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Liver SBRT in Combination With Immune Checkpoint Inhibition in Patients With Metastatic Non-small Cell Lung Cancer

Primary Purpose

Liver Metastases, Non-small Cell Lung Cancer

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Liver SBRT
Pembrolizumab
Sponsored by
VA Ann Arbor Healthcare System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Liver Metastases

Eligibility Criteria

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

Inclusion Criteria:

  • Adult patients (≥18 years of age)
  • Histologically or cytologically confirmed NSCLC with liver metastases
  • Eligible for immune checkpoint inhibitors per treating medical oncologist
  • Disease must be measurable per RECIST criteria
  • ECOG Performance status of 0 - 2
  • Adequate organ function per protocol.
  • Allowable prior therapy includes adjuvant durvalumab, prior radiotherapy outside the upper abdomen.
  • Patients must be willing and able to sign an informed consent form.
  • Participants of childbearing potential willing to undergo pregnancy test and use contraception per Appendix.

Exclusion Criteria:

  • Liver tumor burden which cannot be targeted with SBRT per treating radiation oncologist
  • Presence of uncontrolled intercurrent illness or significant comorbidities precluding participation in a clinical study as determined by investigator
  • Diagnosis of underlying parenchymal end stage liver disease (cirrhosis) or biliary disease (primary biliary cirrhosis).
  • Other invasive malignancy active within 1 years, excluding in situ cancers
  • Presence of psychiatric or substance abuse disorders that would interfere with compliance or safety
  • Has a known history of active Bacillus Tuberculosis (TB), Hepatitis B or Hepatitis C infection
  • Has received a live (active) vaccine within 30 days of enrollment.
  • Active autoimmune disease that has required systemic treatment in the past 1 years aside from hormone replacement therapy (ie. thyroxine, insulin, or physiologic corticosteroid replacement therapy)
  • Baseline corticosteroid use (>10 mg prednisone daily or equivalent) at study entry
  • Pregnancy or breast feeding

Sites / Locations

  • Veterans Affairs Ann Arbor Healthcare SystemRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm 1

Arm Description

This is an open-label, single-arm, single center clinical trial to evaluate the feasibility of liver SBRT (up to 4 metastases) during the first cycle of physician's choice ICI for NSCLC.

Outcomes

Primary Outcome Measures

Percentage of patients who receive all fractions of radiotherapy as planned
Feasibility determination. Analyzed with descriptive statistics.

Secondary Outcome Measures

Proportion of patients who develop grade 3 or higher toxicity
Any serious adverse event that occurs within 60 days after treatment with SBRT or after this time frame and is considered related to the study treatment will also be reported. Analyzed with descriptive statistics.
Progression-free survival
PFS defined as the time from start of treatment to date of radiological or clinical progression (leading to withdrawal from the study), or death from any cause, whichever comes first. Assessed Per RECIST v1.1; analyzed using Kaplan-Meier curves and descriptive statistics.
Overall survival (OS)
OS defined as the time from start of treatment to death. This will be analyzed using Kaplan-Meier curves and descriptive statistics.
Proportion of patients with local control
Freedom from local progression (local control) is defined as the lack of progression of the tumors treated by RT, either by tumor size or enhancement. Progression or development of new tumors elsewhere in the liver or outside of the liver would not constitute a local control failure. Tumors which increase in size or demonstrate new or increasing enhancement are considered progression. Analyzed using Kaplan-Meier curves and descriptive statistics.

Full Information

First Posted
June 17, 2022
Last Updated
July 27, 2022
Sponsor
VA Ann Arbor Healthcare System
Collaborators
LUNGevity Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT05430009
Brief Title
Liver SBRT in Combination With Immune Checkpoint Inhibition in Patients With Metastatic Non-small Cell Lung Cancer
Official Title
Phase I Trial of Feasibility and Safety of Liver SBRT in Combination With Immune Checkpoint Inhibition in Patients With Metastatic Non-small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 17, 2022 (Actual)
Primary Completion Date
December 15, 2025 (Anticipated)
Study Completion Date
June 15, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
VA Ann Arbor Healthcare System
Collaborators
LUNGevity Foundation

