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Combination of Platinum Doublets and Hypofractionated Radiotherapy in NSCLC (HYPOLAN)

Primary Purpose

Non-Small Cell Lung Cancer

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Cisplatin
hypofractionated radiotherapy
Pemetrexed
Etoposide
Sponsored by
The Netherlands Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-Small Cell Lung Cancer focused on measuring cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Provision of signed, written and dated informed consent prior to any study specific procedures
  • Male or female aged 18 years or older
  • Cytological or histological proven NSCLC stage III or inoperable stage II (cT1-3-3N0-1), according to the 8th edition of the AJCC staging.
  • Patients with locoregional recurrent lung tumor following surgery or a second primary cancer are eligible, unless a pneumonectomy was performed.
  • Minimum required laboratory data
  • Adequate bone marrow reserve: absolute neutrophil (segmented and bands) count (ANC) ≥1.5 x 109/L, platelets ≥ 100 x 109/L, and hemoglobin ≥ 5.5 mmol/L.
  • Hepatic:

    i. Serum bilirubin ≤ 1.5 times the upper limit of normal (× ULN); alkaline phosphatase (AP), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) ≤ 3.0 × ULN.

ii. This does not apply to patients with confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinaemia that is predominantly unconjugated in the absence of evidence of haemolysis or hepatic pathology) who will be allowed in consultation with their physician.

  • Renal: GFR ≥ 60 ml/min; if below this threshold a creatinine clearance (CrCL) can be calculated based on the original weight based Cockcroft and Gault formula and should be ≥ 45 ml/min.

Exclusion Criteria:

  • WHO performance status ≥ 2
  • FEV-1 and DLCO < 35 % of the age- and gender adjusted normal value
  • Patients with grade 3 dyspnea or worse at baseline (according to CTCAE version 4.03)
  • Prior radiotherapy to the thorax.
  • Mean lung dose > 20.0 Gy and/or exceeding other organs-at-risk constraints (page 21).
  • Participation in another clinical study with an investigational product during the last 4 weeks.
  • Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or the follow-up period of an interventional study
  • Recent major surgery within 4 weeks prior to entry into the study (excluding the placement of vascular access) that would prevent administration of chemotherapy.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the patient to give written informed consent
  • Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
  • Female patients who are pregnant, breast-feeding or male or female patients of reproductive potential who are not employing an effective method of birth control
  • Any condition that, in the opinion of the investigator, would interfere with evaluation of the chemoradiotherapy or interpretation of patient safety or study results.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    chemotherapy combined with radiotherapy

    Arm Description

    Patients will be treated with two 3-weekly courses of cisplatin (Day 1: 75mg/m2) and pemetrexed (Day 1: 500mg/m2 for non-squamous) or etoposide (Day1-3 100mg/m2 for squamous), together with hypofractionated radiotherapy (24 daily fractions of 2.42 Gy to the involved mediastinal lymph nodes with an integrated boost of 2.75 Gy to the primary tumor).

    Outcomes

    Primary Outcome Measures

    Incidence of treatment related Adverse events (according to CTCAE v 4.03)
    safety defined by the rate of grade 3-5 adverse events

    Secondary Outcome Measures

    safety defined by the rate of grade 3-4 treatment related adverse events
    safety will be assessed by the incidence of grade 3-4 related adverse event (CTCAE v 4.03)
    disease control rate
    progression free survival
    overall survival

    Full Information

    First Posted
    October 14, 2016
    Last Updated
    November 28, 2017
    Sponsor
    The Netherlands Cancer Institute
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02947113
    Brief Title
    Combination of Platinum Doublets and Hypofractionated Radiotherapy in NSCLC
    Acronym
    HYPOLAN
    Official Title
    Feasibility Trial on Combination of Platinum Doublets and Hypofractionated Radiotherapy for Locally-advanced Stage and / or Inoperable Non-small Cell Lung Carcinoma
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    November 2017
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    New studies available with immunotherapy so recruitment is no longer acceptable.
    Study Start Date
    November 2017 (Anticipated)
    Primary Completion Date
    November 2017 (Anticipated)
    Study Completion Date
    November 2017 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    The Netherlands Cancer Institute

