Non-Small Cell Lung CancerPhase 2ORCHARDNCT03944772
Phase 2 Platform Study in Patients With Advanced Non-Small Lung Cancer Who Progressed on First-Line Osimertinib Therapy (ORCHARD)
A Phase 2 study testing Osimertinib, Savolitinib and Gefitinib in people with Non-Small Cell Lung Cancer, run by AstraZeneca at 47 sites in 9 countries.
Trial summary
Phase 2 Platform Study in Patients with Advanced Non-Small Lung Cancer who progressed on First-Line Osimertinib Therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments. Read more about this study
- Who is it for?
- Ages 18 to 130 years
- Conditions the study is for
- Non-Small Cell Lung Cancer
- What is being tested?
- Osimertinib, Savolitinib and Gefitinib
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 247 participants
- Where
- 47 sitesin 9 countries
- Study dates
- 25 Jun 2019to 6 May 2025
- Phase
- Phase 2
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 130 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Inclusion criteria applicable to all study treatment modules (Group A \& B)
- NSCLC with the following features:
- Locally advanced or metastatic disease (ie, advanced NSCLC) not amenable to curative surgery or radiotherapy at study entry.
- Histologically or cytologically confirmed adenocarcinoma of the lung (patients with mixed histology are eligible if adenocarcinoma is the predominant histology) harboring EGFR mutation(s) known to be associated with EGFR TKI sensitivity at diagnosis. Any histologically identifiable component of neuroendocrine transformation to SCLC or large cell NEC is required for treatment under Module 7.
- Received only one line of therapy, with single-agent osimertinib, for advanced NSCLC, with clinical benefit as judged by investigator discretion. (Note: a 'line' of therapy is defined as a daily anti-cancer treatment administered for >14 days, or a single infusion of an intravenous anti-cancer treatment. For instance, patients who have had <14 days of a first- or second- generation TKI prior to osimertinib, and stopped due to adverse events, would be eligible to enter this study, see also exclusion criteria 5). Patients previously treated adjuvantly or neo-adjuvantly are eligible per exclusion criterion 5.
- Evidence of radiological disease progression on first-line monotherapy with osimertinib 80 mg po QD.
- Suitable for a mandatory biopsy defined as having an accessible tumor; by whichever modality the site uses and, ideally, confirmed by the person who will perform the procedure; and a stable clinical condition that will allow the patient to tolerate the procedure. The biopsy should be performed within 60 days of the planned first dose of study treatment.
- Patients must have measurable disease per RECIST 1.1, as defined by at least 1 lesion that can be accurately measured at baseline as ≥ 10 mm at the longest diameter (except lymph nodes which must have a short axis ≥ 15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI), which is suitable for accurate repeated measurements. Previously irradiated lesions or a lesion in the field of radiation should not be used as measurable disease unless the lesion(s) has/have demonstrated unequivocal disease progression by RECIST 1.1. Target lesions should not be used for the baseline tumour biopsy, unless there are no other lesions suitable for biopsy and they fulfil requirements.
- Adequate coagulation parameters, defined as:
International Normalisation Ratio (INR) < 1.5 × upper limit of normal (ULN) and activated partial thromboplastin time < 1.5 × ULN unless patients are receiving therapeutic anti-coagulation which affects these parameters.
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Exclusion Criteria applicable to all study treatment modules (Groups A/B):
- Patients whose disease has progressed within the first 3 months of osimertinib treatment (refractory to osimertinib treatment).
- Patients must not have experienced a toxicity(-ies) that led to permanent discontinuation or dose reduction of prior osimertinib. (a) Patients who had dose reductions in the past, but were receiving a full dose of osimertinib at the time of pre-screening should be discussed with the Study Physician.
- Any unresolved toxicities from prior osimertinib treatment greater than CTCAE Grade 1 at the time of starting study treatment.
- Patients should not have discontinued osimertinib >60 days prior to the first dose of study treatment.
- Inadequate bone marrow reserve or organ function as demonstrated by any of the following laboratory values:
- Absolute neutrophil count < 1.5 × 109/L.
- Platelet count < 100 × 109/L.
- Haemoglobin < 9 g/dL.
- Alanine transaminase (ALT) > 2.5 × ULN.
- Aspartate aminotransferase (AST) > 2.5 × ULN.
- Total bilirubin (TBL) > 1.5 × ULN, or > 3 × ULN in the presence of documented Gilbert's Syndrome (unconjugated hyperbilirubinaemia).