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.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Determine the feasibility of liver stereotactic body radiation therapy (SBRT) given in combination with systemic therapy (immune checkpoint inhibitors) in adult patients with metastatic NSCLC with liver metastases.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm 1
Arm Type
Experimental
Arm Description
This is an open-label, single-arm, single center clinical trial to evaluate the feasibility of liver SBRT (up to 4 metastases) during the first cycle of physician's choice ICI for NSCLC.
Intervention Type
Radiation
Intervention Name(s)
Liver SBRT
Intervention Description
24-45 Gy delivered in 3-5 fractions to 1-4 lesions.
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Intervention Description
200 mg every 3 weeks or 400 mg every 6 weeks
Primary Outcome Measure Information:
Title
Percentage of patients who receive all fractions of radiotherapy as planned
Description
Feasibility determination. Analyzed with descriptive statistics.
Time Frame
Up to 0.5 years after start of study treatment
Secondary Outcome Measure Information:
Title
Proportion of patients who develop grade 3 or higher toxicity
Description
Any serious adverse event that occurs within 60 days after treatment with SBRT or after this time frame and is considered related to the study treatment will also be reported. Analyzed with descriptive statistics.
Time Frame
Up to 1 year after start of study treatment
Title
Progression-free survival
Description
PFS defined as the time from start of treatment to date of radiological or clinical progression (leading to withdrawal from the study), or death from any cause, whichever comes first. Assessed Per RECIST v1.1; analyzed using Kaplan-Meier curves and descriptive statistics.
Time Frame
Time Frame: Up to 3 years after end of study treatment
Title
Overall survival (OS)
Description
OS defined as the time from start of treatment to death. This will be analyzed using Kaplan-Meier curves and descriptive statistics.
Time Frame
Time Frame: Up to 3 years after end of study treatment
Title
Proportion of patients with local control
Description
Freedom from local progression (local control) is defined as the lack of progression of the tumors treated by RT, either by tumor size or enhancement. Progression or development of new tumors elsewhere in the liver or outside of the liver would not constitute a local control failure. Tumors which increase in size or demonstrate new or increasing enhancement are considered progression. Analyzed using Kaplan-Meier curves and descriptive statistics.
Time Frame
Time Frame: Up to 3 years after end of study treatment
Other Pre-specified Outcome Measures:
Title
Proportion of responders with increased frequency of circulating lymphocytes
Description
Flow cytometry quantification of circulating biomarkers. Analyzed with paired T-test.
Time Frame
Time Frame: Up to 3 years after end of study treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult patients (≥18 years of age) Histologically or cytologically confirmed NSCLC with liver metastases Eligible for immune checkpoint inhibitors per treating medical oncologist Disease must be measurable per RECIST criteria ECOG Performance status of 0 - 2 Adequate organ function per protocol. Allowable prior therapy includes adjuvant durvalumab, prior radiotherapy outside the upper abdomen. Patients must be willing and able to sign an informed consent form. Participants of childbearing potential willing to undergo pregnancy test and use contraception per Appendix. Exclusion Criteria: Liver tumor burden which cannot be targeted with SBRT per treating radiation oncologist Presence of uncontrolled intercurrent illness or significant comorbidities precluding participation in a clinical study as determined by investigator Diagnosis of underlying parenchymal end stage liver disease (cirrhosis) or biliary disease (primary biliary cirrhosis). Other invasive malignancy active within 1 years, excluding in situ cancers Presence of psychiatric or substance abuse disorders that would interfere with compliance or safety Has a known history of active Bacillus Tuberculosis (TB), Hepatitis B or Hepatitis C infection Has received a live (active) vaccine within 30 days of enrollment. Active autoimmune disease that has required systemic treatment in the past 1 years aside from hormone replacement therapy (ie. thyroxine, insulin, or physiologic corticosteroid replacement therapy) Baseline corticosteroid use (>10 mg prednisone daily or equivalent) at study entry Pregnancy or breast feeding
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Michael Green, MD
Phone
734-845-3914
Email
Michael.Green4@va.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Shaneta Waddy, MHA
Phone
734-845-3914
Email
Shaneta.Waddy@va.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Green, MD
Organizational Affiliation
VA Ann Arbor
Official's Role
Principal Investigator
Facility Information:
Facility Name
Veterans Affairs Ann Arbor Healthcare System
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Michael D Green, MD, PhD
Phone
734-845-3914
Email
migr@med.umich.edu

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Liver SBRT in Combination With Immune Checkpoint Inhibition in Patients With Metastatic Non-small Cell Lung Cancer

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