NeoCOAST-2: A phase 2 study of neoadjuvant durvalumab plus novel immunotherapies (IO) and chemotherapy (CT) or MEDI5752 (volrustomig) plus CT, followed by surgery and adjuvant durvalumab plus novel IO or volrustomig alone in patients with resectable non-small-cell lung cancer (NSCLC).

Authors

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Florian Guisier

Department of Pneumology, Rouen University Hospital, Rouen, France

Florian Guisier , Jaafar Bennouna , Alexander I. Spira , Dong-Wan Kim , Byoung Yong Shim , Houssein Abdul Sater , Italia Grenga , Swapnil S Parmar , Agata A. Bielska , Alula Yohannes , Raymond Mager , Oday Hamid , Lara McGrath , Yun He , Yee Soo-Hoo , Rakesh Kumar , Jonathan Spicer , Patrick M. Forde , Tina Cascone

Organizations

Department of Pneumology, Rouen University Hospital, Rouen, France, Department of Medical Oncology, University Hospital of Nantes, Nantes, France, Virginia Cancer Specialists, Fairfax, VA, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-Do, Korea, Republic of (South), Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, FL, AstraZeneca, Waltham, MA, AstraZeneca, Gaithersburg, MD, Department of Thoracic Surgery, McGill University, Montreal, QC, Canada, Bloomberg–Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Research Funding

Pharmaceutical/Biotech Company
AstraZeneca

Background: Neoadjuvant platinum-based CT plus IO prolongs event-free survival (EFS) and increases pathological complete response (pCR) rate in patients with resectable NSCLC vs CT alone (Forde et al. N Engl J Med 2022). IO+IO+CT combinations have the potential to further improve pCR and survival outcomes. The phase 2 NeoCOAST-2 study (NCT05061550) is evaluating multiple neoadjuvant IO+IO+CT combinations in patients with resectable, early stage NSCLC. Novel IO molecules being evaluated include the anti-CD73 monoclonal antibody (mAb), oleclumab; the anti-NKG2A mAb, monalizumab; and the PD-1/CTLA-4 bispecific mAb, volrustomig. The latter recently demonstrated durable responses vs a PD-1 inhibitor plus CT as first-line treatment for patients with metastatic NSCLC (ESMO 2022; LBA56). Here we describe the NeoCOAST-2 study design. Methods: This randomized, open-label, multicenter study will enrol approximately 210 patients with previously untreated, histologically/cytologically confirmed, resectable Stage IIA–IIIB (AJCC 8th edition) NSCLC. Patients will be stratified by PD-L1 expression ( < 1% vs ≥1%) and receive treatment with durvalumab + oleclumab + CT, durvalumab + monalizumab + CT, or volrustomig + CT every 3 weeks for 4 cycles prior to surgery, followed by adjuvant durvalumab + oleclumab, durvalumab + monalizumab, or volrustomig for up to 1 year or until disease progression per RECIST v1.1. Surgery should occur within 40 days after the last dose of neoadjuvant therapy and adjuvant therapy should commence within 10 weeks after surgery. The primary endpoints are pCR rate (per blinded independent pathologist review) and safety and tolerability. Secondary endpoints include investigator-assessed EFS, disease-free survival and overall survival, feasibility to surgery, major pathological response rate, objective response rate following neoadjuvant therapy, pharmacokinetics, immunogenicity, and changes in circulating tumor DNA. The study is currently recruiting patients across the US, Europe, Canada, and Asia. Clinical trial information: NCT05061550.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Local-Regional Non–Small Cell Lung Cancer

Clinical Trial Registration Number

NCT05061550

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr TPS8604)

DOI

10.1200/JCO.2023.41.16_suppl.TPS8604

Abstract #

TPS8604

Poster Bd #

228b

Abstract Disclosures