Patient case: 32-year-old male with melanoma; genetic feature: NRAS (Q61H)

Clinical trial: Phase II Trial Assessing the Efficacy of Immuno-Radiation Abscopal Effect in Patients With Metastatic Cancers

Summary: 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.

Eligibility: 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

Relevance to patient case: not relevant