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Report for Clinical Trial NCT04081688

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

A Phase I Trial of Atezolizumab and Varlilumab in Combination With Radiation in Patients With Metastatic Non-Small Cell Lung Cancer (NSCLC)

This phase I trial studies the side effects of atezolizumab, varlilumab, and radiation therapy in treating patients with non-small cell lung cancer that has spread to other places in the body (advanced) and cannot be removed by surgery (unresectable). Immunotherapy with monoclonal antibodies such as atezolizumab may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Immunotherapy with monoclonal antibodies such as varlilumab may induce changes in body?s immune system and may interfere with the ability of tumor cells to grow and spread. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving atezolizumab, varlilumab, and radiation therapy may increase the amount of time the disease is not active or does not spread to another part of the body.

NCT04081688 Metastatic Lung Non-Small Cell Carcinoma Refractory Lung Non-Small Cell Carcinoma Stage III Lung Cancer AJCC v8 Stage IIIA Lung Cancer AJCC v8 Stage IIIB Lung Cancer AJCC v8 Stage IIIC Lung Cancer AJCC v8 Stage IV Lung Cancer AJCC v8 Unresectable Lung Non-Small Cell Carcinoma
MeSH:Carcinoma Lung Neoplasms Carcinoma, Non-Small-Cell Lung
HPO:Carcinoma Neoplasm of the lung Non-small cell lung carcinoma

3 Interventions

Name: Atezolizumab 1200 MG in 20 ML Injection

Description: Given IV every 3 weeks on day 2 of each cycle (cycle is 21 days)
Type: Drug
Group Labels: 1

Treatment (varlilumab, atezolizumab, SBRT)

Name: Stereotactic Body Radiation Therapy

Description: Undergo SBRT between cycle 1 and cycle 2 (each cycle is 21 days)
Type: Radiation
Group Labels: 1

Treatment (varlilumab, atezolizumab, SBRT)

Name: Varlilumab 3 mg/kg

Description: Given IV every 3 weeks on day 1 of each cycle (cycle is 21 days)
Type: Drug
Group Labels: 1

Treatment (varlilumab, atezolizumab, SBRT)


Primary Outcomes

Description: Will include grade 3 and 4 toxicities as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.

Measure: Assess the safety and tolerability of combined therapy in patients with metastatic NSCLC who have progressed on prior PD-1/PD-L1 therapy

Time: Up to 30 days after the last dose of treatment

Secondary Outcomes

Description: Will be defined as the proportion of all subjected confirmed with an immune-related partial response (irPR) or immune-related complete response (irCR) divided by the number of assigned patients according to immune-related Response Evaluation Criteria in Solid Tumors (irRECIST).

Measure: To determine objective response rate (ORR) of therapy

Time: From the start of treatment until disease progression/recurrence, assessed up to 1 year

Description: Will be defined as the percentage of patients who achieve irCR, irPR, and immune-related stable disease.

Measure: To estimate clinical benefit rate of the combination

Time: Up to 1 year

Description: The log-rank test will be used to analyze PFS for comparison of treatment effects, i.e., the only covariate that will be used is the treatment arm. Distributions of PFS times will be estimated using the Kaplan- Meier product-limit method. The median PFS times with two-sided 95% confidence intervals will be estimated for each treatment group.

Measure: To estimate median progression-free survival (PFS) of the combination

Time: From cycle 1, day 1 (each cycle is 21 days) of treatment until the criteria for disease progression is met as defined by irRECIST or death as a result of any cause, assessed up to 1 year

Description: irAE's are defined as any treatment-related AE that is inflammatory in nature, consistent with the mechanism of action of immunotherapy and generally medically manageable with topical and/or systemic immunosuppressants.

Measure: To compare the frequency of immune-related adverse events (irAEs)

Time: Up to 30 days after the last dose of treatment

Other Outcomes

Description: Will be assessed by immunohistochemistry (IHC) and will score the percentage of cells staining positively for PD-L1 incrementally. Scoring will be performed for the percentage of malignant tumor cells and for the percentage of nonmalignant inflammatory cell compartment that express PD-L1, separately.

Measure: To compare pre- and post-treatment tumor PD-L1 expression

Time: Baseline up to cycle 2, day 8 (each cycle is 21 days)

Description: Will be assessed by IHC staining to identify tumor infiltrating lymphocytes at the tumor stroma interface.

Measure: To compare pre- and post-treatment tumor levels of infiltrating CD3+, CD8+ T-cells

Time: Baseline up to cycle 2, day 8 (each cycle is 21 days)

Purpose: Treatment

Allocation: N/A

Single Group Assignment


There are 2 SNPs

SNPs


1 T790M

Patients with a EGFR T790M resistant mutation must have failed a 3rd generation TKI such as osimertinib - Must not have received any prior therapy with immune regulatory molecule (such as targeting OX-40, IDO-1, LAG-3) or anti-CD27 monoclonal antibody (including varlilumab) - Must have at least one lesion that has not previously been irradiated (and is not within a previously radiated field) and for which palliative radiation is potentially indicated. --- T790M ---


2 V600E

Treatment should be initiated at least 4 weeks since last dose of systemic therapy - Subjects with an actionable molecular alteration (such as EGFR mutation, ALK or ROS1 rearrangement, BRAF V600E mutation) are eligible only after failing standard-of-care targeted therapy with tyrosine kinase inhibitor (TKI). --- V600E ---



HPO Nodes


HPO: