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NCT02336451: Ascend-7

A Phase II Study to Evaluate the Efficacy and Safety of Oral Ceritinib in Patients With ALK-positive NSCLC Metastatic to the Brain and/or to Leptomeninges

Completed Phase 2 Results posted Last updated 21 April 2020
What this trial tests

Phase 2 trial testing Ceritinib in ALK-positive Non-small Cell Lung Cancer in 156 participants. Completed in 6 February 2019.

Timeline
1 April 2015
Primary endpoint
6 February 2019
6 February 2019

Quick facts

Lead sponsorNovartis Pharmaceuticals
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationnon randomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment156
Start date1 April 2015
Primary completion6 February 2019
Estimated completion6 February 2019
Sites57 locations across France, Hong Kong, Italy, Netherlands, Russia, Belgium, Taiwan, United Kingdom

Drugs / interventions tested

Conditions studied

Sponsor

Novartis Pharmaceuticals — full company profile →

Who can join

18 and older, any sex, with ALK-positive Non-small Cell Lung Cancer. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Overall Response Rate (ORR) Per Investigator Assessment Primary · 43 months

Overall response rate (ORR) is defined as the percentage of participants with a best overall confirmed response of complete response (CR) or partial response (PR) in the whole body as assessed per RECIST 1.1 by the investigator. CR: Disappearance of all non-nodal target and non-target lesions. In addition, all lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), and no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the sum of diameter of all target lesions (taking as refer

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)35.721.6 – 52.0
Arm 2 (PrALKi=Y, PrBRad=N)30.016.6 – 46.5
Arm 3 (PrALKi=N, PrBRad=Y)50.021.1 – 78.9
Arm 4 (PrALKi=N, PrBRad=N)59.143.2 – 73.7
Arm 5 (LepDis)16.73.6 – 41.4
Disease Control Rate (DCR) Per Investigator Assessment Secondary · 43 months

DCR: percentage of parts. with best overall response of CR, PR or stable disease (SD) in the whole body, as assessed per RECIST 1.1 by investigator. CR: Disappearance of all non-nodal target and non-target lesions. In addition, all lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the sum of diameter of all target lesions (taking as reference the baseline sum of diameters) is observed and non-target lesions are not in

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)66.750.5 – 80.4
Arm 2 (PrALKi=Y, PrBRad=N)82.567.2 – 92.7
Arm 3 (PrALKi=N, PrBRad=Y)66.734.9 – 90.1
Arm 4 (PrALKi=N, PrBRad=N)70.554.8 – 83.2
Arm 5 (LepDis)66.741.0 – 86.7
Overall Intracranial Response Rate (OIRR) Per Modified RECIST 1.1 Per Investigator Assessment Secondary · 43 months

OIRR was calculated based on response assessments in the brain for patients having measurable brain metastases at baseline. OIRR was defined as the percentage of participants with a best overall confirmed response of CR or PR in the brain as assessed per modified RECIST 1.1. This was applied to the brain only. CR: Disappearance of all non-nodal target \& non-target lesions. All lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or decreased by at least 30% in

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)39.321.5 – 59.4
Arm 2 (PrALKi=Y, PrBRad=N)27.612.7 – 47.2
Arm 3 (PrALKi=N, PrBRad=Y)28.63.7 – 71.0
Arm 4 (PrALKi=N, PrBRad=N)51.533.5 – 69.2
Arm 5 (LepDis)12.50.3 – 52.7
Overall Intracranial Response Rate (OIRR) Per Modified RECIST 1.1 Per Blinded Independent Review Committee (BIRC) Assessment Secondary · 43 months

OIRR was calculated based on response assessments in the brain for patients having measurable brain metastases at baseline. OIRR was defined as the percentage of participants with a best overall confirmed response of CR or PR in the brain as assessed per modified RECIST 1.1. This was applied to the brain only. CR: Disappearance of all non-nodal target \& non-target lesions. All lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or decreased by at least 30% in

