Priming Immunotherapy in Advanced Disease With Radiation
Primary Purpose
Non-small Cell Lung Cancer, Squamous Cell Carcinoma of the Head and Neck
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Immune checkpoint inhibitor
Radiation Therapy
Sponsored by
About this trial
This is an interventional treatment trial for Non-small Cell Lung Cancer
Eligibility Criteria
Inclusion Criteria:
- Histologically proven advanced or metastatic non-small cell lung cancer or squamous cell carcinoma head and neck with tumor at least 1 cm in size.
- Eligible for treatment with radiation therapy.
Prior treatment: chemotherapy or radiotherapy or surgery.
- Prior chemotherapy or radiation must have concluded ≥ 21 days prior to the start of study treatment.
- No limit is placed on prior systemic treatment, but subjects must be eligible for immune checkpoint inhibitors therapy, for an FDA approved indication.
- No major surgery within 14 days of start of study treatment.
- No previous or concurrent malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has been disease free for the past 3 years.
- Age ≥ 18 years.
- Life expectancy ≥ 3 months.
Required initial laboratory values:
- Absolute neutrophil count ≥ 1,000/mm3
- Platelets ≥ 100,000/mm3
- Total bilirubin ≤ 1.5 x ULN
- AST and ALT if no hepatic metastasis ≤ 2.5 times x ULN
- AST and ALT with hepatic metastasis ≤ 5 x ULN
- Creatinine ≤ 1.5 x ULN and Requires CrCl ≥ 60ml/min (per 24-hour urine collection or calculated according to the Cockcroft-Gault formula)
- Non pregnant and non-nursing women. Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment. Women of childbearing potential and men must agree to use adequate contraception (barrier method of birth control) prior to study entry and for the duration of study participation. Subjects should use adequate birth control for at least 3 months after the last administration of immune checkpoint inhibitors.
- Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
- Active clinically serious infection > CTCAE Grade 2.
- Serious non-healing wound, ulcer or bone fracture.
- Prior treatment with immune checkpoint inhibitors.
- Ineligible for immune checkpoint inhibitors based on package insert of the chosen immune checkpoint inhibitor (e.g., uncontrolled immunologic disorders, active hepatitis, active colitis, active pneumonitis, uncontrolled/active hormone gland problems - including thyroid, pituitary, adrenal glands and pancreas).
- Major surgical procedure (including craniotomy and open brain biopsy) or significant traumatic injury within 14 days prior to registration or those patients who receive a non-CNS minor surgical procedures (e.g. core biopsy or fine needle aspiration) within 3 days prior to registration. There is no waiting period for central line placement. There is a 7-day window for recovery prior to registration for patients who underwent stereotactic biopsy of the brain.
- Participants may not have uncontrolled inter-current illness. This includes, but is not limited to: ongoing or active infection; symptomatic congestive heart failure (NYHA class III or IV); unstable angina pectoris or new onset angina that began within the last 3 months; cardiac ventricular arrhythmias requiring anti-arrhythmic therapy; or thrombotic/embolic events such as cerebrovascular accident, including transient ischemic attacks within the past 6 months. Uncontrolled hypertension defined as systolic blood pressure >150 mmHg or diastolic pressure > 90 mmHg, despite optimal medical management. Known human immunodeficiency virus (HIV) infection or chronic Hepatitis B or C. Known Grade 3 or 4 neurotoxicity.
Sites / Locations
- University of Kentucky Markey Cancer CenterRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Immune Checkpoint Inhibitor + Radiation
Arm Description
Immune checkpoint inhibitor (Nivolumab OR Pembrolizumab OR Atezolizumab) PLUS Radiation Therapy (Stereotactic Body Radiation Therapy OR fractionated radiation therapy)
Outcomes
Primary Outcome Measures
The primary study endpoint is 6-month progression-free survival.
Progression-free survival will be calculated as time from enrollment in the study to progression at 6-months post enrollment.