- Creatinine clearance (CrCl) < 50 mL/min, calculated using Cockcroft-Gault equation (Cockcroft and Gault 1976) or 24-hour urine collection. For medical conditions where the Cockcroft-Gault equation is inappropriate or 24-hour urine collection is unfeasible, CrCl may be calculated differently following written approval from the Study Physician.
Trial locations and contacts
47 sites in 9 countries.
47 sites in 9 countries
United States16 sites
Research Site
Baltimore, Maryland, 21224
Research Site
Boston, Massachusetts, 02114
Research Site
Boston, Massachusetts, 02215
Research Site
Chicago, Illinois, 60612
Research Site
Duarte, California, 91010
Research Site
Grand Rapids, Michigan, 49503
Research Site
Houston, Texas, 77030
Research Site
Los Angeles, California, 90048
Research Site
New Haven, Connecticut, 06510
Research Site
New York, New York, 10017
Research Site
New York, New York, 10032
Research Site
Pittsburgh, Pennsylvania, 15232
Research Site
Portland, Oregon, 97239
Research Site
Sacramento, California, 95817
Research Site
Santa Monica, California, 90404
Research Site
Seattle, Washington, 98109
Japan6 sites
Research Site
Chūōku, 104-0045
Research Site
Fukuoka, 812-8582
Research Site
Kōtoku, 135-8550
Research Site
Nagoya, 464-8681
Research Site
Osaka, 541-8567
Research Site
Wakayama, 641-8510
Spain6 sites
Research Site
A Coruña, 15006
Research Site
Barcelona, 08025
Research Site
Barcelona, 08036
Research Site
Madrid, 28041
Research Site
Madrid, 28046
Research Site
Seville, 41009
Italy5 sites
Research Site
Catania, 95123
Research Site
Naples, 80131
Research Site
Orbassano, 10043
Research Site
Padova, 35128
Research Site
Varese, 21100
Netherlands5 sites
Research Site
Amsterdam, 1066 CX
Research Site
Amsterdam, 1081 HV
Research Site
Maastricht, 6229 HX
Research Site
Nijmegen, 6525 GA
Research Site
Rotterdam, 3015GD
South Korea4 sites
Research Site
Seongnam-si, 13620
Research Site
Seoul, 03722
Research Site
Seoul, 05505
Research Site
Seoul, 06351
Norway3 sites
Research Site
Drammen, 3004
Research Site
Oslo, N-0310
Research Site
Trondheim, 7030
About this study
Official title: A Biomarker-directed Phase 2 Platform Study in Patients With Advanced Non-Small Lung Cancer Whose Disease Has Progressed on First-Line Osimertinib Therapy.
Phase 2 Platform Study in Patients with Advanced Non-Small Lung Cancer who progressed on First-Line Osimertinib Therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments.
Read the detailed description
This is an open-label, multicentre, multi-drug, biomarker-directed Phase 2 platform study in patients with advanced non-small cell lung cancer (NSCLC) harbouring an epidermal growth factor receptor (EGFR)-sensitizing mutation whose disease has progressed on first-line monotherapy with osimertinib.Treatment options for these patients are limited. Novel treatments for these patients are urgently required.
This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments.
- Conditions
- Non-Small Cell Lung Cancer
- Being tested
- Osimertinib, Savolitinib, Gefitinib, Necitumumab, Durvalumab
- Keywords
- Non-small cell lung cancer, NSCLC, tSCLC, NEC, Phase II, Platform study, Biomarker-directed, Durvalumab, Osimertinib, Savolitinib, Selumetinib, Etoposide, Gefitinib, Necitumumab, Platinum-containing doublet, Pemetrexed, EGFR positive, Carboplatin, Alectinib, Selpercatinib
- Medical subject headings
- Carcinoma, Non-Small-Cell Lung
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
OsimertinibDrug
Also called TAGRISSO
Osimertinib given orally at 80 mg once daily
SavolitinibDrug
Savolitinib will be given orally at 300 mg or 600mg once daily
GefitinibDrug
Also called Iressa
Gefitinib given orally at 250 mg once daily
NecitumumabDrug
Also called Portrazza
Necitumumab given IV at 800 mg on Day 1 and Day 8 of every 3-week cycle
DurvalumabDrug
Also called IMFINZI
Durvalumab given IV at 1500 mg on Day 1 of every cycle
CarboplatinDrug
Carboplatin given IV on Day 1 of every 21-day cycle for up to 6 cycles
PemetrexedDrug
Pemetrexed given IV at 500 mg/m2 body BSA on Day 1 of every cycle
AlectinibDrug
Also called Alecensa
Alectinib given orally at 600mg twice daily and for Japanese patients at 300mg twice daily.
