A Phase 1/2 Open-Label, Dose-Escalation and Clinical Response Study of Quaratusugene Ozeplasmid in Combination With Osimertinib in Patients With Advanced, Metastatic EGFR-Mutant, Metastatic Non-Small Cell Lung Cancer
Summary
The purpose of this randomized study is to determine the safety and efficacy of quaratusugene ozeplasmid (Reqorsa) added to osimertinib in NSCLC patients with activating EGFR mutations who have progressed while on treatment with osimertinib. Quaratusugene ozeplasmid consists of non-viral lipid nanoparticles that encapsulate a DNA plasmid with the TUSC2 tumor suppressor gene and is the first systemic gene therapy for cancer. The study is comprised of a Phase 1 dose escalation portion and two Phase 2 portions evaluating safety and efficacy. Enrollment in the Phase 1 dose escalation portion is complete and the recommended Phase 2 dose (RP2D) was determined. Phase 2a has initiated and enrolled patients are treated with quaratusugene ozeplasmid at the RP2D in combination with osimertinib. In Phase 2b, patients will be randomized to receive either quaratusugene ozeplasmid plus osimertinib or platinum-based chemotherapy.
Detailed description
Acclaim-1 is an open-label, multi-center, Phase 1/2 study evaluating quaratusugene ozeplasmid (Reqorsa) plus osimertinib (investigational arm) versus platinum-based chemotherapy (control arm) in patients with advanced metastatic or recurrent NSCLC. Toxicities will be assessed by the Investigator using United States National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Serious Adverse Events and Dose Limiting Toxicities (DLT) will be reviewed by a Safety Review Committee. Phase 1 - Dose Escalation: The RP2D of quaratusugene ozeplasmid when given in combination with osimertinib has been identified. Phase 2a: This expansion cohort will be enrolled to better characterize safety, tolerability, and preliminary anti-tumor activity of the combination therapy. Phase 2b: Quaratusugene ozeplasmid in combination with osimertinib will be further evaluated using the RP2D identified in Phase 1. Patients may receive local therapy, such as radiation therapy, to progressing lesions prior to enrollment. Patients will be randomized to receive either the investigational arm or the control arm in a 1 to 1 ratio and stratified based on prior local radiotherapy.
Arms & interventions
- Biologicalquaratusugene ozeplasmid
Quaratusugene ozeplasmid is an experimental non-viral immunogene therapy utilizing the TUSC2 gene, designed to target cancer cells by interrupting cell signaling pathways that allow cancer cells to grow, reestablishing pathways that promote cancer cell death and modulating the immune response against cancer cells.
- Drugosimertinib
Osimertinib is a 3rd generation EGFR tyrosine kinase inhibitor (TKI) oral tablet administered daily, as indicated for treatment of patients with metastatic NSCLC whose tumors have EGFR genetic deletions or mutations.
- DrugPlatinum-Based Chemotherapy
Cisplatin and carboplatin are intravenously administered platinum agents that are combined with other cytotoxic chemotherapy agents such as pemetrexed.
Outcome measures
Primary
Recommended Phase 2 Dose (RP2D) - Phase 1
RP2D, which will be the maximum tolerated dose (MTD) or, if the MTD is not defined by the safety data, RP2D will be determined based on an integrated assessment of all available clinical safety and preliminary efficacy data.
Time frame: First 21-day treatment cycle for each dose level cohort
Overall Response Rate (ORR) - Phase 2a
ORR (complete response \[CR\]+ partial response \[PR\]) according to RECIST using best overall response.
Time frame: Approximately 3 months
Progression-free Survival (PFS) - Phase 2b
PFS from randomization to disease progression or death. Response according to RECIST.
Time frame: Approximately 11 months
Secondary
Progression-free Survival (PFS) - Phase 1
Time frame: Approximately 9 months
Overall Response Rate (ORR) - Phase 1
Time frame: Approximately 3 months
Duration of Response (DOR) - Phase 1
Time frame: Approximately 9 months
Pharmacokinetics (PK) of Quaratusugene Ozeplasmid - Phase 1
Time frame: First 21-day treatment cycle
Progression-free Survival (PFS) - Phase 2a
Time frame: Approximately 11 months
Time to Progression (TTP) - Phase 2a
Time frame: Approximately 11 months
Overall Survival (OS) - Phase 2a
Time frame: Approximately 21 months
Pharmacokinetics (PK) of Quaratusugene Ozeplasmid - Phase 2a
Time frame: Approximately 22 days
Overall Response Rate (ORR) - Phase 2b
Time frame: Approximately 3 months
Time to Progression (TTP) - Phase 2b
Time frame: Approximately 11 months
Duration of Response (DOR) - Phase 2b
Time frame: Approximately 11 months
Overall Survival (OS) - Phase 2b
Time frame: Approximately 21 months
Incidence of Adverse Events - Phase 2b
Time frame: Approximately 11 months
Pharmacokinetics (PK) of Quaratusugene Ozeplasmid - Phase 2b
Time frame: Approximately 22 days
Eligibility criteria
Study locations (10)
Valkyrie Clinical Trials
Los Angeles, California, 90067
Rocky Mountain Cancer Centers
Lone Tree, Colorado, 80124
Carle Cancer Institute
Urbana, Illinois, 61801
Markey Cancer Center
Lexington, Kentucky, 40536
Maryland Oncology Hematology
Rockville, Maryland, 20850
The Valley Hospital - Luckow Pavilion
Paramus, New Jersey, 07652
Gabrail Cancer Center Research
Canton, Ohio, 44718
Millennium Oncology
Houston, Texas, 77090
Virginia Cancer Specialists
Fairfax, Virginia, 22031
Virginia Oncology Associates
Norfolk, Virginia, 23502
References
- Spira AI, Berz D, Jotte RM, Pachipala KK, Berger MS. Dose Escalation Trial of the Combination of Osimertinib and Quaratusugene Ozeplasmid Gene Therapy in Patients with Advanced NSCLC. Clin Lung Cancer. 2026 Jan;27(1):75-81. doi: 10.1016/j.cllc.2025.11.009. Epub 2025 Nov 17.(PubMed)