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RECRUITING
NCT06908993
PHASE3

Tepotinib vs Standard Treatment in Patients With Advanced MET Exon 14 Mutated Non-Small Cell Lung Cancer Previously Treated

Sponsor: Intergroupe Francophone de Cancerologie Thoracique

View on ClinicalTrials.gov

Summary

The hypothesize is that tepotinib is more effective than the investigator's choice of treatment in patients with MET-mutated NSCLC who have progressed after at least one first-line treatment. The main benefit concerns patient access to tepotinib. There is currently no access to a new-generation MET TKI in France for METex14 patients, due to lack of comparative data. There are no phase III RCTs underway anywhere in the world. This study is the only opportunity, perhaps the last, to generate comparative data which, if positive, will enable the drug to be reimbursed. With this in mind, the methodology of this study was discussed with the HAS on several occasions beforehand, to ensure that it met their expectations. With a response rate of around 50% and a median progression-free survival of 11 months in previously-treated subjects based on clinical trials data, tepotinib is a key drug for METex14 NSCLC patients, who are generally elderly and frail, and for whom therapeutic options are limited. The investigators expect to observe a benefit for patients treated with tepotinib compared to the control arm in terms of PFS, quality of life, objective response rate and duration of response. The overall survival benefit may be compromised by allowing patients in the control arm to cross over to tepotinib once they have progressed. However, the investigators have decided to maintain this crossover and consequently use PFS as the primary endpoint, as there is no clinical equipoise regarding the efficacy of tepotinib in METex14 NSCLC patients. The EMA has already approved tepotinib based on efficacy and safety data from clinical trials, and patients and investigators already consider this treatment as an important therapeutic option. Indeed, both ESMO and ASCO guidelines recommend the use of MET TKIs in these patients. In France, although neither tepotinib nor capmatinib are available, crizotinib, a multi-target TKI also active on MET, can be used off-label. If cross-over to tepotinib was not allowed in this trial, most patients would still benefit from cross-over to a MET TKI by receiving off-label crizotinib, which would in any case lead to a misinterpretation of the OS data. Therefore, the investigators believe it is preferable to control for cross-over and expose progressive patients in the control arm to tepotinib and use PFS as the primary endpoint. Toxicity of MET TKIs is considered as manageable. In the VISION trial, of 313 patients treated with tepotinib (median age: 72 years), 109 (34.8%) experienced grade ≥3 treatment-related adverse events, leading to discontinuation in 46 patients (14.7%). Rates of adverse events (AE) were broadly consistent irrespective of prior therapies. Edema, the most common adverse event of clinical interest (AECI), was reported in 67.1% (grade ≥ 3, 11.2%). Median time to first edema onset was 7.9 weeks (range: 0.1-58.3). Edema was manageable with supportive measures, dose reduction (18.8%), and/or treatment interruption (23.1%), and rarely prompted discontinuation (4.3%). Other AECIs were also manageable and predominantly mild/moderate: hypoalbuminemia, 23.6% (grade ≥ 3, 3.5%); creatinine increase, 22.0% (grade ≥ 3, 1.0%); nausea, 23.3% (grade ≥ 3, 0.6%), diarrhea, 22.4% (grade ≥ 3, 0.3%), decreased appetite (grade ≥ 3, 0.3%), and ALT increase, 14.1% (grade ≥ 3, 2.2%). GI AEs typically occurred early and resolved in the first weeks10,13. Given the efficacy of tepotinib, the manageable safety profile, and the oral administration of tepotinib, the investigators anticipate that treatment with tepotinib will be associated with improved quality of life. Treatments offered in the control group correspond to standard treatments for advanced NSCLC in second line or beyond. In terms of prior lines of treatment, the eligibility criteria of the trial are aligned with the EMA label of tepotinib: "indicated for the treatment of adult patients with advanced non-small cell lung cancer (NSCLC) harboring alterations leading to MET gene exon 14 (METex14) skipping, who require systemic therapy following prior treatment with immunotherapy and/or platinum-based chemotherapy". The investigators have not included platinum-based chemotherapy as a treatment option in the control arm, considering that patients who are eligible to platinum-based chemotherapy should have received this regimen in first-line, as per ESMO guidelines14. Given the low efficacy of immunotherapy in patients with oncogene addiction, it is unlikely that some patients would receive immunotherapy alone as first-line treatment. Thus, the absence of platinum-based chemotherapy as a treatment choice in the control arm seems reasonable and will reduce the heterogeneity of this arm.

Official title: A Randomized Controlled Trial of Tepotinib vs Standard Treatment in Patients With Advanced MET Exon 14 Mutated Non-Small Cell Lung Cancer

Key Details

Gender

All

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

133

Start Date

2025-12-09

Completion Date

2028-07-15

Last Updated

2025-12-17

Healthy Volunteers

No

Interventions

DRUG

Tepotinib

Tepotinib will be given orally once daily at the dose of 500mg of tepotinib hydrochloride hydrate.

DRUG

Pemetrexed (Alimta)

500 mg/m² every 3 weeks

DRUG

Vinorelbine

25-30 mg/m² D1, D8, every 3 weeks

DRUG

Gemcitabine alone

1250 mg/m² D1, D8, every 3 weeks

DRUG

Docetaxel

75 mg/m² every 3 weeks

DRUG

Paclitaxel

90 mg/m² D1, D8, D15 every 4 weeks If bevacizumab added: 10 mg/kg D1, D15 every 4 weeks

DRUG

Pembrolizumab

200 mg every 3 weeks

DRUG

Nivolumab

240 mg every 2 weeks

DRUG

Atezolizumab

1200 mg every 3 weeks

Locations (29)

Besançon - CHU

Besançon, France

Bordeaux - Institut Bergonie

Bordeaux, France

Brest - CHU

Brest, France

Caen - CRLCC

Caen, France

Centre Hospitalier Intercommunal de Créteil

Créteil, France

Dijon - Centre Georges-François Leclerc

Dijon, France

Grenoble - CHU

Grenoble, France

CHD Vendée

La Roche-sur-Yon, France

Le Mans - CHG

Le Mans, France

CHRU de Lille

Lille, France

Centre Léon Bérard

Lyon, France

Institut Paoli Calmette

Marseille, France

Marseille - APHM

Marseille, France

Montpellier - CHU

Montpellier, France

Centre Antoine Lacassagne

Nice, France

AP-HP Hôpital Cochin

Paris, France

AP-HP Hôpital Tenon

Paris, France

Paris - APHP Bichat

Paris, France

Centre Hospitalier Général - Pau

Pau, France

Bordeaux - CHU

Pessac, France

Institut de Cancérologie de l'Ouest - René Gauducheau

Saint-Herblain, France

Sens - CH

Sens, France

Strasbourg - NHC

Strasbourg, France

Toulon - CHI

Toulon, France

CHU Toulouse

Toulouse, France

CHRU de Tours

Tours, France

CH de Valence

Valence, France

Nancy - CHU

Vandœuvre-lès-Nancy, France

Gustave Roussy

Villejuif, France