Clinical Trials /

SBRT in Multi-metastatic NSCLC Patients Which Are Pan-negative for Driver Mutations

NCT02940990

Description:

This protocol is a phase II multi-center randomized controlled trial (RCT) evaluating the efficacy of SBRT in multi-metastatic NSCLC patients who are pan-negative for driver mutations.

Related Conditions:
  • Non-Small Cell Lung Carcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: SBRT in Multi-metastatic NSCLC Patients Which Are Pan-negative for Driver Mutations
  • Official Title:

Clinical Trial IDs

  • ORG STUDY ID: SCHLC007
  • NCT ID: NCT02940990

Conditions

  • NSCLC
  • SBRT
  • GM-CSF

Interventions

DrugSynonymsArms
two-drug chemotherapy containing platinum, including carboplatin/Cisplatin + pemetrexed/docetaxel/paclitaxel/etoposide/gemcitabine/vinorelbine/albumin-bound paclitaxelGroup A

Purpose

This protocol is a phase II multi-center randomized controlled trial (RCT) evaluating the efficacy of SBRT in multi-metastatic NSCLC patients who are pan-negative for driver mutations.

Detailed Description

      Lung cancer is the leading cause of cancer death. Forty percent of patients are diagnosed as
      metastatic lung cancer, and about 50% of them are pan-negative for driver mutations. The
      median overall survival(OS) for these patients is 11 months, and maintenance therapy can only
      prolong 2 months of OS. The NCCN guidelines recommend 4-6 cycles of chemotherapy with or
      without maintenance chemotherapy.

      Published data showed that radiotherapy modulates tumor phenotypes, enhances antigen
      presentation and tumor immunogenicity. The regression of out-field lesions was termed as
      "abscopal effect". The combination of radiotherapy with immunotherapeutic agents may promote
      the host anti-tumor immune response and increase the rate of abscopal effect.Published data
      showed that abscopal effect appeared in 20%-30% patients with metastatic malignant tumors who
      were treated with the combination of SBRT and GM-CSF.

      The investigators evaluate the efficacy of the combination of SBRT and GM-CSF in the
      multi-metastatic NSCLC participants who are pan-negative for driver mutations. Patients
      enrolled will be randomized into two groups. The control group will receive the standard
      regimen as NCCN recommends. The experimental group will receive both the standard
      chemotherapy and the extra SBRT to primary lesions or metastatic lesions combined with
      GM-CSF. The investigators compare progress free survival(PFS) of the two groups.
    

Trial Arms

NameTypeDescriptionInterventions
Group APlacebo ComparatorParticipants in the Group A will receive 4-6 cycles of standard two-drug chemotherapy. After that, clinical observation or maintenance chemotherapy will be given.
  • two-drug chemotherapy containing platinum, including carboplatin/Cisplatin + pemetrexed/docetaxel/paclitaxel/etoposide/gemcitabine/vinorelbine/albumin-bound paclitaxel
Group BExperimentalParticipants in the Group B will also receive 4-6 cycles of standard two-drug chemotherapy. However, they will receive an additional treatment of SBRT to primary lesions or metastatic lesions combined with GM-CSF.
  • two-drug chemotherapy containing platinum, including carboplatin/Cisplatin + pemetrexed/docetaxel/paclitaxel/etoposide/gemcitabine/vinorelbine/albumin-bound paclitaxel

Eligibility Criteria

        Inclusion Criteria:

          -  Histologically proven non-small-cell lung cancer.

          -  Stage IV according to UICC stage system(version 7,2009).The number of metastatic
             lesions>5

          -  Pan-negative for driver mutations including EGFR ALK ROS1 c-MET

          -  At least Three evaluable lesions among which at least two must be suitable for SBRT.

          -  ECOG performance status 0-2.

          -  Expected lifespan ≥3 months.

          -  No brain metastasis in MRI.

          -  No liver metastasis in abdominal CT or MRI.

          -  No malignant pleural effusion or pericardial effusion from chest CT and/or pathology.

          -  Stable lab values: Hematological:

        Absolute neutrophil count (ANC) ≥1.5×109/L, Platelets ≥100×109/L, Hemoglobin ≥9 g/dL Renal:
        Creatinine OR Measured or calculated creatinine clearance (CrCl) (glomerular filtration
        rate [GFR] can also be used in place of creatinine or CrCl) ≤1.5× the upper limit of normal
        (ULN) OR ≥60 mL/min for patient with creatinine levels >1.5× institutional ULN Hepatic:
        Total bilirubin ≤1.5×ULN OR Direct bilirubin ≤ULN for patients with total bilirubin levels
        >1.5×ULN, Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5×ULN OR
        ≤5×ULN for patients with liver metastases ,globulin≥20 g/L, albumin≥30 g/L.

        - Able to understand and give written informed consent and comply with study procedures.

        Exclusion Criteria:

          -  Any unstable systemic disease, including active infection, uncontrolled high blood
             pressure, unstable angina, newly observed angina pectoris within the past 3 months,
             congestive heart failure (New York heart association (NYHA) class II or higher),
             myocardial infarction onset six months before included into the group, and severe
             arrhythmia, liver, kidney, or metabolic disease in need of drug therapy.

          -  Previously diagnosed with immunodeficiency disease.

          -  Human immunodeficiency virus (HIV) infection.

          -  Women in pregnancy or lactation .

          -  Patients with mental illness, considered as "can't fully understand the issues of this
             research".

          -  other Cancer history.

          -  Histologically confirmed small cell carcinoma or other non NSCLC compositions in the
             cancer tissue.

          -  Brain metastasis or liver metastasis or malignant pleural effusion or pericardial
             effusion.

          -  Allergy of rhGM-CSF and its accessories.

          -  Contraindications to GM-CSF treatment.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progress Free Survival (PFS)
Time Frame:2 years
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Overall Survival (OS)
Time Frame:2 years
Safety Issue:
Description:
Measure:Incidence of treatment-related adverse events
Time Frame:2 years
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Shanghai Chest Hospital

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