KPMNG Study of MOlecular Profiling Guided Therapy Based on Genomic Alterations in Advanced Solid Tumors II

NCT ID: NCT05525858

Last Updated: 2025-04-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

1000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-09-28

Study Completion Date

2027-03-31

Brief Summary

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A national, prospective, multi-center, open-label, multi-cohort study comprised of a framework to screen patients for actionable targets and evaluation of molecular profiling guided therapy recommended by MTB based on genomic alterations using targeted and/or immunotherapies outside of the approved indications via local clinical practice (Tier 1 \& 2) and clinical trials (Tier 3)

Detailed Description

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A. The KOSMOS-II study will recruit locally advanced or metastatic solid tumor patients who had disease progression on standard first line anti-cancer treatment and/or has no standard treatment option, in order to prove MTB value to guide treatment within local clinical practice.

B. After site physicians confirm that NGS results of patients are available, they preliminarily decide initial treatment before MTB submission and collect informed consent form, and then patients can register to the KOSMOS-II study. Site physicians upload patients' clinical, pathologic, and genomic data for MTB submission. If site physician cannot determine initial treatment before MTB, site physician can record 'initial treatment cannot be determined' and can register the patient for MTB.

C. MTB records its treatment recommendations within available drugs list based on uploaded data, then site physicians make a final treatment decision, after informing patient about MTB decision and assessment of patients' final health status and preference.

D. Patients who have insufficient genomic information from their NGS results (e.g., lack of variant calling format file or uninterpretable reports) or who are candidates of immunotherapy will submit their tissue and/or blood, for central NGS testing and exploratory biomarker analysis.

E. Recommended treatment option There are three different options including (1) Tier 1: Therapeutic use of investigational products (KOSMOS-II drugs), (2) Tier 2: alternative treatment options, and (3) Tier 3: clinical trials

Conditions

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Solid Tumor Advanced Solid Tumor Metastatic Cancer

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Tier 1. Therapeutic use of investigational products (KOSMOS-II drugs)

If there are no drugs available under current regulation or patients are not feasible to any clinical trials, and If tumors have actionable genetic alterations and approved drug in any indications but tumor type is not indicative, the MTB may recommend one of KOSMOS-II drugs, therapeutic use of investigational products.

Alectinib

Intervention Type DRUG

ALK fusion or mutations, Mutations or amplification in any of the following: RET

Atezolizumab

Intervention Type DRUG

MSI high status by any method Or Any mutation in any of these genes:

MLH1 or MSH2 or MSH6 or PMS2 or EPCAM Or Any of the following mutations in POLE: R150X, P286R, P286H, S297F, Y298fs, F367S, V411, L424V, P436R, S459F, R665W, L698fs, R762W, R1519C, R1826W, D316H, D316G, R409W, L474P Or Any of the following mutations in POLD1: P112fs, A930fs, S478N Or Any mutation in the following: POLE not listed above, POLD1 not listed above, POLD2, POLD3, POLD4, POLQ or PRKDC Or Any loss of function mutations in BRCA1, BRCA2, ATM, MSH3, PMS1, MLH3, EXO1, RFC1, RFC2, RFC3, RFC4, RFC5, PCNA, RPA1, PRA2, PRA3, PRA4, or SSBP1 High tumor mutational burden decided by KOSMOS-II MTB (TMB ≥20/Mb in local NGS or if 10-20/Mb, confirmed by central NGS te sting)

Erlotinib

Intervention Type DRUG

EGFR Exon 19 deletions in the region E746\_E759;

Any of the following EGFR mutations:

E709A, E709G, E709K, E884K, G719A, G719C, G719S, L858R, L861Q, L833V, S768I

Trastuzumab + Pertuzumab

Intervention Type DRUG

ERBB2 amplification, or over-expression; or presence of any of the following ERBB2 mutations:

G309A, G309E, S310F, S310Y, R678Q, I655V, D769H, D769Y, L755S, p.L75 5\_T759del, I767M, V777L, E321G, R896C; P780ins; delL755-T759 ERBB2 amplification or approved by the KOSMOS Molecular Tumor Board

Trastuzumab emtansine

Intervention Type DRUG

ERBB2 amplification, or over-expression; or presence of any of the following ERBB2 mutations:

