Study to Evaluate SBRT for EGFR Mutant NSCLC Patients Receiving Osimertinib (CULTRO)

Trial Title: Study to Evaluate SBRT for EGFR Mutant NSCLC Patients Receiving Osimertinib (CULTRO)

NCT ID: NCT05998993

Condition: EGF-R Positive Non-Small Cell Lung Cancer
Non Small Cell Lung Cancer
EGFR Exon 19 Deletion
EGFR Exon 21 Mutation
EGFR G719X

Conditions: Official terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung

Study type: Interventional

Study phase: N/A

Overall status: Not yet recruiting

Study design:

Allocation: N/A

Intervention model: Single Group Assignment

Primary purpose: Treatment

Masking: None (Open Label)

Intervention:

Intervention type: Radiation
Intervention name: Stereotactic Body Radiation Therapy SBRT
Description: This is a non-randomized Phase II study in which all patients receive the experimental treatment with Stereotactic Ablative Radiotherapy (SABR) to residual tumor lesions (up to 5 residual metastatic lesions in a maximum of 2 organs) following 12 weeks of systemic treatment with Osimertinib. The study aims to enroll 35 patients diagnosed and treated at CTIC Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo.
Arm group label: Radiation

Other name: Stereotactic radiosurgery SRS

Summary: Phase II Study to Evaluate the Impact of SBRT (Stereotactic Body Radiation Therapy) and/or SRS (Stereotactic Radiosurgery) on Oligoresidual Disease in EGFR Mutation Patients Treated with Osimertinib as First-Line Systemic Intervention. All candidates must exhibit a partial response after 12 weeks of treatment with the third-generation tyrosine kinase inhibitor (alone or in combination with chemotherapy) and a maximum of five (5) residual lesions in a maximum of two (2) organs. The primary outcome will be progression-free survival (PFS), and secondary outcomes will include overall survival (OS), proportion of patients without progression at months 12 and 36, safety, and overall response rate (ORR). Additionally, an exploratory analysis will be conducted on the prognostic value of liquid biopsy (supplementary information), considering baseline presence of mutations (determined by Next Generation Sequencing tests) and reduction or negativization of allelic fraction (AF).

