RecruitingInterventionalPhase 3

A Phase III, Open-label, Randomised Study of Osimertinib With or Without Datopotamab Deruxtecan (Dato-DXd), as First-line Treatment in Participants With Epidermal Growth Factor Receptor (EGFR) Mutation-positive, Locally Advanced or Metastatic Non-small Cell Lung Cancer

NCT ID: NCT06350097Sponsor: AstraZenecaLast updated: 2026-05-06

Summary

The purpose of this study is to evaluate efficacy and safety of osimertinib (tablet) in combination with Dato-DXd (i.v. infusion) compared with osimertinib (tablet) monotherapyas a first-line therapy in participants with locally advanced or metastatic EGFRm (Ex19del and/or L858R) NSCLC. Study details include: 1. The study duration will be event-driven, with an estimated duration of approximately 8 years. 2. Participants may receive study treatment until disease progression, unacceptable toxicity, or other specific discontinuation criteria are met. 3. The visit frequency will be every 3 weeks during the treatment period. Note: Participants on osimertinib treatment(osimertinib only arm or who have discontinued Dato-DXd while are still receiving osimertinib) are required to attend visits to perform assessments every 6 weeks from Cycle 7 until Cycle 17 and then visits every 12 weeks until disease progression or IP discontinuation. Participants who are receiving osimertinib + Dato-DXd are still required to attend visit to perform assessment every 3 weeks (q3w) per SoA.

Detailed description

This is a global Phase III, open-label, randomised, multicentre study assessing the efficacy and safety of osimertinib in combination with Datopotamab Deruxtecan compared with osimertinib in participants with locally advanced or metastatic EGFRm (Ex19del and/or L858R) NSCLC who have not received any prior therapy for advanced disease.

Arms & interventions

DrugOsimertinib
Osimertinib 80 mg administered orally once daily (QD).
DrugDatopotamab Deruxtecan
Datopotamab Deruxtecan 6 mg/kg administered as an intravenous (i.v.) infusion every 3 weeks (q3w).

Outcome measures

Primary

To demonstrate the superiority of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of Progression Free Survival (PFS) by BICR in all randomised participants.
PFS is defined as time from randomisation until progression per RECIST 1.1 as assessed by BICR, or death due to any cause (in the absence of progression).
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.

Secondary

To demonstrate the superiority of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of Overall Survival (OS) in all randomised participants.
Time frame: It is anticipated that it will be performed approximately 7 years after the first participant has been randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of PFS on Central nervous system (CNS) metastases in participants with CNS metastases at baseline
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of PFS by investigator in all randomised participants.
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of Overall Response Rate (ORR) in all randomised participants with measurable disease at baseline.
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of Duration of Response (DoR) in all randomised participants with measurable disease at baseline.
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib on the prevention of CNS metastases
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan relative to osimertinib by assessment of PFS2 in all randomised participants
Time frame: It is anticipated that it will be analyzed by time of PFS primary which is about 3 years after the first participant has been randomised.
To assess the Pharmacokinetics (PK) of osimertinib and Datopotamab Deruxtecan
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant has been randomised.
To investigate the immunogenicity of Datopotamab Deruxtecan
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant has been randomised, together with PFS primary.
To compare the local EGFR mutation test result used for patient selection with the retrospective central cobas® EGFR Mutation Test v2 results from baseline tumour samples
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant is randomised.
To demonstrate the effectiveness of osimertinib in combination with Datopotamab Deruxtecan vs. osimertinib monotherapy based on the cobas® EGFR Mutation Test v2 plasma screening test result for Ex19del or L858R EGFR mutations
Time frame: It is anticipated that it will be performed approximately 3 years after the first participant has been randomised, together with PFS primary.