G309A, G309E, S310F, S310Y, R678Q, I655V, D769H, D769Y,L755S, p.L75 5\_T759del, I767M, V777L, E321G, R896C; P780ins; delL755-T759 ERBB2 oncogenic mutations; G152V, X215\_splice, D277Y, G292C, N302K, V308M, G309A, S310F, S310Y, S244C, L651V, V659E, G660D, R678Q, V697L, G727A, T733I, L755A, L755P, L755S, D769H, D769Y, A775\_G776insSVMA, A775\_G776insYVMA (i.e.,Y772\_A775dup,M774\_A775insAYVME 770delinsEAYVM), G776\_V777 \> AVCV, G776\_V777 \> AVGCV, G776\_V777 \> VCV, G776\_V777insVC, G776C, G776delinsLCT, G776L, G776dleinsVC, G776L777\_G778insC, V777L, V777M, G778\_Y779insGSP, P780\_Y781insGSP (i.e.,G778\_P780dup), L786V, N813D, R840W, V842I, T862A, R896G, E1021Q or approved by the KOSMOS Molecular Tumor Board

Vemurafenib

Intervention Type DRUG

BRAF\_V600E/D/K/R mutations

Bevacizumab + Erlotinib

Intervention Type DRUG

FH inactivating mutations or approved by the KOSMOS Molecular Tumor Board

Entrectinib

Intervention Type DRUG

ROS1 gene fusion using either a fluo rescence in situ hybridization (FISH) or next-generation sequencing (NGS) or approved by the KOSMOS Molecular Tumor Board

Pralsetinib

Intervention Type DRUG

RET fusion or mutations; CCDC6 RET, RET V804L, RET V804M, RET M918T, KIF5B-RET, RET C634W or approved by the KOSMOS Molecular Tumor Board

Tier 2: Alternative treatments

If there are no KOSMOS-II drugs (Tier 1) or clinical trials (Tier 3) appropriate for patients, the MTB may recommend alternative treatment options (e.g., conventional therapy, radiotherapy, or supportive care).

No interventions assigned to this group

Tier 3: Clinical trial

If patient is eligible for clinical trials matched for actionable genomic alterations found in NGS testing, the MTB will recommend enrollment to clinical trials.

No interventions assigned to this group

Interventions

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Alectinib

ALK fusion or mutations, Mutations or amplification in any of the following: RET

Intervention Type DRUG

Atezolizumab

MSI high status by any method Or Any mutation in any of these genes:

MLH1 or MSH2 or MSH6 or PMS2 or EPCAM Or Any of the following mutations in POLE: R150X, P286R, P286H, S297F, Y298fs, F367S, V411, L424V, P436R, S459F, R665W, L698fs, R762W, R1519C, R1826W, D316H, D316G, R409W, L474P Or Any of the following mutations in POLD1: P112fs, A930fs, S478N Or Any mutation in the following: POLE not listed above, POLD1 not listed above, POLD2, POLD3, POLD4, POLQ or PRKDC Or Any loss of function mutations in BRCA1, BRCA2, ATM, MSH3, PMS1, MLH3, EXO1, RFC1, RFC2, RFC3, RFC4, RFC5, PCNA, RPA1, PRA2, PRA3, PRA4, or SSBP1 High tumor mutational burden decided by KOSMOS-II MTB (TMB ≥20/Mb in local NGS or if 10-20/Mb, confirmed by central NGS te sting)

Intervention Type DRUG

Erlotinib

EGFR Exon 19 deletions in the region E746\_E759;

Any of the following EGFR mutations:

E709A, E709G, E709K, E884K, G719A, G719C, G719S, L858R, L861Q, L833V, S768I

Intervention Type DRUG

Trastuzumab + Pertuzumab

ERBB2 amplification, or over-expression; or presence of any of the following ERBB2 mutations:

G309A, G309E, S310F, S310Y, R678Q, I655V, D769H, D769Y, L755S, p.L75 5\_T759del, I767M, V777L, E321G, R896C; P780ins; delL755-T759 ERBB2 amplification or approved by the KOSMOS Molecular Tumor Board

Intervention Type DRUG

Trastuzumab emtansine

ERBB2 amplification, or over-expression; or presence of any of the following ERBB2 mutations:

G309A, G309E, S310F, S310Y, R678Q, I655V, D769H, D769Y,L755S, p.L75 5\_T759del, I767M, V777L, E321G, R896C; P780ins; delL755-T759 ERBB2 oncogenic mutations; G152V, X215\_splice, D277Y, G292C, N302K, V308M, G309A, S310F, S310Y, S244C, L651V, V659E, G660D, R678Q, V697L, G727A, T733I, L755A, L755P, L755S, D769H, D769Y, A775\_G776insSVMA, A775\_G776insYVMA (i.e.,Y772\_A775dup,M774\_A775insAYVME 770delinsEAYVM), G776\_V777 \> AVCV, G776\_V777 \> AVGCV, G776\_V777 \> VCV, G776\_V777insVC, G776C, G776delinsLCT, G776L, G776dleinsVC, G776L777\_G778insC, V777L, V777M, G778\_Y779insGSP, P780\_Y781insGSP (i.e.,G778\_P780dup), L786V, N813D, R840W, V842I, T862A, R896G, E1021Q or approved by the KOSMOS Molecular Tumor Board

