A phase II study assessing safety and efficacy of REPotrectinib in ROS1-positive non-small cell lung cancer patients with active brain mEtastasis (The REPOSE study)

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Medica Scientia Innovation Research S.L., Medical University Of Vienna

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Neoplasms [C04]

Trial duration

15 Apr 2025 → ongoing

Decision date (initial)

2024-11-18

Transition trial

No

Low-intervention

No

Rare-disease indication

No

Vulnerable population

No

Funding sources

Bristol Myers Squibb

External identifiers

EU CT number

2023-508112-35-00

ClinicalTrials.gov

NCT06315010

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy, Safety

To assess the efficacy in terms of intracranial objective response rate (IC-ORR).

Secondary objectives 7

1. To assess the efficacy in terms of progression-free survival (PFS), overall survival (OS), extracranial ORR (EC-ORR), clinical benefit rate (CBR), time to response (TTR), duration of response (DoR), disease control rate (DCR), best percentage of change in tumor burden for intracranial lesions as per RANO-BM and RECIST v.1.1 for extracranial and overall lesions (bicompartmental ORR).
2. Safety objectives: To evaluate changes in neurocognitive functions and health-related quality-of-life (QoL) assessments from baseline using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the brain cancer specific questionnaire (EORTC QLQ-BN20) in all patients.
3. Safety objectives: To assess neurological function according to The Neurologic Assessment in Neuro-Oncology (NANO) scale.
4. Safety objectives: To determine the safety and toxicity profile according to the NCI-CTCAE v.5.0 of repotrectinib treatment in all patients.
5. Exploratory objectives Exploratory objectives are still to be defined but can include (but are not limited to): To assess the association of treatment efficacy outcomes with biomarkers analyzed in blood samples.
6. Exploratory objectives Exploratory objectives are still to be defined but can include (but are not limited to): To determine the association of treatment efficacy outcomes with radiological imaging biomarkers.
7. Exploratory objectives Exploratory objectives are still to be defined but can include (but are not limited to): To evaluate the treatment efficacy outcomes according to ROS1 expression level at baseline tumor samples.