Secondary Outcome Measures
Percentage of (programmed death) PD-1+ CD4+ T (helper) cells and PD-1+ CD8+ T (cytotoxic) cells prior to treatment versus with concurrent treatment.
Percentage of CD8+ T-cells that are gamma-interferon positive during treatment.
Percentage PD-L1+ CD4+ and PD-L1+ CD8+ T-cell expression differences during treatment
Full Information
NCT ID
NCT03313804
First Posted
September 29, 2017
Last Updated
November 10, 2022
Sponsor
John L. Villano, MD, PhD
1. Study Identification
Unique Protocol Identification Number
NCT03313804
Brief Title
Priming Immunotherapy in Advanced Disease With Radiation
Official Title
Priming Immunotherapy in Advanced Disease With Radiation
Study Type
Interventional
2. Study Status
Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
October 26, 2017 (Actual)
Primary Completion Date
February 2025 (Anticipated)
Study Completion Date
February 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
John L. Villano, MD, PhD
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
5. Study Description
Brief Summary
This study proposes to treat metastatic non-small cell lung cancer (NSCLC) and head/neck squamous cell cancer (HNSCC) patients who are already initiating an immune checkpoint inhibitor (such as Nivolumab, Atezolizumab or Pembrolizumab) for disease treatment as per FDA approved guidelines. In these patients we will deliver a short-course radiation to a single systemic (non-CNS) site within 14 days of receiving the first dose of immune checkpoint inhibitors. This sequence allows radiation to release tumor antigens from immune inaccessible areas such as necrotic tumor or low perfusion to provide a robust anti-tumor immune response with immune checkpoint inhibitors.
The primary objective is to assess six-month progression free survival (PFS) compared to historical control.
Detailed Description
Subjects with front-line or relapsed NSCLC or relapsed HNSCC who are intended to receive standard of care immune checkpoint inhibitors without a contraindication to Stereotactic Body Radiation Therapy (SBRT) to a single cancer deposit greater than 1 cm (metastasis or primary cancer) will be enrolled. Subjects will receive standard of care (SOC) immune checkpoint inhibitors and within 2 weeks of initiation, and will receive either:
SBRT to target to achieve Biological Equivalent Dose (BED) > 100 Gy OR
30 Gy fractionated radiation therapy (RT) delivered as a 3 dimensional (3-D) dose.
The lesion choice will be made by the treating radiation oncologist and will be directed to a single malignant focus (non-CNS) that measures ≥ 1 cm. Essentially, the goals of both techniques are the same but SBRT is reserved for lesions that are readily encompassed by a single field with large RT fractions in which dose-limiting organs are within safe limits.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-small Cell Lung Cancer, Squamous Cell Carcinoma of the Head and Neck
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
57 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Immune Checkpoint Inhibitor + Radiation
Arm Type
Experimental
Arm Description
Immune checkpoint inhibitor (Nivolumab OR Pembrolizumab OR Atezolizumab) PLUS Radiation Therapy (Stereotactic Body Radiation Therapy OR fractionated radiation therapy)
Intervention Type
Drug
Intervention Name(s)
Immune checkpoint inhibitor
Intervention Description
Standard of care immune checkpoint inhibitor
Intervention Type
Radiation
Intervention Name(s)
Radiation Therapy
Intervention Description
Stereotactic Body Radiation Therapy OR Fractionated radiation therapy
Primary Outcome Measure Information:
Title
The primary study endpoint is 6-month progression-free survival.
Description
Progression-free survival will be calculated as time from enrollment in the study to progression at 6-months post enrollment.
Time Frame
6-months post enrollment
Secondary Outcome Measure Information:
Title
Percentage of (programmed death) PD-1+ CD4+ T (helper) cells and PD-1+ CD8+ T (cytotoxic) cells prior to treatment versus with concurrent treatment.
Time Frame
Assessed at specified points--1) prior to each cycle of therapy for 4 cycles (one cycle equals 6 weeks) 2) at disease progression (date first progression post-randomization, assessed up to 3 years) 3) when participant is off-study, assessed up to 3 years
Title
Percentage of CD8+ T-cells that are gamma-interferon positive during treatment.
