Stereotactic Ablative Radiotherapy for Oligo-Progressive Non Small Cell Lung Cancer

Overview

A registry-based randomized screening phase II trial. A total of 68 patients with metastatic non small cell lung cancer on systemic therapy with oligoprogression to 1-5 extracranial lesions will be randomized using a 1:1 ratio to standard of care (begin next-line systemic therapy, best supportive care, continue current systemic line, based on treating physician decision) vs. receive stereotactic ablative radiotherapy to all oligoprogressive lesions while continuing their current systemic therapy.

Full Title of Study: “Stereotactic Ablative Radiotherapy for Oligo-Progressive Disease REfractory to Systemic Therapy in Non Small Cell Lung Cancer: A Registry-based Phase II Randomized Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: July 1, 2025

Interventions

  • Radiation: SABR
    • SABR to all oligoprogressive lesions + continuation of current systemic therapy
  • Other: Standard of care
    • Patients on the standard arm will be treated as per standard of care in our institution. Treatment options could include switching to next systemic therapy line, best supportive care or continuing on current systemic therapy.

Arms, Groups and Cohorts

  • Active Comparator: Standard of care
    • Switch to subsequent systemic therapy line, best supportive care or continue current systemic line
  • Experimental: Experimental SABR arm
    • Definitive SABR to oligoprogressive lesions + continue current systemic therapy

Clinical Trial Outcome Measures

Primary Measures

  • PFS
    • Time Frame: 5 years
    • PFS defined from randomization to disease progression at any site or death
  • OS
    • Time Frame: 5 years
    • OS defined as time from randomization to time of death from any cause.

Secondary Measures

  • Quality of life Measured using the FACT-G tool, lung cancer-related patient reported outcome- CTCAE (PRO-CTCAE)
    • Time Frame: 5 years
    • Measured using the FACT-G tool, lung cancer-related patient reported outcome- CTCAE (PRO-CTCAE)
  • Quality of life 5-level EQ-5D (EQ-5D-5L)
    • Time Frame: 5 years
    • questionnaire
  • Grade ≥ 3 toxicity
    • Time Frame: 5 years
    • Measured using the Common Terminology Criteria for Adverse Events (CTCAE v5.0)
  • Local control
    • Time Frame: 5 years
    • Defined as time from the end of SABR treatment to date of local failure and will be measured only in the experimental arm
  • Time to next systemic therapy
    • Time Frame: 5 years
    • Defined as time from randomization to time of subsequent therapy line

Participating in This Clinical Trial

Inclusion Criteria

  • Age ≥18 years – Metastatic NSCLC enrolled in our CRCHUM Lung Cancer Registry and co-enrolled to the PERa registry – Ability to provide written informed consent – Eastern Cooperative Oncology Group (ECOG) performance status 0-3 – Oligoprogression to 1-5 extracranial lesions ≤ 5cm and involving ≤ 3 organs. Progression at the primary tumor site should be counted within the total of 5 lesions. For patients with lymph node metastases, each node is counted as one site of metastasis. – Oligoprogression while on ICI or TKI (any line) – Patients with brain metastasis are allowed; brain metastasis are not counted in the maximum number of lesions and should be treated as per standard of care – All sites of disease can, in the opinion of the investigator, be safely treated and targetable with SABR (taking into account prior local therapy, organ function and underlying medical condition such as inflammatory bowel disease, pulmonary fibrosis, etc.) – Patients with prior metastases that have been treated with ablative therapies (e.g. radiotherapy, surgery or radiofrequency ablation) before their current line of systemic therapy, are eligible. Exclusion Criteria:

  • Any lesion beyond 5 cm – Pregnancy or breastfeeding – Any medical condition that could, in the opinion of the investigator, preclude radiotherapy or prevent follow-up after radiotherapy. – Presence of spinal cord compression Metastatic disease that invades the GI tract (including esophagus, stomach, small or large bowel)

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Centre hospitalier de l’Université de Montréal (CHUM)
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Houda Bahig, MD PhD, Study Chair, Centre hospitalier de l’Université de Montréal (CHUM)
    • Bertrand Routy, MD PhD, Study Chair, Centre hospitalier de l’Université de Montréal (CHUM)
  • Overall Contact(s)
    • Silvine Benth, 514-890-8254, silvine.benth.chum@ssss.gouv.qc.ca

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