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Durvalumab Followed by Chemoradiation and Consolidation Durvalumab for Stage III Non-small Cell Lung Cancer

Primary Purpose

Lung Cancer, Non-small Cell Carcinoma

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Induction Durvalumab
Chemotherapy
Radiation
Consolidation durvalumab
Sponsored by
Rachel Sanborn
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Written informed consent and HIPAA authorization for release of personal health information prior to registration. NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
  • Age ≥ 18 years at the time of consent.
  • ECOG Performance Status of 0 or 1.
  • Histological or cytological confirmation of stage III non-small cell lung cancer per AJCC, 8th edition, eligible for curative-intent concurrent chemoradiation. NOTE: subjects are not candidates for surgical resection either due to medical inoperability or surgically unresectable disease.
  • Measurable disease according to RECIST 1.1 criteria.
  • Plan for treatment with concurrent chemoradiation with a dose of radiation ranging from 54-66 Gy:

    • Planned mean dose delivery to the lung <20 Gy
    • V20 <35%
  • No prior therapy for stage III NSCLC.
  • Demonstrate adequate organ function as defined in the protocol. All screening labs to be obtained within 14 days prior to registration.
  • Females of childbearing potential must have a negative serum pregnancy test within 24 hours of C1D1. NOTE: Females are considered of child bearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months.
  • Females of childbearing potential must be willing to abstain from heterosexual intercourse or to use contraception as outlined in the protocol.
  • Men who are sexually active with WOCBP must be willing to abstain from heterosexual intercourse or to use contraception as outlined in the protocol.
  • Life expectancy of at least 12 weeks per investigator discretion.
  • As determined by the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study.

Exclusion Criteria

Subjects meeting any of the criteria below may not participate in the study:

  • Prior therapy for stage III NSCLC
  • Mixed histology with small cell lung cancer will not be allowed.
  • Sequential chemoradiation will not be permitted.
  • Induction and consolidation chemotherapy (separate from concurrent chemoradiation) will not be allowed.
  • Prior exposure to anti-PD-1 or anti-PD-L1 antibodies including durvalumab.
  • Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab. The following are exceptions to this criterion:

    • Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection)
    • Systemic corticosteroids at physiologic doses not to exceed <<10 mg/day>> of prednisone or its equivalent
    • Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication)
  • History of pulmonary fibrosis, interstitial lung disease, or pneumonitis requiring steroids.
  • Active or prior documented autoimmune disease within the last 2 years. Patients with vitiligo, stable hypothyroidism, Grave's disease, or psoriasis not requiring systemic treatment are not excluded.
  • Body weight < 30 kg
  • Active and ongoing steroid use, except for non-systemically absorbed treatments (such as inhaled or topical steroid therapy for asthma, COPD, allergic rhinitis).
  • Active infection requiring systemic therapy.
  • Uncontrolled current illness that in the opinion of the investigator renders the investigational treatment plan unsafe.
  • Receipt of live attenuated vaccine within 30 days prior to the first dose of IP. Note: Patients, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP.
  • Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of IP. NOTE: Local surgery of isolated lesions for palliative intent is acceptable.
  • Active other malignancy; exceptions include basal cell or squamous cell skin cancer, in situ cervical or bladder cancer.
  • Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
  • Treatment with any investigational drug within 30 days prior to registration.
  • History of organ transplantation (including allogeneic stem cell transplantation).
  • Other medical or psychiatric conditions that in the opinion of the site investigator would preclude safe participation in this protocol.

Eligibility Criteria for Consolidation Durvalumab

  • Patients must have recovered from toxicities associated with prior chemoradiation to CTCAE < Grade 2.
  • Patients must not have progressed following chemoradiation therapy, as measured on imaging per RECIST 1.1.
  • Confirmation of ECOG Performance Status of 0 or 1.
  • Any grade pneumonitis from prior chemoradiation will not be permitted.

Sites / Locations

  • Rush University Medical Center
  • Cancer Center of Kansas
  • HealthPartners Institute
  • Summit Medical Group, P. A.
  • Providence Portland Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Induction durvalumab, chemoradiation, consolidation durvalumab

Arm Description

Induction durvalumab at 1500 mg intravenously (IV) on Day 1 of a four week cycle for 1 cycle, followed by concurrent definitive chemoradiation, followed by consolidation durvalumab at 1500 mg IV Day 1 of every 4 week cycle for up to 12 cycles.

