A Phase 3, Double-blind, Randomized Study of Zolbetuximab in Combination With Pembrolizumab and Chemotherapy (CAPOX or mFOLFOX6) in First-line Treatment of Locally Advanced Unresectable or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma in Participants Whose Tumors Are HER2-negative, Claudin (CLDN) 18.2-positive and Programmed Death-ligand 1 (PD-L1)-Positive
Summary
Zolbetuximab is being studied in people with cancer in and around the stomach or where the food pipe (esophagus) joins the stomach, called gastroesophageal junction (GEJ) cancer. Zolbetuximab with chemotherapy may be used to treat stomach and GEJ cancer when the cancer cells do not have a protein called HER2 (human epidermal growth factor receptor 2) on their surface (HER2-negative) but do have a protein called Claudin 18.2 (Claudin 18.2-positive). Zolbetuximab is thought to work by attaching to the Claudin 18.2 protein in their tumor, which switches on the body's immune system to attack the tumor. Certain stomach and GEJ cancers may be treated with immunotherapy, which helps the body's immune system fight cancer. This study will give more information about how well zolbetuximab works when given with an immunotherapy medicine called pembrolizumab and chemotherapy. In this study, adults with stomach cancer or GEJ cancer will either be given zolbetuximab with pembrolizumab and chemotherapy or a placebo with pembrolizumab and chemotherapy. A placebo looks like zolbetuximab but doesn't have any medicine in it. The main aim of the study is to check how long people with stomach cancer and GEJ cancer live after treatment with zolbetuximab with pembrolizumab and chemotherapy compared to placebo with pembrolizumab and chemotherapy. Adults with locally advanced unresectable or metastatic stomach cancer or GEJ cancer can take part. Locally advanced means the cancer has spread to nearby tissue. Unresectable means the cancer cannot be removed by surgery. Metastatic means the cancer has spread to other parts of the body. A tumor sample (biopsy) of their cancer will have the Claudin 18.2 protein, PD-L1 protein, and be HER2-negative. They may have been previously treated with certain standard therapies. People can also take part if they need to take medicines like steroids to suppress their immune system. They cannot take part if they have blockages or bleeding in their gut, have specific uncontrollable cancers such as symptomatic or untreated cancers in the nervous system, or have a specific heart condition, or infections. The study treatments are either zolbetuximab with pembrolizumab and chemotherapy, or placebo with pembrolizumab and chemotherapy. People who take part will receive just 1 of the study treatments by chance. The people in the study and the study doctors will not know who takes which of the study treatments. Study treatment will be given in 6-week (42-day) cycles. The study treatment is mainly given to people slowly through a tube into a vein. This is called an infusion. People will receive study treatment as follows: Zolbetuximab or placebo: 1 infusion every 2 or 3 weeks (2 or 3 infusions in a cycle) together with: Chemotherapy (1 of the following types of chemotherapy): 1. CAPOX (capecitabine and oxaliplatin): 1 infusion of oxaliplatin every 3 weeks (2 infusions in a cycle). People will also take 1 tablet of capecitabine twice a day for 2 weeks (14 days) at the start of each cycle (Day 1) and again in the middle of each cycle (Day 22). After 8 study treatments people will receive capecitabine only. 2. Modified FOLFOX6 or mFOLFOX6 (5-fluorouracil, folinic acid and oxaliplatin): 1 infusion every 2 weeks (3 infusions in a cycle). After 12 study treatments people will receive folinic acid and fluorouracil only, instead of mFOLFOX6. Pembrolizumab: 1 infusion every 3 or 6 weeks (1 or 2 infusions in a cycle). People can be in the study and will receive study treatment until their cancer worsens, they cannot tolerate the study treatment, or they need to start another cancer treatment. People may receive pembrolizumab for up to 2 years. People will visit the clinic on certain days to receive their study treatment and have health checks. The study doctors will check if people had any medical problems from taking zolbetuximab or the other study treatments. On some visits they will have scans to check for any changes in their cancer. People will have the option of giving a tumor sample if they stop treatment because their cancer has worsened. People will visit the clinic after they stop their study treatment. People will be asked about any medical problems and will have a health check. People will continue to have scans every 9 or 12 weeks to check for any changes in their cancer. They will have telephone health checks every 3 months. The number of visits and checks done at each visit will depend on the health of each person and whether they completed their study treatment or not.
Detailed description
Zolbetuximab (Vyloy), has received marketing approval in Japan. The study is considered a post marketing study in Japan.
Arms & interventions
- Drugzolbetuximab
Participants will receive an IV infusion of zolbetuximab on Cycle 1 Day 1 (C1D1) followed by subsequent IV infusion every 2 weeks or every 3 weeks.
- DrugPembrolizumab
Participants will receive an IV infusion of pembrolizumab every 3 weeks or every 6 weeks.
- DrugCapecitabine
Participants receiving CAPOX regimen of chemotherapy will receive capecitabine Tablet twice daily orally on days 1 through 14 and days 22 through 35 of each cycle.
