search
Back to results

Best Supportive Care With or Without Low Dose Whole Lung Radiation Therapy for the Treatment of COVID-19 (RESCUE1-19)

Primary Purpose

Pneumonia, Severe Acute Respiratory Syndrome, Symptomatic COVID-19 Infection Laboratory-Confirmed

Status
Active
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Best Practice
Low Dose Radiation Therapy
Sponsored by
Emory University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pneumonia focused on measuring Radiotherapy, COVID-19, low dose radiotherapy, anti-inflammatory, cytokine storm

Eligibility Criteria

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

Inclusion Criteria:

  • Be age 50 or over; Not pregnant (will undergo pregnancy testing if below age 55);
  • Have had a positive PCR-based test confirming the diagnosis of COVID-19 within 5 days (+/-2 day)of study enrollment*
  • Have had clinical signs of severe acute respiratory syndrome or pneumonia (ie. dyspnea, cough,fever) that primary team feels like patient needs rescuing with LD-RT.**
  • Have visible bilateral consolidations/ground glass opacities on chest imaging
  • Require supplemental oxygen at the time of enrollment, defined by inability to wean from supplemental oxygen within 24 hours prior to enrollment.
  • Not require intubation within 12 hours of randomization (ie, not screen fail). Intubation after enrollment but within 12 hours of randomization will be defined as a screen failure for both the LD-RT and control cohorts.
  • Be enrolled within 5 days (+/- 2) of first hospitalization for COVID-19. Prior hospitalization for COVID-19 will be an exclusion criteria (prior ED visits are permissible).
  • Willingness and ability of the subject to comply with scheduled visits, protocol-specified laboratory tests, other study procedures, and study restrictions
  • Evidence of a signed informed consent/assent indicating that the subject is aware of the infectious nature of the disease and has been informed of the procedures to be followed, potential risks and discomforts, potential benefits, and other pertinent aspects of study participation

Exclusion Criteria:

  • Pregnant and/or planned to be pregnant within in next 6 months
  • Age 49 or younger at time of enrollment
  • Prior inpatient hospitalization for COVID-19 (prior emergency department [ED] visits are not an exclusion criteria)
  • Prior enrollment on a separate COVID-19-related therapeutric trial (subsequent co-enrollment is permitted for patinets randomized to the control arm).
  • Notably, concurrent use of COVID-directed therapies is no longer an exclusion criteria for this trial. This includes azithromycin, dexamethasone, remdesevir, convalescent plasma, or any other COVIDdirected drug therapy.

Sites / Locations

  • Emory University Hospital/Winship Cancer Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Arm I (physician choice)

Arm II (LDRT)

Arm Description

Patients get best supportive care + physician choice of treatment

Patients receive best supportive care + low dose RT (whole lung)

Outcomes

Primary Outcome Measures

Time to clinical recovery
Will be measured by improvements on oxygenation need prior to intervention compared with after intervention and/or hospital discharge.

Secondary Outcome Measures

Freedom from ICU admission
The rates from both cohort will be reported.
Temperature
Temperature in degrees (F)
Heart rate
Heart rate in beats per minutes
Systolic Blood pressure
Systolic blood pressure in mm Hg
Oxygen saturation
Oxygen saturation in percentage
Supplemental oxygenation need
Oxygen saturation in percentage
Respiratory rate
Respiratory rate in breaths per minute.
Glasgow Comma Scale from minimum of 3 to maximum of 15.
Pre and post intervention; Minimum of 3 (poor) to best (15)
Performance status
Easter Cooperative Oncology Group (ECOG) Performance Status Scale from 0-5; 0 being best; 5 being dead;
Survival
Survival in percentage
Serial chest x-rays severe acute respiratory syndrome (SARS) scoring
Serial chest x-rays categorized using published scale into ordinal ranks 1-5 for SARS.
Changes on computed tomography (CT) scans pre and post RT
CT scans with volume of consolidation measured in cubic centimeters.
CRP
C-Reactive Protein in mg/L
Serum chemistry + complete blood cell (CBC) with differential
Will be summarized descriptively.
Blood gases pH(when available)
pH (no unit)
Albumin
Albumin in gm/dL
Procalcitonin
Procalcitonin in ng/mL
Aspartate aminotransferase (AST)
Asparatate Aminotransferase in units/L
Creatine kinase
Creatinine in mg/dL
Prothrombin time (PT)/partial thromboplastin time (PTT)
Coagulation pathway time in seconds
Troponin
Troponin-I in ng/mL
Lactate
Lactic Acid in mmol/L
NT-pBNP (cardiac injury)
B-Natriuretic Peptid in pg/mL
Gamma-glutamyl transferase (GGT)
Gamma-glutamyl transferase in units/L
Triglycerides
Trygliciericdes in mg/dL
Fibrinogen
Fibrinogen in mg/dL
Changes in CD8 T cells
Will be summarized descriptively.
Changes in CD4 T cells
Will be summarized descriptively.
Changes in serum antibodies against COVID-19 epitope
Will be summarized descriptively.
LDH
Lactate Dehydrogenase in units/L
D-Dimer
D-Dimer in ng/mL
IL-6
Interleukin-6 in pg/mL
Myoglobin
Myoglobin in ng/mL
Potassium
Potassium in mmol/L
Ferritin
Ferritin in ng/mL
ALT
Alanine Aminotransferase in units/L

