My Pathway: An Open-Label Phase IIa Study Evaluating Trastuzumab/Pertuzumab, Erlotinib, Vemurafenib/Cobimetinib, Vismodegib, Alectinib, and Atezolizumab in Patients Who Have Advanced Solid Tumors With Mutations or Gene Expression Abnormalities Predictive of Response to One of These Agents


Condition: Neoplasms, Solid Tumors, Biliary Cancer, Salivary Cancer, Bladder Cancer

Intervention:

  • Drug: Trastuzumab
  • Drug: Pertuzumab
  • Drug: Erlotinib
  • Drug: Vemurafenib
  • Drug: Cobimetinib
  • Drug: Vismodegib
  • Drug: Alectinib
  • Drug: Atezolizumab

Purpose: This multicenter, non-randomized, open-label study will evaluate the efficacy and safety of six treatment regimens in participants with advanced solid tumors for whom therapies that will convey clinical benefit are not available and/or are not suitable options per the treating physician’s judgment.

Study Type: Interventional

Clinical Trials Identifier NCT 8-digits: NCT02091141

Sponsor: Genentech, Inc.

Primary Outcome Measures:

  • Measure: Percentage of Participants in All Tumor-Pathway Cohorts With Overall Response, as Assessed by the Investigator
  • Time Frame: From the date of first study treatment until disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:
  • Measure: Percentage of Atezolizumab-Treated Participants With Tissue Tumor Mutational Burden (tTMB) ≥16 Mutations/Mb With Overall Response, as Assessed by the Independent Review Committee (IRC)
  • Time Frame: From the date of first study treatment until disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:

Secondary Outcome Measures:

  • Measure: Percentage of Participants With Disease Control
  • Time Frame: From the date of first study treatment until disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:
  • Measure: Progression-Free Survival (PFS)
  • Time Frame: From the date of first study treatment until disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:
  • Measure: Percentage of Participants who are Alive at Year 1
  • Time Frame: 1 year
  • Safety Issue:
  • Measure: Duration of Response
  • Time Frame: From the date of first documented response (complete response [CR] or partial response [PR]) to the time of disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:
  • Measure: Percentage of Atezolizumab-Treated Participants with tTMB ≥10 Mutations/Mb and <16 Mutations/Mb With Overall Response, as Assessed by the Investigator
  • Time Frame: From the date of first study treatment until disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:
  • Measure: Percentage of Atezolizumab-Treated Participants with Blood Tumor Mutational Burden (bTMB) ≥16 Mutations With Overall Response, as Assessed by the IRC
  • Time Frame: From the date of first study treatment until disease progression or death from any cause, whichever occurs first (up to approximately 5 years)
  • Safety Issue:
  • Measure: Percentage of Participants With Adverse Events
  • Time Frame: From first study treatment administration to 30 days (45 days for vismodegib, 90 days for atezolizumab) after the last dose (up to approximately 5 years)
  • Safety Issue:

Estimated Enrollment: 765

Study Start Date: April 14, 2014

Phase: Phase 2

Eligibility:

  • Age: minimum 18 Years maximum N/A
  • Gender: All

Inclusion Criteria:

