Trial Outcomes & Findings for Regorafenib and Methotrexate in Treating Participants With Recurrent or Metastatic KRAS Mutated Non-Small Cell Lung Cancer (NCT NCT03520842)

NCT ID: NCT03520842

Last Updated: 2023-08-01

Results Overview

Progression free survival (PFS), measured from time of first study treatment until objective tumor progression as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria or death from any cause, whichever occurs earlier. PFS was calculated using the Kaplan-Meier method along with 95% confidence interval. RECIST v1.1 criteria are: * Complete Response (CR) = Disappearance of all target lesions * Partial Response (PR) = ≥ 30% decrease in the sum of the longest diameter of target lesions * Overall Response (OR) = CR + PR * Progressive disease (PD) = 20% increase in the sum of the longest diameter of target lesions, and/or the appearance of one or more new lesion(s) * Stable disease (SD) = Small changes that do not meet any of the above criteria

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

22 participants

Primary outcome timeframe

From first study treatment assessed up to 15 months

Results posted on

2023-08-01

Participant Flow

22 patients signed consent, 18 were allocated to treatment.

Participant milestones

Participant milestones
Measure
Treatment (Regorafenib, Methotrexate)
Participants receive regorafenib PO once daily (QD) on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Overall Study
STARTED
18
Overall Study
COMPLETED
18
Overall Study
NOT COMPLETED
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Regorafenib and Methotrexate in Treating Participants With Recurrent or Metastatic KRAS Mutated Non-Small Cell Lung Cancer

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Age, Continuous
68.9 years
STANDARD_DEVIATION 7.7 • n=39 Participants
Sex: Female, Male
Female
12 Participants
n=39 Participants
Sex: Female, Male
Male
6 Participants
n=39 Participants
Race/Ethnicity, Customized
White
10 Participants
n=39 Participants
Race/Ethnicity, Customized
Asian
5 Participants
n=39 Participants
Race/Ethnicity, Customized
Hispanic
3 Participants
n=39 Participants
Region of Enrollment
United States
18 Participants
n=39 Participants
Smoking Status
Never
4 Participants
n=39 Participants
Smoking Status
Former
14 Participants
n=39 Participants
ECOG Performance Status
0
2 Participants
n=39 Participants
ECOG Performance Status
1
16 Participants
n=39 Participants
Disease Presentation
Recurrent
11 Participants
n=39 Participants
Disease Presentation
Metastatic
7 Participants
n=39 Participants
History of Pleural Effusion
Yes
9 Participants
n=39 Participants
History of Pleural Effusion
No
9 Participants
n=39 Participants
Brain Metastases
Previously treated
3 Participants
n=39 Participants
Brain Metastases
Untreated stable
1 Participants
n=39 Participants
Brain Metastases
None
14 Participants
n=39 Participants
Tumor Histology: Adenocarcinoma
18 Participants
n=39 Participants
KRAS Mutation Subtype
G12C
5 Participants
n=39 Participants
KRAS Mutation Subtype
G12D
6 Participants
n=39 Participants
KRAS Mutation Subtype
G12R
2 Participants
n=39 Participants
KRAS Mutation Subtype
G12V
2 Participants
n=39 Participants
KRAS Mutation Subtype
Q61L
1 Participants
n=39 Participants
KRAS Mutation Subtype
G12C/K117N
1 Participants
n=39 Participants
KRAS Mutation Subtype
G12S/A146V
1 Participants
n=39 Participants
Previous Lines of Systemic Therapy
1
10 Participants
n=39 Participants
Previous Lines of Systemic Therapy
2-3
5 Participants
n=39 Participants
Previous Lines of Systemic Therapy
4-5
3 Participants
n=39 Participants

PRIMARY outcome

Timeframe: From first study treatment assessed up to 15 months

Progression free survival (PFS), measured from time of first study treatment until objective tumor progression as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria or death from any cause, whichever occurs earlier. PFS was calculated using the Kaplan-Meier method along with 95% confidence interval. RECIST v1.1 criteria are: * Complete Response (CR) = Disappearance of all target lesions * Partial Response (PR) = ≥ 30% decrease in the sum of the longest diameter of target lesions * Overall Response (OR) = CR + PR * Progressive disease (PD) = 20% increase in the sum of the longest diameter of target lesions, and/or the appearance of one or more new lesion(s) * Stable disease (SD) = Small changes that do not meet any of the above criteria

Outcome measures

Outcome measures
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Progression Free Survival (PFS)
3.7 months
Interval 1.8 to 8.6

SECONDARY outcome

Timeframe: Up to 24 months

Objective response rate (ORR; as determined by RECIST v1.1) will be assessed as the proportion (percent) of participants with either complete response (CR; disappearance of all target lesions) or partial response (PR; ≥ 30% decrease in the sum of the longest diameter of target lesions), with exact 95% confidence intervals based on a binomial distribution.