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)33.317.3 – 52.8
Arm 2 (PrALKi=Y, PrBRad=N)24.110.3 – 43.5
Arm 3 (PrALKi=N, PrBRad=Y)33.34.3 – 77.7
Arm 4 (PrALKi=N, PrBRad=N)58.840.7 – 75.4
Arm 5 (LepDis)20.02.5 – 55.6
Intracranial Disease Control Rate (IDCR) Per Modified RECIST 1.1 Per Investigator Assessment at Weeks 8 & 16 Secondary · Week 8 and Week 16

IDCR overall: percentage of participants with a best overall response of CR, PR, SD or non-CR/non-PD in the brain, as assessed per modified RECIST 1.1 by the Investigator. This was applied to the brain only. CR: Disappearance of all non-nodal target \& non-target lesions. All lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the sum of diameter of all target lesions (taking as reference the baseline sum of diameters)

IDCR at Week 8
GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)71.455.4 – 84.3
Arm 2 (PrALKi=Y, PrBRad=N)75.058.8 – 87.3
Arm 3 (PrALKi=N, PrBRad=Y)58.327.7 – 84.8
Arm 4 (PrALKi=N, PrBRad=N)68.252.4 – 81.4
Arm 5 (LepDis)66.741.0 – 86.7
IDCR at Week 16
GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)59.543.3 – 74.4
Arm 2 (PrALKi=Y, PrBRad=N)62.545.8 – 77.3
Arm 3 (PrALKi=N, PrBRad=Y)58.327.7 – 84.8
Arm 4 (PrALKi=N, PrBRad=N)65.950.1 – 79.5
Arm 5 (LepDis)50.026.0 – 74.0
Intracranial Disease Control Rate (IDCR) Per Modified RECIST 1.1 Per Investigator Assessment - Overall Secondary · 43 months

IDCR overall: percentage of participants with a best overall response of CR, PR, SD or non-CR/non-PD in the brain, as assessed per modified RECIST 1.1 by the Investigator. This was applied to the brain only. CR: Disappearance of all non-nodal target \& non-target lesions. All lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the sum of diameter of all target lesions (taking as reference the baseline sum of diameters)

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)71.455.4 – 84.3
Arm 2 (PrALKi=Y, PrBRad=N)85.070.2 – 94.3
Arm 3 (PrALKi=N, PrBRad=Y)75.042.8 – 94.5
Arm 4 (PrALKi=N, PrBRad=N)75.059.7 – 86.8
Arm 5 (LepDis)66.741.0 – 86.7
Intracranial Disease Control Rate (IDCR) Per Modified RECIST 1.1 Per BIRC Assessment at Weeks 8 & 16 Secondary · Week 8 and Week 16

IDCR overall: percentage of participants with a best overall response of CR, PR, SD or non-CR/non-PD in the brain, as assessed per modified RECIST 1.1 by Investigator. This was applied to the brain only. CR: Disappearance of all non-nodal target \& non-target lesions. All lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the sum of diameter of all target lesions (taking as reference the baseline sum of diameters) is o

IDCR at 8 weeks
GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)76.260.5 – 87.9
Arm 2 (PrALKi=Y, PrBRad=N)80.064.4 – 90.9
Arm 3 (PrALKi=N, PrBRad=Y)58.327.7 – 84.8
Arm 4 (PrALKi=N, PrBRad=N)68.252.4 – 81.4
Arm 5 (LepDis)66.741.0 – 86.7
IDCR at 16 weeks
GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)69.052.9 – 82.4
Arm 2 (PrALKi=Y, PrBRad=N)62.545.8 – 77.3
Arm 3 (PrALKi=N, PrBRad=Y)58.327.7 – 84.8
Arm 4 (PrALKi=N, PrBRad=N)68.252.4 – 81.4
Arm 5 (LepDis)38.917.3 – 64.3
Intracranial Disease Control Rate (IDCR) Per Modified RECIST 1.1 Per BIRC Assessment - Overall Secondary · 43 months