Full Information

First Posted
June 12, 2020
Last Updated
August 8, 2023
Sponsor
Emory University
Collaborators
National Cancer Institute (NCI)
search

1. Study Identification

Unique Protocol Identification Number
NCT04433949
Brief Title
Best Supportive Care With or Without Low Dose Whole Lung Radiation Therapy for the Treatment of COVID-19
Acronym
RESCUE1-19
Official Title
Radiation Eliminates Storming Cytokines and Unchecked Edema as a 1-Day Treatment for COVID-19 (RESCUE 1-19): A Randomized Phase III Trial of Best Supportive Care Plus Provider's Choice of Pharmaceutical Treatment With or Without Whole Lung Low-Dose Radiation Therapy (LD-RT) in Hospitalized Patients With COVID-19
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
June 23, 2020 (Actual)
Primary Completion Date
October 19, 2022 (Actual)
Study Completion Date
May 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Emory University
Collaborators
National Cancer Institute (NCI)

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
This phase III trial compares low dose whole lung radiation therapy to best supportive care plus physicians choice in treating patients with COVID-19 infection. Low dose whole lung radiation therapy may work better than the current best supportive care and physician's choice in improving patients' clinical status, the radiographic appearance of their lungs, or their laboratory blood tests.
Detailed Description
PRIMARY OBJECTIVE: I. Intubation-free survival (IFS) and (2) time to clinical recovery (TTCR) based on weaning off supplementary oxygenation or hospital discharge in COVID 19 patients. SECONDARY OBJECTIVES: I. To investigate (1) other clinical, (2) radiographic, (3) serologic markers, and (4) immune marker response to best supportive care plus provider's choice of pharmaceutical treatment either with or without whole-lung LD-RT II. Secondary clinical improvements will look at time to hospital discharge, prevention of ICU admissions, and overall survival. OUTLINE: Patients are blindly randomized to 1 of 2 arms. ARM I: Patients receive best supportive care plus physician choice of treatment ARM II: Patients receive best supportive care plus LDRT (experimental arm). After completion of study, patients are followed up for 14 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pneumonia, Severe Acute Respiratory Syndrome, Symptomatic COVID-19 Infection Laboratory-Confirmed
Keywords
Radiotherapy, COVID-19, low dose radiotherapy, anti-inflammatory, cytokine storm