Conditions and MedDRA coding

ROS1-positive non-small cell lung cancer (NSCLC) with active brain metastasis

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 22

1. Patient must be capable to understand the purpose of the study and have signed written informed consent form (ICF) prior to beginning specific protocol procedures.
2. Female or male patients ≥ 18 years of age at the time of signing ICF.
3. Patients must be capable to swallow capsules intact (without chewing, crushing, or opening).
4. Histologically documented NSCLC.
5. Patients may have symptoms attributed to brain metastases.
6. No indication for immediate local therapy (neurosurgery, brain radiotherapy) of brain metastases per local investigator. Note: in case of immediate local therapy is needed, the study’s medical monitor should be consulted
7. Type II leptomeningeal disease per ESMO-EANO guidelines are allowed.
8. Patients with confirmed ROS1 rearrangement. Prior to study enrollment, patients must have had confirmation of ROS1 rearrangement, which should have been determined locally by a certified laboratory using methods such as FISH, NGS, qPCR, or IHC.
9. Measurable disease according to Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria, with at least one measurable brain lesion of ≥10 mm on T1-weighted, gadoliniumenhanced magnetic resonance imaging (MRI).
10. ECOG PS of ≤ 2.
11. Minimum life expectancy of ≥ 6 weeks at screening.
12. No limit in number of prior chemotherapies, immunotherapy or other non-ROS1 TKI regimens.
13. Patients must not have previously received any ROS1 TKI-based treatment.
14. Left ventricular ejection fraction (LVEF) ≥ 50% by echocardiogram (ECHO) or multigated acquisition (MUGA) scan
15. If feasible, archival tumor biopsy sample at baseline (from primary tissue or any metastatic site) should be provided.
16. Patient has adequate bone marrow, liver, and renal function: I. Hematological (without platelet, red blood cell transfusion, and/or granulocyte colonystimulating factor support within 7 days before first study treatment dose): White blood cell (WBC) count > 3.0 x 109/L, absolute neutrophil count (ANC) ≥ 1.5 x 109/L, platelet count ≥ 100.0 x109/L, and hemoglobin ≥ 8.0 g/dL (≥ 4.96 mmol/L).
17. Patient has adequate bone marrow, liver, and renal function: II. Hepatic: Total bilirubin ≤ 1.5 times upper limit of normal (ULN) (≤ 3 in patients with liver metastases or know history of Gilbert’s disease); alkaline phosphatase (ALP) ≤ 2.5 times ULN; aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 3 times ULN (≤ 5 in patients with liver metastases); international normalized ratio (INR) < 1.5.
18. Patient has adequate bone marrow, liver, and renal function: III. Renal: serum creatinine ≤ 1.5 x ULN or creatinine clearance ≥ 40 mL/min/1.73 m2 based on Cockcroft−Gault glomerular filtration rate estimation for patients with creatinine levels above institutional normal.
19. Resolution of all acute toxic effects of prior anti-cancer therapy to grade ≤ 1 as determined by the US National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 (v.5.0) (except for alopecia or other toxicities not considered a safety risk for the patient at investigator's discretion).
20. Women of childbearing potential (WOCBP) who are sexually active with a non-sterilized male partner must have a negative serum pregnancy test within 14 days before study treatment initiation. In addition, they must agree to use one highly effective method of birth control from the time of screening until 2 months after the last dose of study treatments. Female patients must refrain from egg cell donation and breastfeeding during this same period. Note: Due to a potential loss of effectiveness of hormonal contraceptives caused by interaction with study intervention, if WOCBP use hormonal contraceptives (including oral hormonal contraceptives), they must use either another form of non-hormonal highly effective contraception or a reliable barrier method.
21. Male participants who are sexually active with a WOCBP partner must be surgically sterile or using an acceptable method of contraception from the time of screening until 4 months after the last administration of the study drug. Male participants must not donate or bank sperm during this same period.
22. Patient must be accessible for treatment and follow-up.

Exclusion criteria 14

1. Major surgery within four weeks of the start of treatment.
2. Type I leptomeningeal disease per ESMO-EANO guidelines.
3. Mean resting corrected QT interval (ECG interval measured from the onset of the QRS complex to the end of the T wave) for heart rate (QTc) > 470 msec obtained from 3 ECGs, using the screening clinic ECG machine-derived QTc value.
4. Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG (e.g., complete left bundle branch block, third degree heart block, second degree heart block, PR interval > 250 msec).
5. Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalemia, congenital long QT syndrome, family history of long QT syndrome, or any concomitant medication known to prolong the QT interval.
6. Clinically significant cardiovascular disease (either active or within 6 months prior to enrollment): myocardial infarction, unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure (New York Heart Association Classification Class ≥ II), cerebrovascular accident or transient ischemic attack, symptomatic bradycardia, requirement for anti-arrhythmic medication. Ongoing cardiac dysrhythmias of NCI CTCAE grade ≥ 2.
7. Known clinically significant active infections not controlled with systemic treatment (bacterial, fungal, viral including HIV positivity).
8. Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut syndrome) or other malabsorption syndromes that would impact on drug absorption.
9. Peripheral neuropathy grade ≥ 2.
10. History of extensive, disseminated, bilateral, or presence of NCI CTCAE grade 3 or 4 interstitial fibrosis or interstitial lung disease (ILD) including a history of pneumonitis, hypersensitivity pneumonitis, interstitial pneumonia, ILD, obliterative bronchiolitis, and pulmonary fibrosis. Patients with a history of prior radiation pneumonitis are not excluded.
11. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or that may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the patient inappropriate for entry into this study or could compromise the protocol objectives in the opinion of the Investigator.
12. Presence or history of any other primary malignancy other than NSCLC within 5 years prior to enrollment into the study. Note: Patients with a history of adequately treated basal or squamous cell carcinoma of the skin or any adequately treated in situ carcinoma may be included in the study
13. Current use or anticipated need for drugs that are known to be strong Cytochrome P450, family 3, subfamily A (CYP3A) inhibitors or inducers. Note: midazolam requires diligent monitoring in situations where there is an unprecedented necessity for co-administration. These cases should be discussed with the study’s medical monitor.
14. Patients requiring concomitant use of chronic systemic (intravenously [IV] or oral) corticosteroids at doses higher than 8 mg dexamethasone per day or other immunosuppressive medications except for managing adverse events (AEs); (inhaled steroids or intra articular steroid injections are permitted in this study). Note: The use of stable corticosteroid therapy in patients with brain metastases should be discussed with the Sponsor’s Medical Monitor.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. IC-ORR at any timepoint as judged by best central nervous system (CNS) response according to the Response assessment in neuro-oncology brain metastases (RANO-BM) criteria.

