Clinical trial NCT04505267: NBTXR3 and Radiation Therapy for the Treatment of Inoperable Recurrent Non-small Cell Lung Cancer
Official title: Phase I Study of Reirradiation With NBTXR3 for Inoperable Locoregional Recurrent Non-Small Cell Lung Cancer (NSCLC)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
Conditions: Recurrent Lung Non-Small Cell Carcinoma
Stage I Lung Cancer AJCC v8
Stage IA1 Lung Cancer AJCC v8
Stage IA2 Lung Cancer AJCC v8
Stage IA3 Lung Cancer AJCC v8
Stage IB Lung Cancer AJCC v8
Stage II Lung Cancer AJCC v8
Stage IIA Lung Cancer AJCC v8
Stage IIB Lung Cancer AJCC v8
Stage III Lung Cancer AJCC v8
Stage IIIA Lung Cancer AJCC v8
Stage IIIB Lung Cancer AJCC v8
Stage IIIC Lung Cancer AJCC v8
Unresectable Lung Non-Small Cell Carcinoma
Lead sponsor: M.D. Anderson Cancer Center
Sponsor class: OTHER
Collaborators: name: National Cancer Institute (NCI)
First posted: 2020-08-10
Enrollment: 24
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This phase I trial investigates the best dose and side effects of NBTXR3 when given together with radiation therapy for the treatment of non-small cell lung cancer that cannot be treated by surgery (inoperable) and has come back (recurrent). NBTXR3 is a radio-enhancer designed to increase the radiotherapy energy dose deposition inside tumor cells. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving NBTXR3 and radiation therapy may increase radiation-dependent tumor cell killing without increasing the radiation exposure of healthy surrounding tissues.

Detailed description: PRIMARY OBJECTIVE:

I. To assess the safety of 45 Gy in 15 fractions in patients with inoperable, locoregional recurrent NSCLC, previously treated with definitive radiation therapy.

II. To determine the recommended phase II dose (RP2D) of NBTXR3 activated by radiotherapy in patients with inoperable, locoregional recurrent NSCLC, previously treated with definitive radiation therapy.

SECONDARY OBJECTIVES:

I. To evaluate the safety and feasibility of reirradiation with NBTXR3 in patients with inoperable, locoregionally recurrent NSCLC.

II. To evaluate the anti-tumor response of reirradiation with NBTXR3 in patients with inoperable, locoregionally recurrent NSCLC.

III. To evaluate time-to-event outcomes after reirradiation with NBTXR3 in patients with inoperable, locoregionally recurrent NSCLC

EXPLORATORY OBJECTIVE:

I. To assess biomarkers of response in patients treated with NBTXR3/radiation therapy (RT).

OUTLINE: This is a dose-escalation and dose-expansion study of NBTXR3.

Patients receive NBTXR3 intratumorally (IT) or intranodally on day 1. Within 15 days, patients undergo RT 5 times weekly (Monday-Friday) over 3 weeks for a total of 10-15 fractions.

After completion of study treatment, patients are followed up every 3 months for 2 years, then every 6 months for up to 5 years.

Eligibility criteria: Inclusion Criteria:

1. Biopsy proven locoregionally recurrent NSCLC after prior definitive radiation therapy, or patients that have imaging characteristics highly suggestive of recurrence but no pathologic or cytologic diagnosis. Pathologic diagnosis will be confirmed during the procedure to inject NBTXR3, prior to injecting the drug. If pathologic diagnosis cannot be established, the procedure will be aborted and the patient will be considered a screening failure. For stage IV patients, oligometastatic disease should be confirmed at screening. Oligometastatic disease is defined as ≤ 3 cancer lesions, not including the primary tumor.
2. Participant deemed medically inoperable by the investigator or treating physician.
3. Overlap between recurrent disease in need of treatment and prior radiation treatment field as determined by treating Radiation Oncologist.

   1. As a general reference, recurrent disease within 50% isodose line of prior radiation treatment field would be considered significant.
   2. Radiation treatment received more than 6 months prior to enrollment.
4. Amenable to undergo bronchoscopic (EBUS, CBCT) or CT-guided injection of NBTXR3 as per investigator or treating physician.

