Combining durvalumab and grid therapy for advanced lung cancer

Restoring Sensitivity to Immunotherapy Post Failure to the Pacific Regimen: a Pilot Study of Combined Durvalumab (MEDI 4736) and Grid Therapy for Non-Small Cell Lung Cancer

This study is testing whether combining an immunotherapy drug called durvalumab with a special type of radiation therapy can help people with advanced lung cancer who haven't responded well to previous treatments.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 11 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Mayo Clinic (Academic / other)
• Drugs / interventions: durvalumab, immunotherapy, radiation, prednisone
• Locations: 1 site (Rochester, Minnesota)
• Trial ID: NCT05443971 on ClinicalTrials.gov

What this trial studies

This phase II trial evaluates the safety and effectiveness of combining durvalumab, an immunotherapy drug, with grid therapy, a specialized radiation treatment, for patients with non-small cell lung cancer who have experienced disease progression during or shortly after receiving durvalumab. The study aims to assess the safety profile of this combination and measure the overall response rate in treating the cancer. Patients will receive durvalumab intravenously and undergo grid therapy, followed by additional palliative radiation if needed. Blood samples will also be collected to monitor immune responses throughout the treatment.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with primary non-small cell lung cancer who have progressed during or within 6 months after receiving durvalumab as part of the PACIFIC regimen.

Not a fit: Patients with rapidly progressing polymetastatic disease or those who have received stereotactic body radiation therapy within the last month may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could enhance the effectiveness of treatment for patients with advanced non-small cell lung cancer.

How similar studies have performed: While the combination of immunotherapy and radiation is being explored in various contexts, this specific approach is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

* Age \>= 18 years
* Primary non-small cell lung cancer treated previously on PACIFIC regimen (concurrent chemoradiation followed by durvalumab for stage III lung cancer)
* Progression during durvalumab administration or within 6 months after completion of final durvalumab infusion
* Body weight \> 30 kg
* Extracranial lesion \>= 4 cm amenable to grid therapy

  * Patients with brain metastases are permitted to enroll
  * Patients with polymetastatic disease are permitted to enroll
  * Patients with local recurrence are permitted to enroll
  * Patients who do not have rapid polymetastatic progression (at the discretion of the enrolling physician)
  * Patients who have not had stereotactic body radiation therapy (SBRT) within 1 month of enrollment
  * Patients may receive conventional palliative radiation to other symptomatic metastatic disease
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2
* Hemoglobin \>= 9.0 g/dL (obtained =\< 15 days prior to registration)
* Absolute neutrophil count (ANC) \>= 1500/mm\^3 (obtained =\< 15 days prior to registration)
* Platelet count \>= 100,000/mm\^3 (obtained =\< 15 days prior to registration)
* Total bilirubin =\< 1.5 x upper limit of normal (ULN) or direct bilirubin =\< ULN if total bilirubin is \> 1.5 x ULN (obtained =\< 15 days prior to registration)
* Alanine aminotransferase (ALT) and aspartate transaminase (AST) =\< 2.5 x ULN (=\< 5 x ULN for patients with liver involvement) (obtained =\< 15 days prior to registration)
* Creatinine ≤ 1.5 x ULN OR glomerular filtration rate (GFR) \> 60 mL/min for patients with creatinine \> 1.5 x ULN
* Negative pregnancy test done =\< 7 days prior to registration, for persons of childbearing potential only
* Persons able to become pregnant OR able to father a child must be willing to use an adequate method of contraception while on treatment and for 120 days after last treatment
* Life expectancy \>= 12 weeks
* Provide written informed consent
* Willingness to provide mandatory blood specimens for correlative research
* Willing to return to Mayo Clinic for follow-up (during the Active Monitoring Phase of the study)

Exclusion Criteria:

* Any of the following because this study involves an investigational agent whose genotoxic, mutagenic, and teratogenic effects on the developing fetus and newborn are unknown:

