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Patient-Reported Outcomes Following Chemoradiotherapy for Locally Advanced Non-small Cell Lung Cancer (REPAINT)

Primary Purpose

Non-small Cell Lung Cancer

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
PET-based, dose-painted, accelerated chemoradiotherapy
Standard chemoradiotherapy
Sponsored by
Albert Einstein College of Medicine
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 radiation therapy, chemotherapy, PET Imaging

Eligibility Criteria

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

Inclusion Criteria:

Pathologically proven (either histologic or cytologic) diagnosis of NSCLC with any of the following stages (according to the AJCC Staging Manual, 7th edition,

Appendix):

  • Stage IIIA or IIIB
  • Stage II NSCLC with contraindication to curative surgical resection
  • Stage IV disease with solitary brain metastasis that has been treated radically (eg: with surgical resection and/or stereotactic radiosurgery) and thoracic disease that would be classified as stage II-III

Appropriate diagnostic/staging workup, including:

  • Complete history and physical examination
  • PET/CT within 42 days prior to study entry demonstrating hypermetabolic pulmonary lesion(s) and/or thoracic lymph node(s). If PET/CT was obtained more than 42 days prior to study entry and is not repeated, chest CT within 28 days prior to study entry demonstrating stable disease is required.
  • MRI of the brain or head CT with contrast within 42 days prior to study entry
  • No prior chemotherapy or thoracic radiotherapy for lung cancer
  • ECOG Performance Status 0-2
  • Age > 18
  • Able to read and write in one of the following languages, in which the PROCTCAE tool is available: English, Danish, German, Italian, Japanese, Korean, Spanish
  • Laboratory studies obtained within 28 days prior to study entry demonstrating adequate bone marrow and end organ function
  • Women of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to the start of study therapy, agree to utilize an adequate method of contraception throughout treatment and for at least 4 weeks after study therapy is completed,and be advised of the importance of avoiding pregnancy during trial participation and the potential risks of an unintentional pregnancy.

All patients must sign study specific informed consent prior to study entry.

Exclusion Criteria:

  • Pleural or pericardial effusion (A patient with pleural effusion may be enrolled the effusion is sampled by thoracentesis and cytology is negative or the effusion is seen on axial imaging but not on chest x-ray and deemed too small to tap under CT or ultrasound guidance.)
  • Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious) illness
  • Women who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 4 weeks after cessation of study therapy
  • have a positive pregnancy test at baseline
  • are pregnant or breastfeeding
  • Poorly controlled diabetes (defined as fasting glucose level > 200 mg/dL) despite attempts to improve glucose control by fasting duration and adjustment of medications. Patients with diabetes will preferably be scheduled for PET/CT imaging in the morning, and instructions for fasting and use of medications will be provided in consultation with the patients' primary physicians

Sites / Locations

  • Montefiore Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Standard chemoradiotherapy

PET-based, dose-painted, accelerated chemoradiotherapy,

Arm Description

Patients receiving standard radiotherapy will receive a total dose of 60 Gy in 30 fractions over 6 weeks, delivered to all involved lesions (tumors and lymph nodes).

For patients receiving PET-based, dose-painted, accelerated chemoradiotherapy, lesions with MTV exceeding 20 cc will be treated with 55 Gy in 20 fractions over 4 weeks, while lesions with MTV below 20 cc will receive 44 Gy in 20 fractions over the same 4 weeks.

Outcomes

Primary Outcome Measures

PRO-CTCAE adverse events with score ≥ 3, observed 6 weeks after initiation of chemoradiotherapy

Secondary Outcome Measures

Locoregional progression-free survival
Lack of local disease progression based on repeat imaging
Progression-free survival
Lack of any disease progression based on repeat imaging
Overall survival
Follow ups will be maintained with study patients to determine survival status
Grade 3-5 adverse events, scored using CTCAE v. 4
Evaluation of any side effects or toxicities using a standard grading system
PRO-CTCAE adverse events with score ≥ 3 at any time
Evaluation of severe, patient reported side effects or toxicities
PRO-CTCAE adverse events with any score
Evaluation of any patient reported side effects or toxicities

Full Information

First Posted
March 22, 2018
Last Updated
June 17, 2023
Sponsor
Albert Einstein College of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT03481114
Brief Title
Patient-Reported Outcomes Following Chemoradiotherapy for Locally Advanced Non-small Cell Lung Cancer
Acronym
REPAINT
Official Title
Patient-Reported Outcomes Following Chemoradiotherapy for Locally Advanced Non-small Cell Lung Cancer: A Randomized Trial Comparing Two Radiotherapy Schedules
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 28, 2017 (Actual)
Primary Completion Date
May 25, 2023 (Actual)
Study Completion Date
March 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Albert Einstein College of Medicine

4. Oversight

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

5. Study Description

Brief Summary
The primary objective of this study is to evaluate patient-reported outcomes during and after concurrent chemoradiotherapy for locally-advanced non-small cell lung cancer. Patients will be randomized to a standard 6-week radiotherapy course or a 4-week radiotherapy course using dose-painting based on pre-treatment PET findings.
Detailed Description
This study is open for patients with non-small cell lung cancer. This study offers such patients the chance for a shorter and more personalized treatment course utilizing PET imaging. Patients will be stratified based on performance status and tumor size and randomized to one of two treatment plans: PET-based, dose-painted, accelerated chemoradiotherapy over 4 weeks (20 radiotherapy fractions) Standard chemoradiotherapy over 6 weeks (30 radiotherapy fractions) All patients will receive standard weekly doses of chemotherapy (carboplatin and paclitaxel) during radiotherapy. This may be followed by adjuvant systemic therapy, at the discretion of the treating physicians. All patients will undergo standard evaluations prior to enrollment, during treatment, and after treatment. Additionally, patient-reported outcomes will be assessed periodically using a PRO-CTCAE tool.