Eligibility criteria

Sex: AllAge: 18 Years and olderHealthy volunteers: No

Inclusion Criteria: Age 1. Participant must be ≥ 18 years. Type of Participant and Disease Characteristics 2. Histologically or cytologically documented nonsquamous NSCLC. NSCLC of mixed histology is allowed if adenocarcinoma is the predominant histology. Mixed small-cell lung cancer and NSCLC histology, and sarcomatoid variant of NSCLC is ineligible. 3. Stage IIIB or IIIC or Stage IV metastatic NSCLC or recurrent NSCLC (based on the American Joint Committee on Cancer Edition 8) not amenable to curative surgery or definitive chemoradiation at the time of randomisation. 4. Participants must not have received prior EGFR TKIs or other systemic therapy for Stage IIIB, IIIC or IV NSCLC. 5. The tumour harbors at least 1 of the 2 common EGFR mutations known to be associated with EGFR-TKI sensitivity (Ex19del or L858R), either alone or in combination with other genomic alterations, which may include EGFR T790M, assessed by a CLIA-certified (US sites) or an accredited (outside of the US) local laboratory or by central prospective tissue testing. 6. For participants enrolled in randomisation period, mandatory provision of an unstained, archival tumour tissue sample in a quantity sufficient to allow for central confirmation of the EGFR mutation status. 7. WHO performance status of 0 or 1. 8. At least one lesion not previously irradiated that qualifies as a RECIST 1.1 TL at baseline and can be accurately measured at baseline as ≥10 mm in the longest diameter (except lymph nodes, which must have short axis ≥15 mm) with CT or MRI and is suitable for accurate repeated measurements. 9. Adequate bone marrow reserve and organ function before the first dose of study intervention. Exclusion Criteria: 1. As judged by the investigator, any evidence of diseases (such as severe or uncontrolled systemic diseases, including active bleeding diseases, history of allogenic organ transplant which, in the investigator's opinion, makes it undesirable for the participant to participate in the study or that would jeopardise compliance with the protocol. 2. Refractory nausea and vomiting, chronic gastrointestinal disease, inability to swallow the formulated product, or previous significant bowel resection that would preclude adequate absorption, distribution, metabolism, or excretion of osimertinib. 3. History of another primary malignancy. 4. Spinal cord compression and/or unstable brain metastases, as defined by Protocol. 5. Clinically significant corneal disease. 6. Has active or uncontrolled hepatitis B or C virus infection, as defined by Protocol. 7. Past medical history of ILD/penumonitis, including radiation pneumonitis (apart from radiation pneumonitis that did not require steroids), or drug-induced ILD/pneumonitis, or has suspected ILD/pneumonitis that cannot be ruled out by imaging at screening. 8. Pulmonary embolism within 3 months of the study enrolment or has severe pulmonary function compromise. 9. Has clinically severe pulmonary function compromise resulting from intercurrent pulmonary illnesses.

Study locations (36)

Research Site

Fountain Valley, California, 92708

Suspended

Research Site

Los Alamitos, California, 90720

Recruiting

Research Site

Los Angeles, California, 90017

Recruiting

Research Site

Los Angeles, California, 90033

Recruiting

Research Site

Orange, California, 92868

Not Yet Recruiting

Research Site

San Diego, California, 92123

Recruiting

Research Site

Santa Monica, California, 90404

Recruiting

Research Site

Walnut Creek, California, 94598

Recruiting

Research Site

New Haven, Connecticut, 06510

Recruiting

Research Site

Washington D.C., District of Columbia, 20037

Withdrawn

Research Site

Jacksonville, Florida, 32256

Recruiting

Research Site

Ocala, Florida, 34474

Recruiting

Research Site

Orange City, Florida, 32763

Recruiting

Research Site

Honolulu, Hawaii, 96819

Withdrawn

Research Site

Chicago, Illinois, 60611

Withdrawn

Research Site

Hinsdale, Illinois, 60521

Recruiting

Research Site

North Chicago, Illinois, 60064

Recruiting

Research Site

Fort Wayne, Indiana, 46845

Recruiting

Research Site

Bethesda, Maryland, 20817

Recruiting

Research Site

Detroit, Michigan, 48201

Recruiting

Research Site

Saint Paul, Minnesota, 55102

Recruiting

Research Site

Bridgeton, Missouri, 63044

Withdrawn

Research Site

St Louis, Missouri, 63110

Recruiting

Research Site

Las Vegas, Nevada, 89169

Recruiting

Research Site

Brooklyn, New York, 11212

Not Yet Recruiting

Research Site

New York, New York, 10065

Recruiting

Research Site

Dallas, Texas, 75390

Withdrawn

Research Site

Houston, Texas, 77030

Recruiting

Research Site

Houston, Texas, 77090

Withdrawn

Research Site

Webster, Texas, 77598

Recruiting

Research Site

Woodway, Texas, 76712

Recruiting

Research Site

Fairfax, Virginia, 22031

Recruiting

Research Site

Fort Belvoir, Virginia, 22060

Recruiting

Research Site

Midlothian, Virginia, 23114

Recruiting

Research Site

Seattle, Washington, 98104

Withdrawn

Research Site

Milwaukee, Wisconsin, 53226

Recruiting

References

Lu S, Pulla MP, Mascarenhas E, Tanizaki J, Kim HR, Liu Y, Feng S, Zhang B, Toms L, Yang JC, Goldberg SB. TROPION-Lung14 study protocol: a phase III study of osimertinib in combination with datopotamab deruxtecan versus osimertinib alone as first-line treatment for patients with EGFR-mutated locally advanced or metastatic non-small cell lung cancer. Ther Adv Med Oncol. 2026 May 20;18:17588359261430561. doi: 10.1177/17588359261430561. eCollection 2026.(PubMed)