Combination of chemotherapy and immunotherapy for advanced lung cancer

An Open-label, Multi-center, Phase 2 Study of Chemo-immunotherapy Followed by Reduced-dose Hypo-fractionated RT and Maintenance Immunotherapy for Stage III Unresectable Non -Small-cell Lung Carcinoma (NSCLC).

This study is testing a new treatment that combines chemotherapy and immunotherapy to see if it can help people with advanced lung cancer feel better while causing fewer side effects.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 45 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Fondazione IRCCS Policlinico San Matteo di Pavia (Academic / other)
• Drugs / interventions: durvalumab, chemotherapy, radiation
• Locations: 1 site (Pavia)
• Trial ID: NCT05128630 on ClinicalTrials.gov

What this trial studies

This phase 2 study aims to evaluate the safety and efficacy of a new treatment regimen for patients with stage III unresectable non-small cell lung cancer (NSCLC). The approach involves using induction chemotherapy combined with durvalumab, followed by reduced-dose hypo-fractionated thoracic radiotherapy, also concurrent with durvalumab, and maintenance therapy with durvalumab. The hypothesis is that this combination will enhance treatment effectiveness while minimizing side effects associated with radiation therapy.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with locally-advanced, unresectable stage III NSCLC who are not eligible for concurrent chemoradiation.

Not a fit: Patients with resectable stage III NSCLC or those with a poor performance status may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could improve survival rates and quality of life for patients with advanced lung cancer.

How similar studies have performed: Other studies have shown promising results with similar combinations of chemotherapy and immunotherapy, suggesting potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

1. Capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
2. Provision of signed and dated, written ICF prior to any mandatory study specific procedures, sampling, and analyses.

   Age
3. 18 years or older at the time of signing the ICF. Type of patient and disease characteristics
4. Histologically- or cytologically-documented NSCLC with locally-advanced, unresectable Stage III disease (according to the IASLC Staging Manual Version 8 \[IASLC 2016\]). Positron emission tomography (PET)/CT, MRI of the brain, and endobronchial ultrasound with biopsy are highly encouraged at diagnosis.
5. Patients with measurable disease assessed at baseline by CT/MRI will be entered in this study.
6. Must have a life expectancy of at least 12 weeks at enrolment.
7. WHO/ECOG PS 0-1.
8. Patient not eligible for concurrent chemo radiation according to investigator assessment
9. Adequate organ and marrow function at enrollment as defined below. These parameters should be achieved without augmentation by growth factors, transfusions, or infusions within 28 days of screening unless required for SoC:

   1. Haemoglobin ≥9.0 g/dL;
   2. Absolute neutrophil count \>1.0 × 109/L;
   3. Platelet count \>75 × 109/L;
   4. Serum bilirubin ≤1.5 × upper limit of normal (ULN). This will not apply to patients with confirmed Gilbert's syndrome, who will be allowed in consultation with their physician.
   5. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × ULN.
   6. Measured creatinine clearance \>40 mL/min or calculated creatinine clearance \>40 mL/min as determined by Cockcroft-Gault (using actual body weight) (Cockcroft and Gault 1976).

   Males:

   Creatinine clearance (mL/min) = \[Weight (kg) × (140 - Age)\] / 72 × serum creatinine (mg/dL)

   Females:

   Creatinine clearance (mL/min) = \[Weight (kg) × (140 - Age) × 0.85\] / 72 × serum creatinine (mg/dL)
10. Body weight \>30 kg at enrollment
11. Male or female. Reproduction
12. Evidence of post-menopausal status, or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:

    1. Women \<50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
    2. Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses \>1 year ago, had chemotherapy-induced menopause with last menses \>1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy, or hysterectomy).

Exclusion Criteria:Patients should not enter the study if any of the following exclusion criteria are fulfilled:

1. Patients who have disease considered for surgical treatment as part of their care plan, such as Pancoast or superior sulcus tumors.
2. Mixed small-cell lung cancer and NSCLC histology.
3. History of allogeneic organ transplantation.
4. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease \[eg, colitis or Crohn's disease\], diverticulitis \[with the exception of diverticulosis\], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc\]). The following are exceptions to this criterion:

   1. Patients with vitiligo or alopecia.
   2. Patients with hypothyroidism (eg, following Hashimoto syndrome) stable on hormone replacement.
   3. Any chronic skin condition that does not require systemic therapy.
   4. Patients without active disease in the last 5 years at enrolment may be included but only after consultation with the Study Physician.
   5. Patients with celiac disease controlled by diet alone.
5. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, ILD, serious chronic GI conditions associated with diarrhoea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs, or compromise the ability of the patient to give written informed consent.
6. History of another primary malignancy except for:

   1. Malignancy treated with curative intent and with no known active disease ≥5 years before the first dose of IP and of low potential risk for recurrence.
   2. Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
   3. Adequately treated carcinoma in situ without evidence of disease.
7. History of leptomeningeal carcinomatosis.
8. History of active primary immunodeficiency.
9. Active infection including hepatitis B (known positive hepatitis B surface antigen \[HbsAg\] result), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) (positive HIV 1/2 antibodies). Patients with a past or resolved hepatitis B virus (HBV) infection (defined as the presence of hepatitis B core antibody \[anti-HBc\] and absence of HbsAg) are eligible. Patients positive for hepatitis C antibody are eligible only if polymerase chain reaction is negative for HCV ribonucleic acid (RNA).
10. Any unresolved toxicity of NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria.

    1. Patients with Grade ≥2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician.
    2. Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab may be included only after consultation with the Study Physician.
11. Known allergy or hypersensitivity to durvalumab or any of the IP excipients. Prior/concomitant therapy
12. Prior chemo-radiotherapy for lung cancer. Prior surgical resection (ie, Stage I or II) is permitted.
13. Receipt of live attenuated vaccine within 30 days prior to the first dose of IP.

    Note: Patients, if enrolled, should not receive live vaccine while receiving IP and up to 30 days after the last dose of IP.
14. 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.

Where this trial is running

Pavia

• Fondazione IRCCS Policlinico San Matteo — Pavia, Italy (Recruiting)

Study contacts

• Study coordinator: Alessandra Ferrari, dr.

Conditions NSCLC, Stage III; durvalumab; radiotherapy; immunotherapy