AzTrials
AzTrials

Lung CancerPhase 3APPROACHNCT04841811

MDT-bridged Radical Therapy After Aumolertinib With MRD-guided Maintenance in EGFRm+ Unresectable Stage III NSCLC (APPROACH)

A Phase 3 study testing Almonertinib in people with Lung Cancer, run by Guangdong Association of Clinical Trials at 1 site in China.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
Search all trials

Trial summary

This is an open-label, multi-center, randomized, phase III study. It is aimed to firstly evaluate the effectiveness and safety of almonertinib induction therapy in EGFR-mutated patients with unresectable stage III non-small cell lung cancer, and to evaluate the effectiveness and safety of dynamic MRD guided… Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Lung Cancer
What is being tested?
Almonertinib
Could I receive a placebo?
No, everyone receives an active treatment
How many people
192 participants
Where
1 siteChina
Study dates
20 Jun 2022to 31 Dec 2028
Phase
Phase 3
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 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects must meet all of the following inclusion criteria to be included in this study:
  • Over 18 years old (including 18 years old) and under 70 years old (including 70 years old).
  • The Eastern Cooperative Oncology Group (ECOG) physical status score is 0 or 1, and there is no deterioration within 2 weeks before the study drug treatment, and the expected survival period is not less than 12 weeks.
  • Stage III non-squamous cell non-small cell lung cancer confirmed by histopathology or cytology and determined by the investigator to be unresectable (International Association for the Study of Lung Cancer Eighth Edition Lung Cancer Staging).
  • Tumor tissue samples or blood samples, pleural effusions, ascites effusions, and pericardial effusions are confirmed to be EGFR sensitive mutations (ie, exon 19 deletion or L858R, alone or coexisting, Or with other EGFR mutations, but patients with EGFR20 exon insertion mutations cannot be included in the group) by laboratory tests approved by the investigator.
  • According to the RECIST1.1 standard, the subject must have at least one imaging measurable lesion. The baseline tumor imaging evaluation was performed within 28 days before the first medication.
Show all 12Show fewer
  • Women of childbearing age should take appropriate contraceptive measures from screening to 3 months after stopping the study treatment and should not breastfeed. Before starting the administration, the pregnancy test is negative, or meeting one of the following criteria proves that there is no risk of pregnancy:
  • Postmenopausal is defined as age greater than 50 years,and amenorrhea for at least 12 months after stopping all exogenous hormone replacement therapy.
  • For women younger than 50 years old, if the amenorrhea is 12 months or more after stopping all exogenous hormone treatments, and the luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels are within the laboratory postmenopausal reference value range, also It can be considered postmenopausal.
  • Have received irreversible sterilization, including hysterectomy, bilateral ovariectomy or bilateral fallopian tube resection, except for bilateral fallopian tube ligation.
  • Male subjects should use barrier contraception (ie, condoms) from screening to 3 months after the study treatment is stopped.
  • The subjects themselves participated voluntarily and signed a written informed consent form.

