Try our beta test site
IMPORTANT: Listing of a study on this site does not reflect endorsement by the National Institutes of Health. Talk with a trusted healthcare professional before volunteering for a study. Read more...
Trial record 4 of 16 for:    cancer | Studies received from 04/21/2016 to 04/21/2016

INTENSE: A Phase I/II Study of INhomogeneous Targeted Dose Escalation in Non-Small CEll Lung Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2017 by Cancer Trials Ireland
Sponsor:
Information provided by (Responsible Party):
Cancer Trials Ireland
ClinicalTrials.gov Identifier:
NCT02764086
First received: April 21, 2016
Last updated: April 18, 2017
Last verified: April 2017
  Purpose

This is a prospective non-randomised Phase I/II study with patients recruited to escalated dose cohorts. Escalated dose to the iGTV (internal gross tumour volume), with 60 Gy to the conventional PTV (planning target volume), will be delivered to successive cohorts of participants (6-12 participants/cohort) until the maximum tolerated oesophageal dose is determined. The minimum dose will be 60 Gy delivered via intensity modulated radiation therapy (IMRT) or volume modulated arc therapy (VMAT), planned on an Average Intensity Projection (AVIP) dataset.

Standard of care chemotherapy. In the initial part of this study patients can receive either neo-adjuvant chemotherapy or no chemotherapy at all.

Following initial toxicity evaluation, the study will be extended to include a concurrent chemotherapy arm.


Condition Intervention Phase
Non Small Cell Lung Cancer
Radiation: Radiation
Phase 1
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment

Resource links provided by NLM:


Further study details as provided by Cancer Trials Ireland:

Primary Outcome Measures:
  • To assess the safe delivery of an achievable level of dose escalation in a dose escalated and intensified RT regime delivered via VMAT/IMRT and focussed on the GTV by the proportion of grade ≥3 toxicities determined to be related to RT [ Time Frame: 4 years 3 months ]

Secondary Outcome Measures:
  • To compare grade ≥3 toxicity 3, 6, 9, 12, 18 and 24 months, post-treatment, graded by NCI-CTCAE Version 4 (V4) [ Time Frame: 2 years post treatment ]
  • To estimate the rate of overall survival; death from any cause is considered an event [ Time Frame: 8 years ]
  • To estimate the rate of disease-free survival. All disease recurrences will be recorded. In disease-free survival, any tumour recurrence, development of distant metastases or death is considered an event. [ Time Frame: 8 years ]
  • To estimate the time to local failure (failure defined by RECIST V1.1 ) [ Time Frame: 8 years ]
  • To evaluate tumour response at 6, 12 and 24 months (response measured by RECIST V1.1) [ Time Frame: 2 years ]
  • The estimate the time to distant metastases as assessed by imaging or biopsy [ Time Frame: 8 years ]
  • To assess Quality of life according to the EORTC QLQ-C30 and EORTC QLQ-LC13 [ Time Frame: 8 years ]
  • To assess the MTD to the oesophagus. The MTD is defined as the highest dose that does not cause unacceptable toxicities. Toxicities of interest are any CTCAE V4 grade ≥3 oesophageal toxicity determined to be related to radiation therapy. [ Time Frame: 5 years ]
  • The change in pulmonary function post-treatment will be analysed by calculating the differences in measurements from baseline to the 1-year follow-up [ Time Frame: 1 year ]

Estimated Enrollment: 104
Actual Study Start Date: June 2016
Estimated Primary Completion Date: July 2021 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Trial Cohort Description

Escalated dose to the iGTV, with 60 Gy to PTV delivered to successive cohorts of patients (pts) until the MTD oesophageal dose is determined (minimum dose 65 Gy).

Once 6 pts have been treated in a cohort, a 2 month break will be taken before toxicity is analysed.

If: ≤2 pts have ≥G3 toxicity, next cohort will be enrolled and receive escalated dose (+5 Gy at each escalation up to max 75 Gy) / 3 of 6 pts have ≥G3 toxicity, a further 6 pts will be recruited into that dose level / ≥4 pts have ≥G3 toxicity, the MTD is fixed at dose level of previous cohort

Cohort is extended to 12 pts:

If: ≤4 pts have ≥G3 toxicity, next cohort will be enrolled and will receive escalated dose / 5 of 12 pts have ≥G3 toxicity, the MTD is fixed at that dose level and recruitment continues up to 24 pts / ≥6 pts have ≥G3 toxicity, the MTD is fixed at the dose level of previous cohort.

Once the maximum dose cohort is established, pts will continue to be recruited at that dose level up to 24 pts.

Radiation: Radiation

Detailed Description:

This is a prospective non-randomised Phase I/II cohort study; please see above for Radiation Therapy and Chemotherapy treatment details

Each cohort will require a minimum of 6 and a maximum of 12 patients. Once 6 patients have been treated in a cohort a two-month break is taken before toxicity is analysed.

