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Intensified Chemo-immuno-radiotherapy With Durvalumab for Stage III Non-Small Cell Lung Cancers (PACIFIC BRAZIL)

Primary Purpose

Lung Neoplasms

Status
Active
Phase
Phase 2
Locations
Brazil
Study Type
Interventional
Intervention
Durvalumab
Sponsored by
Latin American Cooperative Oncology Group
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Neoplasms focused on measuring Stage III Non-Small Cell Lung Cancer, Unresectable Non-Small Cell Lung Cancer, Durvalumab, MEDI4736

Eligibility Criteria

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

INCLUSION CRITERIA

  1. Histologically or cytologically confirmed non-small cell lung cancer.
  2. Stage III according to the American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition.
  3. No prior systemic therapy, radiation therapy, or surgery for the current cancer.
  4. Age ≥ 18 years at time of study entry
  5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
  6. Body weight >30kg
  7. Pre- or post-bronchodilator forced expiratory volume 1 ≥ 1.2 litres/second or ≥ 50% of predicted value
  8. Adequate normal organ and marrow function

EXCLUSION CRITERIA

  1. Patients whose radiation treatment is likely to encompass a volume of whole lung receiving ≥ 20 Gy in total of more than 35% of lung volume.
  2. Patients whose radiation treatment is likely to deliver a cardiac dose V50 > 25%
  3. Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients
  4. Participation in another clinical study with an investigational product with anti-neoplastic activity during the last 3 weeks prior to treatment initiation
  5. Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study
  6. History of allogenic organ transplantation.
  7. Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria
  8. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab.
  9. Prior randomisation or treatment in a previous durvalumab clinical study regardless of treatment arm assignment.
  10. Patients who have received prior anti-PD-1, anti PD-L1 or anti CTLA-4 antibodies
  11. Receipt of live attenuated vaccine within 30 days prior to the first dose of investigational product.
  12. Prior radiation therapy to the region of the study cancer that would result in overlap of radiation therapy fields.
  13. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of the investigational product.
  14. Active or prior documented autoimmune or inflammatory disorders
  15. Uncontrolled intercurrent illness
  16. History of another primary malignancy
  17. Known active infection including tuberculosis , hepatitis B, hepatitis C, or human immunodeficiency virus.

Sites / Locations

  • Liga Norte Riograndense Contra o Câncer
  • CPO
  • INCA
  • COI Américas
  • Beneficiencia Portuguesa de São Paulo/Hospital São José
  • ICESP

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

DURVALUMAB (MEDI4736) + carboplatin-paclitaxel

Arm Description

Induction chemo-immunotherapy phase: Two cycles of Paclitaxel 200 mg/m2, Carboplatin AUC 6 and Durvalumab 1500 mg intravenously every 21 days. Concurrent chemo-immuno-radiotherapy phase: Radiation therapy concomitantly with: paclitaxel 50 mg/m2 intravenously every 7 days (+/- 3 days) until completion of radiation therapy, carboplatin AUC 2 intravenously every 7 days (+/- 3 days) until completion of radiation therapy and durvalumab 1500 mg intravenously every 21 days (+/- 6 days) for a maximum of 2 doses. Concurrent chemo-immuno-radiotherapy: Durvalumab 1500 mg intravenously every 28 days (+/- 7 days) for a maximum of 12 doses

Outcomes

Primary Outcome Measures

12 months Progression-Free Survival
Proportion of patients who are alive and progression-free 12 months after cycle 1, day 1 of induction treatment, estimated by the Kaplan-Maier method and using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.

Secondary Outcome Measures

Overall Survival (OS)
Time from cycle 1, day 1 of induction treatment until death due to any cause.
Overall response rate to induction treatment
The proportion of patients with at least one tumor scan of complete response (CR) or partial response (PR) using RECIST v1.1.
Patterns of Failure
Rate of disease failure in local, regional and distant sites

Full Information

First Posted
January 10, 2020
Last Updated
October 3, 2023
Sponsor
Latin American Cooperative Oncology Group
Collaborators
AstraZeneca, Libbs Farmacêutica LTDA
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1. Study Identification

Unique Protocol Identification Number
NCT04230408
Brief Title
Intensified Chemo-immuno-radiotherapy With Durvalumab for Stage III Non-Small Cell Lung Cancers
Acronym
PACIFIC BRAZIL
Official Title
Intensified Chemo-immuno-radiotherapy With Durvalumab (MEDI4736) for Stage III Non-Small Cell Lung Cancers (NSCLCs): a Brazilian Single Arm Phase II Study (PACIFIC BRAZIL)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 5, 2021 (Actual)
Primary Completion Date
September 2, 2024 (Anticipated)
Study Completion Date
December 19, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Latin American Cooperative Oncology Group
Collaborators
AstraZeneca, Libbs Farmacêutica LTDA