Who cannot join

  • Subjects who meet any of the following criteria cannot be included in this study:
  • Have received any of the following treatments:
  • Have received lung surgery in the past;
  • Have used any EGFR tyrosine kinase inhibitor in the past;
  • Previously received any systemic chemotherapy or immunotherapy for lung cancer;
  • Receive any lung cancer radiotherapy in the past;
Show all 36Show fewer
  • The patient has undergone open surgery on other parts except the lungs within 14 days before using the study drug for ≤14 days.
  • In addition to NSCLC, another malignant disease has been diagnosed in the past 5 years (excluding completely resected basal cell carcinoma, bladder carcinoma in situ, and cervical carcinoma in situ).
  • Have used proprietary Chinese medicines with anti-tumor effects in the past. Those who have used proprietary Chinese medicines with anti-tumor effects but have been used for no more than 7 days and have been stopped for 2 weeks or more before the drug treatment in this study can be included in the group.
  • There are serious or uncontrollable systemic diseases (such as severe mental, neurological, epilepsy or dementia, unstable or uncompensated respiratory, cardiovascular, liver or kidney disease, left ventricular ejection fraction (LVEF) < 50%, uncontrolled hypertension [that is, it is still greater than or equal to CTCAE level 3 hypertension after drug treatment]); suffering from swallowing dysfunction, active gastrointestinal disease, or other significant effects on the absorption of oral drugs, Disorders of distribution, metabolism, and excretion. Those who have had most gastrectomy operations in the past.
  • Fever and body temperature above 38℃ in the past week, or active infection with clinical significance. Active tuberculosis. Active fungal, bacterial and/or viral infections requiring systemic treatment.
  • Those who have active bleeding, new thrombotic diseases, are taking anticoagulant drugs, or have bleeding tendency;
  • The resting electrocardiogram has major clinically significant abnormalities in rhythm, conduction, or morphology, such as complete left bundle branch block, heart block above Ⅱ degree, clinically significant ventricular arrhythmia or atrial fibrillation, Unstable angina pectoris, congestive heart failure, chronic heart failure grade ≥ 2 by the New York Heart Association (NYHA).
  • Myocardial infarction, coronary artery/peripheral artery bypass or cerebrovascular accident occurred within 3 months.
  • The QT interval (QTc) of 12-lead ECG is ≥450 ms for males and ≥470 ms for females.
  • There are risk factors that lead to prolonged QT interval or risk factors that increase arrhythmia, such as heart failure, ≥CTCAE (version 4.03) 2nd degree hypokalemia (2nd degree hypokalemia is defined as: serum potassium <the lower limit of the normal value is 3.0mmol/L, and there are symptoms and needs treatment), congenital long QT syndrome, family history of long QT syndrome.
  • Any drug known to prolong the QT interval is being used within 2 weeks before the first dose.
  • Insufficient bone marrow reserve or organ function, reaching any of the following laboratory limits (no corrective treatment within 1 week before laboratory examination of blood):
  • Absolute neutrophil count <1.5×109 / L;
  • Platelet count <90×109 / L;
  • Hemoglobin <90 g/L (<9 g/dL);
  • Alanine aminotransferase> 3 times the upper limit of normal (ULN);
  • Aspartate aminotransferase>3×ULN
  • Total bilirubin> 1.5×ULN;
  • Creatinine> 1.5×ULN or creatinine clearance rate <45 mL/min (calculated by Cockcroft-Gault formula);
  • Serum albumin (ALB) <28 g/L;
  • Female subjects who are pregnant, lactating, or planning to become pregnant during the study period.
  • A history of interstitial lung disease, a history of drug-induced interstitial lung disease, a history of interstitial pneumonia requiring steroid therapy, or any evidence of clinically active interstitial lung disease.
  • Have a history of hypersensitivity to any active or inactive ingredients of Almonertinib, or to drugs with similar chemical structure to Almonertinib or in the same category as Almonertinib.
  • Any serious or uncontrolled eye disease (especially severe dry eye syndrome, dry keratoconjunctivitis, severe exposure keratitis or other diseases that may increase epithelial damage), according to the doctor's judgment, it may increase the safety risk of the subject; or patients with eye abnormalities who require surgery or are expected to require surgical treatment during the study period.
  • Use/consumption of drugs or foods that are known to have potent CYP3A4 inhibitory effects within 2 weeks, including but not limited to atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefa Oxazolone, nelfinavir, ritonavir, saquinavir, telithromycin, aceto-eandomycin, voriconazole, and grapefruit or grapefruit juice.
  • Use drugs known to have potent CYP3A4 inducing effects within 2 weeks, including but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin and Hypericum perforatum.
  • Use drugs that are CYP3A4 substrates (with a narrow therapeutic index) within 2 weeks, including but not limited to dihydroergotamine, ergotamine, pimozide, astemizole, cisapride, and terfenadine.
  • Have used strong P-gp inhibitors (including but not limited to verapamil, cyclosporin A, dexverapamil) within 2 weeks.
  • Subjects judged by the investigator who may not be in compliance with the research procedures and requirements, such as subjects who have a clear history of neurological or mental disorders (including epilepsy or dementia), currently suffering from mental disorders, etc. .
  • The investigator judges that there are any subjects that endanger the safety of the subject or interfere with the evaluation of the study.