Intervention Type DRUG

Vemurafenib

BRAF\_V600E/D/K/R mutations

Intervention Type DRUG

Bevacizumab + Erlotinib

FH inactivating mutations or approved by the KOSMOS Molecular Tumor Board

Intervention Type DRUG

Entrectinib

ROS1 gene fusion using either a fluo rescence in situ hybridization (FISH) or next-generation sequencing (NGS) or approved by the KOSMOS Molecular Tumor Board

Intervention Type DRUG

Pralsetinib

RET fusion or mutations; CCDC6 RET, RET V804L, RET V804M, RET M918T, KIF5B-RET, RET C634W or approved by the KOSMOS Molecular Tumor Board

Intervention Type DRUG

Other Intervention Names

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Alecensa Tecentriq Tarceva Herceptin + Perjeta Kadcyla Zelboraf Avastin + Tarceva Rozlytrek Gavreto

Eligibility Criteria

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Inclusion Criteria

* 19 years of age or older
* Histologically proven locally advanced or metastatic solid tumors\*\*\* who showed disease progression on standard first line anti-cancer treatment and/or has no standard treatment option

\*\*\* very rare diseases without standard treatment option which form solid mass, such as Erdheim Chester disease can be enrolled after KOSMOS MTB approval
* A genomic test results must be available in a MFDS-accredited for laboratories offering service, or in part of clinical trial/study or other commercial labs approved and certified by regulatory bodies compatible with MFDS, such as CLIA. A genomic test can be conducted with tumor tissue as well as plasma circulating tumor DNA.

1. Results from genomic profiling tests performed after diagnosis with metastatic/advanced disease to registration are acceptable. NGS results performed within three years prior to registration are preferred. Those patients with NGS results from primary tumor or more than 3 years prior to enrollment can be registered and whether NGS data is acceptable will be subject to MTB decision.
2. NGS panels should be i. Tested in a lab that is accredited by one or more quality assurance program (e.g., Korean Institute of Genomic Testing Evaluation, The Korean Society of Pathologists, Korean Society for Laboratory Medicine, Korea Laboratory Accreditation Scheme, etc.) ii. Patients who have insufficient genomic information from their NGS results (e.g., lack of variant calling format file or uninterpretable reports) or who are candidates of immunotherapy will submit their tissue and/or blood, for central NGS testing and exploratory biomarker analysis.
* Ability to understand and the willingness to sign a written informed consent document
* Life expectancy of at least 12 weeks
* Adequate recovery from most recent systemic or local treatment for cancer.

Exclusion Criteria

* Patients receiving any anti-cancer treatment (local treatment, chemotherapy, immunotherapy, targeted therapy) within 2 weeks prior to the start of study treatment
* Any clinical condition, according to the opinion of site physicians, which makes molecular profiling guided therapy not at the best interest of the participating patient.
* Patients who have ongoing toxicities of ≥ CTCAE 2, other than peripheral neuropathy, related to previous anti-cancer treatment. Patients with ongoing peripheral neuropathy of ≥ CTCAE 3 will be excluded. Laboratory abnormalities ≥ CTCAE 2 considered as not clinically significant by the study physician will be allowed.
* Pregnant or breastfeeding, or intending to become pregnant during the study
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Korean Cancer Study Group

OTHER

Sponsor Role collaborator

Roche Pharma AG

INDUSTRY

Sponsor Role collaborator

Seoul National University Bundang Hospital

OTHER

Sponsor Role lead

Responsible Party

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Jee Hyun Kim

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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JEEHYUN KIM

Role: STUDY_DIRECTOR

Seoul National University Bundang Hospital

Locations

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Soonchunhyang University Hospital Bucheon