Outcomes

Primary Outcome Measures

Progression Free Survival (PFS)
12-month progression-free survival will be measured using imaging after completion of chemoradiation, prior to C1 consolidation durvalumab (1-42 days after completion of chemoradiation). This will be compared with PACIFIC trial 12-month progression-free survival as historical control.
Assess the frequency and severity of adverse events
Toxicity will be measured by the NCI Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.

Secondary Outcome Measures

Objective Response Rate (ORR)
ORR will be measured using two timepoints, per RECIST 1.1. "ORR1" will be assessed using baseline imaging in comparison to imaging obtained after completion of induction durvalumab and chemoradiation. "ORR2" will be assessed using imaging after completion of induction durvalumab and chemoradiation in comparison to imaging obtained while receiving, and after completion of, consolidation durvalumab.

Full Information

First Posted
April 24, 2020
Last Updated
June 22, 2023
Sponsor
Rachel Sanborn
Collaborators
AstraZeneca, Providence Cancer Center, Earle A. Chiles Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT04364048
Brief Title
Durvalumab Followed by Chemoradiation and Consolidation Durvalumab for Stage III Non-small Cell Lung Cancer
Official Title
Induction Durvalumab Followed by Chemoradiation and Consolidation Durvalumab (MEDI4736) for Stage III Non-small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
June 18, 2020 (Actual)
Primary Completion Date
October 2023 (Anticipated)
Study Completion Date
November 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Rachel Sanborn
Collaborators
AstraZeneca, Providence Cancer Center, Earle A. Chiles Research Institute