Trial locations and contacts

1 site in 1 country.

China1 site
  • Guangdong Lung cancer institute

    Guangzhou, Guangdong, 510080

Other trials in China

About this study

Official title: Effectiveness and Safety of Dynamic MRD Guiding Treatment After Aumolertinib Induction Therapy of EGFR-mutation-positive Unresectable Stage III Non-Small Cell Lung Cancer in the MDT Diagnostic Model: an Open-label, Multicenter, Randomized, Phase III Study

This is an open-label, multi-center, randomized, phase III study. It is aimed to firstly evaluate the effectiveness and safety of almonertinib induction therapy in EGFR-mutated patients with unresectable stage III non-small cell lung cancer, and to evaluate the effectiveness and safety of dynamic MRD guided maintenance therapy with almonertinib after induction therapy with almonertinib and local therapy (radical surgery or radiotherapy) evaluated by MDT diagnostic model. The study includes a screening period (not more than 28 days after the subject with signed informed consent before first medication), treatment period (including induction therapy with almonertinib\ radical therapy under MDT model\ consolidation therapy with almonertinib) and follow-up period.

Read the detailed description

This is an open-label, multi-center, randomized, phase III study. It is aimed to firstly evaluate the effectiveness and safety of almonertinib induction therapy in EGFR-mutated patients with unresectable stage III non-small cell lung cancer, and to evaluate the effectiveness and safety of dynamic MRD guided maintenance therapy with almonertinib after induction therapy with almonertinib and local therapy (radical surgery or radiotherapy) evaluated by MDT diagnostic model. The study includes a screening period (not more than 28 days after the subject with signed informed consent before first medication), treatment period (including induction therapy with almonertinib\ radical therapy under MDT model\ consolidation therapy with almonertinib) and follow-up period.

Eligible subjects receive 110 mg of almonertinib once a day for 8 consecutive weeks of induction therapy; local treatment (surgical or radical radiotherapy) is selected after MDT assessment. Subjects will be randomly assigned to groups A and B. Stratification factors included EGFR 19deletion or EGFR 21L858R mutation; shedding or non-shedding ctDNA at baseline; radical surgery or radiotherapy under MDT model.

Subjects in group A will receive 110 mg of almonertinib once a day for 2 years. Imaging evaluation is conducted every 12 weeks. Subjects in group B will receive almonertinib guided by dynamic MRD monitoring. When ctDNA was positive (MRD+), subjects will receive 110 mg of almonertinib once a day for 12 weeks; when ctDNA was negative (MRD-), subjects will stop almonertinib and be observed for 12 weeks. This model will continue until disease recurrence or metastasis.

Conditions
Lung Cancer
Being tested
Almonertinib
Keywords
unresectable stageIII NSCLC, EGFR mutation, MDT, ctDNA MRD, adaptive deescalation treatment
Medical subject headings
Lung Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AlmonertinibDrug

    Also called ctDNA dynamic monitoring guided the Almonertinib treatment

    ctDNA dynamic monitoring guided the Almonertinib treatment group after redical surgery orradiotherapy