IDCR overall: percentage of participants with a best overall response of CR, PR, SD or non-CR/non-PD in the brain, as assessed per modified RECIST 1.1 by Investigator. This was applied to the brain only. CR: Disappearance of all non-nodal target \& non-target lesions. All lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), \& no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the sum of diameter of all target lesions (taking as reference the baseline sum of diameters) is o

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)73.858.0 – 86.1
Arm 2 (PrALKi=Y, PrBRad=N)85.070.2 – 94.3
Arm 3 (PrALKi=N, PrBRad=Y)66.734.9 – 90.1
Arm 4 (PrALKi=N, PrBRad=N)75.059.7 – 86.8
Arm 5 (LepDis)66.741.0 – 86.7
Time to Intracranial Tumor Response (TTIR) Per Modified RECIST 1.1 Per Investigator Assessment Secondary · 43 months

TTIR was defined as the time from the date of the first dose of ceritinib to the date of the first documented response (CR or PR) in the brain as assessed per modified RECIST 1.1 criteria for patients with measurable brain metastases at baseline. This was applied to the brain only. CR: Disappearance of all non-nodal target and non-target lesions. In addition, all lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), and no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)1.871.7 – 7.5
Arm 2 (PrALKi=Y, PrBRad=N)1.841.6 – 9.1
Arm 3 (PrALKi=N, PrBRad=Y)3.561.8 – 5.3
Arm 4 (PrALKi=N, PrBRad=N)1.771.3 – 7.4
Arm 5 (LepDis)1.801.8 – 1.8
Time to Intracranial Tumor Response (TTIR) Per Modified RECIST 1.1 Per BIRC Assessment Secondary · 43 months

TTIR was defined as the time from the date of the first dose of ceritinib to the date of the first documented response (CR or PR) in the brain as assessed per modified RECIST 1.1 criteria for patients with measurable brain metastases at baseline. This was applied to the brain only. CR: Disappearance of all non-nodal target and non-target lesions. In addition, all lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), and no new lesion is identified. PR: When all target lesions have disappeared or there is a decrease by at least 30% in the

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)1.911.7 – 5.6
Arm 2 (PrALKi=Y, PrBRad=N)1.681.6 – 7.2
Arm 3 (PrALKi=N, PrBRad=Y)6.313.5 – 9.1
Arm 4 (PrALKi=N, PrBRad=N)1.811.3 – 9.2
Arm 5 (LepDis)1.220.7 – 1.8
Duration of Intracranial Response (DOIR) by Modified RECIST 1.1 Per Investigator Assessment Secondary · 43 months

Defined as the time from the first documented response (PR or CR) in the brain to the date of the first documented disease progression in the brain or death due to any cause, amongst participants with measurable brain metastases at baseline and a confirmed response (PR or CR) in the brain as per modified RECIST 1.1. This was applied to the brain only. CR: Disappearance of all non-nodal target and non-target lesions. In addition, all lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), and no new lesion is identified. PR: When all target

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)9.23.7 – NA
Arm 2 (PrALKi=Y, PrBRad=N)10.13.8 – 17.3
Arm 3 (PrALKi=N, PrBRad=Y)NANA – NA
Arm 4 (PrALKi=N, PrBRad=N)7.55.6 – 11.2
Arm 5 (LepDis)5.5NA – NA
Duration of Intracranial Response (DOIR) by Modified RECIST 1.1 Per BIRC Assessment Secondary · 43 months

Defined as the time from the first documented response (PR or CR) in the brain to the date of the first documented disease progression in the brain or death due to any cause, amongst participants with measurable brain metastases at baseline and a confirmed response (PR or CR) in the brain as per modified RECIST 1.1. CR: Disappearance of all non-nodal target and non-target lesions. In addition, all lymph nodes assigned a target or a non-target lesions must be non-pathological in size (\< 10 mm short axis), and no new lesion is identified. PR: When all target lesions have disappeared or there is