SelpercatinibDrug
Also called Loxo-292, Retevmo, Retsevmo
Selpercatinib given orally at 160mg twice daily
SelumetinibDrug
Also called Koselugo
Selumetinib given orally at 75 mg twice daily for 4 days, followed by 3 days off treatment
EtoposideDrug
Etoposide 80-100 mg/m2 given IV on day 1, 2 and 3 of every 21-day cycle for up to 4 cycles.
CisplatinDrug
Cisplatin 75-80 mg/m2 given IV on days 1 of each cycle
Datopotamab deruxtecanDrug
Also called DS 1062a
Datopotamab deruxtecan given IV at 4 or 6 mg/kg on Day 1 of every 3-week cycle.
| Study group | Role | What they receive |
|---|---|---|
| Module 1: Osimertinib + Savolitinib | Experimental | The patients in this group will receive osimertinib taken in combination with savolitinib Receives: Drug: Osimertinib; Drug: Savolitinib |
| Module 2: Osimertinib + Gefitinib | Experimental | The patients in this group will receive osimertinib taken in combination with gefitinib Receives: Drug: Osimertinib; Drug: Gefitinib |
| Module 3: Osimertinib + Necitumumab | Experimental | The patients in this group will receive osimertinib taken in combination with necitumumab Receives: Drug: Osimertinib; Drug: Necitumumab |
| Module 4: Carboplatin + Pemetrexed + Durvalumab) | Experimental | The patients in this group will receive platinum-containing doublet (carboplatin + pemetrexed) taken in combination with durvalumab. Receives: Drug: Durvalumab; Drug: Carboplatin; Drug: Pemetrexed |
| Observational Cohort: No study drug | No intervention | Patients in this group will not receive study treatment but receive further anticancer care (Standard of Care therapy or other experimental therapies) or supportive care, as clinically indicated, in accordance with local practice. With Group C, the aim is to understand the clinical course and/or outcome for the overall clinical population after progression on first-line monotherapy with osimertinib. |
| Module 5: Osimertinib + Alectinib | Experimental | The patients in this group will receive osimertinib taken in combination with alectinib Receives: Drug: Osimertinib; Drug: Alectinib |
| Module 6: Osimertinib + Selpercatinib | Experimental | The patients in this group will receive osimertinib taken in combination with selpercatinib Receives: Drug: Osimertinib; Drug: Selpercatinib |
| Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin | Experimental | The patients in this group will receive platinum-containing doublet (etoposide + carboplatin or cisplatin) taken in combination with durvalumab. Receives: Drug: Durvalumab; Drug: Carboplatin; Drug: Etoposide; Drug: Cisplatin |
| Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin. | Experimental | The patients in this group will receive Osimertinib plus platinum-containing doublet (pemetrexed + carboplatin or cisplatin). Receives: Drug: Osimertinib; Drug: Carboplatin; Drug: Pemetrexed; Drug: Cisplatin |
| Module 9: Osimertinib + Selumetinib | Experimental | The patients in this group will receive osimertinib taken in combination with selumetinib Receives: Drug: Osimertinib; Drug: Selumetinib |
| Module 10: Osimertinib + datopotamab deruxtecan | Experimental | The patients in this group will receive osimertinib taken in combination with datopotamab deruxtecan. Receives: Drug: Osimertinib; Drug: Datopotamab deruxtecan |
What is being measured
The primary outcome is the main question the study is designed to answer.
Objective response rate (ORR)
The percentage of patients with a confirmed investigator-assessed complete or partial response according to Response Evaluation Criteria In Solid Tumours (RECIST) 1.1. Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond progression).
Measured: Measured from first dose until confirmed response or progression. For each patient this is expected to be 3 months on average
Secondary outcomes (6)
Progression-free survival (PFS)
The time from first dose until the date of objective disease progression or death (by any cause in the absence of progression). Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST (Response Evaluation Criteria In Solid Tumours)1.1 defined disease progression or cessation of study treatment (if treating beyond progression).