Study groups in NCT04841811
Study groupRoleWhat they receive
Group A (almonertinib continuous treatment)Active comparatorSubjects will be randomly assigned to groups A and B after radical therapy (surgery or radiothrapy) and will receive 110 mg of almonertinib once a day for 2 years or until disease recurrence or metastasis.
Receives: Drug: Almonertinib
Group B (ctDNA monitoring guided the almonertinib treatment)ExperimentalSubjects will be randomly assigned to group B after radical therapy (surgery or radiothrapy) and will receive almonertinib guided by ctDNA dynamic monitoring (every 3 months test ctDNA once, if it is positive, continue to receive almonertinib 110 mg once a day, if it is negative, stop almonertinib until ctDNA turns positive and receive almonertinib treatment again).
Receives: Drug: Almonertinib

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Assess the anti-tumor activity by IRC: ORR

    The objective response rate (ORR) was assessed by IRC for all eligible subjects after 8 weeks of Almonertinib induction therapy.

    Until the disease progresses or in the absence of disease progression, the last evaluable data will be recorded in the ORR assessment. However, any CR or PR that occurs after the termination of the study treatment and receiving further anti-tumor therapy will not be included in the ORR calculation.

    Measured: 8 weeks

  2. Assess the anti-tumor activity by IRC: Event free survival (EFS) rate

    The 18 months event-free survival period is defined as the time from random to the occurrence of any of the following events within 18 months, whichever occurs first:

    Tumor progression assessed by IRC according to RECIST 1.1; Tumor recurrence confirmed by IRC, including local recurrence or distant metastasis; Death caused by any cause.

    Measured: 18 months

Secondary outcomes (7)
  1. Assess the anti-tumor activity by investigators: ORR

    The objective response rate (ORR) was assessed by investigators for all eligible subjects after 8 weeks of Almonertinib induction therapy.

    Until the disease progresses or in the absence of disease progression, the last evaluable data will be recorded in the ORR assessment. However, any CR or PR that occurs after the termination of the study treatment and receiving further anti-tumor therapy will not be included in the ORR calculation.

    Measured: 8 weeks

  2. Assess the anti-tumor activity by investigators: Event free survival (EFS)

    The 18 months event-free survival period is defined as the time from random to the occurrence of any of the following events within 18 months, whichever occurs first:

    Tumor progression assessed by investigators according to RECIST 1.1; Tumor recurrence confirmed by investigators, including local recurrence or distant metastasis; Death caused by any cause.

    Measured: 18 months

  3. Event free survival (EFS)

    The event-free survival period is defined as the time from random to the occurrence of any of the following events, whichever occurs first:

    Tumor progression assessed by IRC according to RECIST 1.1; Tumor recurrence confirmed by IRC, including local recurrence or distant metastasis; Death caused by any cause.

    Measured: 2 years

  4. Overall survival (OS)

    Overall survival is defined as the time between the date of first administration and the date of death of the subject for any reason.Subjects not dead at the time of the statistical analysis will be truncated at the time when the subject was last known to be alive.

    Measured: more than 2 years

  5. Major pathological response (MPR)

    The major pathological response rate is defined as the incidence of tumor regression induced by neoadjuvant therapy with pathological residual tumor ≤10% (only applicable to subjects who have received surgical treatment).

    Measured: 8 weeks

  6. Assess the safety of Almonertinib

    To evaluate number of participants with treatment-related adverse events as assessed by CTCAE v4.0

    Measured: 2 years

  7. Quality of life(QOL) assessed by EORTC QLQ-C30

    Quality of Life assessed by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30(EORTC QLQ-C30)

    Measured: 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Apr 2021
  2. Study start20 Jun 2022
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Dec 2028 (estimated)

Resources

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
192 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04841811
Sponsor's protocol ID
CTONG2101
Acronym
APPROACH
Status last verified
May 2026
First submitted
1 Apr 2021
Last updated
22 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Almonertinib in people with Lung Cancer, run by Guangdong Association of Clinical Trials at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 36 exclusion criteria. 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 22 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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?

Assess the anti-tumor activity by IRC: ORR (time frame: 8 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 22 May 2026; AzTrials last refreshed its copy on 7 Nov 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in