Outcome measures

Outcome measures
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Objective Response Rate (ORR)
16.7 percentage of participants
Interval 3.5 to 41.4

SECONDARY outcome

Timeframe: At 8 weeks

Disease control rate (DCR) will be assessed as the proportion of complete responses (CR) + partial responses (PR) + stable disease (SD) after 8 weeks of treatment (+/- 1 week), as determined by using RECIST v1.1

Outcome measures

Outcome measures
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Disease Control Rate (DCR)
66.7 percentage of participants
Interval 41.0 to 86.7

SECONDARY outcome

Timeframe: Up to 38 months

Participants who experienced any treatment emergent adverse event and any ≥ grade 3 adverse event is reported.

Outcome measures

Outcome measures
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Number of Participants With Adverse Events
Any grade
17 Participants
Number of Participants With Adverse Events
≥ grade 3
14 Participants

SECONDARY outcome

Timeframe: Cycle 1, Days 1, 8, 15, and 22

Pharmacokinetics (PK) of methotrexate when co-administered with regorafenib, as indicated by the trough serum concentration, was accessed by a fluorescent polarization immunoassay, and is reported as the mean with standard deviation. Participants treated with at least 1 dose of regorafenib and methotrexate and with at least one evaluable baseline pharmacokinetic sample and one follow up trough pharmacokinetic sample treated were included.

Outcome measures

Outcome measures
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Trough Serum Concentration of Methotrexate
Cycle 1, Day 1
0.04 μmol/L
Standard Deviation 0.02
Trough Serum Concentration of Methotrexate
Cycle 1, Day 8
0.04 μmol/L
Standard Deviation 0.01
Trough Serum Concentration of Methotrexate
Cycle 1, Day 15
0.05 μmol/L
Standard Deviation 0.03
Trough Serum Concentration of Methotrexate
Cycle 1, Day 22
0.05 μmol/L
Standard Deviation 0.02

SECONDARY outcome

Timeframe: Cycle 1, Days 1, 8, and 15

Pharmacokinetics (PK) of methotrexate when co-administered with regorafenib, as indicated by the maximum serum concentration (Cmax) of methotrexate, was assessed by a fluorescent polarization immunoassay, and is reported as the mean with standard deviation. Participants treated with at least 1 dose of regorafenib and methotrexate and with at least one evaluable Cmax pharmacokinetic sample were included in the assessment.

Outcome measures

Outcome measures
Measure
Treatment (Regorafenib, Methotrexate)
n=18 Participants
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Maximum Serum Concentration (Cmax) of Methotrexate
Cycle 1, Day 1
0.43 μmol/L
Standard Deviation 0.23
Maximum Serum Concentration (Cmax) of Methotrexate
Cycle 1, Day 8
0.60 μmol/L
Standard Deviation 0.30
Maximum Serum Concentration (Cmax) of Methotrexate
Cycle 1, Day 15
0.60 μmol/L
Standard Deviation 0.43

Adverse Events

Treatment (Regorafenib, Methotrexate)

Serious events: 8 serious events
Other events: 17 other events
Deaths: 2 deaths

Serious adverse events

Serious adverse events
Measure
Treatment (Regorafenib, Methotrexate)
n=18 participants at risk
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Respiratory, thoracic and mediastinal disorders
Aspiration
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Dyspnea
16.7%
3/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Hypoxia
11.1%
2/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Pneumothorax
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Hemoptysis
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Abdominal pain
5.6%
1/18 • Up to 38 months
Vascular disorders
Thromboembolic event: pulmonary embolism
5.6%
1/18 • Up to 38 months
Cardiac disorders
Atrial fibrillation
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Pancreatitis
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Productive Cough
5.6%
1/18 • Up to 38 months