Measured: Measured from first dose until progression. For each patient this is expected to be 6 months on average
Duration of response (DoR)
The time from the date of first response until date of disease progression or death in the absence of disease progression. Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond progression).
Measured: Measured from response until progression. For each patient this is expected to be 6 months on average
Overall survival (OS)
The time from the date of the first dose of study treatment until death due to any cause.
Measured: Measured from first dose until death or final cohort data cut-off. For each patient this is expected to be 20 months on average
Plasma/serum concentrations of therapeutic agents
Blood samples will be collected at various timepoints to evaluate the sparse pharmacokinetics of study therapeutic agents.
Measured: Pre-dose and 1 hour post-dose blood samples on Day 1 of Cycles 1, 3 (Cycle 2 for durvalumab), 6 for all therapeutic agents and a sample at the 90-day safety follow up for durvalumab only. (One Cycle = 21 or 28 days, depending on treatment).
Plasma/serum concentrations of therapeutic agents
Blood samples will be collected at various timepoints to evaluate the serial pharmacokinetics of study therapeutic agents
Measured: Pre-dose and serial post-dose blood samples (1 hour, 2 hours, 4 hours, 6 hours, 8 hours) on Day 15 of Cycle 1 for alectinib and selpercatinib only.
Incidence of Treatment-emergent adverse events (AEs) and serious adverse events (SAEs) as characterized and graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event [CTCAE] v5
To evaluate safety and tolerability of each study treatment
Measured: Continuously from first dose to end of safety follow up after study treatment discontinuation (approximately up to 21 Months)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 May 2019
- Study start25 Jun 2019
- Primary completion6 May 2025 (estimated)
- Study completion6 May 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Non-Small Cell Lung CancerStudies of the same condition, open and under way.
- More trials run by AstraZenecaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Model description
- Phase 2 platform study in patients with advanced Non-Small Lung Cancer harbouring an epidermal growth factor receptor (EGFR)-sensitizing mutation with evidence of radiological progression following first-Line osimertinib therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments. The study will be conducted in three groups (Groups A, B and C). Patient allocation to a study treatment within each group will be based on tumour molecular profile. Biomarker positive patients or patients with histologically identifiable neuroendocrine transformation to small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (NEC) will be allocated to a biomarker-matched study treatment in Group A, patients without a biomarker will be allocated to a study treatment in Group B and patients with a biomarker amenable to therapies not currently available in ORCHARD will be allocated to Group C.
- Masking
- None (open label)
- Enrolment
- 247 participants (actual)
Sponsor and investigators
- Lead sponsor
- AstraZeneca
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Helena A Yu, MD, Principal investigator, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03944772
- Sponsor's protocol ID
- D6186C00001
- Other IDs
- 2023-504624-25-00, 2018-003974-29, 2018, 2023
- Acronym
- ORCHARD
- Status last verified
- Dec 2024
- First submitted
- 29 Apr 2019
- Last updated
- 30 Jan 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Publications
Okamoto I, Cho BC, Goldberg SB, Goldman JW, de Langen AJ, Piotrowska Z, Riess JW, Yu HA, Garcia Campelo MR, Cetnar J, Kim YJ, Novello S, Shiraishi Y, Ambrose H, Smith PE, Tang KH, Lehman JM, Le X. Durvalumab plus etoposide-platinum in patients with epidermal growth factor receptor (EGFR)-mutated advanced NSCLC and neuroendocrine transformation after first-line osimertinib: ORCHARD. Lung Cancer. 2026 Aug;218:109501. doi: 10.1016/j.lungcan.2026.109501. Epub 2026 Jun 18.
PubMed 42361644Riess JW, Yu HA, Le X, de Langen AJ, Cho BC, Piotrowska Z, Hendriks LEL, Morabito A, Bonanno L, Brustugun OT, Halvorsen TO, Kim YJ, Marrone KA, Shiraishi Y, Goldman JW, Ambrose H, Smith PE, FraenkeI PG, Tang KH, Lehman JM, Goldberg SB. Osimertinib plus datopotamab deruxtecan in patients with EGFR-mutated advanced NSCLC after progression on first-line osimertinib: ORCHARD. Ann Oncol. 2026 Jun;37(6):825-836. doi: 10.1016/j.annonc.2026.02.014. Epub 2026 Mar 2.