  * Pregnant persons
  * Nursing persons
  * Persons of childbearing potential OR able to father a child who are unwilling to employ adequate contraception
* Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety of the prescribed regimens
* Active autoimmune disease requiring systemic treatment, documented history of severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents

  * NOTE: Exceptions are allowed for:

    * Vitiligo
    * Resolved childhood asthma/atopy
    * Intermittent use of bronchodilators or inhaled steroids
    * Daily steroids at dose of =\< 10mg of prednisone (or equivalent)
    * Local steroid injections
    * Stable hypothyroidism on replacement therapy
    * Stable diabetes mellitus on non-insulin therapy
    * Sjogren's syndrome
* Uncontrolled intercurrent illness including, but not limited to:

  * Ongoing or active infection requiring systemic therapy
  * Interstitial lung disease
  * Serious, chronic gastrointestinal conditions associated with diarrhea (e.g., Crohn's disease or others)
  * Known active hepatitis B (i.e., known positive hepatitis B virus \[HBV\] surface antigen \[HBsAg\] reactive)
  * Known active hepatitis C (i.e., positive for hepatitis C virus \[HCV\] ribonucleic acid \[RNA\] detected by polymerase chain reaction \[PCR\])
  * Known active tuberculosis (TB)
  * Symptomatic congestive heart failure
  * Unstable angina pectoris
  * Unstable cardiac arrhythmia or
  * Psychiatric illness/social situations that would limit compliance with study requirements (e.g., substance abuse)
* History of myocardial infarction =\< 6 months, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
* Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
* Hypersensitivity to durvalumab or any of its excipients
* Previous adverse event attributed to durvalumab or other PD-1 or PD-L1 directed therapy that led to drug discontinuation
* History of grade \>= 3 immune-related adverse event or any grade of immune-related neurologic or ocular adverse event while receiving immunotherapy

  * Note: Patients who had endocrine adverse events =\< grade 2 are allowed to enroll if they are stable on appropriate replacement therapy and asymptomatic
* Other active malignancy \< 6 months prior to registration

  * EXCEPTIONS: Non-melanotic skin cancer, papillary thyroid cancer, prostate cancer, or carcinoma-in-situ of the cervix, or others curatively treated and now considered to be at less than 30% risk of relapse
* Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of investigational product (IP)

  * Note: Local surgery of isolated lesions for palliative intent is acceptable
* History of allogenic organ transplantation
* History of active primary immunodeficiency
* Known to have tested positive for human immunodeficiency virus (HIV) (positive HIV 1/2 antibodies) or active tuberculosis infection (clinical evaluation that may include clinical history, physical examination and radiographic findings, or tuberculosis testing in line with local practice)
* Known active hepatitis infection, positive hepatitis C virus (HCV) antibody, hepatitis B virus (HBV) surface antigen (HBsAg) or HBV core antibody (anti-HBc), at screening. Participants with a past or resolved HBV infection (defined as the presence of anti-HBc and absence of HBsAg) are eligible. Participants positive for HCV antibody are eligible only if polymerase chain reaction is negative for HCV RNA. Adjust wording as necessary and consider evaluating at screening for studies with known hepatotoxicity or other relevant requirements
* Receipt of live attenuated vaccine within 30 days prior to the first dose of IP

  * Note: Patients, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP
* Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab. The following are exceptions to this criterion:

  * Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection)
  * Systemic corticosteroids at physiologic doses not to exceed \<\<10 mg/day\>\> of prednisone or its equivalent
  * Steroids as premedication for hypersensitivity reactions (e.g., computed tomography \[CT\] scan premedication)

Where this trial is running

Rochester, Minnesota

• Mayo Clinic in Rochester — Rochester, Minnesota, United States (Recruiting)

Study contacts

• Principal investigator: Dawn Owen, MD — Mayo Clinic in Rochester
• Study coordinator: Clinical Trials Referral Office

Conditions Lung Non-Small Cell Carcinoma; Stage III Lung Cancer AJCC V8