NBTXR3 with radiation for locally advanced non-small cell lung cancer

NBTXR3 With Radiation Therapy Alone for Locally-advanced Non-small Cell Lung Cancer

This study will test whether adding NBTXR3 to radiation helps people with stage I–III non-small cell lung cancer who cannot have chemotherapy or surgery.

Quick facts

• Phase: PHASE1; PHASE2
• Study type: Interventional
• Enrollment: 40 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: M.D. Anderson Cancer Center (other)
• Drugs / interventions: chemotherapy, immunotherapy, radiation
• Locations: 1 site (Houston, Texas)
• Trial ID: NCT07224152 on ClinicalTrials.gov

What this trial studies

This single-institution, single-arm Phase I/II trial gives NBTXR3 (a nanoparticle radioenhancer) injected into up to four lung lesions followed by definitive radiation across several dose levels in patients with inoperable or surgery-declining stage I–III NSCLC. Phase I uses a dose-escalation design to define a recommended phase II dose and to evaluate feasibility and safety across 15-fraction radiation regimens. Phase II will estimate efficacy of radiation alone with the phase II dose of NBTXR3 and continue safety monitoring, with secondary endpoints including tumor response and time-to-event outcomes. Injections are performed bronchoscopically or under CT guidance and all injected lesions are treated with conformal radiation.

Who should consider this trial

Good fit: Adults (≥18) with biopsy-proven stage I–III NSCLC who are medically inoperable or decline surgery, have ECOG 0–2, measurable target lesions (nodes ≥15 mm short axis), have had no systemic therapy within 4 weeks, and are amenable to bronchoscopic or CT-guided injection of up to four lesions are ideal candidates.

Not a fit: Patients who are surgical candidates or eligible for standard chemoradiation, those with lesions not amenable to injection, ECOG >2, or with extensive metastatic disease are unlikely to benefit from this approach.

Why it matters

Potential benefit: If successful, adding NBTXR3 could boost the tumor-killing effect of radiation and improve local control for patients who cannot receive chemotherapy or surgery.

How similar studies have performed: Early clinical data have shown promising radioenhancement with NBTXR3 in other tumor types, but data in lung cancer remain limited and this approach is not yet established for NSCLC.

Eligibility criteria

Inclusion Criteria:

1. Signed informed consent form (ICF) indicating that participant understands the purpose of, and procedures required for, the study and is willing to participate in the study.
2. Age ≥ 18 years.
3. ECOG Performance Status 0-2
4. Biopsy proven stage I-III NSCLC.
5. Participant deemed medically inoperable by the investigator or treating physician, or patient declines surgery.
6. No prior or concurrent systemic therapies within 4 weeks of injection. Patient may receive up to 1 line of prior systemic therapy prior to starting RT.
7. Amenable to undergo bronchoscopic (EBUS, CBCT) or CT-guided injection of NBTXR3 as per investigator or treating physician.

   a. Up to 4 lung lesions may be injected with NBTXR3, including the primary tumor and involved lymph node(s) All injected lesions must be radiated.
8. The target lesion(s) should be measurable on cross sectional imaging (RECIST 1.1), Nodal target lesions must be ≥15mm (short axis) based on CT (slice thickness of 5mm or less) or MRI.
9. Adequate screening laboratory values

   1. Hemoglobin ≥ 8.0 g/dL
   2. Absolute Neutrophil Count (ANC) ≥ 1,500/mm3
   3. Platelet Count ≥ 100,000/mm3
   4. Creatinine ≤ 1.5 x upper limit of normal (ULN)
   5. Calc. Creatinine Clearance ≥ 30 mL/min
   6. Total Bilirubin ≤ 2.0 mg/dL
   7. AST / ALT ≤ 3.0 x upper limit of normal (ULN) or 5.0 x ULN if known liver metastases
   8. Serum albumin ≥ 3.0 g/dL Negative urine or serum pregnancy test ≤ 7 days of NBTXR3 injection in all females of child-bearing potential.

Exclusion Criteria:

1. Unable to undergo NBTXR3 injection via bronchoscopic or CT-guided approach
2. Unable to undergo radiation therapy for any reason
3. Female patients who are pregnant or breastfeeding.
4. Women of child-bearing potential and their male partners who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period. Acceptable methods of contraception are those that, alone or in combination, result in a failure rate of \< 1% per year when used consistently and correctly.
5. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments.
6. At screening, past medical history of:

   1. Interstitial lung disease
   2. Drug related pneumonitis
   3. Radiation therapy to lung or other intrathoracic organs (e.g. prior breast radiation okay)
7. Has received any approved or investigational anti-neoplastic or immunotherapy agent within 4 weeks prior to NBTXR3 injection
8. Receipt of more than 1 line of systemic therapy prior to RT
9. Use of concurrent systemic therapy (chemotherapy, immunotherapy, targeted therapy) or patient participation on another therapeutic clinical trial.
10. Known contraindication to iodine-based or gadolinium-based IV contrast.
11. Active malignancy, in addition to locoregional recurrent NSCLC, with the exception of definitively treated and relapse free within 1 year from diagnosis of non-melanoma skin cancer or cervical cancer in situ; definitively treated non-metastatic prostate cancer; or patients with another primary malignancy who are definitely treated and relapse free with at least 2 years elapsed since the diagnosis of the other primary malignancy.
12. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, recent severe pulmonary infection, symptomatic congestive heart failure, unstable angina pectoris, renal failure, cardiac arrhythmia, or psychiatric illness that would limit compliance with treatment.
13. Known active, uncontrolled (high viral load) HIV or hepatitis B or hepatitis C infection
14. Cognitively impaired subjects

Where this trial is running

Houston, Texas

• The University of Texas M. D. Anderson Cancer Center — Houston, Texas, United States (RECRUITING)

Study contacts

• Principal investigator: Aileen Chen, MD — M.D. Anderson Cancer Center
• Study coordinator: Aileen Chen, MD

Conditions: Locally-Advanced Non-Small Cell Lung Cancer