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Single arm study of induction durvalumab (1500 mg IV) for 1 cycle (every 4 weeks), administered prior to starting concurrent definitive chemoradiation, followed by consolidation durvalumab (1500 mg IV every 4 weeks) for up to 12 cycles. The study will include an initial safety run-in portion. Patients in the safety run-in will be monitored through completion of induction durvalumab, chemoradiation, and 2 cycles of consolidation durvalumab for assessment of safety prior to completion of enrollment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer, Non-small Cell Carcinoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Induction durvalumab, chemoradiation, consolidation durvalumab
Arm Type
Experimental
Arm Description
Induction durvalumab at 1500 mg intravenously (IV) on Day 1 of a four week cycle for 1 cycle, followed by concurrent definitive chemoradiation, followed by consolidation durvalumab at 1500 mg IV Day 1 of every 4 week cycle for up to 12 cycles.
Intervention Type
Drug
Intervention Name(s)
Induction Durvalumab
Other Intervention Name(s)
IMFINZI
Intervention Description
Induction durvalumab at 1500 mg intravenously (IV) will be given on Day 1 of a four week cycle for 1 cycle,
Intervention Type
Drug
Intervention Name(s)
Chemotherapy
Other Intervention Name(s)
cisplatin, carboplatin, etoposide, pemetrexed, taxane
Intervention Description
Concurrent chemoradiation will be with platinum-based chemotherapy (cisplatin or carboplatin, with etoposide, taxane, or pemetrexed) selected at the treating physician's discretion. The chemotherapy regimen used should be administered per institutional standards following the prescribing guidelines for each drug
Intervention Type
Radiation
Intervention Name(s)
Radiation
Intervention Description
Treatment will be delivered using IMRT or 3DCRT using typically 6-10MV photons per institutional standards. 4D simulation and appropriate IGRT are encouraged. Radiation therapy must begin within one week of the first day of chemotherapy (or vice versa). Therapy will be 1.8-2 Gy per day; 5 days per week, excluding holidays per institutional standard as this is a standard of care regimen for this patient population. 54-66 Gy will be delivered.
Intervention Type
Drug
Intervention Name(s)
Consolidation durvalumab
Other Intervention Name(s)
IMFINZI
Intervention Description
Durvalumab at 1500 mg intravenously (IV) will be given on Day 1 of a four week cycle for 12 cycles
Primary Outcome Measure Information:
Title
Progression Free Survival (PFS)
Description
12-month progression-free survival will be measured using imaging after completion of chemoradiation, prior to C1 consolidation durvalumab (1-42 days after completion of chemoradiation). This will be compared with PACIFIC trial 12-month progression-free survival as historical control.
Time Frame
12 months
Title
Assess the frequency and severity of adverse events
Description
Toxicity will be measured by the NCI Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Objective Response Rate (ORR)
Description
ORR will be measured using two timepoints, per RECIST 1.1. "ORR1" will be assessed using baseline imaging in comparison to imaging obtained after completion of induction durvalumab and chemoradiation. "ORR2" will be assessed using imaging after completion of induction durvalumab and chemoradiation in comparison to imaging obtained while receiving, and after completion of, consolidation durvalumab.
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent and HIPAA authorization for release of personal health information prior to registration. NOTE: HIPAA authorization may be included in the informed consent or obtained separately. Age ≥ 18 years at the time of consent. ECOG Performance Status of 0 or 1. Histological or cytological confirmation of stage III non-small cell lung cancer per AJCC, 8th edition, eligible for curative-intent concurrent chemoradiation. NOTE: subjects are not candidates for surgical resection either due to medical inoperability or surgically unresectable disease. Measurable disease according to RECIST 1.1 criteria. Plan for treatment with concurrent chemoradiation with a dose of radiation ranging from 54-66 Gy: Planned mean dose delivery to the lung <20 Gy V20 <35% No prior therapy for stage III NSCLC. Demonstrate adequate organ function as defined in the protocol. All screening labs to be obtained within 14 days prior to registration. Females of childbearing potential must have a negative serum pregnancy test within 24 hours of C1D1. NOTE: Females are considered of child bearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months. Females of childbearing potential must be willing to abstain from heterosexual intercourse or to use contraception as outlined in the protocol. Men who are sexually active with WOCBP must be willing to abstain from heterosexual intercourse or to use contraception as outlined in the protocol. Life expectancy of at least 12 weeks per investigator discretion. As determined by the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study. Exclusion Criteria Subjects meeting any of the criteria below may not participate in the study: Prior therapy for stage III NSCLC Mixed histology with small cell lung cancer will not be allowed. Sequential chemoradiation will not be permitted. Induction and consolidation chemotherapy (separate from concurrent chemoradiation) will not be allowed. Prior exposure to anti-PD-1 or anti-PD-L1 antibodies including durvalumab. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab. The following are exceptions to this criterion: Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection) Systemic corticosteroids at physiologic doses not to exceed <<10 mg/day>> of prednisone or its equivalent Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication) History of pulmonary fibrosis, interstitial lung disease, or pneumonitis requiring steroids. Active or prior documented autoimmune disease within the last 2 years. Patients with vitiligo, stable hypothyroidism, Grave's disease, or psoriasis not requiring systemic treatment are not excluded. Body weight < 30 kg Active and ongoing steroid use, except for non-systemically absorbed treatments (such as inhaled or topical steroid therapy for asthma, COPD, allergic rhinitis). Active infection requiring systemic therapy. Uncontrolled current illness that in the opinion of the investigator renders the investigational treatment plan unsafe. Receipt of live attenuated vaccine within 30 days prior to the first dose of IP. Note: Patients, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of IP. NOTE: Local surgery of isolated lesions for palliative intent is acceptable. Active other malignancy; exceptions include basal cell or squamous cell skin cancer, in situ cervical or bladder cancer. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA. Treatment with any investigational drug within 30 days prior to registration. History of organ transplantation (including allogeneic stem cell transplantation). Other medical or psychiatric conditions that in the opinion of the site investigator would preclude safe participation in this protocol. Eligibility Criteria for Consolidation Durvalumab Patients must have recovered from toxicities associated with prior chemoradiation to CTCAE < Grade 2. Patients must not have progressed following chemoradiation therapy, as measured on imaging per RECIST 1.1. Confirmation of ECOG Performance Status of 0 or 1. Any grade pneumonitis from prior chemoradiation will not be permitted.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rachel Sanborn, MD
Organizational Affiliation
Providence Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rush University Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Cancer Center of Kansas
City
Wichita
State/Province
Kansas
ZIP/Postal Code
67214
Country
United States
Facility Name
HealthPartners Institute
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55440
Country
United States
Facility Name
Summit Medical Group, P. A.
City
Berkeley Heights
State/Province
New Jersey
ZIP/Postal Code
07922
Country
United States
Facility Name
Providence Portland Medical Center
City
Portland
State/Province
Oregon
ZIP/Postal Code
97213
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Durvalumab Followed by Chemoradiation and Consolidation Durvalumab for Stage III Non-small Cell Lung Cancer

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