PubMed 41780641Le X, Baik C, Cho BC, Riess JW, Piotrowska Z, Johannes de Langen A, Goldberg SB, Goldman JW, Reguart N, Shiraishi Y, Ambrose H, Fraenkel PG, Ruiz BM, Smith PE, Tang KH, Yu HA. Osimertinib Plus Savolitinib in Patients With EGFR-Mutated Advanced NSCLC With MET Alterations After First-Line Osimertinib: Clinical Outcomes, Safety, and Biomarker Analysis: A Brief Report. J Thorac Oncol. 2026 Feb;21(2):318-327. doi: 10.1016/j.jtho.2025.10.009. Epub 2025 Oct 21.
PubMed 41130408Riess JW, de Langen AJ, Ponce S, Goldberg SB, Piotrowska Z, Goldman JW, Le X, Cho BC, Yoneshima Y, Ambrose H, Cavazzina R, Tang KH, Lau J, Yu HA. ORCHARD: Osimertinib Plus Necitumumab in Patients With Epidermal Growth Factor Receptor-Mutated Advanced Non-Small Cell Lung Cancer With a Secondary Epidermal Growth Factor Receptor Alteration Whose Disease Had Progressed on First-Line Osimertinib. JCO Precis Oncol. 2025 Jun;9:e2400818. doi: 10.1200/PO-24-00818. Epub 2025 Jun 4.
PubMed 40466026Lu S, Wu L, Wang Q, Wang Z, Lv D, Ma R, Zhu B, van Tran N, Jiang L, Nan K, Laktionov K, Clarke S, Song M, Mann H, Liu Y, Shi X, Wu YL. Durvalumab Versus Chemotherapy as First-line Treatment for Metastatic NSCLC With Tumor PD-L1 Expression of 25% or Higher: Results From the Randomized Phase 3 PEARL Study. J Thorac Oncol. 2025 Mar;20(3):366-382. doi: 10.1016/j.jtho.2024.10.024. Epub 2024 Nov 7.
PubMed 39521433Yu HA, Goldberg SB, Le X, Piotrowska Z, Goldman JW, De Langen AJ, Okamoto I, Cho BC, Smith P, Mensi I, Ambrose H, Kraljevic S, Maidment J, Chmielecki J, Li-Sucholeiki X, Doughton G, Patel G, Jewsbury P, Szekeres P, Riess JW. Biomarker-Directed Phase II Platform Study in Patients With EGFR Sensitizing Mutation-Positive Advanced/Metastatic Non-Small Cell Lung Cancer Whose Disease Has Progressed on First-Line Osimertinib Therapy (ORCHARD). Clin Lung Cancer. 2021 Nov;22(6):601-606. doi: 10.1016/j.cllc.2021.06.006. Epub 2021 Jun 25.
PubMed 34389237Schmid S, Fruh M, Peters S. Targeting MET in EGFR resistance in non-small-cell lung cancer-ready for daily practice? Lancet Oncol. 2020 Mar;21(3):320-322. doi: 10.1016/S1470-2045(19)30859-9. Epub 2020 Feb 3. No abstract available.
PubMed 32027845
Study at a glance
From the registry record, last updated by the sponsor on 30 Jan 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Biomarker-directed Phase 2 Platform Study in Patients With Advanced Non-Small Lung Cancer Whose Disease Has Progressed on First-Line Osimertinib Therapy.
- ClinicalTrials.gov ID
- NCT03944772
- Acronym / sponsor ID
- ORCHARD / D6186C00001
- Conditions
- Non-Small Cell Lung Cancer
- Keywords
- Non-small cell lung cancer, NSCLC, tSCLC, NEC, Phase II, Platform study, Biomarker-directed, Durvalumab
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 247 participants (actual)
- Lead sponsor
- AstraZenecaIndustry (pharma, biotech, devices)
- Study start
- 25 Jun 2019 (actual)
- Primary completion
- 6 May 2025 (estimated)
- Study completion
- 6 May 2025 (estimated)
- First posted
- 10 May 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Phase 2 Platform Study in Patients with Advanced Non-Small Lung Cancer who progressed on First-Line Osimertinib Therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments.
Detailed description
This is an open-label, multicentre, multi-drug, biomarker-directed Phase 2 platform study in patients with advanced non-small cell lung cancer (NSCLC) harbouring an epidermal growth factor receptor (EGFR)-sensitizing mutation whose disease has progressed on first-line monotherapy with osimertinib.Treatment options for these patients are limited. Novel treatments for these patients are urgently required.