Secondary endpoints 14

1. PFS, defined as the period from treatment initiation to the first occurrence of disease progression or death from any cause, whichever occurs first, as determined locally by the investigator using RECIST v.1.1.
2. OS, defined as the period from treatment initiation to death from any cause, as determined locally by the investigator.
3. EC-ORR, defined as the rate of patients with complete response (CR) or partial response (PR), as determined locally by the investigator using RECIST v.1.1.
4. CBR, defined as the rate of patients with objective response (CR or PR), or stable disease for at least 24 weeks, as determined locally by the investigator using RECIST v.1.1.
5. DCR, defined as the percentage of patients with advanced cancer whose therapeutic intervention has led to a complete response, partial response, or stable disease.
6. TTR, defined as the period from treatment initiation to the first objective tumor response (tumor shrinkage of ≥ 30%) observed for patients who achieved a CR or PR, as determined locally by the investigator using RECIST v.1.1.
7. DoR, defined as the period from the first occurrence of a documented objective response to disease progression or death from any cause, whichever occurs first, as determined locally by the investigator using RECIST v.1.1.
8. Best percentage of change in tumor burden (RANOBM) for intracranial lesions 3 and RECIST v.1.1 for extracranial and overall lesions (bicompartmental ORR).
9. Safety endpoints: Changes from baseline in the EORTC QLQ-C30 and EORTC QLQ-BN20 scales, and symptoms scores.
10. Safety endpoints: Neurological function assessment as per NANO scale.
11. Safety endpoints: Safety and tolerability as per NCI-CTCAE v.5.0.
12. Exploratory endpoints: Exploratory endpoints can include (but are not limited to): Relationship of treatment efficacy outcomes in all patients with biomarkers analyzed in blood samples.
13. Exploratory endpoints Exploratory endpoints can include (but are not limited to): Association of efficacy outcomes in all patients with radiological imaging biomarkers.
14. Exploratory endpoints Exploratory endpoints can include (but are not limited to): Efficacy endpoints for all patients according to ROS1 gene expression level at baseline.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Medica Scientia Innovation Research S.L.

Sponsor organisation

Medica Scientia Innovation Research S.L.

Address

Carrer De Pere IV 128 3rd Floor

City

Barcelona

Postcode

08005

Country

Spain

Scientific contact point

Organisation

Medica Scientia Innovation Research S.L.

Contact name

Alicia García Sanz

Public contact point

Organisation

Medica Scientia Innovation Research S.L.

Contact name

Alba Meya

Third parties 6

Medical University Of Vienna

Sponsor organisation

Medical University Of Vienna

Address

Spitalgasse 23, Alsergrund Alsergrund

City

Vienna

Postcode

1090

Country

Austria

Scientific contact point

Organisation

Medical University Of Vienna

Contact name

Matthias Preusser

Public contact point

Organisation

Medical University Of Vienna

Contact name

Matthias Preusser

Sponsor responsibilities

Article 77 compliance

Medica Scientia Innovation Research S.L.

Contact point sponsor

Medica Scientia Innovation Research S.L.

Article 77 implementation

Medica Scientia Innovation Research S.L.

Locations

3 EU/EEA countries · 23 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 28 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

5 submissions — initial application plus substantial / non-substantial modifications