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
radiation therapy, chemotherapy, PET Imaging

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
50 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Standard chemoradiotherapy
Arm Type
Active Comparator
Arm Description
Patients receiving standard radiotherapy will receive a total dose of 60 Gy in 30 fractions over 6 weeks, delivered to all involved lesions (tumors and lymph nodes).
Arm Title
PET-based, dose-painted, accelerated chemoradiotherapy,
Arm Type
Experimental
Arm Description
For patients receiving PET-based, dose-painted, accelerated chemoradiotherapy, lesions with MTV exceeding 20 cc will be treated with 55 Gy in 20 fractions over 4 weeks, while lesions with MTV below 20 cc will receive 44 Gy in 20 fractions over the same 4 weeks.
Intervention Type
Combination Product
Intervention Name(s)
PET-based, dose-painted, accelerated chemoradiotherapy
Intervention Description
Patients in this arm will receive a more personalized and shorter radiation therapy treatment course utilizing PET imaging.
Intervention Type
Combination Product
Intervention Name(s)
Standard chemoradiotherapy
Intervention Description
Patients in this arm will receive a standard radiotherapy course.
Primary Outcome Measure Information:
Title
PRO-CTCAE adverse events with score ≥ 3, observed 6 weeks after initiation of chemoradiotherapy
Time Frame
6 Weeks after initiation of Chemoradiation
Secondary Outcome Measure Information:
Title
Locoregional progression-free survival
Description
Lack of local disease progression based on repeat imaging
Time Frame
Weeks 19, 32 and 45 on study
Title
Progression-free survival
Description
Lack of any disease progression based on repeat imaging
Time Frame
Weeks 19, 32 and 45 on study
Title
Overall survival
Description
Follow ups will be maintained with study patients to determine survival status
Time Frame
From treatment start through 5 years post treatment
Title
Grade 3-5 adverse events, scored using CTCAE v. 4
Description
Evaluation of any side effects or toxicities using a standard grading system
Time Frame
From treatment start through study week 45
Title
PRO-CTCAE adverse events with score ≥ 3 at any time
Description
Evaluation of severe, patient reported side effects or toxicities
Time Frame
From treatment start through study week 45
Title
PRO-CTCAE adverse events with any score
Description
Evaluation of any patient reported side effects or toxicities
Time Frame
From treatment start through study week 45

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pathologically proven (either histologic or cytologic) diagnosis of NSCLC with any of the following stages (according to the AJCC Staging Manual, 7th edition, Appendix): Stage IIIA or IIIB Stage II NSCLC with contraindication to curative surgical resection Stage IV disease with solitary brain metastasis that has been treated radically (eg: with surgical resection and/or stereotactic radiosurgery) and thoracic disease that would be classified as stage II-III Appropriate diagnostic/staging workup, including: Complete history and physical examination PET/CT within 42 days prior to study entry demonstrating hypermetabolic pulmonary lesion(s) and/or thoracic lymph node(s). If PET/CT was obtained more than 42 days prior to study entry and is not repeated, chest CT within 28 days prior to study entry demonstrating stable disease is required. MRI of the brain or head CT with contrast within 42 days prior to study entry No prior chemotherapy or thoracic radiotherapy for lung cancer ECOG Performance Status 0-2 Age > 18 Able to read and write in one of the following languages, in which the PROCTCAE tool is available: English, Danish, German, Italian, Japanese, Korean, Spanish Laboratory studies obtained within 28 days prior to study entry demonstrating adequate bone marrow and end organ function Women of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to the start of study therapy, agree to utilize an adequate method of contraception throughout treatment and for at least 4 weeks after study therapy is completed,and be advised of the importance of avoiding pregnancy during trial participation and the potential risks of an unintentional pregnancy. All patients must sign study specific informed consent prior to study entry. Exclusion Criteria: Pleural or pericardial effusion (A patient with pleural effusion may be enrolled the effusion is sampled by thoracentesis and cytology is negative or the effusion is seen on axial imaging but not on chest x-ray and deemed too small to tap under CT or ultrasound guidance.) Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious) illness Women who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 4 weeks after cessation of study therapy have a positive pregnancy test at baseline are pregnant or breastfeeding Poorly controlled diabetes (defined as fasting glucose level > 200 mg/dL) despite attempts to improve glucose control by fasting duration and adjustment of medications. Patients with diabetes will preferably be scheduled for PET/CT imaging in the morning, and instructions for fasting and use of medications will be provided in consultation with the patients' primary physicians
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nitin Ohri, MD
Organizational Affiliation
Montefiore Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Montefiore Medical Center
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Patient-Reported Outcomes Following Chemoradiotherapy for Locally Advanced Non-small Cell Lung Cancer

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