Bucheon-si, , South Korea

Site Status RECRUITING

Chungbuk National University Hospital

Chungju, , South Korea

Site Status RECRUITING

Keimyung University Dongsan Hospital

Daegu, , South Korea

Site Status RECRUITING

Kyungpook National University Chilgok Hospital

Daegu, , South Korea

Site Status RECRUITING

Yeungnam University Medical Center

Daegu, , South Korea

Site Status RECRUITING

Chungnam National University Hospital

Daejeon, , South Korea

Site Status RECRUITING

National Cancer Center

Goyang, , South Korea

Site Status RECRUITING

Chonnam National University Hwasun Hospital

Hwasun, , South Korea

Site Status RECRUITING

Gachon University Gil Medical Center

Incheon, , South Korea

Site Status RECRUITING

The Catholic University of Korea, Incheon St. Mary's Hospital

Incheon, , South Korea

Site Status RECRUITING

Jeonbuk National University Hospital

Jeonju, , South Korea

Site Status RECRUITING

Gyeongsang National University Hospital

Jinju, , South Korea

Site Status RECRUITING

Dong-A University Hospital

Pusan, , South Korea

Site Status RECRUITING

Cha University Bundang Medical Center

Seongnam, , South Korea

Site Status RECRUITING

Seoul National University Bundang Hospital

Seongnam, , South Korea

Site Status RECRUITING

Asan Medical Center

Seoul, , South Korea

Site Status RECRUITING

Chung-ang University Hospital

Seoul, , South Korea

Site Status RECRUITING

Ewha womans university Mokdong Hospital

Seoul, , South Korea

Site Status RECRUITING

Gangbuk Samsung Hospital

Seoul, , South Korea

Site Status RECRUITING

Hanyang University Hospital

Seoul, , South Korea

Site Status TERMINATED

Korea University Anam Hospital

Seoul, , South Korea

Site Status RECRUITING

Korea University Guro Hospital

Seoul, , South Korea

Site Status RECRUITING

Samsung Medical Center

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Hospital

Seoul, , South Korea

Site Status RECRUITING

The Catholic University of Korea, Seoul ST. Mary's Hospital

Seoul, , South Korea

Site Status RECRUITING

The Catholic University of Korea, Yeouido St. Mary's Hospital

Seoul, , South Korea

Site Status RECRUITING

Yonsei Cancer Hospital

Seoul, , South Korea

Site Status RECRUITING

Ajou University Hospital

Suwon, , South Korea

Site Status RECRUITING

The Catholic University of Korea, ST. Vincent's Hospital

Suwon, , South Korea

Site Status RECRUITING

Ulsan University Hospital

Ulsan, , South Korea

Site Status RECRUITING

Wonju Severance Christian Hospital

Wŏnju, , South Korea

Site Status RECRUITING

Pusan National University Yangsan Hospital

Yangsan, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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JEEHYUN KIM

Role: CONTACT

+82)070-4193-8602

Facility Contacts

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Jin-A Yun

Role: primary

Yae-Won Yang

Role: primary

Keon-Uk Park

Role: primary

In-Hee Lee

Role: primary

Ji-Yoon Jeong

Role: primary

So-ra Kang

Role: primary

Wonyoung Choi

Role: primary

Sang Hee Cho

Role: primary

YoungSaing Kim

Role: primary

JaeHo Byun

Role: primary

So-Yeon Jeon

Role: primary

Gyeong-Won Lee

Role: primary

Seok-Jae Huh

Role: primary

Beo-Deul Kang

Role: primary

Jee Hyun Kim

Role: primary

Min-Hee Ryu

Role: primary

Yong-Ho Noh

Role: primary

Kyung-Eun Lee

Role: primary

Dong-Hoe Koo

Role: primary

Jiwon Lee

Role: primary

Eunju Kang

Role: primary

Jin-Young Kim

Role: primary

Tae-Yong Kim

Role: primary

Se-Jun Park

Role: primary

In-Sook Woo

Role: primary

Min-Kyu Jung

Role: primary

Mi-Sun Ahn

Role: primary

Ho-Jung An

Role: primary

Hyeon-Su Im

Role: primary

Seung-Taek Lim

Role: primary

Jung-Hoon Kim

Role: primary

References

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Kim SY, Kim JH, Kim TY, Park SR, Yoon S, Lee S, Lee SH, Kim TM, Han SW, Kim HR, Yun H, Lee S, Kim J, Choi YL, Choi KS, Chae H, Ryu H, Lee GW, Zang DY, Ahn JB. Pragmatic nationwide master observational trial based on genomic alterations in advanced solid tumors: KOrean Precision Medicine Networking Group Study of MOlecular profiling guided therapy based on genomic alterations in advanced Solid tumors (KOSMOS)-II study protocol KCSG AL-22-09. BMC Cancer. 2024 May 9;24(1):574. doi: 10.1186/s12885-024-12338-y.

Reference Type DERIVED
PMID: 38724991 (View on PubMed)

Other Identifiers

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KCSG AL 22-09

Identifier Type: -

Identifier Source: org_study_id

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