Other adverse events

Other adverse events
Measure
Treatment (Regorafenib, Methotrexate)
n=18 participants at risk
Participants receive regorafenib PO QD on days 1-21, and methotrexate PO twice weekly with 2-3 days apart on a 3 week on/ 1 week off cycle. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Gastrointestinal disorders
Abdominal pain
5.6%
1/18 • Up to 38 months
Investigations
Alanine aminotransferase increased
16.7%
3/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Alopecia
22.2%
4/18 • Up to 38 months
Investigations
Amylase increased
16.7%
3/18 • Up to 38 months
Metabolism and nutrition disorders
Anorexia
44.4%
8/18 • Up to 38 months
Blood and lymphatic system disorders
Anemia
5.6%
1/18 • Up to 38 months
Psychiatric disorders
Anxiety
5.6%
1/18 • Up to 38 months
Investigations
Aspartate aminotransferase increased
16.7%
3/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Aspiration
5.6%
1/18 • Up to 38 months
Cardiac disorders
Atrial fibrillation
5.6%
1/18 • Up to 38 months
Musculoskeletal and connective tissue disorders
Back pain
16.7%
3/18 • Up to 38 months
Blood and lymphatic system disorders
Thrombocytosis
5.6%
1/18 • Up to 38 months
Blood and lymphatic system disorders
Thrombocytopenia
5.6%
1/18 • Up to 38 months
Investigations
Blood bilirubin increased
11.1%
2/18 • Up to 38 months
Musculoskeletal and connective tissue disorders
Bone pain
5.6%
1/18 • Up to 38 months
Injury, poisoning and procedural complications
Bruising
5.6%
1/18 • Up to 38 months
Cardiac disorders
Cardiomyopathy
5.6%
1/18 • Up to 38 months
Cardiac disorders
Tachycardia
5.6%
1/18 • Up to 38 months
General disorders
Chills
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Colitis
5.6%
1/18 • Up to 38 months
Nervous system disorders
Concentration impairment
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Constipation
22.2%
4/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Cough
16.7%
3/18 • Up to 38 months
Investigations
Creatinine increased
5.6%
1/18 • Up to 38 months
Psychiatric disorders
Delirium
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Diarrhea
27.8%
5/18 • Up to 38 months
Nervous system disorders
Dizziness
16.7%
3/18 • Up to 38 months
Eye disorders
Dry eye
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Dry mouth
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Dry skin
11.1%
2/18 • Up to 38 months
Nervous system disorders
Dysgeusia
16.7%
3/18 • Up to 38 months
Gastrointestinal disorders
Dysphagia
16.7%
3/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Dyspnea
50.0%
9/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Epistaxis
16.7%
3/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Erythema multiforme
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Esophageal stenosis
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Esophagitis
5.6%
1/18 • Up to 38 months
Injury, poisoning and procedural complications
Fall
5.6%
1/18 • Up to 38 months
General disorders
Fatigue
50.0%
9/18 • Up to 38 months
Gastrointestinal disorders
Fecal incontinence
5.6%
1/18 • Up to 38 months
General disorders
Fever
5.6%
1/18 • Up to 38 months
General disorders
Flu like symptoms
5.6%
1/18 • Up to 38 months
Injury, poisoning and procedural complications
Fracture
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Gastroesphogeal reflux disease
11.1%
2/18 • Up to 38 months
Gastrointestinal disorders
Gas Pain (chest)
5.6%
1/18 • Up to 38 months
General disorders
Hyperhidrosis
5.6%
1/18 • Up to 38 months
General disorders
Bleeding gums
5.6%
1/18 • Up to 38 months
Nervous system disorders
Headache
16.7%
3/18 • Up to 38 months
Nervous system disorders
Hiccups
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Hoarseness
38.9%
7/18 • Up to 38 months
Vascular disorders
Hot flashes
5.6%
1/18 • Up to 38 months
Metabolism and nutrition disorders
Hypercalcemia
5.6%
1/18 • Up to 38 months
Vascular disorders
Hypertension
27.8%
5/18 • Up to 38 months
Metabolism and nutrition disorders
Hypoalbuminemia
5.6%
1/18 • Up to 38 months
Metabolism and nutrition disorders
Hypocalcemia
11.1%
2/18 • Up to 38 months
Metabolism and nutrition disorders
Hypokalemia
16.7%
3/18 • Up to 38 months
Metabolism and nutrition disorders
Hyponatremia
27.8%
5/18 • Up to 38 months
Metabolism and nutrition disorders
Hypophosphatemia
50.0%
9/18 • Up to 38 months
Vascular disorders
Hypotension
11.1%
2/18 • Up to 38 months
Endocrine disorders
Hypothyroidism
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Hypoxia
11.1%
2/18 • Up to 38 months
Investigations
Thyroid stimulating hormone increased
5.6%
1/18 • Up to 38 months
