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Neoadjuvant LDRT Combined With Durvalumab in Potentially Resectable Stage III NSCLC

Primary Purpose

Stage III Non-small Cell Lung Cancer

Status
Recruiting
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Durvalumab
nanoparticle albumin bound paclitaxel
low dose radiation therapy
Sponsored by
Juan LI, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stage III Non-small Cell Lung Cancer

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Aged 18 ≥ years.
  2. Histological or cytological diagnosis of NSCLC by needle biopsy, and potentially resectable stage III confirmed by image logical examinations (CT, PET-CT or EBUS).
  3. Eastern Cooperative Oncology Group (ECOG) performance-status score of 0 or 1.
  4. Life expectancy is at least 12 weeks.
  5. At least 1 measurable lesion according to RECIST 1.1.
  6. With the feasibility or anticipated feasibility after neoadjuvant therapy to receive radical surgery;
  7. Patients with good function of other main organs (liver, kidney, blood system, etc.):

1) ANC count ≥1.5×10^9/L, platelet count ≥100×10^9/L,hemoglobin ≥90 g/L; 2) the international standard ratio of prothrombin time (INR) and prothrombin time (PT) < 1.5 times of upper limit of normal (ULN); 3) Partial thromboplastin time (APTT) ≤1.5×ULN; 4) Total bilirubin ≤1.5×ULN; 5) Alanine aminotransferase (ALT) aspartate aminotransferase (AST) ≤2.5×ULN, or ALT and AST ≤5×ULN in the patients with liver metastatic tumor.

8. Patients with normal lung function can tolerate surgery; 9. Without systematic metastasis (including M1a, M1b and M1c); 10. The patient shall sign the Informed Consent Form.

Exclusion Criteria:

  1. Participants who have received any systemic anti-cancer treatment for thymic epithelial tumor, including surgical treatment, local radiotherapy, cytotoxic drug treatment, targeted drug treatment and experimental treatment;
  2. Administration of any Chinese medicine against cancer before administration of the drug;
  3. Participants with other cancer within five years before the start of this study;
  4. Participants with any unstable systemic disease (including active infection, uncontrolled hypertension), unstable angina pectoris, angina pectoris starting in the last three months, congestive heart failure (>= NYHA) Grade II), myocardial infarction (6 months before admission), severe arrhythmia requiring drug treatment, liver, kidney or metabolic diseases;
  5. With activate or suspectable autoimmune disease, or autoimmune para cancer syndrome requiring systemic treatment;
  6. Antibiotics were used to treat the infection for 4 weeks prior to the start of the trial;
  7. Participants who were systemically treated with corticosteroids (prednisone or other corticosteroids >10 mg/ day) or other immunosuppressive agents within 2 weeks prior to first administration. In the absence of active autoimmune disease, inhaled or topical corticosteroids and adrenal hormone replacement therapy with a dose of less than 10 mg/ day of prednisone are permitted;
  8. Participants who are allergic to the test drug or any auxiliary materials;
  9. Participants with active hepatitis B, hepatitis C or HIV;
  10. The vaccine was administered within 4 weeks of the start of the trial;
  11. Participants who have undergone major surgery or severe trauma in other systems within 2 months before the start of this trial;
  12. Pleural effusion, pericardial effusion or ascites that are not clinically controlled and require pleural puncture or abdominal puncture drainage within 2 weeks before inclusion;
  13. The patients have active pia meningioma, uncontrolled or untreated brain metastases;
  14. Pregnant or lactating women;
  15. Participants suffering from nervous system diseases or mental diseases that cannot cooperate;
  16. Participated in another therapeutic clinical study;
  17. Other factors that researchers think it is not suitable for enrollment.

Sites / Locations

  • Sichuan Cancer HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm

Arm Description

Durvalumab 1500mg, IV, Q3W, 2 cycles Albumin paclitaxel 260 mg/m2 + Carboplatin AUC5, IV, Q3W, 2 cycles Chemoradiotherapy(CRT): Cohort 1: 2 Gy in 5 Fraction Cohort 2: 2 Gy in 10 Fraction Cohort 3: 2 Gy in 15 Fraction

Outcomes

Primary Outcome Measures

Incidence of treatment-emergent adverse events
Safety is based on evaluation of adverse events (AEs) and serious adverse events (SAEs) from the time of study drug administration through the End of Study visit. AEs and SAEs will be examined with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v 4.03.