Time Frame
Assessed at specified points--1) prior to each cycle of therapy for 4 cycles (one cycle equals 6 weeks) 2) at disease progression (date first progression post-randomization, assessed up to 3 years) 3) when participant is off-study, assessed up to 3 years
Title
Percentage PD-L1+ CD4+ and PD-L1+ CD8+ T-cell expression differences during treatment
Time Frame
Assessed at specified points--1) prior to each cycle of therapy for 4 cycles (one cycle equals 6 weeks) 2) at disease progression (date first progression post-randomization, assessed up to 3 years) 3) when participant is off-study, assessed up to 3 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histologically proven advanced or metastatic non-small cell lung cancer or squamous cell carcinoma head and neck with tumor at least 1 cm in size.
Eligible for treatment with radiation therapy.
Prior treatment: chemotherapy or radiotherapy or surgery.
Prior chemotherapy or radiation must have concluded ≥ 21 days prior to the start of study treatment.
No limit is placed on prior systemic treatment, but subjects must be eligible for immune checkpoint inhibitors therapy, for an FDA approved indication.
No major surgery within 14 days of start of study treatment.
No previous or concurrent malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has been disease free for the past 3 years.
Age ≥ 18 years.
Life expectancy ≥ 3 months.
Required initial laboratory values:
Absolute neutrophil count ≥ 1,000/mm3
Platelets ≥ 100,000/mm3
Total bilirubin ≤ 1.5 x ULN
AST and ALT if no hepatic metastasis ≤ 2.5 times x ULN
AST and ALT with hepatic metastasis ≤ 5 x ULN
Creatinine ≤ 1.5 x ULN and Requires CrCl ≥ 60ml/min (per 24-hour urine collection or calculated according to the Cockcroft-Gault formula)
Non pregnant and non-nursing women. Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment. Women of childbearing potential and men must agree to use adequate contraception (barrier method of birth control) prior to study entry and for the duration of study participation. Subjects should use adequate birth control for at least 3 months after the last administration of immune checkpoint inhibitors.
Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
Active clinically serious infection > CTCAE Grade 2.
Serious non-healing wound, ulcer or bone fracture.
Prior treatment with immune checkpoint inhibitors.
Ineligible for immune checkpoint inhibitors based on package insert of the chosen immune checkpoint inhibitor (e.g., uncontrolled immunologic disorders, active hepatitis, active colitis, active pneumonitis, uncontrolled/active hormone gland problems - including thyroid, pituitary, adrenal glands and pancreas).
Major surgical procedure (including craniotomy and open brain biopsy) or significant traumatic injury within 14 days prior to registration or those patients who receive a non-CNS minor surgical procedures (e.g. core biopsy or fine needle aspiration) within 3 days prior to registration. There is no waiting period for central line placement. There is a 7-day window for recovery prior to registration for patients who underwent stereotactic biopsy of the brain.
Participants may not have uncontrolled inter-current illness. This includes, but is not limited to: ongoing or active infection; symptomatic congestive heart failure (NYHA class III or IV); unstable angina pectoris or new onset angina that began within the last 3 months; cardiac ventricular arrhythmias requiring anti-arrhythmic therapy; or thrombotic/embolic events such as cerebrovascular accident, including transient ischemic attacks within the past 6 months. Uncontrolled hypertension defined as systolic blood pressure >150 mmHg or diastolic pressure > 90 mmHg, despite optimal medical management. Known human immunodeficiency virus (HIV) infection or chronic Hepatitis B or C. Known Grade 3 or 4 neurotoxicity.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
John Villano, MD, PhD
Phone
859-323-0405
Email
jlvillano@uky.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Villano, MD, PhD
Organizational Affiliation
University of Kentucky
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Kentucky Markey Cancer Center
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40536
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
John Villano, MD, PhD
Phone
859-323-0405
Email
jlvillano@uky.edu
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Priming Immunotherapy in Advanced Disease With Radiation
We'll reach out to this number within 24 hrs