Description:
The proposed theory is based on combination of radiation therapy with usual targeted
therapies capable of ADCC (Antibody-Dependant Cell Cytotoxicity). This association could
enhance in a additive/synergistic way the benefic impact of immune system activation on tumor
control. Stereotactic Body Radio-Therapy (SBRT) will be combined with the first line
chemotherapy for metastatic breast, colorectal or VADS (upper aerodigestive tract) cancers.
The IRAM study objective is to highlight a possible abscopal effect of this combination for
metastatic cancer patients.
Title
- Brief Title: Phase II Trial Assessing the Efficacy of Immuno-Radiation Abscopal Effect in Patients With Metastatic Cancers
- Official Title: Phase II Trial Assessing the Efficacy of Immuno-Radiation Abscopal Effect in Patients With Metastatic Cancers (IRAM)
Clinical Trial IDs
- ORG STUDY ID:
2017-0301
- SECONDARY ID:
2017-A02043-50
- NCT ID:
NCT03323424
Conditions
- Metastatic Breast Cancer
- Metastatic Colorectal Cancer
- Metastatic Head and Neck Cancer
Purpose
The proposed theory is based on combination of radiation therapy with usual targeted
therapies capable of ADCC (Antibody-Dependant Cell Cytotoxicity). This association could
enhance in a additive/synergistic way the benefic impact of immune system activation on tumor
control. Stereotactic Body Radio-Therapy (SBRT) will be combined with the first line
chemotherapy for metastatic breast, colorectal or VADS (upper aerodigestive tract) cancers.
The IRAM study objective is to highlight a possible abscopal effect of this combination for
metastatic cancer patients.
Detailed Description
Nowadays, metastatic cancer treatment is evolving with systemic treatments (target therapies
and immunotherapies). Combinations and new therapeutic schemes have recently boosted the
interest for an effect called "abscopal". This effect is based on the immune-stimulating
effect of high doses ionizing radiations, but also on synergistic association with systemic
treatment with immunologic mechanisms. This effect could enhance the tumor local control, but
also its distant control.
Numerous preclinical evidences as well as some clinical case reports described the abscopal
effect.
Ongoing clinical studies are investigating with radiotherapy abscopal effect alone, or
associated with immunotherapies (anti-CTLA-4, PD-1 or PDL-1). The present study proposes a
new association, based on an original biological rational. The proposed theory is based on
combination of radiation therapy with usual targeted therapies capable of ADCC
(Antibody-Dependant Cell Cytotoxicity). This association could enhance in an
additive/synergistic way the benefic impact of immune system activation on tumor control.
In the present study, Stereotactic Body Radio-Therapy (SBRT) will be combined to the standard
systemic treatment for first line treatment of metastatic breast, colorectal and VADS (upper
aerodigestive tract) cancers. Indeed, these treatments have in common the use of target
therapies capable of ADCC.
The IRAM study objective is to highlight a possible abscopal effect of this combination for
metastatic cancer patients.
Trial Arms
Name | Type | Description | Interventions |
---|
Systemic treatment + Stereotactic Body Radio-Therapy (SBRT) | Experimental | Patients with metastatic breast, colorectal or head or neck cancers and corresponding with the inclusion criteria will receive a systemic treatment, according to the usual practice, but also a Stereotactic Body Radio-Therapy (SBRT). | |
Systemic treatment | Active Comparator | Patients with metastatic breast, colorectal or head or neck cancers and corresponding with the inclusion criteria will receive a systemic treatment, according to the usual practice. | |
Eligibility Criteria
Inclusion Criteria:
- Patients with a metastatic breast adenocarcinoma HER2+, a metastatic squamous
carcinoma of VADS, or a colorectal adenocarcinoma with a wild status for RAS (NRAS and
KRAS)
- Patient presenting at least two measurable metastases (according to the RECIST v1.1
criteria):
- At least one eligible to SBRT (hepatic, pulmonary, bone or intra-cranial metastasis,
with a diameter between 1 and 4cm)
- At least one non irradiated measurable metastasis
- Performance Status corresponding to 0, 1, or 2
- Realisation of a PET (Positron Emission Tomography)-Scanner and a TAP
(Thoraco-AbdominoPelvic)-Scanner 30 days maximum before inclusion
- Informed consent patient
- Patients affiliated to a social security scheme.
Exclusion Criteria:
- Patient presenting a known non-indication or contraindication to the first line
treatment administered
- Pregnant or nursing women
- Patient with an another cancer during the 5 last years, excepting basocellular
carcinoma, and skin epidermoid carcinoma
- Patient presenting a non-controlled pain linked to the cancer
- Patient presenting a non-controlled hypercalcemia or symptomatic hypercalcemia needing
an ongoing use of bisphosphonates or denosumab.
- Patient presenting an inflammatory pathology or active autoimmune pathology or history
of.
- Patient having received one or more vaccines during the 4 weeks preceding the
beginning of the systemic treatment.
- Patient currently using corticosteroids or other immune-suppressors during the two
weeks before inclusion, and any other situation where this kind of treatments could be
necessary during the study.
- Patient deprive of liberty or under administrative supervision, patients with an
impossible take care supervision for psychological or geographical reasons.
- Stereotactic Body Radio-Therapy (SBRT) must not include metastases localized in the 3
centimeters of the structure previously irradiated.
- Patient presenting serious active comorbidities defined by the protocol.
- Known seropositivity to the HIV
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Survival rate without progression for patients with metastatic breast cancer |
Time Frame: | 18 months |
Safety Issue: | |
Description: | The rate of survival without progression according to the RECIST (v1.1) criteria for patients with metastatic breast cancer will be calculated at 18 months after the beginning of the systemic treatment. |
Secondary Outcome Measures
Measure: | Response rate on predetermined metastatic abscopal sites |
Time Frame: | 3 months |
Safety Issue: | |
Description: | The response rate on predetermined metastatic abscopal sites will be evaluated at 3 months after the beginning of the systemic treatment according to the RECIST v1.1 criteria. |
Measure: | Response rate on the irradiated site |
Time Frame: | 3 months |
Safety Issue: | |
Description: | The response rate on the irradiated site will be evaluated at 3 months after the beginning of the systemic treatment according to the RECIST v1.1 criteria. |
Measure: | Progression-free survival (PFS) |
Time Frame: | 5 years |
Safety Issue: | |
Description: | The median PFS according to the RECIST v1.1 criteria will be reported at 5 years after the beginning of the systemic treatment. |
Measure: | Overall survival (OS) |
Time Frame: | 5 years |
Safety Issue: | |
Description: | The OS will be reported at 5 years after the beginning of the systemic treatment. |
Measure: | Toxicity of the treatments combination |
Time Frame: | 6 cycles |
Safety Issue: | |
Description: | During the first line of systemic treatment (six cycles of treatment maximum), the number and the grade (CTCAE v4.4) of toxicities related to the systemic treatment /Radiation therapy combination will be reported. |
Measure: | Toxicity of the treatments combination |
Time Frame: | 5 years |
Safety Issue: | |
Description: | Sub-group analysis will be performed following the 3 binary stratification criteria: total number of metastasis, localization of the irradiated metastasis and irradiated volume. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Withdrawn |
Lead Sponsor: | Institut de Cancérologie de la Loire |
Trial Keywords
- Metastatic cancer
- Abscopal effect
- Ionizing radiation
- Antibody-Dependant Cell Cytotoxicity (ADCC)
- Immuno-Radiation effect
- Stereotactic Body Radio-Therapy (SBRT)
- Targeted therapies
Last Updated
January 30, 2020