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Concurrent chemoradiotherapy is the standard treatment for locally advanced non-small cell lung carcinoma (NSCLC). Different chemotherapy and radiation regimens have been advocated but in general, cisplatin-doublets are deemed standard of care. Decreasing the overall treatment time of irradiation by hypofractionation is thought to increase the efficacy. Extensive experience is available on the combination of daily-dose cisplatin in combination with hypofractionated radiotherapy. However, no data is available on the safety of cisplatin doublets and hypofractionated radiotherapy
    Detailed Description
    Patients presenting with locally advanced NSCLC will be consented to participate in this phase 2 trial that evaluates the concurrent treatment of cisplatin (Day 1: 75mg/m2) and pemetrexed (Day 1: 500mg/m2 for non-squamous cell lung cancer) or etoposide (Day1-3 100mg/m2 for squamous cell lung cancer), 3-weekly regimens, together with radiotherapy (24 daily fractions of 2.42 Gy to the mediastinal lymph nodes with an integrated boost of 2.75 Gy to the primary tumour). An interim analysis is planned following the first cohort of 25 patients to assess safety.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Non-Small Cell Lung Cancer
    Keywords
    cancer

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    chemotherapy combined with radiotherapy
    Arm Type
    Experimental
    Arm Description
    Patients will be treated with two 3-weekly courses of cisplatin (Day 1: 75mg/m2) and pemetrexed (Day 1: 500mg/m2 for non-squamous) or etoposide (Day1-3 100mg/m2 for squamous), together with hypofractionated radiotherapy (24 daily fractions of 2.42 Gy to the involved mediastinal lymph nodes with an integrated boost of 2.75 Gy to the primary tumor).
    Intervention Type
    Drug
    Intervention Name(s)
    Cisplatin
    Intervention Description
    Cisplatin will be administrated in a 3-weekly scheme for 2 courses combined with pemetrexed (non-squamous cell lung cancer) or etoposide (squamous cell lung cancer)
    Intervention Type
    Radiation
    Intervention Name(s)
    hypofractionated radiotherapy
    Intervention Description
    Hypofractionated radiotherapy of 24 x 2.75 Gy will be given combined with a 3-weekly scheme of cisplatin and pemetrexed/etoposide
    Intervention Type
    Drug
    Intervention Name(s)
    Pemetrexed
    Other Intervention Name(s)
    Alimta
    Intervention Description
    Pemetrexed will be administrated in a combination with cisplatin and hypofractionated radiotherapy (for non-squamous cell lung cancer)
    Intervention Type
    Drug
    Intervention Name(s)
    Etoposide
    Other Intervention Name(s)
    Etoposin
    Intervention Description
    etoposide will be administrated in a combination with cisplatin and hypofractionated radiotherapy (for squamous cell lung cancer)
    Primary Outcome Measure Information:
    Title
    Incidence of treatment related Adverse events (according to CTCAE v 4.03)
    Description
    safety defined by the rate of grade 3-5 adverse events
    Time Frame
    within 3 months FU
    Secondary Outcome Measure Information:
    Title
    safety defined by the rate of grade 3-4 treatment related adverse events
    Description
    safety will be assessed by the incidence of grade 3-4 related adverse event (CTCAE v 4.03)
    Time Frame
    3 months
    Title
    disease control rate
    Time Frame
    1 year
    Title
    progression free survival
    Time Frame
    2 years
    Title
    overall survival
    Time Frame
    2 years
    Other Pre-specified Outcome Measures:
    Title
    biomarker
    Description
    assessment of circulating cell free tumor DNA for residual disease
    Time Frame
    through study completion, an average of 2 years

