NCT06726265

Brief Summary

The purpose of this study is to compare eftilagimod alfa (efti) in combination with pembrolizumab and chemotherapy versus placebo in combination with pembrolizumab and chemotherapy with respect to overall survival (OS) and progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) among adults with metastatic non-small cell lung cancer (NSCLC). Participants will receive either efti plus standard treatment (pembrolizumab and platinum doublet chemotherapy) or placebo plus standard treatment and will be treated for up to 2 years.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Strong global presence with extensive site network
Enrollment
756

participants targeted

Target at P75+ for phase_3

Timeline
40mo left

Started Mar 2025

Typical duration for phase_3

Geographic Reach
26 countries

145 active sites

Status
active not recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Progress25%
Mar 2025Sep 2029

First Submitted

Initial submission to the registry

December 3, 2024

Completed
7 days until next milestone

First Posted

Study publicly available on registry

December 10, 2024

Completed
3 months until next milestone

Study Start

First participant enrolled

March 21, 2025

Completed
2.2 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

June 1, 2027

Expected
2.3 years until next milestone

Study Completion

Last participant's last visit for all outcomes

September 1, 2029

Last Updated

March 18, 2026

Status Verified

November 1, 2025

Enrollment Period

2.2 years

First QC Date

December 3, 2024

Last Update Submit

March 17, 2026

Conditions

Outcome Measures

Primary Outcomes (2)

  • Determination of Overall survival (OS)

    Up to approximately 54 months

  • Determination of Progression free survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)

    Up to approximately 54 months

Secondary Outcomes (6)

  • Determination of Objective response rate (ORR) per RECIST 1.1

    Up to approximately 54 months

  • Frequency of adverse events (AEs)

    Up to approximately 27 months

  • Severity of adverse events (AEs) according to the United States National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), v5.0

    Up to approximately 27 months

  • Determination of Time to Response (TTR) by RECIST 1.1.

    Up to approximately 54 months

  • Determination of Duration of Response (DOR) by RECIST 1.1.

    Up to approximately 54 months

  • +1 more secondary outcomes

Study Arms (2)

efti + Standard of Care arm

EXPERIMENTAL

Combination of efti, pembrolizumab (KEYTRUDA®) and histology-based platinum doublet chemotherapy

Biological: eftilagimod alfaDrug: carboplatin plus paclitaxelDrug: cisplatin or carboplatin + pemetrexedBiological: pembrolizumab (KEYTRUDA®)

Placebo + Standard of Care arm

PLACEBO COMPARATOR

Combination of efti-matching placebo, pembrolizumab (KEYTRUDA®) and histology-based platinum doublet chemotherapy

Drug: carboplatin plus paclitaxelDrug: cisplatin or carboplatin + pemetrexedBiological: pembrolizumab (KEYTRUDA®)Other: Placebo

Interventions

30 mg of efti every 2 weeks subcutaneously for the first 6 months, thereafter every 3 weeks for up to 24 months in total

Also known as: IMP321, LAG-3Ig, efti, eftilagimod alpha
efti + Standard of Care arm

For participants with squamous histology for 4 cycles (1 cycle = 3 weeks) as follows: every 3 weeks: carboplatin area under the curve (AUC) 5 or 6 in combination with paclitaxel 175 mg/m2 or 200 mg/m2

Placebo + Standard of Care armefti + Standard of Care arm

For participants with nonsquamous histology for 4 cycles (1 cycle = 3 weeks) as follows: every 3 weeks: cisplatin 75 mg/m2 or carboplatin AUC 5 or 6 in combination with pemetrexed 500 mg/m2. After the initial 4 cycles, pemetrexed 500 mg/m2 maintenance therapy will be administered every 3 weeks

Placebo + Standard of Care armefti + Standard of Care arm

200 mg pembrolizumab (KEYTRUDA®) every 3 weeks i.v. for up to approximately 24 months