  • If 2 or fewer patients experience a grade ≥3 toxicity, the next cohort will be enrolled and will receive an escalated dose (+5 Gy at each escalation up to a maximum of 75 Gy)
  • If 3 of the 6 patients experience a grade ≥3 toxicity, a further 6 patients will be recruited into that dose level
  • If 4 or more patients experience a grade ≥3 toxicity then the MTD is fixed at the dose level of the previous cohort

If the cohort is extended to 12 patients, the following rules apply:

  • If 4 or fewer patients experience a grade ≥3 toxicity, the next cohort will be enrolled and will receive an escalated dose.
  • If 5 of the 12 patients experience a grade ≥3 toxicity, then the MTD is fixed at that dose level and recruitment continues up to a total of 24 patients at that dose level.
  • If 6 or more patients experience a grade ≥3 toxicity, then the MTD is fixed at the dose level of the previous cohort.

Once the maximum dose cohort is established, patients will continue to be recruited at that dose level up to a total of 24 patients.

Once the maximum dose cohort is established patients will continue to be recruited at that dose level up to a total of 24 patients. The first concurrent chemotherapy cohort will open 6 months after the first neo-adjuvant /no chemotherapy cohort have completed radiation therapy. The concurrent and neo-adjuvant /no chemotherapy arms will then be escalated independently of each other.

For each chemotherapy arm the following number of patients will be required:

  • Minimum number (if maximum dose level reached) = 36 (6 at 65 Gy, 6 at 70 Gy and 24 at 75 Gy)
  • Maximum number (if maximum dose level reached) = 48 (12 at 65 Gy, 12 at 70 Gy and 24 at 75 Gy) A maximum of 48 patients are required to complete each chemotherapy arm (neo-adjuvant or none /concurrent) of the trial.

Acute toxicity will be assessed weekly during treatment and at 2, 4 and 8 weeks post-treatment Late toxicities will be assessed at 3, 6, 9, 12, 18 and 24 months post-treatment and annually thereafter until disease relapse / patient withdrawal / patient death.

  Eligibility

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. 18 years of age
  2. ECOG (European Cooperative Oncology Group) performance status 0-2 (0-1 for concurrent chemotherapy)
  3. Weight loss <10% within 3 months of diagnosis
  4. Histological diagnosis (biopsy or cytology) of NSCLC (Squamous Cell Carcinoma (SCC), Adenocarcinoma, Large Cell).

    Eligible NSCLC stages: IIA (provided N1); IIB (including T3N0 if unresectable or unsuitable for stereotactic ablative body radiation therapy (SABR)); IIIA and IIIB

  5. Inoperable (as per Multi-disciplinary Team (MDT)) or patient refuses surgery
  6. No evidence of distant metastases
  7. Respiratory function:

    Forced Expiratory Volume (FEV1) ≥ 1L or ≥ 40% of predicted Diffusing Capacity of Lung for Carbon Monoxide (DLCO) ≥ 40%

  8. Positron emission tomography (PET) scan prior to commencement of RT (radiation therapy)
  9. Life expectancy, from causes other than lung cancer, of greater than 12 months (as per physician's opinion)
  10. Females of child bearing potential (see Appendix H) must not be pregnant and must be prepared to take adequate contraception methods during treatment. Males whose female partners are of child-bearing potential must be prepared to take adequate contraception methods during treatment. Examples of effective contraception methods are a condom or a diaphragm with spermicidal jelly, or oral, injectable or implanted birth control.
  11. Provision of written consent in line with ICH-GCP guidelines

Exclusion Criteria:

  1. Previous thoracic radiation therapy
  2. Known co-existing or prior malignancy which is likely to interfere with treatment or assessment of outcomes
  3. Known distant metastases or metastatic pleural effusion
  4. Pancoast tumours (tumour of the pulmonary apex)
  5. Supraclavicular nodal involvement
  6. Spinal cord involvement
  7. Patients with syndromes or conditions associated with increased radiosensitivity or development of lung fibrosis
  8. Suitable for SABR
  9. Idiopathic pulmonary fibrosis/usual interstitial pneumonia
  10. Uncontrolled intercurrent illness that is likely to interfere with treatment or assessment of outcomes
  11. Psychiatric illness/social situations that would limit compliance with study requirements
  12. Pregnant or lactating at the time of proposed randomisation
  13. Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the patient to participate in the study, or if it is felt by the research / medical team that the patient may not be able to comply with the protocol
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02764086

Contacts
Contact: Cancer Trials Ireland, 60 Fitzwilliam Square north, Dublin 2, Ireland +353 1 6677211

Locations
Ireland
St Lukes Radiaiton Oncology Network Recruiting
Dublin, Ireland
Sponsors and Collaborators
Cancer Trials Ireland
Investigators
Principal Investigator: Prof John Armstrong St Luke's Centre for Radiation Oncology
  More Information

Responsible Party: Cancer Trials Ireland
ClinicalTrials.gov Identifier: NCT02764086     History of Changes
Other Study ID Numbers: ICORG 15-47
Study First Received: April 21, 2016
Last Updated: April 18, 2017
Individual Participant Data  
Plan to Share IPD: Undecided

Additional relevant MeSH terms:
Carcinoma, Non-Small-Cell Lung
Lung Neoplasms
Carcinoma, Bronchogenic
Bronchial Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on April 27, 2017