GroupValue95% CI
Arm 1 (PrALKi=Y, PrBRad=Y)11.03.8 – NA
Arm 2 (PrALKi=Y, PrBRad=N)4.63.5 – 20.3
Arm 3 (PrALKi=N, PrBRad=Y)NA18.4 – NA
Arm 4 (PrALKi=N, PrBRad=N)9.25.7 – 11.3
Arm 5 (LepDis)3.42.0 – 4.7

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse events were collected from first dose of study treatment until end of study treatment plus 30 days post treatment, up to maximum duration of approx. 168 weeks.. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Arm 1 (PrALKi=Y, PrBRad=Y)
Serious: 28/42 (67%)
Deaths: 8/42
Arm 2 (PrALKi=Y, PrBRad=N)
Serious: 17/40 (43%)
Deaths: 5/40
Arm 3 (PrALKi=N, PrBRad=Y)
Serious: 4/12 (33%)
Deaths: 3/12
Arm 4 (PrALKi=N, PrBRad=N)
Serious: 15/44 (34%)
Deaths: 6/44
Arm 5 (LepDis)
Serious: 11/18 (61%)
Deaths: 9/18
All Participants
Serious: 75/156 (48%)
Deaths: 31/156

Serious adverse events (81 terms)

ReactionSystemArm 1 (PrALKi=Y, PrBRad=Y)Arm 2 (PrALKi=Y, PrBRad=N)Arm 3 (PrALKi=N, PrBRad=Y)Arm 4 (PrALKi=N, PrBRad=N)Arm 5 (LepDis)All Participants
PneumoniaInfections and infestations
HyperglycaemiaMetabolism and nutrition disorders
SeizureNervous system disorders
PericarditisCardiac disorders
Pericardial effusionCardiac disorders
PyrexiaGeneral disorders
EpilepsyNervous system disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
TachycardiaCardiac disorders
Disease progressionGeneral disorders
Non-cardiac chest painGeneral disorders
Sudden deathGeneral disorders
HyponatraemiaMetabolism and nutrition disorders
AphasiaNervous system disorders
DysarthriaNervous system disorders
Confusional statePsychiatric disorders
Pleural effusionRespiratory, thoracic and mediastinal disorders
Pulmonary embolismRespiratory, thoracic and mediastinal disorders
Respiratory failureRespiratory, thoracic and mediastinal disorders
LymphadenopathyBlood and lymphatic system disorders
Atrial fibrillationCardiac disorders
Left ventricular dysfunctionCardiac disorders
KeratitisEye disorders
Abdominal painGastrointestinal disorders
NauseaGastrointestinal disorders
Other adverse events (132 terms — click to expand)

ReactionSystemArm 1 (PrALKi=Y, PrBRad=Y)Arm 2 (PrALKi=Y, PrBRad=N)Arm 3 (PrALKi=N, PrBRad=Y)Arm 4 (PrALKi=N, PrBRad=N)Arm 5 (LepDis)All Participants
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
Alanine aminotransferase increasedInvestigations
VomitingGastrointestinal disorders
Aspartate aminotransferase increasedInvestigations
Decreased appetiteMetabolism and nutrition disorders
FatigueGeneral disorders
HeadacheNervous system disorders
AstheniaGeneral disorders
Gamma-glutamyltransferase increasedInvestigations
Abdominal painGastrointestinal disorders
ConstipationGastrointestinal disorders
CoughRespiratory, thoracic and mediastinal disorders
Abdominal pain upperGastrointestinal disorders
PyrexiaGeneral disorders
Weight decreasedInvestigations
AnaemiaBlood and lymphatic system disorders
Blood creatinine increasedInvestigations
DizzinessNervous system disorders
RashSkin and subcutaneous tissue disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Non-cardiac chest painGeneral disorders
Blood alkaline phosphatase increasedInvestigations
Oedema peripheralGeneral disorders
Back painMusculoskeletal and connective tissue disorders
DyspepsiaGastrointestinal disorders
HyperglycaemiaMetabolism and nutrition disorders
ArthralgiaMusculoskeletal and connective tissue disorders
HypokalaemiaMetabolism and nutrition disorders
Lipase increasedInvestigations
InsomniaPsychiatric disorders
Muscle spasmsMusculoskeletal and connective tissue disorders
Abdominal discomfortGastrointestinal disorders
Upper respiratory tract infectionInfections and infestations
Urinary tract infectionInfections and infestations
Musculoskeletal painMusculoskeletal and connective tissue disorders
SeizureNervous system disorders
Muscular weaknessMusculoskeletal and connective tissue disorders
Productive coughRespiratory, thoracic and mediastinal disorders
Amylase increasedInvestigations