Placebo + Standard of Care armefti + Standard of Care arm
PlaceboOTHER

efti-matching placebo every 2 weeks subcutaneously for the first 6 months, thereafter every 3 weeks for up to 24 months in total

Placebo + Standard of Care arm

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Participants may be enrolled if they meet all of the following criteria at screening:
  • Willing to give written informed consent and to comply with the protocol.
  • Histologically- or cytologically-confirmed diagnosis of advanced or metastatic (stage IIIB/C or stage IV) non-small cell lung cancer (NSCLC) not amenable to curative treatment or locally available oncogenic driver mutation-based first-line therapy, treatment naïve for systemic therapy given for advanced/metastatic disease.
  • Archival tumor tissue sample or newly obtained core, or excisional biopsy of a tumor lesion not previously irradiated has been provided. Details pertaining to tumor tissue submission can be found in the Laboratory Manual.
  • Availability of programmed death-ligand 1 (PD-L1) biomarker result from central laboratory, using the Food and Drug Administration (FDA) approved Dako standardized diagnostic test (PD-L1 IHC 22C3 pharmDx).
  • Be ≥ 18 years of age on the day of signing the informed consent.
  • Participants assigned male at birth must follow specific contraception guidelines during and after the trial intervention period. The required contraception duration varies by drug. Participants must refrain from donating sperm and either remain abstinent or use condoms with an additional contraceptive method during intercourse with a nonpregnant partner. Contraceptive measures must adhere to local regulations, with stricter local label requirements taking precedence over the trial's guidelines.
  • A participant of childbearing potential (POCBP) is eligible if they are not pregnant, confirmed by a negative pregnancy test before the first trial dose. They must not breastfeed during the trial or for a defined duration after the last dose of each drug. POCBPs must use highly effective contraception, with low user dependency or long-term abstinence during and after the trial intervention, and refrain from egg donation or storage. The required contraception duration varies by drug. Local contraception regulations must be followed.
  • An Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1 assessed within 7 days before randomization.
  • Expected survival \> 3 months.
  • Evidence of measurable disease as defined by Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as determined by site.
  • Participants must have recovered from all AEs due to previous anticancer therapies to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0 ≤ Grade 1 or baseline. Participants with CTCAE ≤ Grade 2 neuropathy, alopecia, and elevated transaminases in case of liver metastases may be eligible.
  • Participants who received major surgery prior to trial start must have recovered adequately from the toxicity and/or complications from the intervention prior to starting trial treatment.
  • Participants who are hepatitis B surface antigen (HBsAg) positive are eligible if they have received hepatitis B virus (HBV) antiviral therapy for at least 4 weeks, and have undetectable HBV viral load prior to randomization.
  • Participants with history of hepatitis C virus (HCV) infection are eligible if HCV viral load is undetectable at screening and have completed curative antiviral therapy at least 4 weeks prior to randomization.
  • +2 more criteria

You may not qualify if:

  • Participants are to be excluded from the trial at the time of screening for any of the following reasons:
  • Is expected to require any other form of systemic or localized antineoplastic therapy (other than the trial treatment) while on trial (including maintenance therapy with another agent for NSCLC, radiation therapy, and/or surgical resection).
  • Received prior radiotherapy within 2 weeks of start of trial intervention, or has radiation-related toxicities, requiring corticosteroids.
  • Participants whose tumor harbors any of the following actionable molecular alterations:
  • Epidermal growth factor receptor (EGFR)-sensitizing (activating) mutation
  • Anaplastic lymphoma kinase (ALK) gene fusion positive (ALK translocation)
  • c-ROS oncogene 1 (ROS1) translocation
  • For any indication has received any of the following therapies
  • within 3 weeks prior to cycle 1 day 1: systemic cytotoxic chemotherapy, targeted small molecule therapy (e.g. kinase inhibitors), biological therapy, any other systemic cancer therapy or had major surgery;
  • within 4 weeks prior to cycle 1 day 1 has been treated with an investigational agent or has used an investigational device, or is still a participant in the active phase of an investigational trial;
  • within 6 months prior to cycle1 day 1 received lung radiation therapy of \>30 Gray (Gy).
  • Has received any treatment as part of adjuvant, neoadjuvant therapy or definitive chemoradiation for the treatment of NSCLC within 12 months prior to the diagnosis of advanced/metastatic disease.
  • Received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor (e.g., cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), OX40, CD137) or Lymphocyte Activation Gene 3 (LAG-3) targeting therapy (e.g., anti-LAG-3 antibodies). Prior treatment with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent for nonmetastatic resectable NSCLC (e.g. in the neoadjuvant or adjuvant setting) or following definitive chemoradiation, is allowed as long as therapy was completed at least 12 months before diagnosis of metastatic NSCLC.
  • Prior high-dose chemotherapy requiring hematopoietic stem cell rescue.
  • Known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable (i.e., without evidence of progression) for at least 4 weeks as confirmed by repeat imaging performed during trial screening, are clinically stable and have not required steroid treatment for at least 14 days before the first dose of trial intervention.
  • +14 more criteria