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Provision of signed, written and dated informed consent prior to any study specific procedures Male or female aged 18 years or older Cytological or histological proven NSCLC stage III or inoperable stage II (cT1-3-3N0-1), according to the 8th edition of the AJCC staging. Patients with locoregional recurrent lung tumor following surgery or a second primary cancer are eligible, unless a pneumonectomy was performed. Minimum required laboratory data Adequate bone marrow reserve: absolute neutrophil (segmented and bands) count (ANC) ≥1.5 x 109/L, platelets ≥ 100 x 109/L, and hemoglobin ≥ 5.5 mmol/L. Hepatic: i. Serum bilirubin ≤ 1.5 times the upper limit of normal (× ULN); alkaline phosphatase (AP), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) ≤ 3.0 × ULN. ii. This does not apply to patients with confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinaemia that is predominantly unconjugated in the absence of evidence of haemolysis or hepatic pathology) who will be allowed in consultation with their physician. Renal: GFR ≥ 60 ml/min; if below this threshold a creatinine clearance (CrCL) can be calculated based on the original weight based Cockcroft and Gault formula and should be ≥ 45 ml/min. Exclusion Criteria: WHO performance status ≥ 2 FEV-1 and DLCO < 35 % of the age- and gender adjusted normal value Patients with grade 3 dyspnea or worse at baseline (according to CTCAE version 4.03) Prior radiotherapy to the thorax. Mean lung dose > 20.0 Gy and/or exceeding other organs-at-risk constraints (page 21). Participation in another clinical study with an investigational product during the last 4 weeks. Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or the follow-up period of an interventional study Recent major surgery within 4 weeks prior to entry into the study (excluding the placement of vascular access) that would prevent administration of chemotherapy. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the patient to give written informed consent Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial Female patients who are pregnant, breast-feeding or male or female patients of reproductive potential who are not employing an effective method of birth control Any condition that, in the opinion of the investigator, would interfere with evaluation of the chemoradiotherapy or interpretation of patient safety or study results.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Judi van Diessen, MD
    Organizational Affiliation
    The Netherlands Cancer Institute
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    21903745
    Citation
    Curran WJ Jr, Paulus R, Langer CJ, Komaki R, Lee JS, Hauser S, Movsas B, Wasserman T, Rosenthal SA, Gore E, Machtay M, Sause W, Cox JD. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011 Oct 5;103(19):1452-60. doi: 10.1093/jnci/djr325. Epub 2011 Sep 8. Erratum In: J Natl Cancer Inst. 2012 Jan 4;104(1):79.
    Results Reference
    background
    PubMed Identifier
    22560551
    Citation
    Kwint M, Uyterlinde W, Nijkamp J, Chen C, de Bois J, Sonke JJ, van den Heuvel M, Knegjens J, van Herk M, Belderbos J. Acute esophagus toxicity in lung cancer patients after intensity modulated radiation therapy and concurrent chemotherapy. Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):e223-8. doi: 10.1016/j.ijrobp.2012.03.027. Epub 2012 May 5.
    Results Reference
    background
    PubMed Identifier
    22753901
    Citation
    Mauguen A, Le Pechoux C, Saunders MI, Schild SE, Turrisi AT, Baumann M, Sause WT, Ball D, Belani CP, Bonner JA, Zajusz A, Dahlberg SE, Nankivell M, Mandrekar SJ, Paulus R, Behrendt K, Koch R, Bishop JF, Dische S, Arriagada R, De Ruysscher D, Pignon JP. Hyperfractionated or accelerated radiotherapy in lung cancer: an individual patient data meta-analysis. J Clin Oncol. 2012 Aug 1;30(22):2788-97. doi: 10.1200/JCO.2012.41.6677. Epub 2012 Jul 2.
    Results Reference
    background

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    Combination of Platinum Doublets and Hypofractionated Radiotherapy in NSCLC

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