Most-reported serious reactions: Pneumonia, Hyperglycaemia, Seizure, Pericarditis, Pericardial effusion, Pyrexia, Epilepsy, Dyspnoea.

Data from ClinicalTrials.gov NCT02336451 adverse events section.

Sponsor's own description

This was a phase II, multi-center, open-label, five-arm study in which the efficacy and safety of oral ceritinib treatment was assessed in patients with NSCLC metastatic to the brain and/or to leptomeninges harboring a confirmed ALK rearrangement, using the FDA approved Vysis ALK Break Apart FISH Probe Kit (Abbott Molecular Inc.) test and scoring algorithm (including positivity criteria). If documentation of ALK rearrangement as described above was not locally available, a test to confirm ALK rearrangement was performed by a Novartis designated central laboratory. Patients waited for the central laboratory result of the ALK rearrangement status before initiating treatment with ceritinib.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Activity and safety of ceritinib in patients with ALK-rearranged non-small-cell lung cancer (ASCEND-1): updated results from the multicentre, open-label, phase 1 trial.
    Kim DW, Mehra R, Tan DSW, Felip E, et al · · 2016 · cited 355× · PMID 26973324 · DOI 10.1016/s1470-2045(15)00614-2
  2. Pediatric low-grade glioma in the era of molecular diagnostics.
    Ryall S, Tabori U, Hawkins C. · · 2020 · cited 254× · PMID 32164789 · DOI 10.1186/s40478-020-00902-z
  3. Leptomeningeal metastasis from systemic cancer: Review and update on management.
    Wang N, Bertalan MS, Brastianos PK. · · 2018 · cited 167× · PMID 29165794 · DOI 10.1002/cncr.30911
  4. Clinical development of targeted and immune based anti-cancer therapies.
    Seebacher NA, Stacy AE, Porter GM, Merlot AM. · · 2019 · cited 147× · PMID 30975211 · DOI 10.1186/s13046-019-1094-2
  5. Systemic therapy of brain metastases: non-small cell lung cancer, breast cancer, and melanoma.
    Chamberlain MC, Baik CS, Gadi VK, Bhatia S, et al · · 2017 · cited 134× · PMID 28031389 · DOI 10.1093/neuonc/now197
  6. ALK inhibitors in non-small cell lung cancer: the latest evidence and developments.
    Sullivan I, Planchard D. · · 2016 · cited 89× · PMID 26753004 · DOI 10.1177/1758834015617355
  7. Brain Metastases in Oncogene-Addicted Non-Small Cell Lung Cancer Patients: Incidence and Treatment.
    Remon J, Besse B. · · 2018 · cited 58× · PMID 29696132 · DOI 10.3389/fonc.2018.00088
  8. Targeted therapy of brain metastases: latest evidence and clinical implications.
    Di Lorenzo R, Ahluwalia MS. · · 2017 · cited 50× · PMID 29449898 · DOI 10.1177/1758834017736252

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Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT02336451.

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