Detailed description: Phase II study with a single-stage Fleming design based on a normal approximation to the binomial distribution, with a one-sided type I error of 10% and a power of 90% to detect 30 events related to disease progression. Under the alternative hypothesis to detect a 35% improvement in PFS, 35 patients are required to be recruited over 22 months, with a minimum median follow-up of 14 months. An interim analysis will be conducted to determine early termination of the study using a Lan-DeMets monitoring boundary and an O'Brien-Fleming stopping rule. The interim analysis will be performed when 20 out of the expected 30 events have been observed. Employing the O'Brien-Fleming statistic, the critical value for the Z-score in the interim analysis (to stop and reject the null hypothesis) will be 1.054, and the critical value for the Z-score to stop and reject the alternative (futility) will be -0.204.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Be older than 18 years of age. - Be capable of giving informed consent to participate in the study. - Have histological confirmation compatible with EGFR mutant non-small cell lung cancer (NSCLC) and metastatic disease (with or without histological confirmation of metastatic lesions). - Have confirmation of the presence of common EGFR mutations (exon 19 deletion, L858R/exon 21, or G719X) through any locally and internationally accepted standard tests. - Have received at least 12 weeks of Osimertinib treatment (with or without the addition of chemotherapy based on FLAURA2 study results after discussion with the investigative team). - Have a partial response defined by RECIST 1.1 criteria. - Have a maximum of 5 residual tumor lesions in up to 2 organs suitable for treatment with Stereotactic Ablative Radiotherapy (SABR). - Have the following imaging and clinical tests within 4 weeks before study entry: - Contrast-enhanced brain MRI. - Chest/abdomen/pelvis CT scan, with or without bone scan (at the investigator's discretion) if PET-CT was not performed. - 18-FDG PET-CT. - Spinal MRI for patients with vertebral or paravertebral metastases. - Electrocardiogram (EKG) and transthoracic echocardiogram. - Complete blood count and standard blood chemistry. - Negative pregnancy test for fertile women within 4 weeks prior to starting radiotherapy. - Liquid biopsy for assessment of tumor allelic fraction (baseline). - ECOG performance status 0-2. - All sites of oligoresidual disease must be safely treatable according to the following criteria: - All brain lesions must be treatable with SRS. - The maximum size for extracranial lesions will be up to 6 cm, with exceptions for bone metastases which may include lesions larger than 6 cm at the discretion of the investigative medical team (e.g., ribs, scapula, or pelvis). - Life expectancy >6 months. - Not eligible for surgical treatment. - Osimertinib treatment must be suspended 48 hours before the start of ablative therapy and cannot be initiated within 48 hours of receiving the last fraction. In patients receiving SBRT for central lung lesions, the suspension time for Osimertinib may be extended up to 5 days before and after ablative therapy. - Patients may have previously received treatments such as radiofrequency or microwave ablation for oligoresidual lesions, but imaging must demonstrate that the lesion persists and is treatable with SABR. - Metastatic tumor lesions that received initial treatment with radiosurgery cannot be included for SABR treatment. - If initial treatment was conventional radiotherapy, SABR could be considered if safe to administer. In this case, the ablative therapy must be discussed by the investigative team. - The eligibility and prognosis criteria will be reviewed by the multidisciplinary thoracic tumor board at CTIC Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo. Exclusion Criteria: - Severe comorbidities contraindicating radiation therapy. - Bone metastases in the femur with a high risk of fracture. - Complete response to Osimertinib treatment (no oligoresidual disease for ablative treatment). - Inability to treat all oligoresidual lesions with ablative intent. - History of pneumonitis or functionally limiting interstitial lung disease. It may be considered limiting if the patient is unable to perform DLCO maneuvers or if adjusted DLCO is less than 35% of predicted, PaO2 at Bogotá altitude with FiO2 21% is less than or equal to 50 mmHg. - Clinical or radiological evidence of symptomatic spinal cord compression. - Dominant brain metastatic disease requiring surgical management (e.g., imminent herniation or hydrocephalus). - Candidate for a clinical trial with an experimental drug. - Inability to receive Osimertinib with minimal adherence. - Oligoresidual involvement in peritoneum, pleura, or bone marrow (non-measurable disease). - Leptomeningeal involvement (presumed based on imaging findings or confirmed by cerebrospinal fluid cytology). - Pregnant or breastfeeding women.

Gender: All

Minimum age: 18 Years

Maximum age: 99 Years

Healthy volunteers: No

Locations:

Facility:
Name: CTIC - Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo

Address:
City: Bogotá
Country: Colombia

Contact:
Last name: Liliana Gutiérrez, RN

Phone: 573003768158
Email: lgutierrez@fctic.org

Contact backup:
Last name: Briegel De Las Salas, Microb

Phone: 573044921963
Email: bcalderon@fctic.org

Investigator:
Last name: Luis Rojas, MD
Email: Principal Investigator

Investigator:
Last name: Andrés Cardona, MD
Email: Principal Investigator

Investigator:
Last name: Iván Bobadilla, MD
Email: Principal Investigator

Investigator:
Last name: Jairo Zuluaga, MD
Email: Sub-Investigator

Investigator:
Last name: Alejandro González, MD
Email: Sub-Investigator

Investigator:
Last name: Lucía Viola, MD
Email: Sub-Investigator

Investigator:
Last name: Stella Martínez, MD
Email: Sub-Investigator

Start date: November 2023

Completion date: November 2028

Lead sponsor:
Agency: Centro de Tratamiento e Investigación sobre Cáncer, Luis Carlos Sarmiento Angulo
Agency class: Other

Source: Centro de Tratamiento e Investigación sobre Cáncer, Luis Carlos Sarmiento Angulo

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05998993