okuzawa

Daiichi Sankyo, Inc.

Chief Executive Officer

Degree in Social Sciences from Hitotsubashi University

Published Research Related to This Trial

Daratumumab is a first-in-class monoclonal antibody that targets CD38 and is approved for treating relapsed or refractory multiple myeloma, highlighting its role as a new therapeutic option for this challenging disease.

Determining the right dosage regimen for daratumumab is complex due to its unique pharmacokinetics, which are influenced by the drug's target-mediated disposition, necessitating careful evaluation in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Implications of Complex Pharmacokinetics for Daratumumab Dose Regimen in Patients With Relapsed/Refractory Multiple Myeloma. Xu, XS., Yan, X., Puchalski, T., et al.[2023]

Durvalumab, an immunotherapy drug for non-small cell lung cancer (NSCLC), has shown significant activity and acceptable tolerability, especially in patients with at least 25% PD-L1 tumor expression, and has been established as a standard treatment following chemoradiation based on the PACIFIC study results.

While durvalumab is effective in wild-type EGFR and ALK patients, its efficacy is lower in those with EGFR mutations or ALK-positive status, highlighting the need for ongoing research into combination therapies and the management of treatment-related toxicity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Durvalumab for the treatment of non-small cell lung cancer. Mezquita, L., Planchard, D.[2019]

The combination of MEDI0680 and durvalumab was found to be safe and tolerable in patients with advanced clear-cell renal cell carcinoma, but it did not show improved efficacy compared to nivolumab alone, with objective response rates of 16.7% for the combination and 23.8% for nivolumab.

Both treatment groups had a median progression-free survival of 3.6 months, and a notable percentage of patients (23.8% in the combination group) discontinued treatment due to adverse events, highlighting the need for careful monitoring of side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Phase II Study of MEDI0680 in Combination with Durvalumab versus Nivolumab Monotherapy in Patients with Advanced or Metastatic Clear-cell Renal Cell Carcinoma. Voss, MH., Azad, AA., Hansen, AR., et al.[2023]

In a study involving 26 patients with various mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H) tumors, the PD-L1 inhibitor durvalumab demonstrated a clinical benefit in 50% of patients, with a 27% objective response rate, indicating its potential efficacy in this difficult-to-treat population.

Durvalumab was well-tolerated with no unexpected toxicities, and factors such as high structural variant burden and low IFN-γ expression were linked to a lack of clinical benefit, suggesting these could be important biomarkers for future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy, safety and biomarker analysis of durvalumab in patients with mismatch-repair deficient or microsatellite instability-high solid tumours. Geurts, BS., Battaglia, TW., van Berge Henegouwen, JM., et al.[2023]

In a study involving 97 chemotherapy-naïve patients with advanced non-small cell lung cancer, tigatuzumab combined with carboplatin/paclitaxel showed a median progression-free survival of 5.4 months, compared to 4.3 months for the placebo, indicating a slight improvement in disease control.

Despite being well tolerated, tigatuzumab did not significantly enhance overall survival compared to placebo, and there was a higher incidence of grade 3/4 neutropenia in the tigatuzumab group (20.4%) compared to the placebo group (8.3%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized, double-blind, placebo-controlled phase 2 study of tigatuzumab (CS-1008) in combination with carboplatin/paclitaxel in patients with chemotherapy-naïve metastatic/unresectable non-small cell lung cancer. Reck, M., Krzakowski, M., Chmielowska, E., et al.[2022]

This phase I/II clinical trial is investigating the safety and efficacy of a combination treatment involving selumetinib, tremelimumab, and durvalumab in 40 patients with previously treated, unresectable non-small-cell lung cancer (NSCLC).

The study aims to determine the maximum tolerated dose and progression-free survival, while also exploring biomarkers of response and resistance, which could help tailor future treatments for NSCLC patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase I/II Trial of Immunotherapy With Durvalumab and Tremelimumab With Continuous or Intermittent MEK Inhibitor Selumetinib in NSCLC: Early Trial Report. Gaudreau, PO., Lee, JJ., Heymach, JV., et al.[2021]

Durvalumab, a PD-L1 inhibitor, has been shown to be safe for patients with various solid tumors, with common side effects including pruritus and fatigue, based on a meta-analysis of 17 studies involving 1,529 patients.

Higher levels of PD-L1 expression in tumors are linked to better treatment responses to durvalumab, indicating that PD-L1 could serve as a useful biomarker for predicting the drug's efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of durvalumab (MEDI4736) in various solid tumors. Yang, H., Shen, K., Zhu, C., et al.[2022]

Daratumumab, a monoclonal antibody targeting CD38, has been approved in the USA for treating multiple myeloma in patients who have undergone at least three prior therapies, demonstrating its role as a treatment option for difficult-to-treat cases.

In a phase II trial, daratumumab monotherapy showed an overall response rate of about 30% in patients with relapsed or refractory multiple myeloma, indicating its efficacy in this challenging patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Daratumumab: First Global Approval. McKeage, K.[2018]

A meta-analysis of 21 studies involving 11,144 patients revealed that anti-CTLA4 therapy significantly increases the risk of various immune-related adverse events, such as diarrhea and colitis, with a relative risk of 2.43 to 11.39 for different conditions.

In contrast, while anti-PD1 therapy also raises the risk of pruritus (itching) with a relative risk of 4.01, it does not appear to increase the risk of other immune-related adverse events, highlighting the distinct safety profiles of these therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meta-Analysis of the Risk of Immune-Related Adverse Events With Anticytotoxic T-Lymphocyte-Associated Antigen 4 and Antiprogrammed Death 1 Therapies. Komaki, Y., Komaki, F., Yamada, A., et al.[2022]

Citations

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pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/39761483/

Results From the Phase II TROPION-Lung05 Study

Datopotamab Deruxtecan in Advanced or Metastatic Non-Small Cell Lung Cancer With Actionable Genomic Alterations: Results From the Phase II TROPION-Lung05 Study.

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astrazeneca.com

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Datopotamab deruxtecan in advanced or metastatic non–small cell lung cancer with actionable genomic alterations: results from the phase II TROPION-Lung05 study.

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clinicaltrials.gov

clinicaltrials.gov/study/NCT04940325

NCT04940325 | Datopotamab Deruxtecan (Dato-DXd, DS ...

This study aims to evaluate the efficacy and safety of DS-1062a in participants with metastatic, unresectable NSCLC having progressed on one, but not more ...

5.

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Datopotamab Deruxtecan Showed Median Overall Survival ...

Datopotamab deruxtecan showed median overall survival of 14.6 months in patients with advanced nonsquamous non-small cell lung cancer in TROPION-Lung01 Phase 3 ...

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clinicaltrials.gov/study/NCT04612751

NCT04612751 | Phase 1b Study of Dato-DXd in ...

This study will assess safety, tolerability, and treatment activity of datopotamab deruxtecan (Dato-DXd) in combination with immunotherapy with or without ...

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A Phase III, Randomised Study of Adjuvant Dato-DXd in ...

This is a Phase III, randomised, open-label, multicentre, global study assessing the efficacy and safety of adjuvant Dato-DXd in combination with rilvegostomig ...