- DrugOxaliplatin
Participants receiving CAPOX or mFOLFOX6 regimen of chemotherapy will receive an IV infusion of oxaliplatin once every 2 or 3 weeks.
- DrugFolinic acid (leucovorin or local equivalent)
Participants receiving mFOLFOX6 regimen of chemotherapy will receive an IV infusion of Folinic acid (leucovorin or local equivalent) once every 2 weeks.
- Drug5-fluorouracil (5-FU)
Participants receiving mFOLFOX6 regimen of chemotherapy will receive an IV infusion, or IV bolus of 5-FU once every 2 weeks.
- DrugPlacebo
Participants will receive an IV infusion of placebo (0.9% of sodium chloride) on C1D1 followed by subsequent IV infusion every 2 weeks or every 3 weeks.
Outcome measures
Primary
Overall Survival (OS)
OS is defined as the time from the date of randomization until the date of death from any cause.
Time frame: Up to 72 months
Secondary
Progression Free Survival (PFS)
Time frame: Up to 72 Months
Objective Response Rate (ORR)
Time frame: Up to 57 Months
Duration of Response (DOR)
Time frame: Up to 72 Months
Number of participants with adverse Events (AEs)
Time frame: Up to 57 Months
Number of participants with electrocardiograms (ECG) abnormalities and/or AEs
Time frame: Up to 57 Months
Number of Participants with Vital Sign abnormalities and/or AEs
Time frame: Up to 57 Months
Number of participants at each grade of Eastern Cooperative Oncology Group (ECOG) performance status score
Time frame: Up to 57 Months
Number of participants with laboratory assessments abnormalities and/ or AEs
Time frame: Up to 57 Months
Pharmacokinetics (PK) of zolbetuximab in serum: End of Infusion Concentration
Time frame: Up to 57 Months
Pharmacokinetics (PK) of zolbetuximab in serum: Concentration Immediately Prior to Dosing at multiple dosing (Ctrough)
Time frame: Up to 57 Months
Number of participants with positive antidrug antibodies (ADA) to zolbetuximab
Time frame: Up to 57 Months
Eligibility criteria
Study locations (36)
UAB Medicine - UAB Hospital
Birmingham, Alabama, 35294
CBCC Global Research - Comprehensive Blood & Cancer Center
Bakersfield, California, 93309
TOI Clinical Research
Cerritos, California, 90703
University of California, San Diego Moores Cancer Center
La Jolla, California, 92037-0845
The Angeles Clinic and Research Institute, West Los Angeles Office
Los Angeles, California, 90025
Hartford HealthCare - Hartford Hospital
Hartford, Connecticut, 06102
Yale University School of Medicine
New Haven, Connecticut, 06510
MedStar Georgetown University Hospital / Lombardi Comprehensive Cancer Center
Washington D.C., District of Columbia, 20007
Piedmont Physician Medical Oncology Atlanta
Atlanta, Georgia, 30318
Northwestern Memorial Hospital
Chicago, Illinois, 60611
Franciscan Health Oncology and Hematology Specialists
Indianapolis, Indiana, 46237
Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
University of Kansas Cancer Center
Westwood, Kansas, 66205
Saint Elizabeth Medical Center Edgewood
Edgewood, Kentucky, 41017
University of Maryland Medical System - University of Maryland Medical Center
Baltimore, Maryland, 21021
Dana Farber/Harvard Cancer Center
Boston, Massachusetts, 02215
University of Massachusetts - UMass Chan Medical School
Worcester, Massachusetts, 01655
University of Michigan Health System
Ann Arbor, Michigan, 48109
Barbara Ann Karmanos Cancer Center
Detroit, Michigan, 48201
Henry Ford Cancer Institute-Henry Ford Hospital
Detroit, Michigan, 48201
Metro Minnesota Community Oncology Research Consortium (MMCORC)
Saint Louis Park, Minnesota, 55426
University of Nebraska Medical Center
Omaha, Nebraska, 68105
Oncology Hematology West PC dba Nebraska Cancer Specialists
Omaha, Nebraska, 68130
Capital Health - Hematology Oncology Specialists
Pennington, New Jersey, 08534
NYU Langone Medical Center
New York, New York, 10016
Montefiore Medical Center
The Bronx, New York, 10461
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, 27599
Duke University Medical Center - Duke Cancer Centre
Durham, North Carolina, 27710
Allegheny General Hospital (AGH)-Allegheny Singer Research Institute
Pittsburgh, Pennsylvania, 15212
Rhode Island Hospital
Providence, Rhode Island, 02903
The University of Tennessee Medical Center
Knoxville, Tennessee, 37920
Vanderbilt University Medical Center
Nashville, Tennessee, 37232
Texas Oncology-Baylor Charles A Sammons Cancer Center
Dallas, Texas, 75246
The Center For Cancer And Blood Disorders (Texas Cancer Care)
Fort Worth, Texas, 76104
Houston Methodist Cancer Center
Houston, Texas, 77030
Utah Cancer Specialists Cancer Center - Medical Oncology
Salt Lake City, Utah, 84106