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
This is a phase II study that will assess if Durvalumab (MEDI4736) used as induction chemo-immunotherapy followed by concurrent chemo-immuno-radiotherapy and consolidation immunotherapy may improve oncologic outcomes compared with standard of care chemoradiation followed by durvalumab (as in the PACIFIC trial) with a reasonable safety profile.
Detailed Description
Prospective, non-randomized, open label, single arm, multi-institutional, phase 2 study, including patients with stage III non-small cell lung cancer able to receive concurrent chemoradiation. Eligible patients will then receive treatment as follows: Induction chemo-immunotherapy Two 21-day cycles of carboplatin, paclitaxel and durvalumab will be given BEFORE concurrent chemo-immuno-radiotherapy. Thereafter, patients without progressive disease (or patients with disease progression that is still locally advanced and can be safely encompassed within tolerable radiation fields) will receive concurrent chemo-immuno-radiotherapy, as follows: Concurrent chemo-immuno-radiotherapy Concurrent carboplatin, paclitaxel, and durvalumab with radiation therapy, initiated preferably 3-5 weeks after the last dose of induction chemo-immunotherapy. Thereafter, patients without progressive disease will receive consolidation immunotherapy, as follows: Consolidation immunotherapy Twelve 28-day cycles of durvalumab will be given, initiated preferably within one week following concurrent chemo-immuno-radiotherapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Neoplasms
Keywords
Stage III Non-Small Cell Lung Cancer, Unresectable Non-Small Cell Lung Cancer, Durvalumab, MEDI4736

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Prospective single-arm study
Masking
None (Open Label)
Allocation
N/A
Enrollment
48 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
DURVALUMAB (MEDI4736) + carboplatin-paclitaxel
Arm Type
Experimental
Arm Description
Induction chemo-immunotherapy phase: Two cycles of Paclitaxel 200 mg/m2, Carboplatin AUC 6 and Durvalumab 1500 mg intravenously every 21 days. Concurrent chemo-immuno-radiotherapy phase: Radiation therapy concomitantly with: paclitaxel 50 mg/m2 intravenously every 7 days (+/- 3 days) until completion of radiation therapy, carboplatin AUC 2 intravenously every 7 days (+/- 3 days) until completion of radiation therapy and durvalumab 1500 mg intravenously every 21 days (+/- 6 days) for a maximum of 2 doses. Concurrent chemo-immuno-radiotherapy: Durvalumab 1500 mg intravenously every 28 days (+/- 7 days) for a maximum of 12 doses
Intervention Type
Drug
Intervention Name(s)
Durvalumab
Other Intervention Name(s)
Carboplatin, Paclitaxel
Intervention Description
Intensified chemo-immuno-radiotherapy with durvalumab in combination with carboplatin, paclitaxel and radiation
Primary Outcome Measure Information:
Title
12 months Progression-Free Survival
Description
Proportion of patients who are alive and progression-free 12 months after cycle 1, day 1 of induction treatment, estimated by the Kaplan-Maier method and using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.
Time Frame
Tumor scans will be performed at baseline, after the induction and concomitant phases and 3, 6, 9, and 12 months after the last dose of radiation therapy.
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
Time from cycle 1, day 1 of induction treatment until death due to any cause.
Time Frame
OS will be evaluated until month 24 after C1D1.
Title
Overall response rate to induction treatment
Description
The proportion of patients with at least one tumor scan of complete response (CR) or partial response (PR) using RECIST v1.1.
Time Frame
Tumor scans will be performed at baseline, after the induction and concomitant phases and 3, 6, 9, and 12 months after the last dose of radiation therapy.
Title
Patterns of Failure
Description
Rate of disease failure in local, regional and distant sites
Time Frame
Tumor scans will be performed at baseline, after the induction and concomitant phases and 3, 6, 9, and 12 months after the last dose of radiation therapy.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA Histologically or cytologically confirmed non-small cell lung cancer. Stage III according to the American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition. No prior systemic therapy, radiation therapy, or surgery for the current cancer. Age ≥ 18 years at time of study entry Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 Body weight >30kg Pre- or post-bronchodilator forced expiratory volume 1 ≥ 1.2 litres/second or ≥ 50% of predicted value Adequate normal organ and marrow function EXCLUSION CRITERIA Patients whose radiation treatment is likely to encompass a volume of whole lung receiving ≥ 20 Gy in total of more than 35% of lung volume. Patients whose radiation treatment is likely to deliver a cardiac dose V50 > 25% Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients Participation in another clinical study with an investigational product with anti-neoplastic activity during the last 3 weeks prior to treatment initiation Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study History of allogenic organ transplantation. Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab. Prior randomisation or treatment in a previous durvalumab clinical study regardless of treatment arm assignment. Patients who have received prior anti-PD-1, anti PD-L1 or anti CTLA-4 antibodies Receipt of live attenuated vaccine within 30 days prior to the first dose of investigational product. Prior radiation therapy to the region of the study cancer that would result in overlap of radiation therapy fields. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of the investigational product. Active or prior documented autoimmune or inflammatory disorders Uncontrolled intercurrent illness History of another primary malignancy Known active infection including tuberculosis , hepatitis B, hepatitis C, or human immunodeficiency virus.
Facility Information:
Facility Name
Liga Norte Riograndense Contra o Câncer
City
Natal
State/Province
Rio Grande Do Norte
ZIP/Postal Code
59075-740
Country
Brazil
Facility Name
CPO
City
Porto Alegre
State/Province
Rio Grande Do Sul
Country
Brazil
Facility Name
INCA
City
Rio De Janeiro
State/Province
RJ
Country
Brazil
Facility Name
COI Américas
City
Rio De Janeiro
Country
Brazil
Facility Name
Beneficiencia Portuguesa de São Paulo/Hospital São José
City
São Paulo
Country
Brazil
Facility Name
ICESP
City
São Paulo
Country
Brazil

12. IPD Sharing Statement

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Intensified Chemo-immuno-radiotherapy With Durvalumab for Stage III Non-Small Cell Lung Cancers

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