Neoplasms, Secondary Malignant Neoplasm
Conditions
Keywords
Neoplasm Metastasis
Brief summary
Recently, MD Anderson Cancer Center reported the phase II trial to investigate high-dose radiotherapy (HDRT, 20-70 Gy) and low-dose radiotherapy (LDRT, 1-10 Gy) for metastatic cancer patients who had undergone immunotherapy. HDRT or HDRT+LDRT was conducted in two respective groups and the treatment group was determined according to the disease status of participants, not randomization. Immunotherapy was maintained in this clinical study. Therefore, we aim to investigate this abscopal effect from adding LDRT to HDRT, irrespective of previous immunotherapy, in this multicenter, single-arm study.
Interventions
RADIATIONSBRT + LDRT
Stereotactic body radiotherapy (SBRT) and low-dose radiotherapy (LDRT) are administered concurrently. SBRT is administered three times, at intervals of 1-2 days, and patients are treated with LDRT along with SBRT. LDRT is planned to irradiate EQD2 6 Gy considering the scattered dose caused by SBRT.
Sponsors
SMG-SNU Boramae Medical Center
Saint Vincent's Hospital, Korea
Seoul National University Hospital
Chungnam National University Hospital
Soonchunhyang University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who can provide their written informed consent * Age ≥19 years * Patients with histologically confirmed primary solid (irrespective of the status of the primary tumor) * Patients with ECOG performance status 0-2 * Patients planning stereotactic body radiotherapy (three fractions) for extracranial metastases * Based on RECIST v1.1, patients with at least one extracranial measurable lesion other than SBRT lesions * Patients with one or more measurable lesions, which are not suitable for SBRT or palliative radiotherapy and can be considered for LDRT (bone metastasis is not indicated for LDRT) * Patients with hematologic function suitable for radiotherapy (absolute neutrophil count ≥1,500/mm\^3, hemoglobin ≥9 g/dL, platelet count ≥100,000/mm\^3) * Patients with a life expectancy of 6 months or more according to the researcher's judgment
Exclusion criteria
* Patients participating in other clinical studies that may affect the efficacy/safety of this clinical study * Patients with brain metastasis * Patients planning SBRT for all measurable lesions due to oligometastasis * Patients with a history of radiotherapy for extracranial metastases within 3 months of the enrollment * Patients unable to cooperate with stereotactic body radiotherapy * Patients who are pregnant or planning to * Patients with advanced or multiple malignancies requiring aggressive treatment (excluding skin cancers other than melanoma or intraepithelial cancer) * Patients who have received systemic steroid therapy or immunosuppressive therapy within 2 weeks of enrollment - Patients with an (e.g. allergic disease, radiation pneumonitis, etc.) (The use of steroids for preventive purposes is allowed (e.g., to prevent vomiting during chemotherapy)) active autoimmune disease requiring systemic treatment within the past 2 years, evidence of clinically severe autoimmune disease, or syndrome requiring systemic steroid or immunosuppressive therapy (Patients who need intermittent use of bronchodilators, inhaled steroids, or topical steroid injections, hypothyroid patients on stable hormone replacement therapy, type 1 diabetes patients, or patients recovering from childhood asthma/atopic dermatitis are permitted) * Patients with active infection requiring systemic treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Abscopal effect rate of low-dose radiotherapy lesions | 3 months after completion of radiotherapy | The proportion of patients with an abscopal response of low-dose radiotherapy lesions assessed by RECIST v1.1 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall response rate | 1, 3, 6, and 12 months after completion of radiotherapy | The proportion of patients showing complete or partial response of metastatic lesions |
| Progression-free survival rate | 12 months after completion of radiotherapy | From the date of enrollment to the date of progression or death assessed by RECIST v1.1 |
| Abscopal effect rate of low-dose radiotherapy lesions | 1, 6, and 12 months after completion of radiotherapy | The proportion of patients with an abscopal response of low-dose radiotherapy lesions assessed by RECIST v1.1 |
| Adverse event | 12 months after completion of radiotherapy | The proportion of patients with treatment-related adverse events as assessed by CTCAE v5.0 |
| Immune cell subsets of peripheral blood and tissue samples | 1 and 3 months after completion of radiotherapy | Number of immune cell count |
| Overall survival rate | 12 months after completion of radiotherapy | From the date of enrollment to the date of death or last follow-up assessed by RECIST v1.1 |
Countries
South Korea
Contacts
Primary ContactJae Sik Kim, MD
Outcome results
None listed