  • Life expectancy greater than or equal to (≥) 12 weeks
  • Histologically documented metastatic cancer (solid tumors, not including hematologic malignancies)
  • Participants who have received standard first-line therapy for metastatic cancer (except for the tumors for which no first-line therapy exists) and in whom a trial of targeted therapy is considered the best available treatment option. Eligible participants should not have available therapies that will convey clinical benefit and/or are not suitable options per the treating physician’s judgment
  • No previous treatment with the specific assigned study drug or any other drug sharing the same target
  • Measurable disease by RECIST v1.1
  • Eastern Cooperative Oncology Group Performance Status (ECOG PS) score of 0 or 1 (For patients enrolling in the atezolizumab arm, ECOG score must be documented within 7 days prior to first treatment and confirmation of ECOG PS must be entered into the interactive web response system [IWRS] prior to initiation of treatment)
  • Adequate hematologic, renal, and liver function as defined by the protocol
  • If applicable, use of contraception methods or abstinence as defined by the protocol Study-Drug Specific Inclusion Criteria: Trastuzumab plus Pertuzumab
  • Molecular testing results from clinical laboratory improvement amendments (CLIA)-certified laboratories (using tissue and/or blood) demonstrating HER2 overexpression or amplification. Participants must have one of the following tumor types: biliary cancer, salivary cancer, or bladder cancer a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment)
  • Left ventricular ejection fraction (LVEF) greater than (>) 50 percent (%) or above the lower limit of the institutional normal range, whichever is lower
  • Availability of an archival or new pre-treatment tissue sample is required if molecular testing was not performed by Foundation Medicine. Any available tumor tissue sample can be submitted. The tissue sample must be submitted within 4 weeks after enrollment Erlotinib
  • Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating EGFR-activating mutations Vemurafenib plus Cobimetinib
  • Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating BRAF V600 mutations a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment) Vismodegib
  • Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating hedgehog pathway relevant mutation (activating mutation of smoothened [SMO] or loss-of-function mutation of protein patched homolog-1 [PTCH-1]) a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment)
  • All non-hematological adverse events related to any prior chemotherapy, surgery, or radiotherapy must have resolved to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Grade less than or equal to (≤) 2 prior to starting therapy Alectinib
  • Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating anaplastic lymphoma kinase (ALK) gene rearrangements, ALK mutations, ALK copy number gain or (for melanoma only) increased ALK expression or presence of ALK-alternative transcription initiation transcript (ALKATI) a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment) Atezolizumab
  • Molecular testing results from CLIA-certified laboratories (using tissue) demonstrating elevated tissue tumor mutational burden (tTMB ≥10 mutations/ Megabase [Mb])
  • For patients where molecular testing was not performed using Foundation Medicine, submission of an archival or new pretreatment tissue sample is mandatory. For patients where molecular testing was performed using Foundation Medicine, submission of an archival or new pretreatment tissue sample is required, if available. The tissue sample must be submitted within 4 weeks after enrollment General Exclusion Criteria:
  • Participants with hematologic malignancies
  • Concurrent administration of any other anti-cancer therapy (except male participants with prostate cancer receiving androgen blockade): Bisphosphonates and denosumab are allowed; Most recent anti-cancer therapy ≤28 days and have not recovered from the side effects, excluding alopecia; Radiation therapy within ≤14 days
  • Active or untreated brain metastases
  • History of carcinomatous meningitis
  • Uncontrolled concurrent malignancy (early stage is allowed if not requiring active therapy or intervention)
  • Pregnant or breastfeeding women, or intending to become pregnant during the study
  • Any significant cardiovascular events within 6 months prior to study entry
  • Pulmonary embolism within 30 days prior to study entry
  • History or presence of clinically significant ventricular or atrial dysrhythmia >Grade 2 per NCI CTCAE v4.0
  • Any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results
  • Psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol Study-Drug Specific

Exclusion Criteria:

