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
About this trial
This is an interventional treatment trial for Liver Metastases
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
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
NCT ID
NCT05430009
First Posted
June 17, 2022
Last Updated
July 27, 2022
Sponsor
VA Ann Arbor Healthcare System
Collaborators
LUNGevity Foundation
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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