Secondary Outcome Measures

ORR
Objective Response Rate determined by Response Evaluation Criteria in Solid Tumors
EFS
Event-free survival
MPR
Major pathological response rate
pCR
Pathological complete response rate

Full Information

First Posted
May 24, 2021
Last Updated
December 2, 2021
Sponsor
Juan LI, MD
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1. Study Identification

Unique Protocol Identification Number
NCT05157542
Brief Title
Neoadjuvant LDRT Combined With Durvalumab in Potentially Resectable Stage III NSCLC
Official Title
A Phase Ib Trial on the Safety and Feasibility of Neoadjuvant Low Dose Radiation, Chemotherapy and Durvalumab for Potentially Resectable Stage III Non-small Cell Lung Cancer (NSCLC)
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Recruiting
Study Start Date
June 10, 2021 (Actual)
Primary Completion Date
June 10, 2023 (Anticipated)
Study Completion Date
June 10, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Juan LI, MD

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
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
Introduction: Although PACIFIC regimen definitive concurrent chemoradiotherapy (CRT) followed by Durvalumab consolidation therapy is considered the standard of care for most of stage III NSCLC patients, neoadjuvant immunotherapy combined with chemotherapy followed by surgery has shown the trend to be considered for some potentially resectable patients. The rationales for neoadjuvant treatment are tumor regression effect before surgery, early eradication of micrometastasis. Recently the investigators also find some clinical trials exploring the adding of 45 Gy in 25 fractions radiation to the combination of chemotherapy and immunotherapy neoadjuvant therapy and the investigators could see the safety is the most concern, especially the pneumonitis incidence. Low dose radiation could help control the toxicity induced by radiation and has synergic effect with immunotherapy. The aim of this phase Ib study is to assess the safety and feasibility of the combination of the concurrent low dose radiation, chemotherapy and Durvalumab neoadjuvant therapy, to explore which radiation dose is the best among our three-dose designs and evaluate if the combining neoadjuvant therapy could further improve MPR in the meantime no severe toxicities especially the grade 3-4 pneumonitis would happen. Method: 9 eligible patients with histologically confirmed NSCLC (potentially resectable clinical stage III according to the American Joint Committee on Cancer 8th staging system) are enrolled. Patients receive Chemo (Day1 and 22 nanoparticle albumin-bound paclitaxel 260 mg/m2 and carboplatin AUC 5 ) and durvalumab (Day 1 and 22, 1500mg) and radiotherapy of 10 Gy in 5 fractions, 20 Gy in 10 fractions, 30 Gy in 15 fractions respectively in our three groups from Day1, followed by surgery. After surgery, patients are suggested to be treated with durvalumab for one year (every 4weeks, 1500 mg). The primary endpoints are safety and tolerability. The secondary endpoints are objective response rate (ORR), event-free survival EFS), overall survival (OS), pathologic complete response (pCR), and major pathologic response(MPR) in the primary tumor. biomarker analysis of PD-L1 using cancer tissue and LIPI, ctDNA using blood sample will be conducted pre-and post- neoadjuvant and post-surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stage III 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
9 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm
Arm Type
Experimental
Arm Description
Durvalumab 1500mg, IV, Q3W, 2 cycles Albumin paclitaxel 260 mg/m2 + Carboplatin AUC5, IV, Q3W, 2 cycles Chemoradiotherapy(CRT): Cohort 1: 2 Gy in 5 Fraction Cohort 2: 2 Gy in 10 Fraction Cohort 3: 2 Gy in 15 Fraction
Intervention Type
Drug
Intervention Name(s)
Durvalumab
Intervention Description
Day 1 and 22, 1500mg
Intervention Type
Drug
Intervention Name(s)
nanoparticle albumin bound paclitaxel
Intervention Description
Day1 and 22 nanoparticle albumin-bound paclitaxel 260 mg/m2 and carboplatin AUC 5
Intervention Type
Radiation
Intervention Name(s)
low dose radiation therapy
Intervention Description
10 Gy in 5 fractions, 20 Gy in 10 fractions, 30 Gy in 15 fractions respectively in our three groups from Day1
Primary Outcome Measure Information:
Title
Incidence of treatment-emergent adverse events
Description