  • Participants with hematologic malignancies
  • Concurrent administration of any other anti-cancer therapy (except male participants with prostate cancer receiving androgen blockade): Bisphosphonates and denosumab are allowed; Most recent anti-cancer therapy ≤28 days and have not recovered from the side effects, excluding alopecia; Radiation therapy within ≤14 days
  • Active or untreated brain metastases
  • History of carcinomatous meningitis
  • Uncontrolled concurrent malignancy (early stage is allowed if not requiring active therapy or intervention)
  • Pregnant or breastfeeding women, or intending to become pregnant during the study
  • Any significant cardiovascular events within 6 months prior to study entry
  • Pulmonary embolism within 30 days prior to study entry
  • History or presence of clinically significant ventricular or atrial dysrhythmia >Grade 2 per NCI CTCAE v4.0
  • Any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results
  • Psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol Study-Drug Specific Exclusion Criteria: Trastuzumab plus Pertuzumab
  • Previous treatment with any HER2-targeted therapy Erlotinib
  • Non-small cell lung cancer (NSCLC) or pancreatic cancer identified by exon 19 deletions or exon 21 L858R substitution mutations
  • EGFR amplifications in the absence of EGFR-activating mutations
  • Cancers with exon 20 mutations
  • Previous treatment with erlotinib or any other EGFR inhibitor
  • Inability to swallow pills
  • Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of erlotinib Vemurafenib plus Cobimetinib
  • Malignant melanoma, papillary thyroid cancer, colorectal cancer, or hematologic malignancy including multiple myeloma
  • LVEF below institutional lower level of normal (LLN) or below 50%, whichever is lower
  • History of or evidence of retinal pathology on ophthalmologic examination that is considered a risk factor for neurosensory retinal detachment, retinal vein occlusion (RVO), or neovascular macular degeneration
  • Presence of any of the following conditions, which are risk factors for RVO: Uncontrolled glaucoma with intraocular pressure >21 millimetres of mercury (mm Hg); Serum cholesterol ≥Grade 2; Hypertriglyceridemia ≥Grade 2; Hyperglycemia (fasting) ≥Grade 2; Grade ≥2 uncontrolled hypertension (participants with a history of hypertension controlled with anti-hypertensive medication to Grade
  • Prior or concurrent malignancy with known RAS mutation
  • Previous treatment with vemurafenib or any other BRAF inhibitor (prior sorafenib is allowed)
  • Previous treatment with cobimetinib or any other mitogen-activated protein/extracellular signal-regulated kinase (MEK) inhibitor
  • Prior treatment with a RAF inhibitor
  • Inability to swallow pills
  • Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of vemurafenib
  • History of congenital long QT syndrome or mean (average of triplicate measurements) corrected QT (QTc) measured using Fridericia’s method ≥450 millisecond (ms) at baseline or uncorrectable abnormalities in serum electrolytes (sodium, potassium, calcium, magnesium, phosphorus) Vismodegib
  • Basal cell carcinoma of the skin, medulloblastoma, small-cell lung cancer, or hematologic malignancies
  • Previous treatment with vismodegib or any other hedgehog pathway inhibitor
  • Inability to swallow pills
  • Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of vismodegib Alectinib
  • ALK-positive NSCLC, neuroblastoma, and childhood tumors
  • Previous treatment with alectinib or any other ALK inhibitor
  • Participants with symptomatic bradycardia
  • Administration of strong/potent cytochrome P3A4 (CYP3A4) inhibitors or inducers within 14 days prior to the first dose of study treatment and while on treatment with alectinib
  • Inability to swallow pills
  • Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of alectinib Atezolizumab
  • History of leptomeningeal disease
  • Uncontrolled tumor pain
  • Asymptomatic metastatic lesions that would likely cause functional deficits or intractable pain with further growth (e.g., epidural metastasis that is not currently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to enrollment
  • Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Patients with indwelling catheters are allowed
  • Uncontrolled or symptomatic hypercalcemia
  • Previous treatment with atezolizumab or another programmed death-1 (PD-1)/PD-L1 inhibitor
  • History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
  • Known hypersensitivity to biopharmaceutical agents produced in Chinese hamster ovary cells
  • Known allergy or hypersensitivity to any component of the atezolizumab formulation
  • Active or history of autoimmune disease or immune deficiency
  • Prior allogeneic stem cell or solid organ transplantation
  • History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan
  • Positive human immunodeficiency virus (HIV) test, active hepatitis B virus (HBV) infection, active hepatitis C virus (HCV) infection or active tuberculosis
  • Severe infection within 4 weeks prior to initiation of study treatment
  • Treatment with therapeutic oral or IV antibiotics within 2 weeks prior to initiation of study treatment
  • Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction, or cerebrovascular accident within 3 months prior to initiation of study treatment, unstable arrhythmia, or unstable angina
  • Major surgical procedure other than for diagnosis within 4 weeks prior to initiation of study treatment, or anticipation of need for a major surgical procedure during the course of the study
  • Treatment with a live, attenuated vaccine within 4 weeks prior to initiation of study treatment, or anticipation of need for such a vaccine during the course of the study or within 5 months after the final dose of atezolizumab
  • History of other malignancy within 5 years prior to screening, with the exception of those with a negligible risk of metastasis or death, such as adequately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, localized prostate cancer, ductal carcinoma in situ, or Stage I uterine cancer
  • Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the participant at high risk from treatment complications
  • Prior treatment with cluster of differentiation 137 (CD137) agonists or immune checkpoint blockade therapies
  • Treatment with systemic immunostimulatory agents within 4 weeks or five half-lives of the drug (whichever is longer) prior to randomization
  • Treatment with systemic immunosuppressive medication within 2 weeks prior to initiation of study treatment, or anticipation of need for systemic immunosuppressive medication during the course of the study

Contact:

  • Reference Study ID Number: ML28897 www.roche.com/about_roche/roche_worldwide.htm
  • 888-662-6728 (U.S. and Canada)

Locations:

  • Western Regional Medical Center at Cancer Treatment Centers of America
  • Goodyear Arizona 85338 United States
  • Mayo Clinic Arizona
  • Phoenix Arizona 85259 United States
  • Highlands Oncology Group
  • Rogers Arkansas 72758 United States
  • Science 37, Inc
  • Culver City California 90230 United States
  • City of Hope Comprehensive Cancer Center
  • Duarte California 91010 United States
  • Moores UCSD Cancer Center; Dept Clinical Trials Office
  • La Jolla California 92093-0698 United States
  • Eisenhower Medical Center
  • Rancho Mirage California 92270 United States
  • Stanford Comprehensive Cancer Center
  • Stanford California 94305 United States
  • University of Colorado
  • Aurora Colorado 80045-2517 United States
  • Yale Cancer Center
  • New Haven Connecticut 06520 United States
  • SCRI Florida Cancer Specialists South
  • Fort Myers Florida 33916 United States
  • Mayo Clinic
  • Jacksonville Florida 32224 United States
  • Florida Hospital Cancer Inst; Memorial System Onc Clin Rsch
  • Orlando Florida 32804 United States
  • Florida Cancer Specialist, North Region
  • Saint Petersburg Florida 33705 United States
  • Florida Cancer Specialists, Research Department
  • West Palm Beach Florida 33401 United States
  • University Cancer & Blood Center, LLC; Research
  • Athens Georgia 30607 United States
  • Northeast Georgia Medical Center; Oncology Research Dept-5C
  • Gainesville Georgia 30501 United States
  • Southeastern Regional Medical Center, Inc.
  • Newnan Georgia 30265 United States
  • Northwestern University; Robert H. Lurie Comp Can Ctr; Northwestern Medicine Development Inst
  • Chicago Illinois 60611 United States
  • University Of Chicago Medical Center; Section Of Hematology/Oncology
  • Chicago Illinois 60637 United States
  • Midwestern Regional Med Center
  • Zion Illinois 60099 United States
  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Baltimore Maryland 21287 United States
  • Mayo Foundation
  • Rochester Minnesota 55905 United States
  • Research Medical Center – Antibiotic Research Associates, Inc.
  • Kansas City Missouri 64132 United States
  • University of New Mexico Comprehensive Cancer Center
  • Albuquerque New Mexico 87102 United States
  • University of New Mexico Comprehensive Cancer Center – Albuquerque Cedar Street; Drug Shipment
  • Albuquerque New Mexico 87106 United States
  • University of New Mexico Comprehensive Cancer Center – Albuquerque Lang NE; Drug Shipment
  • Albuquerque New Mexico 87109 United States
  • University of New Mexico
  • Albuquerque New Mexico 87131 United States
  • San Juan Oncology Associates
  • Farmington New Mexico 87401 United States
  • Weill Cornell Univ Medical Ctr; Breast Cancer Center
  • New York New York 10021 United States
  • Herbert Irving Comprehensive Cancer Center; Herbert Irving Pavillion
  • New York New York 10032 United States
  • Memorial Sloan Kettering Cancer Center
  • New York New York 10065 United States
  • Univ No Carolina School of Med; Physicians Office Bldg
  • Chapel Hill North Carolina 27599-7305v United States
  • Duke University Medical Center
  • Durham North Carolina 27710 United States
  • Wake Forest Univ Health Svcs; Internal Medicine
  • Winston-Salem North Carolina 27157 United States
  • Sanford Roger Maris Cancer Center
  • Fargo North Dakota 58102 United States
  • Oncology Hematology Care Inc
  • Cincinnati Ohio 45242 United States
  • Cleveland Clinic
  • Cleveland Ohio 44106 United States
  • University Hospitals of Cleveland
  • Cleveland Ohio 44106 United States
  • University of Oklahoma Health Sciences Center
  • Oklahoma City Oklahoma 73104 United States
  • Southwestern Reg Med Ctr Inc
  • Tulsa Oklahoma 74133 United States
  • Providence Portland Medical Center
  • Portland Oregon 97213 United States
  • Abramson Cancer Center
  • Philadelphia Pennsylvania 19104 United States
  • Thomas Jefferson University Hospital
  • Philadelphia Pennsylvania 19107 United States
  • Eastern Regional Medical Ctr
  • Philadelphia Pennsylvania 19124 United States
  • UPMC – Hillman Cancer Center
  • Pittsburgh Pennsylvania 15232 United States
  • Abington Mem Hosp-Abington; Rose. Can Ctr,Gyn Onc Ins
  • Willow Grove Pennsylvania 19090 United States
  • Sanford Cancer Cnt Onco Clinic
  • Sioux Falls South Dakota 57104 United States
  • SCRI Tennessee Oncology Chattanooga
  • Chattanooga Tennessee 37404 United States
  • West Clinic
  • Germantown Tennessee 38138 United States
  • Tennessee Cancer Specialists
  • Knoxville Tennessee 37920 United States
  • Tennessee Onc., PLLC – SCRI
  • Nashville Tennessee 37203 United States
  • Vanderbilt Ingram Cancer Clinic
  • Nashville Tennessee 37232 United States
  • The Center for Cancer and Blood Disorders – Fort Worth
  • Fort Worth Texas 76104 United States
  • MD Anderson
  • Houston Texas 77030 United States
  • Virginia Cancer Institute
  • Richmond Virginia 23226 United States
  • Northwest Medical Specialties
  • Tacoma Washington 98405 United States
  • University of Wisconsin
  • Madison Wisconsin 53792 United States
  • Medical College of Wisconsin
  • Milwaukee Wisconsin 53226 United States

View trial on ClinicalTrials.gov


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