Platinum-Based Chemotherapy and Durvalumab for the Treatment of Stage IIIB or IV Non-small Cell Lung Cancer

  • STATUS
    Recruiting
  • participants needed
    41
  • sponsor
    Emory University
Updated on 16 February 2024
psychiatric disorder
cancer
HIV Infection
estrogen
rheumatoid arthritis
pulmonary disease
hysterectomy
platelet count
corticosteroids
ct scan
immunomodulator
measurable disease
metastasis
platinum-based chemotherapy
carboplatin
solid tumour
gilbert's syndrome
neutrophil count
lung cancer
pemetrexed
paclitaxel
hormone therapy
monoclonal antibodies
liver metastasis
durvalumab
oophorectomy
skin cancer
endocrine therapy
hypertension
heart failure
colitis
organ transplantation
prednisone
immunosuppressive agents
monoclonal antibody therapy
PCR test
immunosuppressive
brain metastases
tumor cells
cancer treatment
carcinoma
solid tumors
follicle stimulating hormone
diarrhea
immunomodulators
serum bilirubin
intra-articular injection
hepatitis b surface antigen
uveitis
uncontrolled hypertension
arrhythmia
premedication
hepatitis
drug test
replacement therapy
stage iv non-small cell lung cancer
carcinoma in situ
estradiol
systemic therapy
tuberculosis
crohn's disease
topical steroids
hypothyroidism
unstable angina
angina pectoris
liver disease
immunodeficiency
adjuvant therapy
live vaccine
hbsag
neuropathy
cancer therapy
celiac disease
solid neoplasm
pd-l1
psychiatric illness
congestive heart failure
ribonucleic acid
nervous
systemic lupus erythematosus
secondary malignant neoplasm of liver
serum bilirubin level
non-small cell carcinoma
hormonal therapy
hemolysis
liver metastases
mental illness
concurrent chemotherapy
angina
inflammatory bowel disease
sarcoidosis
hormone replacement therapy
cardiac arrhythmia
vitiligo
hepatitis b core antibody
hepatitis c
lab tests
brain metastasis
interstitial lung disease
diverticulitis
hypophysitis
hyperbilirubinemia
attenuated vaccines
skin disease
primary immunodeficiency
graves' disease
in situ carcinoma
granulomatosis
skin condition
adjuvant
nervous system
non-small cell lung cancer
prostate cancer
small cell lung cancer
carcinomatous meningitis
irreversible toxicity
wegener syndrome
intra articular injection
diverticulosis
hashimoto syndrome
meningeal carcinomatosis
hashimoto's thyroiditis
lymphomatous meningitis
stage iv lung cancer
interstitial disease
stage iva lung cancer ajcc v8
stage iv lung cancer ajcc v8
stage ivb lung cancer ajcc v8
stage iiib lung cancer ajcc v8

Summary

This phase II trial studies how well platinum-based chemotherapy works when given together with durvalumab in treating patients with stage IIIB or stage IV non-small cell lung cancer. Drugs used in chemotherapy, such as carboplatin, paclitaxel, and pemetrexed, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Immunotherapy with monoclonal antibodies, such as durvalumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. The purpose of this study is to find out if the combination of chemotherapy in combination with the immune therapy drug durvalumab would be efficacious and have an acceptable toxicity profile in patients with advanced non-small cell lung cancer.

Description

PRIMARY OBJECTIVE:

I. To determine the 6-months progression-free survival (PFS) rate with the combination of dose attenuated doublet chemotherapy with durvalumab in advanced non-small cell lung cancer (NSCLC) patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 status or age >= 70.

SECONDARY OBJECTIVES:

I. To investigate overall response rate. II. To determine the safety profile of the regimen. III. To determine the median PFS and overall survival.

EXPLORATORY OBJECTIVE:

I. Exploratory investigation of biomarkers that could potentially serve as predictive indicators: characterize immunoprofile in peripheral blood by flow cytometry.

OUTLINE: Patients are assigned to 1 of 2 arms.

ARM I (SQUAMOUS NSCLC): Patients receive carboplatin intravenously (IV) over 15-60 minutes, paclitaxel IV over 3 hours and durvalumab IV over 1 hour on day 1. Treatment repeats every 3 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients who do not progress receive durvalumab IV every 4 weeks for up to 35 cycles in the absence of disease progression or unacceptable toxicity.

ARM II (NON-SQUAMOUS NSCLC): Patients receive carboplatin IV over 15-60 minutes, pemetrexed IV over 10 minutes and durvalumab IV over 1 hour on day 1. Treatment repeats every 3 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients who do not progress receive durvalumab IV and pemetrexed IV every 3 weeks for up to 35 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months.