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (147)

Norton Cancer Institute - Audubon

Louisville, Kentucky, 40217, United States

Location

New Mexico Oncology Hematology Consultants, Ltd.

Albuquerque, New Mexico, 87109, United States

Location

Ascension Seton Infusion Center

Austin, Texas, 78712, United States

Location

Centro de Endocrinologia y Diabetes Dr. Raul A. Gutman SRL

Buenos Aires, Argentina

Location

Fundacion Respirar

Buenos Aires, Argentina

Location

Hospital Británico de Buenos Aires

Buenos Aires, Argentina

Location

Sanatorio Parque - Rosario

Rosario, Argentina

Location

Clinica Viedma

Viedma, Argentina

Location

Lyell McEwin Hospital

Elizabeth Vale, Australia

Location

Greenslopes Private Hospital

Greenslopes, Australia

Location

The Alfred Hospital

Melbourne, Australia

Location

Tasman Oncology Research Ltd

Southport, Australia

Location

St John of God Subiaco Hospital

Subiaco, Australia

Location

Royal Darwin Hospital

Tiwi, Australia

Location

Calvary Mater Newcastle

Waratah, Australia

Location

Cancer Care Wollongong Pty Limited

Wollongong, Australia

Location

Landeskrankenhaus-Universitätsklinikum Graz, KLinische Abteilung für Pulmonologie

Graz, Austria

Location

Vienna General Hospital

Vienna, Austria

Location

Antwerp University Hospital

Antwerp, Belgium

Location

Algemeen Ziekenhuis Maria Middelares

Ghent, Belgium

Location

Clinique et Maternité Sainte-Elisabeth

Namur, Belgium

Location

Universidade de Caxias do Sul

Caxias do Sul, Brazil

Location

Centro Integrado de Oncologia de Curitiba - CIONC

Curitiba, Brazil

Location

Cetus Oncologia Hospital Dia - Belo Horizonte

Horizonte, Brazil

Location

Oncosite - Centro de Pesquisa Clinica Em Oncologia Ltda

Ijuí, Brazil

Location

Hospital Nossa Senhora da Conceicao (HNSC)

Porto Alegre, Brazil

Location

Santa Casa de Misericórdia de Porto Alegre

Porto Alegre, Brazil

Location

Hospital Beneficencia Portuguesa - Mirante

São Paulo, Brazil

Location

Hospital Santa Rita - Vitoria

Vitória, Brazil

Location

Multiprofile Hospital for Active Treatment - Dobrich AD

Dobrich, Bulgaria

Location

Multiprofile Hospital For Active Treatment "Dr. Tota Venkova" AD

Gabrovo, Bulgaria

Location

MHAT Uni Hospital OOD

Panagyurishte, Bulgaria

Location

Complex Oncology Center Ruse

Rousse, Bulgaria

Location

Multiprofile Hospital for Active Treatment Serdika EOOD

Sofia, Bulgaria

Location

Brampton Civic Hospital

Brampton, Canada

Location

McGill University - Jewish General Hospital (JGH) - Lady Davis Institute for Medical Research