   1. Up to 4 lung lesions may be injected with NBTXR3, including the primary tumor, involved lymph node(s), and/or metastatic lesion(s).
   2. At least 1 injected lesion should be located within a reirradiation field.
   3. All injected lesions must be radiated.
5. The target lesion(s) should be measurable on cross sectional imaging (RECIST 1.1).

   a. Nodal target lesions must be ≥15 mm (short axis) based on CT (slice thickness of 5 mm or less) or MRI.
6. Age ≥ 18 years
7. ECOG Performance Status 0-2
8. For cohort 1, adequate laboratory values to receive radiation as determined by the principal investigator or treating physician.
9. For cohort 2 laboratory values at screening:

   1. Hemoglobin ≥ 8.0 g/dL
   2. Absolute Neutrophil Count (ANC) ≥ 1,500/mm3
   3. Platelet Count ≥ 100,000/mm3
   4. Creatinine ≤ 1.5 x upper limit of normal (ULN)
   5. Calc. Creatinine Clearance ≥ 30 mL/min
   6. Total Bilirubin ≤ 2.0 mg/dL
   7. AST / ALT ≤ 3.0 x upper limit of normal (ULN) or 5.0 x ULN if known liver metastases
   8. Serum albumin ≥ 3.0 g/dL
10. Negative urine or serum pregnancy test ≤ 7 days of NBTXR3 injection in all female of child-bearing potential.
11. Signed informed consent form (ICF) indicating that participant understands the purpose of, and procedures required for, the study and is willing to participate in the study.
12. English speaking or Non-English Speaking subjects

Exclusion Criteria:

1. At screening, past medical history of:

   1. Interstitial lung disease, excluding drug-induced ILD, speficially immunotherapy-induced pneumonitis that has been resolved
   2. Any Grade 4 thoracic radiation related toxicity
   3. Unresolved radiation related

   i. Esophagitis ii. Pneumonitis iii. Bronchopulmonary hemorrhage d. Any Grade i. Esophageal perforation ii. Radiation associated airway necrosis iii. Bronchoesophageal fistula e. Any Grade i. Esophageal perforation ii. Radiation associated airway necrosis iii. Bronchoesophageal fistula iv. Tracheoesophageal fistula v. Spinal cord myelopathy
2. Has received any approved or investigational anti-neoplastic or immunotherapy agent within 2 weeks prior to NBTXR3 injection
3. Use of concurrent systemic therapy (chemotherapy, immunotherapy, targeted therapy) or patient participation on another therapeutic clinical trial.
4. Active malignancy, in addition to locoregionally recurrent NSCLC, with the exception of definitively treated and relapse free within 1 year from diagnosis of non-melanoma skin cancer or cervical cancer in situ; definitively treated non-metastatic prostate cancer; or patients with another primary malignancy who are definitively treated and relapse free with at least 2 years elapsed since the diagnosis of the other primary malignancy.
5. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, renal failure, cardiac arrhythmia, or psychiatric illness that would limit compliance with treatment.
6. Known active, uncontrolled (high viral load) HIV or hepatitis B or hepatitis C infection
7. Female patients who are pregnant or breastfeeding.
8. Women of child-bearing potential and their male partners who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period. Acceptable methods of contraception are those that, alone or in combination, result in a failure rate of \< 1% per year when used consistently and correctly.
9. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments.
10. Cognitively impaired subjects

Primary outcomes:
measure: Incidence of dose limiting toxicity (DLT) Cohort 1
timeFrame: Day 1 to 3 months post radiation therapy (RT)
measure: Determination of the Recommended Phase II Dose (RP2D)
timeFrame: 4 weeks post RT
measure: Incidence of dose limiting toxicity (DLT) Cohort 2
timeFrame: Day 1 to 4 weeks post RT
measure: Determination of the maximum tolerated dose (MTD)
timeFrame: 4 weeks post RT
Secondary outcomes:
measure: Incidence of NBTXR3/RT related late onset toxicities
timeFrame: Up to 5 years
measure: Feasibility of NBTXR3 injection in lung
timeFrame: Up to 5 years
measure: Feasibility of the regional lymph nodes
timeFrame: Up to 5 years
measure: Objective response rate (ORR)
timeFrame: Up to 5 years
measure: Local disease control rate (LDCR)
timeFrame: At 1 and 2 years
measure: Local progression free survival (LPFS)
timeFrame: From NBTXR3 injection to local (i.e., within the lungs or regional nodes) disease recurrence, local progression, or death from any cause, assessed up to 5 years
measure: Distant progression free survival (DPFS)
timeFrame: From NBTXR3 injection to the radiographic confirmation (RECIST v1.1 and irRECIST) of a new lesion outside the lungs and regional nodes or death from any cause, assessed up to 5 years
measure: Progression free survival (PFS)
timeFrame: From NBTXR3 injection to local or recurrence, local progression, distant progression, confirmed radiographically (RECIST v1.1 and irRECIST), or death from any cause, assessed up to 5 years
measure: Overall survival (OS)
timeFrame: From NBTXR3 injection to death from any cause or EoS, assessed up to 5 years
Other outcomes:
measure: Tumor microenvironment
timeFrame: Up to 5 years
measure: Immune activation
timeFrame: Up to 5 years
measure: Circulating tumor deoxyribonucleic acid (DNA) mutations
timeFrame: Up to 5 years
Locations:
city: Houston
country: United States
facility: M D Anderson Cancer Center
state: Texas
Study officials:
affiliation: M.D. Anderson Cancer Center
name: Saumil Gandhi
role: PRINCIPAL_INVESTIGATOR
References: