MILES5 – A randomized phase 2 study comparing immunotherapy with chemotherapy in the treatment of elderly patients with advanced NSCLC

Lab values

• Cancer related 1. Activating epidermal growth factor receptor mutation (exon19 deletion or exon 21 L858R mutation or other activating/sensitizing mutations). 2. ALK or ROS1 positive (immunohistochemistry or FISH) 3. Mixed small-cell lung cancer and NSCLC histology. Prior, current or planned treatment related 4. Prior chemotherapy or any other medical treatment for advanced NSCLC (previous neoadjuvant or adjuvant chemotherapy is allowed if > 6 months previously). 5. Prior exposure to immunomodulatory therapy, including, but not limited to, other anti-programmed cell death1 (PD-1), anti-programmed cell death ligand 1 (PD-L1), or anti PD-L2 antibodies. 6. Current or prior use of immunosuppressive medication within 14 days before the first dose of study treatment (corticosteroids at physiological doses not exceeding 10 mg/day of prednisone or an equivalent corticosteroid are allowed). 7. Any concurrent investigational product or other anticancer treatment. Prior or concomitant conditions or procedures related 8. Active or prior documented autoimmune disease within the past 2 years (subjects with vitiligo, Grave’s disease, or psoriasis not requiring systemic treatment within the past 2 years, are not excluded). 9. Active or prior documented inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis) 10. History of allogeneic organ transplant 11. History of active primary immunodeficiency. 12. Active infection, including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA. 13. Receipt of live attenuated vaccine within 30 days prior to the first dose of study drugs. 14. Patients with previous malignancies in the last 5 years (except for adequately treated carcinoma in situ of the cervix or basal or squamous cell skin cancer or surgically resected prostate cancer with normal PSA) 15. Brain metastases or spinal cord compression, unless asymptomatic, previously treated, and stable off steroids and anti-convulsants for at least one month prior to study entry. 16. Leptomeningeal carcinomatosis 17. Clinically significant cardiovascular disease, including: a. Myocardial infarction or unstable angina pectoris within < 6 months prior to the first study treatment b. New York Heart Association (NYHA) grade II or greater congestive heart failure (CHF) c. Uncontrolled hypertension d. Serious cardiac arrhythmia requiring medication (with the exception of atrial fibrillation or paroxysmal supraventricular tachycardia) e. Peripheral vascular disease > grade 3 (i.e. symptomatic and interfering with activities of daily living requiring repair or revision) f. Mean QT interval corrected for heart rate (QTc) ≥470 ms calculated from 3 electrocardiograms (ECGs) using Fredericia’s Correction. For other criteria, see the protocol.

• Male or female ³ 70 years of age. 2. Histological documentation of primary squamous or non squamous non-small cell lung carcinoma. 3. Stage IV or IIIC disease with supraclavear metastatic nodes (according to TNM 8th edition). 4. PD-L1 expression in tumor cells (TC) ≥ 25%* or unknown due to lack of tumor specimen (no more than 25% of the overall sample size will be allowed as unknown) 5. Clinical or radiologic evidence of disease (at least one measurable or non measurable lesion). 6. ECOG performance status 0 to 1. 7. Life expectancy > 3 months. 8. Adequate renal and hepatic function, defined as: o Total serum bilirubin ≤ 1.5 institutional ULN. o AST and/or ALT ≤ 2.5 x ULN for the institution (or ≤ 5 x ULN if liver metastases are present) o Serum creatinine ≤ 1.5 x ULN for the institution (or calculated creatinine clearance ≥ 40 mL/min/1.73 m2). 9. Adequate bone marrow function, defined as: o Haemoglobin ³ 9.0 g/dL o Absolute Neutrophils count (ANC) ³ 1.5 x 109/L (> 1500 per mm3) o Platelet count ³ 100 x 109/L(>100,000 per mm3). 10. Written informed consent obtained from the subject prior to performing any protocol-related procedures, including screening evaluations. *Note: patients with PD-L1 TC ≥ 50% should receive standard first-line pembrolizumab, if available in clinical practice. Therefore, their enrollment in the MILES-5 study is not encouraged.