This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 11
- Model description
- Phase 2 platform study in patients with advanced Non-Small Lung Cancer harbouring an epidermal growth factor receptor (EGFR)-sensitizing mutation with evidence of radiological progression following first-Line osimertinib therapy. This study is modular in design, allowing evaluation of the efficacy, safety and tolerability of multiple study treatments. The study will be conducted in three groups (Groups A, B and C). Patient allocation to a study treatment within each group will be based on tumour molecular profile. Biomarker positive patients or patients with histologically identifiable neuroendocrine transformation to small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (NEC) will be allocated to a biomarker-matched study treatment in Group A, patients without a biomarker will be allocated to a study treatment in Group B and patients with a biomarker amenable to therapies not currently available in ORCHARD will be allocated to Group C.
| Arm | Type | Receives |
|---|---|---|
| Module 1: Osimertinib + Savolitinib | Experimental | Drug: Osimertinib, Drug: SavolitinibThe patients in this group will receive osimertinib taken in combination with savolitinib |
| Module 2: Osimertinib + Gefitinib | Experimental | Drug: Osimertinib, Drug: GefitinibThe patients in this group will receive osimertinib taken in combination with gefitinib |
| Module 3: Osimertinib + Necitumumab | Experimental | Drug: Osimertinib, Drug: NecitumumabThe patients in this group will receive osimertinib taken in combination with necitumumab |
| Module 4: Carboplatin + Pemetrexed + Durvalumab) | Experimental | Drug: Durvalumab, Drug: Carboplatin, Drug: PemetrexedThe patients in this group will receive platinum-containing doublet (carboplatin + pemetrexed) taken in combination with durvalumab. |
| Observational Cohort: No study drug | No intervention | –Patients in this group will not receive study treatment but receive further anticancer care (Standard of Care therapy or other experimental therapies) or supportive care, as clinically indicated, in accordance with local practice. With Group C, the aim is to understand the clinical course and/or outcome for the overall clinical population after progression on first-line monotherapy with osimertinib. |
| Module 5: Osimertinib + Alectinib | Experimental | Drug: Osimertinib, Drug: AlectinibThe patients in this group will receive osimertinib taken in combination with alectinib |
| Module 6: Osimertinib + Selpercatinib | Experimental | Drug: Osimertinib, Drug: SelpercatinibThe patients in this group will receive osimertinib taken in combination with selpercatinib |
| Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin | Experimental | Drug: Durvalumab, Drug: Carboplatin, Drug: Etoposide, Drug: CisplatinThe patients in this group will receive platinum-containing doublet (etoposide + carboplatin or cisplatin) taken in combination with durvalumab. |
| Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin. | Experimental | Drug: Osimertinib, Drug: Carboplatin, Drug: Pemetrexed, Drug: CisplatinThe patients in this group will receive Osimertinib plus platinum-containing doublet (pemetrexed + carboplatin or cisplatin). |
| Module 9: Osimertinib + Selumetinib | Experimental | Drug: Osimertinib, Drug: SelumetinibThe patients in this group will receive osimertinib taken in combination with selumetinib |
| Module 10: Osimertinib + datopotamab deruxtecan | Experimental | Drug: Osimertinib, Drug: Datopotamab deruxtecanThe patients in this group will receive osimertinib taken in combination with datopotamab deruxtecan. |
Who may qualify
- Ages
- 18 to 130 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| OsimertinibAlso: TAGRISSOOsimertinib given orally at 80 mg once daily | Drug | Module 10: Osimertinib + datopotamab deruxtecan, Module 1: Osimertinib + Savolitinib, Module 2: Osimertinib + Gefitinib, Module 3: Osimertinib + Necitumumab, Module 5: Osimertinib + Alectinib, Module 6: Osimertinib + Selpercatinib, Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin., Module 9: Osimertinib + Selumetinib |
| SavolitinibSavolitinib will be given orally at 300 mg or 600mg once daily | Drug | Module 1: Osimertinib + Savolitinib |