Details
Condition Stage IV Lung Cancer AJCC v8, Stage IIIB Lung Cancer AJCC v8, Stage IVA Lung Cancer AJCC v8, Stage IVB Lung Cancer AJCC v8, Lung Non-Small Cell Carcinoma
Age 18years - 100years
Treatment Carboplatin, Pemetrexed, Paclitaxel, Durvalumab
Clinical Study IdentifierNCT04262869
SponsorEmory University
Last Modified on16 February 2024

Eligibility

Yes No Not Sure

Inclusion Criteria

Patients with grade >= 2 neuropathy will be evaluated on a case-by-case basis after consultation with the study physician
Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab may be included only after consultation with the study physician
Any concurrent chemotherapy, investigational product (IP), biologic, or hormonal therapy for cancer treatment. Concurrent use of hormonal therapy for non-cancer-related conditions (e.g., hormone replacement therapy) is acceptable
Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of IP. Note: Local surgery of isolated lesions for palliative intent is acceptable
History of allogenic organ transplantation
Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this
criterion
Patients with vitiligo
Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement
Any chronic skin condition that does not require systemic therapy
Patients without active disease in the last 5 years may be included but only after consultation with the study physician
Patients with celiac disease controlled by diet alone
Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring adverse events (AEs) or compromise the ability of the patient to give written informed consent
Prior invasive malignancy (except non-melanomatous skin cancer, low or intermediate risk prostate cancer, or in situ carcinoma fully resected) unless disease free for a minimum of one year
History of leptomeningeal carcinomatosis
Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are clinically stable for at least 2 weeks. Subjects with asymptomatic brain metastases may participate, but will require regular imaging of the brain as a site of disease
History of active primary immunodeficiency
Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis [TB] testing in line with local practice), hepatitis B (known positive hepatitis B virus [HBV] surface antigen [HBsAg] result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for 20. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (hepatitis C virus [HCV]) antibody are eligible only if polymerase chain reaction is negative for HCV ribonucleic acid (RNA)
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)
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
Female patients who are pregnant or breastfeeding or male or female patients of reproductive potential who are not willing to employ effective birth control from screening to 90 days after the last dose of durvalumab monotherapy
Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients
Patients may not have received prior anti-PD-1, anti PD-L1 including durvalumab or anti CTLA-4 drugs
Judgment by the investigator that the patient is unsuitable to participate in the study and the patient is unlikely to comply with study procedures, restrictions and requirements

Exclusion Criteria

Participation in another clinical study with an investigational product during the last 4 weeks
ECOG PS 3 or higher
Prior systemic therapy for the treatment of advanced or metastatic NSCLC
Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study
Completed palliative radiotherapy within 7 days of the first dose of trial treatment
Has a known sensitivity to any component of carboplatin, pemetrexed, paclitaxel, or durvalumab
Is unable to unwilling to take folic acid of vitamin b12 supplementation (if non-squamous histology)
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psychiatric disorder
cancer
HIV Infection
estrogen
rheumatoid arthritis
pulmonary disease
hysterectomy
platelet count
corticosteroids
ct scan
immunomodulator
measurable disease
metastasis
platinum-based chemotherapy
carboplatin
solid tumour
gilbert's syndrome
neutrophil count
lung cancer
pemetrexed
paclitaxel
hormone therapy
monoclonal antibodies
liver metastasis
durvalumab
oophorectomy
skin cancer
endocrine therapy
hypertension
heart failure
colitis
organ transplantation
prednisone
immunosuppressive agents
monoclonal antibody therapy
PCR test
immunosuppressive
brain metastases
tumor cells
cancer treatment
carcinoma
solid tumors
follicle stimulating hormone
diarrhea
immunomodulators
serum bilirubin
intra-articular injection
hepatitis b surface antigen
uveitis
uncontrolled hypertension
arrhythmia
premedication
hepatitis
drug test
replacement therapy
stage iv non-small cell lung cancer
carcinoma in situ
estradiol
systemic therapy
tuberculosis
crohn's disease
topical steroids
hypothyroidism
unstable angina
angina pectoris
liver disease
immunodeficiency
adjuvant therapy
live vaccine
hbsag
neuropathy
cancer therapy
celiac disease
solid neoplasm
pd-l1
psychiatric illness
congestive heart failure
ribonucleic acid
nervous
systemic lupus erythematosus
secondary malignant neoplasm of liver
serum bilirubin level
non-small cell carcinoma
hormonal therapy
hemolysis
liver metastases
mental illness
concurrent chemotherapy
angina
inflammatory bowel disease
sarcoidosis
hormone replacement therapy
cardiac arrhythmia
vitiligo
hepatitis b core antibody
hepatitis c
lab tests
brain metastasis
interstitial lung disease
diverticulitis
hypophysitis
hyperbilirubinemia
attenuated vaccines
skin disease
primary immunodeficiency
graves' disease
in situ carcinoma
granulomatosis
skin condition
adjuvant
nervous system
non-small cell lung cancer
prostate cancer
small cell lung cancer
carcinomatous meningitis
irreversible toxicity
wegener syndrome
intra articular injection
diverticulosis
hashimoto syndrome
meningeal carcinomatosis
hashimoto's thyroiditis
lymphomatous meningitis
stage iv lung cancer
interstitial disease
stage iva lung cancer ajcc v8
stage iv lung cancer ajcc v8
stage ivb lung cancer ajcc v8
stage iiib lung cancer ajcc v8

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