Montreal, Canada

Location

Unite de recherche clinique du CISSS des Laurentides

Saint-Jérôme, Canada

Location

Centro de Oncologia de Precision

Las Condes, Chile

Location

Facultad Odontología Unipac

Santiago, Chile

Location

Klinički Bolnički Centar Osijek

Osijek, Croatia

Location

Klinicka Bolnica Centar - Sestre Milosrdnice - Klinika Za Tumore (University Hospital for Tumors)

Zagreb, Croatia

Location

Klinički Bolnički Centar Sestre Milosrdnice

Zagreb, Croatia

Location

Klinički Bolnički Centar Zagreb - Klinika Za Plućne Bolesti Jordanovac

Zagreb, Croatia

Location

High-tech Hospital Med Center

Batumi, Georgia

Location

High Technology Medical Center, University Clinic

Tbilisi, Georgia

Location

Institute of Clinical Oncology

Tbilisi, Georgia

Location

Mardaleishvili Medical Centre

Tbilisi, Georgia

Location

Klinikum St. Marien

Amberg, Germany

Location

Klinikum Augsburg

Augsburg, Germany

Location

HELIOS Klinikum Bad Saarow

Bad Saarow, Germany

Location

Evangelische Lungenklinik Berlin

Berlin, Germany

Location

Universitätsklinikum Köln

Cologne, Germany

Location

Agaplesion Medizinisches Versorgungszentrum - Frankfurt gGmbH

Frankfurt, Germany

Location

Universitätsklinikum Frankfurt

Frankfurt, Germany

Location

Krankenhaus Nordwest

Frankfurt am Main, Germany

Location

Asklepios Fachkliniken München-Gauting

Gauting, Germany

Location

Krankenhaus Martha-Maria Halle-Dölau

Halle, Germany

Location

Facharztzentrum Eppendorf

Hamburg, Germany

Location

Gemeinschaftspraxis für Hämatologie und Onkologie

Münster, Germany

Location

Robert-Bosch-Krankenhaus

Stuttgart, Germany

Location

General Hospital of Athens "Laiko"

Athens, Greece

Location

Sotiria Chest Diseases Hospital

Athens, Greece

Location

University of Thessaly- General University Hospital of Larissa

Larissa, Greece

Location

University of Patras - Rio Regional University Hospital

Pátrai, Greece

Location

Metropolitan Hospital, Department of Oncology

Piraeus, Greece

Location

Bioclinic of Thessaloniki

Thessaloniki, Greece

Location

Interbalkan Medical Center of Thessaloniki

Thessaloniki, Greece

Location

St. Luke's Hospital S.A.

Thessaloniki, Greece

Location

Debreceni Egyetem Klinikai Központ

Debrecen, Hungary

Location

Tolna Vármegyei Balassa János Kórház

Szekszárd, Hungary

Location

HCG Cancer Centre - Double Road (Bangalore Institute of Oncology (BIO))

Bangalore, India

Location

All India Institute of Medical Sciences (AIIMS) - Bhubaneswar

Bhubaneswar, India

Location

Geri Care Hospital T.Nagar

Chennai, India

Location

Voluntary Health Services Hospital

Chennai, India

Location

Chittaranjan National Cancer Institute

Kolkata, India

Location

Maulana Azad Medical College

New Delhi, India

Location

Sunact Cancer Institute Pvt. Ltd.