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
14 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I (physician choice)
Arm Type
Active Comparator
Arm Description
Patients get best supportive care + physician choice of treatment
Arm Title
Arm II (LDRT)
Arm Type
Experimental
Arm Description
Patients receive best supportive care + low dose RT (whole lung)
Intervention Type
Other
Intervention Name(s)
Best Practice
Other Intervention Name(s)
standard of care, standard therapy
Intervention Description
Receive standard of care
Intervention Type
Radiation
Intervention Name(s)
Low Dose Radiation Therapy
Other Intervention Name(s)
Low Dose Radiation
Intervention Description
Undergo LDRT
Primary Outcome Measure Information:
Title
Time to clinical recovery
Description
Will be measured by improvements on oxygenation need prior to intervention compared with after intervention and/or hospital discharge.
Time Frame
Up to follow-up day 14 after study start
Secondary Outcome Measure Information:
Title
Freedom from ICU admission
Description
The rates from both cohort will be reported.
Time Frame
Up to follow-up day 14 after study start; This may be extended up to 28 days after preplanned interim analysis.
Title
Temperature
Description
Temperature in degrees (F)
Time Frame
Up to follow-up day 14 after study start
Title
Heart rate
Description
Heart rate in beats per minutes
Time Frame
Up to follow-up day 14 after study start
Title
Systolic Blood pressure
Description
Systolic blood pressure in mm Hg
Time Frame
Up to follow-up day 14 after study start
Title
Oxygen saturation
Description
Oxygen saturation in percentage
Time Frame
Up to follow-up day 14 after study start
Title
Supplemental oxygenation need
Description
Oxygen saturation in percentage
Time Frame
Up to follow-up day 14 after study start
Title
Respiratory rate
Description
Respiratory rate in breaths per minute.
Time Frame
Up to follow-up day 14 after study start
Title
Glasgow Comma Scale from minimum of 3 to maximum of 15.
Description
Pre and post intervention; Minimum of 3 (poor) to best (15)
Time Frame
Up to follow-up day 14 after study start
Title
Performance status
Description
Easter Cooperative Oncology Group (ECOG) Performance Status Scale from 0-5; 0 being best; 5 being dead;
Time Frame
Up to follow-up day 14 after study start
Title
Survival
Description
Survival in percentage
Time Frame
Up to follow-up day 14 after study start; This may be extended to 28 days after preplanned interim analysis.
Title
Serial chest x-rays severe acute respiratory syndrome (SARS) scoring
Description
Serial chest x-rays categorized using published scale into ordinal ranks 1-5 for SARS.
Time Frame
Up to follow-up day 14 after study start;
Title
Changes on computed tomography (CT) scans pre and post RT
Description
CT scans with volume of consolidation measured in cubic centimeters.
Time Frame
Baseline up to follow-up day 14 after study start
Title
CRP
Description
C-Reactive Protein in mg/L
Time Frame
Up to follow-up day 14 after study start
Title
Serum chemistry + complete blood cell (CBC) with differential
Description
Will be summarized descriptively.
Time Frame
Up to follow-up day 14 after study start
Title
Blood gases pH(when available)
Description
pH (no unit)
Time Frame
Up to follow-up day 14 after study start
Title
Albumin
Description
Albumin in gm/dL
Time Frame
Up to follow-up day 14 after study start
Title
Procalcitonin
Description
Procalcitonin in ng/mL
Time Frame
Up to follow-up day 14 after study start
Title
Aspartate aminotransferase (AST)
Description
Asparatate Aminotransferase in units/L
Time Frame
Up to follow-up day 14 after study start
Title
Creatine kinase
Description
Creatinine in mg/dL
Time Frame
Up to follow-up day 14 after study start
Title
Prothrombin time (PT)/partial thromboplastin time (PTT)
Description
Coagulation pathway time in seconds
Time Frame
Up to follow-up day 14 after study start
Title
Troponin
Description
Troponin-I in ng/mL
Time Frame
Up to follow-up day 14 after study start
Title
Lactate
Description
Lactic Acid in mmol/L
Time Frame
Up to follow-up day 14 after study start
Title
NT-pBNP (cardiac injury)
Description
B-Natriuretic Peptid in pg/mL
Time Frame
Up to follow-up day 14 after study start
Title
Gamma-glutamyl transferase (GGT)
Description
Gamma-glutamyl transferase in units/L
Time Frame
Up to follow-up day 14 after study start
Title
Triglycerides
Description
Trygliciericdes in mg/dL
Time Frame
Up to follow-up day 14 after study start
Title
Fibrinogen
Description
Fibrinogen in mg/dL
Time Frame
Up to follow-up day 14 after study start
Title
Changes in CD8 T cells
Description
Will be summarized descriptively.
Time Frame
Up to follow-up day 14 after study start
Title
Changes in CD4 T cells
Description
Will be summarized descriptively.
Time Frame
Up to follow-up day 14 after study start
Title
Changes in serum antibodies against COVID-19 epitope
Description
Will be summarized descriptively.
Time Frame
Up to follow-up day 14 after study start
Title
LDH
Description
Lactate Dehydrogenase in units/L
Time Frame
Up to follow-up day 14 after study start
Title
D-Dimer
Description
D-Dimer in ng/mL
Time Frame
Up to follow-up day 14 after study start
Title
IL-6
Description
Interleukin-6 in pg/mL
Time Frame
Up to follow-up day 14 after study start
Title
Myoglobin
Description
Myoglobin in ng/mL
Time Frame
Up to follow-up day 14 after study start
Title
Potassium
Description
Potassium in mmol/L
Time Frame
Up to follow-up day 14 after study start
Title
Ferritin
Description
Ferritin in ng/mL
Time Frame
Up to follow-up day 14 after study start
Title
ALT
Description
Alanine Aminotransferase in units/L
Time Frame
Up to follow-up day 14 after study start

