Abstract 2852
Background
Although definitive concurrent chemoradiotherapy (CRT) is considered standard of care for most of stage III NSCLC patients, neoadjuvant treatment followed by surgery can be considered for some potentially resectable patients. Rationales for neoadjuvant treatment are tumor regression effect before surgery, early eradication of micrometastasis and better tolerability of chemotherapy than in the post-surgical setting. Regarding potential benefits of combining PD-1 blockade with CRT, here we have an ongoing phase Ib trial which assesses the safety and feasibility of the combination of neoadjuvant CRT with durvalumab in potentially resectable stage III NSCLC (NCT03694236).
Trial design
Eligible patients with histologically confirmed NSCLC (potentially resectable clinical stage III according to the American Joint Committee on Cancer 8th staging system) are enrolled. Patients receive CRT (weekly paclitaxel 45 mg/m2 and carboplatin AUC 2 with radiotherapy of 45 Gy in 25 fractions) and durvalumab (Day 1 and 29, 1500mg) during 5 weeks followed by surgery. After surgery, patients are treated with durvalumab for one year (every 4weeks, 1500 mg). The primary endpoints are safety and tolerability. The secondary endpoints are objective response rate (ORR), R0 resection rate, disease-free survival (DFS), overall survival (OS), clinical or pathological downstaging rate and, pathologic complete response (pCR) rate in the primary tumor. Immune marker analysis by FACS, exome sequencing and RNA sequencing using cancer tissue of pre-treatment, after surgery, and after recurrence will be performed.Table:
1477TiP
| Steps of trial | No. of patients | Considerations | |
|---|---|---|---|
| Neoadjuvant (weekly paclitaxel 45 mg/m2 and carboplatin AUC 2, radiotherapy 45 Gy in 25 fractions, durvalumab day 1 and 29, 1500mg) | Stage 11 | 9 | 1) If patients of ≥ 5 has grade≥3 TRAE the trial holds 2) If patients of ≤ 4 has grade≥3 TRAE the trial proceeds to the 2nd stage. |
| Stage 2 | 21 | If patients of ≤ 13(43%) has grade≥3 TRAE during the neoadjuvant treatment it will be considered tolerable and further analysis will be performed.2 | |
| Surgery | The time and modality of surgery will depend on the surgeon’s discretion. The maximum allowed interval between the end of neoadjuvant therapy and surgery is 9 weeks. If disease progresses during or after the neoadjuvant therapy, or if the surgeon thinks that the surgery is not feasible, concurrent chemoradiation or chemotherapy alone can be continued. | ||
| Adjuvant (durvalumab 1500mg for one year every 4 weeks, total of 13 times.) | The maximum allowed interval between the surgery and adjuvant therapy is 12 weeks. | ||
| Follow up | Response evaluation will be done until 5 years after the surgery.3 (Chest CT every 3 months, Abdominal pelvic CT at 1, 2, 5 years after the surgery) |
Additional enrollment will be hold until the first 9 patients proceeds surgery.
2Grade≥3 TRAE during neoadjuvant chemoradiotherapy is expected to be 30∼50% according to the previous data.
3Assessed according to the Response Evaluation Criteria in Solid Tumors(RECIST), version 1.1. TRAE; treatment-related adverse event, CT; Computed tomography.
Clinical trial identification
NCT03694236.
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
AstraZeneca.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
3620 - Safety, efficacy, PK and PD biomarker results of the first-in-human study of mutant isocitrate dehydrogenase 1 (mIDH1) inhibitor BAY 1436032 in patients (pts) with mIDH1 advanced solid tumours
Presenter: Wolfgang Wick
Session: Poster Display session 1
Resources:
Abstract
5465 - Proof of concept clinical study by US-guided intratumor injection of VCN-01, an oncolytic adenovirus expressing hyaluronidase in patients with pancreatic cancer
Presenter: Manuel Hidalgo
Session: Poster Display session 1
Resources:
Abstract
2555 - A Phase 1a/b first-in-human, open-label, dose-escalation, safety, PK and PD study of TP-0903 in solid tumors
Presenter: John Sarantopoulos
Session: Poster Display session 1
Resources:
Abstract
3533 - First in human phase 1/2a study of PEN-866, a Heat Shock Protein 90 (HSP90) ligand – SN38 conjugate for patients with advanced solid tumors: Phase 1 results
Presenter: Johanna Bendell
Session: Poster Display session 1
Resources:
Abstract
4114 - A Phase I Open-Label, Non-Randomized Study of Recombinant Super-Compound Interferon (rSIFN-co) In Patients with Advanced Solid Tumors
Presenter: Amanda Seet
Session: Poster Display session 1
Resources:
Abstract
2537 - Evaluation of Pharmacodynamic (PD) Biomarkers in Advanced Cancer Patients Treated with Oxidative Phosphorylation (OXPHOS) Inhibitor, OPC-317 (OPC)
Presenter: Jie Qing Eu
Session: Poster Display session 1
Resources:
Abstract
5764 - Pharmacokinetic (PK) assessment of BT1718: A phase 1/2a study of BT1718, a first in class Bicycle Toxin Conjugate (BTC), in patients (pts) with advanced solid tumours
Presenter: Natalie Cook
Session: Poster Display session 1
Resources:
Abstract
2683 - A phase I open label dose escalation trial evaluating VT1021 in patients with advanced solid tumors.
Presenter: Wael Harb
Session: Poster Display session 1
Resources:
Abstract
3609 - Interim Results from Trial of SL-801, a Novel XPO-1 Inhibitor, in Patients with Advanced Solid Tumors
Presenter: Judy Wang
Session: Poster Display session 1
Resources:
Abstract
3485 - Phase 1 Trial of Fruquintinib in Patients with Advanced Solid Tumors: Results of the Dose Escalation Phase
Presenter: Andrea Wang-Gillam
Session: Poster Display session 1
Resources:
Abstract