Lung Cancer (NSCLC)
Conditions
Brief summary
This is an open-label, multicentre, randomized phase II clinical trial. Patients with stage IV (AJCC 9th edition) non-small cell lung cancer (NSCLC) harboring EGFR exon 19 deletion or exon 21 L858R mutation, who had less than or equal to 3 active oligoresidual cancer sites amenable to local ablative therapy (LAT) (as determined by physician) after 3-6 months of firstline osimertinib treatment, are eligible. Subjects will be randomized 1:1 to osimertinib with or without LAT.
Interventions
RADIATIONLocal ablative therapy
Local ablative therapy (LAT) will be given in the form of stereotactic body radiotherapy (SBRT) or hypofractionated radiotherapy. LAT should be started within 90 days from the screening PET-CT scan.
DRUGOsimertinib alone
Continue osimertinib as per standard of care (40mg or 80mg daily)
Sponsors
Chinese University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years of age or older and able to understand and give written informed consent * Pathologically proven non-small cell lung cancer * Positive for EGFR exon 19 deletion or EGFR exon 21 L858R mutation (either by tissue or plasma testing) * Stage IV disease * Receive first line osimertinib monotherapy for stage IV disease * Undergo a PET-CT scan after 12-24 weeks of initiation of osimertinib treatment, with no evidence of disease progression, and less than or equal to 3 active disease sites (including primary tumour) amenable to local ablative therapy, as determined by investigator * At least one brain imaging (CT Brain or MRI Brain with contrast, preferably MRI Brain), either at time of diagnosis or while on osimertinib treatment but before randomization, to document CNS status for stratification. Patients with asymptomatic CNS metastases are eligible. For patients with brain metastases diagnosed at baseline, follow up brain imaging is recommended before randomization. * Patients with history of palliative radiotherapy are eligible * Eastern Cooperative Oncology Group (ECOG) performance status 0-1 * Adequate haematological values: haemoglobin ≥9.0g/dL, absolute neutreophil count ≥1.0 x 109/L, platelet count ≥100 x 109/L * Adequate hepatic function: bilirubin ≤1.5 x ULN, AST/ALT ≤2.5 x ULN * Adequate renal function: creatinine clearance ≥30ml/min, according to the formula of Cockcroft-Gault equation * Willing and able to comply with the requirements and restrictions in this protocol
Exclusion criteria
* Previous or concomitant malignancy within 5 years prior registration with the exception of adequately treated localized non-melanoma skin cancer or cervical cancer in situ. * Mixed SCLC and NSCLC histology * Positive pregnancy test * Contraindication to radiotherapy * Any serious underlying medical, psychiatric, psychological, familial condition that in the judgement of the investigator, that may interfere with planned staging, treatment and follow up, affect patient compliance, or place the patient at high risk from treatment related complications
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 18 month progression-free survival rate (PFS) in per-protocol population as determined by investigator. | up to 2 years |
Secondary
| Measure | Time frame |
|---|---|
| Overall survival (OS) | 2 years |
| Safety and tolerability reflected by number of participants with treatment related adverse events as assessed by CTCAE v5.0, number of participants with SAE | 2 years |
| Time to treatment failure (TTF), defined as the time period between osimertinib initiation and cessation or death | 2 years |
| Site of tumour progression at disease progression | 2 years |
Countries
Hong Kong
Contacts
CONTACTMolly SC LI, MBBS, MRCP
Outcome results
None listed