Safety is based on evaluation of adverse events (AEs) and serious adverse events (SAEs) from the time of study drug administration through the End of Study visit. AEs and SAEs will be examined with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v 4.03.
Time Frame
30 days after last dose up to 36 months
Secondary Outcome Measure Information:
Title
ORR
Description
Objective Response Rate determined by Response Evaluation Criteria in Solid Tumors
Time Frame
36 months
Title
EFS
Description
Event-free survival
Time Frame
36 months
Title
MPR
Description
Major pathological response rate
Time Frame
36 months
Title
pCR
Description
Pathological complete response rate
Time Frame
36 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 18 ≥ years. Histological or cytological diagnosis of NSCLC by needle biopsy, and potentially resectable stage III confirmed by image logical examinations (CT, PET-CT or EBUS). Eastern Cooperative Oncology Group (ECOG) performance-status score of 0 or 1. Life expectancy is at least 12 weeks. At least 1 measurable lesion according to RECIST 1.1. With the feasibility or anticipated feasibility after neoadjuvant therapy to receive radical surgery; Patients with good function of other main organs (liver, kidney, blood system, etc.): 1) ANC count ≥1.5×10^9/L, platelet count ≥100×10^9/L,hemoglobin ≥90 g/L; 2) the international standard ratio of prothrombin time (INR) and prothrombin time (PT) < 1.5 times of upper limit of normal (ULN); 3) Partial thromboplastin time (APTT) ≤1.5×ULN; 4) Total bilirubin ≤1.5×ULN; 5) Alanine aminotransferase (ALT) aspartate aminotransferase (AST) ≤2.5×ULN, or ALT and AST ≤5×ULN in the patients with liver metastatic tumor. 8. Patients with normal lung function can tolerate surgery; 9. Without systematic metastasis (including M1a, M1b and M1c); 10. The patient shall sign the Informed Consent Form. Exclusion Criteria: Participants who have received any systemic anti-cancer treatment for thymic epithelial tumor, including surgical treatment, local radiotherapy, cytotoxic drug treatment, targeted drug treatment and experimental treatment; Administration of any Chinese medicine against cancer before administration of the drug; Participants with other cancer within five years before the start of this study; Participants with any unstable systemic disease (including active infection, uncontrolled hypertension), unstable angina pectoris, angina pectoris starting in the last three months, congestive heart failure (>= NYHA) Grade II), myocardial infarction (6 months before admission), severe arrhythmia requiring drug treatment, liver, kidney or metabolic diseases; With activate or suspectable autoimmune disease, or autoimmune para cancer syndrome requiring systemic treatment; Antibiotics were used to treat the infection for 4 weeks prior to the start of the trial; Participants who were systemically treated with corticosteroids (prednisone or other corticosteroids >10 mg/ day) or other immunosuppressive agents within 2 weeks prior to first administration. In the absence of active autoimmune disease, inhaled or topical corticosteroids and adrenal hormone replacement therapy with a dose of less than 10 mg/ day of prednisone are permitted; Participants who are allergic to the test drug or any auxiliary materials; Participants with active hepatitis B, hepatitis C or HIV; The vaccine was administered within 4 weeks of the start of the trial; Participants who have undergone major surgery or severe trauma in other systems within 2 months before the start of this trial; Pleural effusion, pericardial effusion or ascites that are not clinically controlled and require pleural puncture or abdominal puncture drainage within 2 weeks before inclusion; The patients have active pia meningioma, uncontrolled or untreated brain metastases; Pregnant or lactating women; Participants suffering from nervous system diseases or mental diseases that cannot cooperate; Participated in another therapeutic clinical study; Other factors that researchers think it is not suitable for enrollment.
Facility Information:
Facility Name
Sichuan Cancer Hospital
City
Chengdu
State/Province
Sichuan
ZIP/Postal Code
610041
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Juan Li, Doctor
Phone
+86 13880276636
Email
dr.lijuan@hotmail.com

12. IPD Sharing Statement

Learn more about this trial

Neoadjuvant LDRT Combined With Durvalumab in Potentially Resectable Stage III NSCLC

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