Reduced-dose carboplatin doublet plus cemiplimab versus cemiplimab alone for older, frail metastatic NSCLC with PD-L1 under 50%
Reduced-dose Carboplatin-doublet-chemotherapy + Cemiplimab vs Cemiplimab Monotherapy in Treatment Naive Older and Frail Patients With Metastatic NSCLC With PD-L1 <50% A Multicentre Randomized Open-label Phase II Trial
This will test whether adding lower-dose carboplatin-based doublet chemotherapy to cemiplimab helps people aged 70 and older who are frail and have metastatic NSCLC with PD-L1 under 50% do better than cemiplimab alone.
Quick facts
| Phase | Phase 2 |
|---|---|
| Study type | Interventional |
| Enrollment | 156 (estimated) |
| Ages | 70 Years and up |
| Sex | All |
| Sponsor | Swiss Cancer Institute Academic / other |
| Drugs / interventions | chemotherapy, immunotherapy, cemiplimab, atezolizumab |
| Locations | 17 sites (Fribourg, Villars-sur-Glâne and 16 other locations) |
| Trial ID | NCT07020065 on ClinicalTrials.gov |
What this trial studies
This is a randomized, open-label phase II trial comparing reduced-dose platinum-doublet chemotherapy combined with cemiplimab to cemiplimab monotherapy in patients aged 70 or older with stage III/IV NSCLC and PD-L1 <50%. Participants are screened with the G8 geriatric tool and must have ECOG 0–2 and be considered unsuitable for full-dose chemotherapy or have a G8 score ≤14. The study will collect data on efficacy, safety, and overall treatment utility to determine whether the reduced-dose combination is better tolerated and more effective than immunotherapy alone in this frail population. Treatments include cemiplimab with a reduced-dose carboplatin-based doublet (pemetrexed, paclitaxel, or gemcitabine) versus cemiplimab alone across Swiss participating centers.
Who should consider this trial
Good fit: Ideal candidates are patients aged 70 or older with metastatic NSCLC, PD-L1 <50%, ECOG performance status 0–2, and a G8 score ≤14 or judged ineligible for full-dose chemotherapy.
Not a fit: Patients younger than 70, those with PD-L1 ≥50%, those fit for full-dose chemotherapy, patients with small-cell components, or those with very limited life expectancy or ECOG >2 are unlikely to benefit from this specific comparison.
Why it matters
Potential benefit: If successful, this approach could provide an effective first-line option that is better tolerated by older or frail patients who cannot handle standard-dose chemotherapy.
How similar studies have performed: Full-dose cemiplimab combined with carboplatin doublets has shown benefit in broader populations (EMPOWER-Lung 03) and immunotherapy alone showed benefit in older chemo-ineligible patients (IPSOS), but prospective evidence for deliberately reduced-dose platinum-doublet plus cemiplimab in frail elderly patients is limited.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Informed Consent as documented by signature * Histologically or cytologically confirmed NSCLC. Mixed histology with small-cell component is not allowed. * Metastatic or advanced or recurrent NSCLC without a curative-intent treatment option (surgery or chemo-radiotherapy). * PD-L1 \<50% by local testing (SP 142 excluded) * ≥70 years * ECOG 0-2 * G8 screening score of ≤14 and/or ineligible for full-dose chemotherapy, defined as doses of carboplatin AUC 5, pemetrexed 500 mg/m2, paclitaxel 175 mg/m2, gemcitabine 1200 mg/m2 (as per Investigator) * Life expectancy ≥6 months * Patients with a prior malignancy (except NSCLC, see EC 7.2.2 and 7.2.3) and treated with curative intent are eligible if all treatment of that malignancy was completed at least 2 years before registration and the patient has no evidence of disease at registration. Less than 2 years is acceptable for malignancies with low risk of recurrence and/or no late recurrence, after consultation with CI. * Patients with asymptomatic