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A Study of Osimertinib With or Without Chemotherapy Versus Chemotherapy Alone as Neoadjuvant Therapy for Patients With EGFRm Positive Resectable Non-Small Cell Lung Cancer (NeoADAURA)

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ClinicalTrials.gov Identifier: NCT04351555
Recruitment Status : Recruiting
First Posted : April 17, 2020
Last Update Posted : March 15, 2023
Sponsor:
Information provided by (Responsible Party):
AstraZeneca

Study Description
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Brief Summary:
This is a Phase III, randomised, controlled, 3-arm, multi-centre study of neoadjuvant osimertinib as monotherapy or in combination with chemotherapy, versus SoC chemotherapy alone, for the treatment of patients with resectable EGFRm Non-Small Cell Lung Cancer

Condition or disease Intervention/treatment Phase
Non-Small Cell Lung Cancer Drug: Osimertinib Drug: Cisplatin Drug: Carboplatin Drug: Placebo Drug: Pemetrexed Phase 3

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 328 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Masking Description:

The two arms with SoC chemotherapy (placebo plus chemotherapy versus osimertinib plus chemotherapy) will be double-blinded and placebo-controlled.

Osimertinib monotherapy arm will be open label, sponsor-blind.
Primary Purpose: Treatment
Official Title: A Phase III, Randomised, Controlled, Multi-center, 3-Arm Study of Neoadjuvant Osimertinib as Monotherapy or in Combination With Chemotherapy Versus Standard of Care Chemotherapy Alone for the Treatment of Patients With Epidermal Growth Factor Receptor Mutation Positive, Resectable Non-small Cell Lung Cancer
Actual Study Start Date : December 16, 2020
Estimated Primary Completion Date : March 26, 2024
Estimated Study Completion Date : March 29, 2029

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lung Cancer
Drug Information available for: Osimertinib

Arms and Interventions
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Arm Intervention/treatment
Placebo Comparator: Arm 1: Placebo with platinum-based chemotherapy
Placebo plus investigator's choice of platinum-based standard of care chemotherapy (pemetrexed/carboplatin or pemetrexed/cisplatin)
 Drug: Cisplatin
Cisplatin (75mg/m2) to be administered with pemetrexed on Day 1 of every 3-week cycle for 3 cycles.

Drug: Carboplatin
Carboplatin (AUC5) to be administered with pemetrexed on Day 1 of every 3-week cycle for 3 cycles

Drug: Placebo
Oral

Drug: Pemetrexed
Pemetrexed (500 mg/m2) to be administered with cisplatin or carboplatin on Day 1 of every 3-week cycle for 3 cycles
Experimental: Arm 2: Osimertinib with platinum-based chemotherapy
Osimertinib 80 mg QD (Dose may be reduced to 40 mg QD at the discretion of the investigator) plus investigator's choice of platinum-based standard of care chemotherapy (pemetrexed/carboplatin or pemetrexed/cisplatin)
 Drug: Osimertinib
Oral
Other Name: AZD9291; TAGRISSO

Drug: Cisplatin
Cisplatin (75mg/m2) to be administered with pemetrexed on Day 1 of every 3-week cycle for 3 cycles.

Drug: Carboplatin
Carboplatin (AUC5) to be administered with pemetrexed on Day 1 of every 3-week cycle for 3 cycles

Drug: Pemetrexed
Pemetrexed (500 mg/m2) to be administered with cisplatin or carboplatin on Day 1 of every 3-week cycle for 3 cycles
Experimental: Arm 3: Osimertinib monotherapy
Osimertinib 80 mg QD (Dose may be reduced to 40 mg QD at the discretion of the investigator)
 Drug: Osimertinib
Oral
Other Name: AZD9291; TAGRISSO


Outcome Measures
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Primary Outcome Measures :
  1. Major Pathological Response (MPR) [ Time Frame: From date of randomization to an average of 12 weeks after the first dose ]
    Defined as ≤10% residual cancer cells in the main tumour, as assessed per central pathology laboratory post-surgery


Secondary Outcome Measures :
  1. Pathological complete response (pCR) [ Time Frame: From date of randomization to an average of 12 weeks after the first dose ]
    Defined as absence of any residual cancer cells in the dissected tumour samples, including the main tumour and lymph nodes, assessed post-surgery

  2. Event-free survival (EFS) [ Time Frame: Up to approximately 42 months after the last patient is randomized ]
    An event is defined as documented disease progression that precludes surgery or requires non-protocol therapy; recurrence or a new lesion, local or distant (a new primary malignancy confirmed by pathology is not considered to be an EFS event.); death due to any cause

  3. Overall Survival (OS) [ Time Frame: Up to approximately 5.5 years after the last patient is randomized ]
    Patients will be followed up to approximately 5.5 years after they are randomized.

  4. Disease free survival (DFS) [ Time Frame: From date of randomization up to approximately 42 months after date of resection ]
    DFS is defined as the time from the date of surgery until the first date of disease recurrence (local or distant) or date of death due to any cause, whichever occurs first.