| GefitinibAlso: IressaGefitinib given orally at 250 mg once daily | Drug | Module 2: Osimertinib + Gefitinib |
| NecitumumabAlso: PortrazzaNecitumumab given IV at 800 mg on Day 1 and Day 8 of every 3-week cycle | Drug | Module 3: Osimertinib + Necitumumab |
| DurvalumabAlso: IMFINZIDurvalumab given IV at 1500 mg on Day 1 of every cycle | Drug | Module 4: Carboplatin + Pemetrexed + Durvalumab), Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin |
| CarboplatinCarboplatin given IV on Day 1 of every 21-day cycle for up to 6 cycles | Drug | Module 4: Carboplatin + Pemetrexed + Durvalumab), Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin, Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin. |
| PemetrexedPemetrexed given IV at 500 mg/m2 body BSA on Day 1 of every cycle | Drug | Module 4: Carboplatin + Pemetrexed + Durvalumab), Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin. |
| AlectinibAlso: AlecensaAlectinib given orally at 600mg twice daily and for Japanese patients at 300mg twice daily. | Drug | Module 5: Osimertinib + Alectinib |
| SelpercatinibAlso: Loxo-292, Retevmo, RetsevmoSelpercatinib given orally at 160mg twice daily | Drug | Module 6: Osimertinib + Selpercatinib |
| SelumetinibAlso: KoselugoSelumetinib given orally at 75 mg twice daily for 4 days, followed by 3 days off treatment | Drug | Module 9: Osimertinib + Selumetinib |
| EtoposideEtoposide 80-100 mg/m2 given IV on day 1, 2 and 3 of every 21-day cycle for up to 4 cycles. | Drug | Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin |
| CisplatinCisplatin 75-80 mg/m2 given IV on days 1 of each cycle | Drug | Module 7: Etoposide + Durvalumab + Carboplatin or Cisplatin, Module 8: Osimertinib + Pemetrexed + Carboplatin or Cisplatin. |
| Datopotamab deruxtecanAlso: DS 1062aDatopotamab deruxtecan given IV at 4 or 6 mg/kg on Day 1 of every 3-week cycle. | Drug | Module 10: Osimertinib + datopotamab deruxtecan |
Primary outcome
Objective response rate (ORR)
Time frame: Measured from first dose until confirmed response or progression. For each patient this is expected to be 3 months on average
The percentage of patients with a confirmed investigator-assessed complete or partial response according to Response Evaluation Criteria In Solid Tumours (RECIST) 1.1. Patients will be followed up every 6 weeks (±1 week) for the first 24 weeks and every 9 weeks thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond progression).
6 secondary outcomes
Progression-free survival (PFS)
Time frame: Measured from first dose until progression. For each patient this is expected to be 6 months on average
Duration of response (DoR)
Time frame: Measured from response until progression. For each patient this is expected to be 6 months on average
Overall survival (OS)
Time frame: Measured from first dose until death or final cohort data cut-off. For each patient this is expected to be 20 months on average
Plasma/serum concentrations of therapeutic agents
Time frame: Pre-dose and 1 hour post-dose blood samples on Day 1 of Cycles 1, 3 (Cycle 2 for durvalumab), 6 for all therapeutic agents and a sample at the 90-day safety follow up for durvalumab only. (One Cycle = 21 or 28 days, depending on treatment).
Plasma/serum concentrations of therapeutic agents
Time frame: Pre-dose and serial post-dose blood samples (1 hour, 2 hours, 4 hours, 6 hours, 8 hours) on Day 15 of Cycle 1 for alectinib and selpercatinib only.
Incidence of Treatment-emergent adverse events (AEs) and serious adverse events (SAEs) as characterized and graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event [CTCAE] v5
Time frame: Continuously from first dose to end of safety follow up after study treatment discontinuation (approximately up to 21 Months)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 Jan 2025.
- Derived from this study: PubMed 42361644Okamoto I, Cho BC, Goldberg SB, Goldman JW, de Langen AJ, Piotrowska Z, Riess JW, Yu HA, Garcia Campelo MR, Cetnar J, Kim YJ, Novello S, Shiraishi Y, Ambrose H, Smith PE, Tang KH, Lehman JM, Le X. Durvalumab plus etoposide-platinum in patients with epidermal growth factor receptor (EGFR)-mutated advanced NSCLC and neuroendocrine transformation after first-line osimertinib: ORCHARD. Lung Cancer. 2026 Aug;218:109501. doi: 10.1016/j.lungcan.2026.109501. Epub 2026 Jun 18.