Thane, India

Location

Regional Cancer Centre Thiruvananthapuram

Thiruvananthapuram, India

Location

Tata Memorial Centre - Mahamana Pandit Madan Mohan Malaviya Cancer Centre

Varanasi, India

Location

Cork University Hospital

Cork, Ireland

Location

Beaumont Hospital

Dublin, Ireland

Location

Mater Misericordiae University Hospital

Dublin, Ireland

Location

Tallaght University Hospital

Dublin, Ireland

Location

Azienda Ospedaliera San Giuseppe Moscati

Avellino, Italy

Location

Centro di Riferimento Oncologico (CRO)

Aviano, Italy

Location

Istituto per la Ricerca e la Cura del Cancro (IRCC) - Istituto di Candiolo

Candiolo, Italy

Location

Fondazione IRCCS Istituto Nazionale dei Tumori

Milan, Italy

Location

Istituto Nazionale Tumori (INT) "Fondazione G. Pascale" di Napoli

Naples, Italy

Location

Azienda Ospedaliera di Perugia - Ospedale Santa Maria della Misericordia

Perugia, Italy

Location

Arcispedale Santa Maria Nuova

Reggio Emilia, Italy

Location

Azienda Ospedaliera Santa Maria di Terni

Terni, Italy

Location

Latvian Oncology Center

Riga, Latvia

Location

Paula Stradiņa Klīniskā Universitātes Slimnīca

Riga, Latvia

Location

Hospital of Lithuanian University of Health Sciences Kauno Klinikos

Kaunas, Lithuania

Location

Nacionalinis Vezio Institutas

Vilnius, Lithuania

Location

Hospital Tengku Ampuan Afzan

Kuantan, Malaysia

Location

Hospital Umum Sarawak - Clinical Research Centre

Kuching, Malaysia

Location

Gleneagles Medical Centre - Penang

Pulau Pinang, Malaysia

Location

Hospital Pulau Pinang

Pulau Pinang, Malaysia

Location

Szpital Morski im. PCK (Maritime Hospital) (Gdynskie Centrum Onkologii)

Gdynia, Poland

Location

Przychodnia Lekarska "KOMED"

Konin, Poland

Location

Instytut Medyczny Santa Familia Sp. z o. o. w Łodzi

Lodz, Poland

Location

IP Clinic Sp. z o.o.

Lodz, Poland

Location

Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie

Warsaw, Poland

Location

Hospital Garcia de Orta, EPE

Almada, Portugal

Location

Hospital CUF Descobertas

Lisbon, Portugal

Location

Hospital Lusíadas Lisboa

Lisbon, Portugal

Location

Unidade Local de Saude de Santa Maria, EPE - Hospital Pulido Valente

Lisbon, Portugal

Location

Unidade Local de Saude de Loures - Odivelas, E. P. E.

Loures, Portugal

Location

Instituto Português Oncologia do Porto Francisco Gentil, EPE

Porto, Portugal

Location

Centrul Medical Medicover Victoria

Bucharest, Romania

Location

Spitalul Memorial Healthcare International

Bucharest, Romania

Location

Onco Clinic Consult SA

Craiova, Romania

Location

OncoLab

Craiova, Romania

Location

Victoria Hospital - Centrul de Oncologie Euroclinic SRL

Iași, Romania

Location

Ovidius Clinical Hospital S.R.L.

Ovidiu, Romania

Location

Hospital Universitari Germans Trias i Pujol

Badalona, Spain

Location

Hospital de la Santa Creu i Sant Pau

Barcelona, Spain

Location

Hospital Universitario Vall d'Hebron

Barcelona, Spain

Location

Instituto Oncologico Dr. Rosell - Hospital Universitari Quiron Dexeus Location

Barcelona, Spain

Location

Hospital Universitario Reina Sofía

Córdoba, Spain

Location

HM Universitario Sanchinarro

Madrid, Spain

Location

Hospital Universitario Fundacion Jimenez Diaz

Madrid, Spain

Location

Hospital Universitario Ramón y Cajal

Madrid, Spain

Location

Hospital Regional Universitario de Málaga - Hospital General

Málaga, Spain

Location

Hospital Universitario Central de Asturias

Oviedo, Spain

Location

Parc Tauli Hospital Universitari

Sabadell, Spain

Location

Hospital Universitario Virgen Macarena

Seville, Spain

Location

Hospital Clinico Universitario de Valencia

Valencia, Spain

Location

Hospital Clínico Universitario "Lozano Blesa"