untreated or symptomatic treated CNS metastases are eligible if corticosteroid dose \<10 mg prednisolone equivalent/day for at least 7 days * Patients must be suitable to receive reduced-dose carboplatin-doublet chemotherapy in combination with immunotherapy including adequate bone marrow, renal and hepatic function as follows: * Hemoglobin ≥90 g/L, neutrophils ≥1.5 G/L, Thrombocytes ≥100G/L * Creatinine clearance (Cockroft-Gault) ≥30 mL/min * ASAT/ALAT ≤2xULN, Bilirubin ≤1.5xULN (≤3xULN for patients with Gilbert's disease), * Men agree not to donate sperm or father a child during trial treatment and until 6 months after the last dose of trial treatment Exclusion Criteria: * Actionable genomic alteration for 1L treatment (EGFR, ALK, ROS1, RET, NTRK, MET Exon14 skipping). Testing is required for any NSQ-NSCLC or patients with SCC and a smoking history of ≤10py. * Prior systemic treatment for metastatic NSCLC. * Prior chemotherapy and/or immunotherapy in curative-intent treatment for locally advanced NSCLC in the past 6 months. * Oligometastatic treatment concept with induction systemic therapy and planned LAT to all lesions. * High tumor burden with a risk of rapid critical progression, as judged by the Investigator. Careful patient selection is important in order to prevent that patients in the comparator arm are not eligible for receiving add-on reduced-dose chemotherapy anymore if primary progression occurs (e.g., pericardial infiltration, high liver metastasis load etc). * Active, treatment-requiring auto-immune disease in the past 2 years other than vitiligo, alopecia, hypothyroidism, type 1 diabetes or diet-controlled celiac disease. * History of pneumonitis in the past 5 years. * Systemic corticosteroid treatment ≥10 mg/day of prednisolone-equivalent or any other systemic immunosuppressive medication within 7 days prior to first dose of study intervention (except as needed for chemotherapy premedication or for physiologic corticosteroid replacement) * Any infection requiring hospitalization or treatment with IV anti-infectives within 2 weeks of first dose of study medication * Uncontrolled infection with HIV, hepatitis B or hepatitis C infection * Receipt of a live vaccine within 4 weeks of start of study medication * Receipt of COVID-19 vaccination within 1 week of planned start of study medication or for which the planned COVID-19 vaccinations would not be completed 1 week prior to start of study medication * Organ transplant
Where this trial is running
Fribourg, Villars-sur-Glâne and 16 other locations
- HFR Fribourg — Fribourg, Villars-sur-Glâne, Switzerland (Recruiting)
- Kantonsspital Aarau — Aarau, Switzerland (Recruiting)
- Kantonsspital Baden — Baden, Switzerland (Recruiting)
- Universitätsspital Basel — Basel, Switzerland (Recruiting)
- Inselspital — Bern, Switzerland (Recruiting)
- Kantonsspital Baselland — Bruderholz, Switzerland (Recruiting)
- Kantonsspital Graubuenden — Chur, Switzerland (Recruiting)
- Spital Thurgau AG - Kantonsspital Frauenfeld — Frauenfeld, Switzerland (Recruiting)
- Hôpitaux Universitaires de Genève — Geneva, Switzerland (Recruiting)
- Kantonsspital Olten - Solothurner Spitäler — Olten, Switzerland (Recruiting)
- Kantonsspital - St. Gallen — Sankt Gallen, Switzerland (Recruiting)
- Hôpital du Valais - Sion — Sion, Switzerland (Recruiting)
- Spital Thun — Thun, Switzerland (Recruiting)
- EOC Istituto Oncologico della Svizzera Italiana (IOSI) — Viganello, Switzerland (Recruiting)
- Kantonsspital Winterthur — Winterthur, Switzerland (Recruiting)
- KSW Kantonsspital Winterthur — Winterthur, Switzerland (Recruiting)
- Stadtspital Zürich Triemli — Zurich, Switzerland (Recruiting)
Study contacts
- Study coordinator: Gisela Müller
- Email: trials@swisscancerinstitute.ch
- Phone: +41 31 389 91 91
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.