- Derived from this study: PubMed 41780641Riess JW, Yu HA, Le X, de Langen AJ, Cho BC, Piotrowska Z, Hendriks LEL, Morabito A, Bonanno L, Brustugun OT, Halvorsen TO, Kim YJ, Marrone KA, Shiraishi Y, Goldman JW, Ambrose H, Smith PE, FraenkeI PG, Tang KH, Lehman JM, Goldberg SB. Osimertinib plus datopotamab deruxtecan in patients with EGFR-mutated advanced NSCLC after progression on first-line osimertinib: ORCHARD. Ann Oncol. 2026 Jun;37(6):825-836. doi: 10.1016/j.annonc.2026.02.014. Epub 2026 Mar 2.
- Derived from this study: PubMed 41130408Le X, Baik C, Cho BC, Riess JW, Piotrowska Z, Johannes de Langen A, Goldberg SB, Goldman JW, Reguart N, Shiraishi Y, Ambrose H, Fraenkel PG, Ruiz BM, Smith PE, Tang KH, Yu HA. Osimertinib Plus Savolitinib in Patients With EGFR-Mutated Advanced NSCLC With MET Alterations After First-Line Osimertinib: Clinical Outcomes, Safety, and Biomarker Analysis: A Brief Report. J Thorac Oncol. 2026 Feb;21(2):318-327. doi: 10.1016/j.jtho.2025.10.009. Epub 2025 Oct 21.
- Derived from this study: PubMed 40466026Riess JW, de Langen AJ, Ponce S, Goldberg SB, Piotrowska Z, Goldman JW, Le X, Cho BC, Yoneshima Y, Ambrose H, Cavazzina R, Tang KH, Lau J, Yu HA. ORCHARD: Osimertinib Plus Necitumumab in Patients With Epidermal Growth Factor Receptor-Mutated Advanced Non-Small Cell Lung Cancer With a Secondary Epidermal Growth Factor Receptor Alteration Whose Disease Had Progressed on First-Line Osimertinib. JCO Precis Oncol. 2025 Jun;9:e2400818. doi: 10.1200/PO-24-00818. Epub 2025 Jun 4.
- Derived from this study: PubMed 39521433Lu S, Wu L, Wang Q, Wang Z, Lv D, Ma R, Zhu B, van Tran N, Jiang L, Nan K, Laktionov K, Clarke S, Song M, Mann H, Liu Y, Shi X, Wu YL. Durvalumab Versus Chemotherapy as First-line Treatment for Metastatic NSCLC With Tumor PD-L1 Expression of 25% or Higher: Results From the Randomized Phase 3 PEARL Study. J Thorac Oncol. 2025 Mar;20(3):366-382. doi: 10.1016/j.jtho.2024.10.024. Epub 2024 Nov 7.
- Derived from this study: PubMed 34389237Yu HA, Goldberg SB, Le X, Piotrowska Z, Goldman JW, De Langen AJ, Okamoto I, Cho BC, Smith P, Mensi I, Ambrose H, Kraljevic S, Maidment J, Chmielecki J, Li-Sucholeiki X, Doughton G, Patel G, Jewsbury P, Szekeres P, Riess JW. Biomarker-Directed Phase II Platform Study in Patients With EGFR Sensitizing Mutation-Positive Advanced/Metastatic Non-Small Cell Lung Cancer Whose Disease Has Progressed on First-Line Osimertinib Therapy (ORCHARD). Clin Lung Cancer. 2021 Nov;22(6):601-606. doi: 10.1016/j.cllc.2021.06.006. Epub 2021 Jun 25.
- Derived from this study: PubMed 32027845Schmid S, Fruh M, Peters S. Targeting MET in EGFR resistance in non-small-cell lung cancer-ready for daily practice? Lancet Oncol. 2020 Mar;21(3):320-322. doi: 10.1016/S1470-2045(19)30859-9. Epub 2020 Feb 3. No abstract available.
- ORCHARD study design article. The article includes Module 5 and Module 6 but was written prior to the subsequent modules being added.Link provided by the sponsor.
- Individual participant dataSharing planned: Yes. Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Helena A Yu, MD principal investigator
Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
47 sites in 9 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Osimertinib, Savolitinib and Gefitinib in people with Non-Small Cell Lung Cancer, run by AstraZeneca at 47 sites in 9 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 30 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 47 sites in United States, Japan, Spain, Italy, Netherlands and 4 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Objective response rate (ORR) (time frame: Measured from first dose until confirmed response or progression. For each patient this is expected to be 3 months on average). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03944772, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jan 2025.