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be age 50 or over; Not pregnant (will undergo pregnancy testing if below age 55); Have had a positive PCR-based test confirming the diagnosis of COVID-19 within 5 days (+/-2 day)of study enrollment* Have had clinical signs of severe acute respiratory syndrome or pneumonia (ie. dyspnea, cough,fever) that primary team feels like patient needs rescuing with LD-RT.** Have visible bilateral consolidations/ground glass opacities on chest imaging Require supplemental oxygen at the time of enrollment, defined by inability to wean from supplemental oxygen within 24 hours prior to enrollment. Not require intubation within 12 hours of randomization (ie, not screen fail). Intubation after enrollment but within 12 hours of randomization will be defined as a screen failure for both the LD-RT and control cohorts. Be enrolled within 5 days (+/- 2) of first hospitalization for COVID-19. Prior hospitalization for COVID-19 will be an exclusion criteria (prior ED visits are permissible). Willingness and ability of the subject to comply with scheduled visits, protocol-specified laboratory tests, other study procedures, and study restrictions Evidence of a signed informed consent/assent indicating that the subject is aware of the infectious nature of the disease and has been informed of the procedures to be followed, potential risks and discomforts, potential benefits, and other pertinent aspects of study participation Exclusion Criteria: Pregnant and/or planned to be pregnant within in next 6 months Age 49 or younger at time of enrollment Prior inpatient hospitalization for COVID-19 (prior emergency department [ED] visits are not an exclusion criteria) Prior enrollment on a separate COVID-19-related therapeutric trial (subsequent co-enrollment is permitted for patinets randomized to the control arm). Notably, concurrent use of COVID-directed therapies is no longer an exclusion criteria for this trial. This includes azithromycin, dexamethasone, remdesevir, convalescent plasma, or any other COVIDdirected drug therapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mohammad K Khan, MD, PhD
Organizational Affiliation
Emory University Hospital/Winship Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Emory University Hospital/Winship Cancer Institute
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Results of the trial and not individual patient data will be shared. The study protocol, consent, and investigator's brochure will be available. The statistical plan is incorporated into the protocol, along with inclusion and exclusion criteria.
Citations:
PubMed Identifier
32373721
Citation
Lara PC, Burgos J, Macias D. Low dose lung radiotherapy for COVID-19 pneumonia. The rationale for a cost-effective anti-inflammatory treatment. Clin Transl Radiat Oncol. 2020 Apr 25;23:27-29. doi: 10.1016/j.ctro.2020.04.006. eCollection 2020 Jul.
Results Reference
background
PubMed Identifier
32437820
Citation
Dhawan G, Kapoor R, Dhawan R, Singh R, Monga B, Giordano J, Calabrese EJ. Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS). Radiother Oncol. 2020 Jun;147:212-216. doi: 10.1016/j.radonc.2020.05.002. Epub 2020 May 8.
Results Reference
background
Links:
URL
https://www.medrxiv.org/content/10.1101/2020.06.03.20116988v1
Description
Interim Results from the phase 1, 2 pilot safety trial of LD-RT for COVID
URL
https://www.forbes.com/sites/jamesconca/2020/06/12/1st-human-trial-successfully-treated-covid-19-using-low-doses-of-radiation/#34a56312dc69
Description
Article on Forbes

Learn more about this trial

Best Supportive Care With or Without Low Dose Whole Lung Radiation Therapy for the Treatment of COVID-19

We'll reach out to this number within 24 hrs