Zaragoza, Spain

Location

Phramongkutklao Hospital

Bangkok, Thailand

Location

Faculty of Medicine Vajira Hospital

Dusit, Thailand

Location

Prince of Songkhla University

Hat Yai, Thailand

Location

Adana Medical Park Seyhan Hospital

Adana, Turkey (Türkiye)

Location

Adana Sehir Training and Research Hospital

Adana, Turkey (Türkiye)

Location

Ankara Universitesi Tip Fakultesi Hastaneleri - Cebeci Hastanesi

Ankara, Turkey (Türkiye)

Location

Gulhane Egitim ve Arastirma Hastanesi

Ankara, Turkey (Türkiye)

Location

Hacettepe Universitesi Kanser Enstitusu (Hacettepe University Cancer Institute)

Ankara, Turkey (Türkiye)

Location

Uludağ Üniversitesi Tıp Fakültesi

Bursa, Turkey (Türkiye)

Location

Istanbul Oncology Hospital

Cevizli, Turkey (Türkiye)

Location

Trakya Universitesi Saglik Arastirma ve Uygulama Merkezi Hastane

Edirne, Turkey (Türkiye)

Location

Bahcelievler Memorial Hospital

Istanbul, Turkey (Türkiye)

Location

T.C. S.B. Prof. Dr. Suleyman Yalcin Sehir Hastanesi

Istanbul, Turkey (Türkiye)

Location

Sakarya Universitesi Tıp Fakultesi Dekanligi

Sakarya, Turkey (Türkiye)

Location

University Hospitals Birmingham NHS Foundation Trust - New Queen Elizabeth Hospital Birmingham

Birmingham, United Kingdom

Location

The Royal Surrey County Hospital NHS Foundation Trust

Guildford, United Kingdom

Location

The Christie NHS Foundation Trust - Christie Hospital

Manchester, United Kingdom

Location

Related Publications (1)

  • O'Byrne K, Esteban E, Lee CL, Hegmane A, Volovat C, Lo Russo G, Ziogas D, Atmaca A, Sebastian M, Majem M. A phase III placebo-controlled study of eftilagimod alfa plus pembrolizumab and chemotherapy in metastatic non-small cell lung cancer. Future Oncol. 2025 Dec;21(30):3885-3890. doi: 10.1080/14796694.2025.2597404. Epub 2025 Dec 12.

MeSH Terms

Conditions

Carcinoma, Non-Small-Cell Lung

Interventions

soluble LAG-3 protein, humanCarboplatinPaclitaxelCisplatinPemetrexedpembrolizumab

Condition Hierarchy (Ancestors)

Carcinoma, BronchogenicBronchial NeoplasmsLung NeoplasmsRespiratory Tract NeoplasmsThoracic NeoplasmsNeoplasms by SiteNeoplasmsLung DiseasesRespiratory Tract Diseases

Intervention Hierarchy (Ancestors)

Coordination ComplexesOrganic ChemicalsTaxoidsCyclodecanesCycloparaffinsHydrocarbons, AlicyclicHydrocarbons, CyclicHydrocarbonsDiterpenesTerpenesChlorine CompoundsInorganic ChemicalsNitrogen CompoundsPlatinum CompoundsGuanineHypoxanthinesPurinonesPurinesHeterocyclic Compounds, 2-RingHeterocyclic Compounds, Fused-RingHeterocyclic CompoundsGlutamatesAmino Acids, AcidicAmino AcidsAmino Acids, Peptides, and ProteinsAmino Acids, Dicarboxylic

Study Design

Study Type
interventional
Phase
phase 3
Allocation
RANDOMIZED
Masking
QUADRUPLE
Who Masked
PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
INDUSTRY
Responsible Party
SPONSOR

Study Record Dates

First Submitted

December 3, 2024

First Posted

December 10, 2024

Study Start

March 21, 2025

Primary Completion (Estimated)

June 1, 2027

Study Completion (Estimated)

September 1, 2029

Last Updated

March 18, 2026

Record last verified: 2025-11

Locations