Using Biomarker Tests to Select and Test New, Personalized Treatments for Extensive Stage Small Cell Lung Cancer, PRISM Study

Summary

Objectives

PRIMARY OBJECTIVES:
I. To test participants' tissue specimens to determine their eligibility to 1 of the 3 treatment cohorts created based on their small cell lung cancer (SCLC) subtype and SLFN11 status. (Screening)
II. To compare progression-free survival (PFS) in participants with extensive stage SCLC (ES-SCLC) (subtypes A or N & SLFN11 positive) or ES-SCLC (subtype P) randomized to durvalumab (MEDI4736) with or without saruparib (AZD5305) as maintenance therapy following induction chemoimmunotherapy with platinum, etoposide, and durvalumab (MEDI4736). (Cohort A)
III. To compare PFS in participants with ES-SCLC subtypes A or N & SLFN11 negative randomized to durvalumab with or without ceralasertib (AZD6738) as maintenance therapy following induction chemoimmunotherapy with cisplatin or carboplatin, etoposide, and durvalumab (MEDI4736). (Cohort B)
IV. To compare PFS participants with ES-SCLC subtype I randomized to durvalumab (MEDI4736) with or without monalizumab (IPH2201) as maintenance therapy following induction chemoimmunotherapy with cisplatin or carboplatin, etoposide, and durvalumab (MEDI4736). (Cohort C)

SECONDARY OBJECTIVES:
I. To evaluate the percentage of participant tissue that are able to have SCLC subtype status determined. (Screening)
II. To evaluate the percentage of participant tissue that are able to have SLFN11 status determined. (Screening)
III. To estimate the percentage of participants assigned to a cohort that register to be randomized. (Screening)
IV. To evaluate the safety of saruparib (AZD5305) in combination with durvalumab by estimating the rate of dose limiting toxicities reported during the first cycle of treatment in the safety-run-in population. (Cohort A)
V. To compare PFS between the arms in the subset of participants with A or N subtype and SLFN11 positive. (Cohort A)
VI. To compare overall survival (OS) between the arms. (Cohort A)
VII. To evaluate the frequency and severity of toxicities by Common Terminology Criteria for Adverse Events (CTCAE) within each treatment arm. (Cohort A)
VIII. To compare OS between the arms. (Cohort B)
IX. To evaluate the frequency and severity of toxicities by CTCAE within each arm. (Cohort B)
X. To compare OS between the arms. (Cohort C)
XI. To evaluate the frequency and severity of toxicities by CTCAE within each arm. (Cohort C)

TRANSLATIONAL MEDICINE OBJECTIVE:
I. To bank specimens for future correlative studies.

OUTLINE:

INDUCTION: Patients may receive a platinum compound plus etoposide per standard care as well as durvalumab intravenously (IV) over 60 minutes on day 1 of each cycle. Cycles repeat every 21 days for 4-6 cycles in the absence of disease progression or unacceptable toxicity.

CONSOLIDATION: Patients may undergo thoracic radiation as clinically indicated.

MAINTENANCE: Patients are assigned to 1 of 3 cohorts and then randomized to 1 of 2 arms within each cohort to which they were assigned.

COHORT A: Patients with ES-SCLC determined to be subtype A or N, and to be SLFN11 positive or patients with subtype P ES-SCLC.

ARM 1: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM 2: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle and saruparib orally (PO) once daily (QD) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

COHORT B (CLOSED TO ASSIGNMENT AND REGISTRATION 01/21/2026): Patients with ES-SCLC determined to be subtype A or N, and to be SLFN11 negative.

ARM 1 (CLOSED TO ASSIGNMENT AND REGISTRATION 01/21/2026): Patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM 2 (CLOSED TO ASSIGNMENT AND REGISTRATION 01/21/2026): Patients receive durvalumab IV over 60 minutes on day 8 and ceralasertib PO twice daily (BID) on days 1-7 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

COHORT C: Patients with ES-SCLC determined to be subtype I.

ARM 1: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM 2: Patients receive durvalumab IV over 60 minutes on day 1 and monalizumab IV over 60 minutes on days 1 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Additionally, patients undergo computed tomography (CT) scan or positron emission tomography (PET)/CT scan and CT scan or magnetic resonance imaging (MRI) throughout the study. Patients also undergo tissue sample collection during screening and may undergo blood sample collection throughout the study.

After completion of study treatment, patients are followed up to 3 years.