Investigations
Hyperbilirubinemia
5.6%
1/18 • Up to 38 months
Investigations
Lipase increased
16.7%
3/18 • Up to 38 months
General disorders
Localized edema
16.7%
3/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Lung infection
5.6%
1/18 • Up to 38 months
Investigations
Lymphocyte count decreased
5.6%
1/18 • Up to 38 months
Nervous system disorders
Memory impairment
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Mucositis oral
50.0%
9/18 • Up to 38 months
Infections and infestations
Mucosal infection
5.6%
1/18 • Up to 38 months
Musculoskeletal and connective tissue disorders
Muscle cramp (bottom of feet)
5.6%
1/18 • Up to 38 months
Musculoskeletal and connective tissue disorders
Weakness
5.6%
1/18 • Up to 38 months
Musculoskeletal and connective tissue disorders
Myalgia
27.8%
5/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Nail discoloration
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Nausea
44.4%
8/18 • Up to 38 months
Nervous system disorders
Anosmia
5.6%
1/18 • Up to 38 months
Musculoskeletal and connective tissue disorders
Non-cardiac chest pain
16.7%
3/18 • Up to 38 months
Gastrointestinal disorders
Oral pain
5.6%
1/18 • Up to 38 months
General disorders
Pain
38.9%
7/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Palmar-plantar erthryodysesthesia syndrome
44.4%
8/18 • Up to 38 months
Gastrointestinal disorders
Pancreatitis
5.6%
1/18 • Up to 38 months
Infections and infestations
Papulopustular rash
5.6%
1/18 • Up to 38 months
Nervous system disorders
Paresthesia
11.1%
2/18 • Up to 38 months
Infections and infestations
Paronychia
5.6%
1/18 • Up to 38 months
Nervous system disorders
Peripheral neuropathy
5.6%
1/18 • Up to 38 months
Investigations
Platelet count decreased
11.1%
2/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Pleural effusion
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Pneumothorax
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Postnasal drip
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Productive cough
16.7%
3/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Pruritus
27.8%
5/18 • Up to 38 months
Vascular disorders
Pulmonary hypertension
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Rash maculopapular
11.1%
2/18 • Up to 38 months
Renal and urinary disorders
Urine output decreased
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Rhinorrhea
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Hemoptysis
11.1%
2/18 • Up to 38 months
Cardiac disorders
Sinus tachycardia
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Tenderness
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Finger fissures
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Scrotal erosion
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Papules
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Rash
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Erythematous plaques
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Rash scalp
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Hyperkeratosis (feet)
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
scalp flaking
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
pustule/cyst (labia)
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
erythema (nasal region/scalp)
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
skin peeling/blisters (fingers, feet, toes)
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Rash (face)
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Nonpruritic rash (upper chest, shoulders, back)
5.6%
1/18 • Up to 38 months
Skin and subcutaneous tissue disorders
Rash (groin)
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Sore throat
11.1%
2/18 • Up to 38 months
Gastrointestinal disorders
Stomach pain
11.1%
2/18 • Up to 38 months
Nervous system disorders
Syncope
5.6%
1/18 • Up to 38 months
Vascular disorders
Thromboembolic event
5.6%
1/18 • Up to 38 months
Ear and labyrinth disorders
Tinnitus
5.6%
1/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Upper respiratory infection
5.6%
1/18 • Up to 38 months
Renal and urinary disorders
Urinary retention
5.6%
1/18 • Up to 38 months
Gastrointestinal disorders
Vomiting
27.8%
5/18 • Up to 38 months
Investigations
Weight loss
27.8%
5/18 • Up to 38 months
Respiratory, thoracic and mediastinal disorders
Wheezing
5.6%
1/18 • Up to 38 months
Injury, poisoning and procedural complications
Wound dehiscence
5.6%
1/18 • Up to 38 months

Additional Information

Heather Wakelee

Stanford University

Phone: (650) 498-6000

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place