  5. Downstaging [ Time Frame: From date of randomization to an average of 12 weeks after the first dose ]
    Measured using pathologic mediastinal lymph node evaluation

  6. Difference between treatment arms in change from baseline in EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 items) [ Time Frame: From randomization to 264 weeks post-surgery ]
    Assess disease-related symptoms, functioning, and global health status/quality-of-life in patients

  7. Concordance of EGFRm status between tumour tissue DNA and patient-matched plasma-derived ctDNA [ Time Frame: Baseline ]
  8. Corcordance of EGFR mutation status between the local and central cobas EGFR mutation test results from baseline tumour samples [ Time Frame: Baseline ]
  9. PK plasma concentrations of osimertinib [ Time Frame: From the pre-dose of Cycle 2 to post-dose of Cycle 3 (each cycle is 21 days) ]
  10. Difference between treatment arms in change from baseline in EORTC QLQ-LC13 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Lung Cancer 13 items) [ Time Frame: From randomization to 264 weeks post-surgery ]
    Assess lung cancer-associated symptoms and side effects from conventional chemotherapy and radiotherapy


Other Outcome Measures:
  1. Cure rate [ Time Frame: From the surgery until 5 years after surgery ]
    The cure rate is defined as the percentage of people in this study who are still alive and disease free for a certain period of time after they finished the surgery. Here 5-year landmark cure rate will be calculated in the same time as OS analysis.

  2. Number of adverse events as assessed by CTCAE 5.0 and other clinical variables for safety and tolerability profile of neoadjuvant osimertinib as monotherapy or in combination with chemotherapy prior to surgery compared with chemotherapy alone [ Time Frame: From the time of enrollment to either 28-days after the last dose of last study treatment for patients who do not undergo surgery, or 90-days post-surgery ]
    Other clinical variables include deaths, laboratory data, vital signs (pulse and BP), ECG, LVEF, ECOG performance status, and ophthalmologic assessment

  3. MPR using plasma-derived circulating-free tumour DNA (ctDNA) [ Time Frame: From randomization to 5 years post-surgery ]

Eligibility Criteria
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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male or female, at least 18 years of age. For patients aged <20 years and enrolled in Japan, a written informed consent should be obtained from the patient and his or her legally acceptable representative
  • Histologically or cytologically documented non-squamous NSCLC with completely resectable (Stage II - IIIB N2) disease (according to Version 8 of the IASLC Cancer Staging Manual [IASLC Staging Manual in Thoracic Oncology 2016]).
  • Complete surgical resection of the primary NSCLC must be deemed achievable, as assessed by a MDT evaluation (which should include a thoracic surgeon, specialised in oncologic procedures).
  • Eastern Cooperative Oncology Group (ECOG) PS of 0 or 1 at enrolment, with no deterioration over the previous 2 weeks prior to baseline or day of first dosing
  • A tumour which harbours one of the 2 common EGFR mutations known to be associated with EGFR-TKI sensitivity (Ex19del, L858R), either alone or in combination with other EGFR mutations (ie, T790M, G719X, Exon20 insertions, S7681 and L861Q).

Exclusion Criteria:

  • Past medical history of ILD, drug-induced ILD, radiation pneumonitis which required steroid treatment, or any evidence of clinically active ILD.
  • History of another primary malignancy, except for the following: Malignancy treated with curative intent and with no known active disease ≥2 years before the first dose of investigational product (IP) and of low potential risk for recurrence; Adequately treated non-melanoma skin cancer or lentigo malignancy without evidence of disease; Adequately treated carcinoma in situ without evidence of disease
  • Patients who have pre-operative radiotherapy treatment as part of their care plan
  • Mixed small cell and NSCLC histology
  • Stages I, IIIB N3, IIIC, IVA, and IVB NSCLC
  • T4 tumours infiltrating the aorta, the oesophagus and/or the heart; and/or any bulky N2 disease
  • Patients who are candidates to undergo only segmentectomies or wedge resections
  • Prior treatment with any systemic anti-cancer therapy for NSCLC including chemotherapy, biologic therapy, immunotherapy, or any investigational drug
  • Prior treatment with EGFR-TKI therapy
  • Current use of (or unable to stop use prior to receiving the first dose of study treatment) medications or herbal supplements known to be strong inducers of cytochrome P450 (CYP) 3A4 (at least 3 weeks prior)
Contacts and Locations
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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): NCT04351555


Contacts
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Contact: AstraZeneca Clinical Study Information Center 1-877-240-9479 information.center@astrazeneca.com
Contact: AstraZeneca Cancer Study Locator 1-877-400-4656 astrazeneca@emergingmed.com

Locations
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Sponsors and Collaborators
AstraZeneca
Investigators
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Principal Investigator: Jamie Chaft, MD Memorial Sloan Kettering, USA
Principal Investigator: Masahiro Tsuboi, MD National Cancer Center Hospital East, Japan
Principal Investigator: Walter Weder, MD Thoraxchirurgie Bethanien, Switzerland
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: AstraZeneca
ClinicalTrials.gov Identifier: NCT04351555    
Other Study ID Numbers: D516AC00001
First Posted: April 17, 2020    Key Record Dates
Last Update Posted: March 15, 2023
Last Verified: March 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Access Criteria: When a request has been approved AstraZeneca will provide access to the de-identified individual patient-level data in an approved sponsored tool. Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
URL: https://astrazenecagroup-dt.pharmacm.com/DT/Home

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by AstraZeneca:
Resectable; NSCLC; Osimertinib; EGFRm Positive; Neoadjuvant; Adjuvant
Additional relevant MeSH terms:
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Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
 Carboplatin
Pemetrexed
Osimertinib
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Folic Acid Antagonists
Nucleic Acid Synthesis Inhibitors
Protein Kinase Inhibitors