Trial Title:
Ascorbate with Durvalumab in Non-Small Cell Lung Cancer (NSCLC)
NCT ID:
NCT06083454
Condition:
Non-small Cell Lung Cancer
Conditions: Official terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Durvalumab
Study type:
Interventional
Study phase:
Phase 1
Overall status:
Recruiting
Study design:
Allocation:
Randomized
Intervention model:
Parallel Assignment
Intervention model description:
This is a descriptive, proof of concept, open-label, randomized, 3-arm, window of
opportunity trial to evaluate the immunomodulatory role of pharmacological ascorbate with
Durvalumab. Translational and clinical findings of this study can then be applied more
broadly to design and address clinically oriented questions in various NSCLC treatment
settings.
Primary purpose:
Treatment
Masking:
Single (Participant)
Intervention:
Intervention type:
Drug
Intervention name:
Durvalumab
Description:
Given intravenous (IV) infusion as monotherapy or in combination with pharmacological
ascorbate
Arm group label:
Combination of pharmacological ascorbate plus Durvalumab
Arm group label:
Durvalumab as monotherapy
Intervention type:
Drug
Intervention name:
Pharmacological ascorbate
Description:
Given intravenously in combination with Durvalumab
Arm group label:
Combination of pharmacological ascorbate plus Durvalumab
Intervention type:
Procedure
Intervention name:
Surgery (SOC)
Description:
Surgery SOC
Arm group label:
Control (no neoadjuvant therapy)
Summary:
This is a descriptive, proof of concept, open-label, randomized, 3-arm, window of
opportunity trial to evaluate the immunomodulatory role of pharmacological ascorbate with
Durvalumab
Detailed description:
Participants in this research study have stage I Non-Small Cell Lung Cancer (NSCLC) that
was found to be suitable for surgery as a first line treatment.
The usual treatment for this disease is to remove the tumor with surgery, and then
evaluate after surgery if other additional treatments such as chemotherapy or targeted
therapy are needed.
The purpose of this research study is to compare three different ways of treating stage 1
NSCLC, to see if adding treatment before surgery can reduce the chance of the tumor
recurring after surgical removal.
In this study, patients will be randomly assigned to one of three treatments:
- Durvalumab followed by surgical resection of the tumor.
- Durvalumab plus ascorbate (also known as vitamin C), followed by surgical resection
of the tumor.
- Surgical resection alone. No therapy prior to surgery. This is the same as standard
care (SOC) for this disease.
Criteria for eligibility:
Criteria:
Inclusion Criteria:
- Capable of giving signed informed consent which includes compliance with the
requirements and restrictions listed in the informed consent form (ICF) and in this
protocol.
- Age > 18 years at time of study entry regardless of gender or ethnic/racial
background.
- Histologically or cytologically confirmed non-small cell lung cancer
- Clinical stage I with tumor size >1 cm to 4 cm (either T1b or T1c or T2a and N0 M0)
according to American Joint Committee on Cancer 8th edition
- Surgically resectable with adequate lung functions to undergo surgery as determined
by thoracic surgeon.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Body weight >30 kg
- Adequate normal organ and marrow function as defined below:
- Hemoglobin ≥9.0 g/dL
- Absolute neutrophil count (ANC) ≥1.0 × 109 /L
- Platelet count ≥75 × 109/L
- Serum bilirubin ≤1.5 x institutional upper limit of normal (ULN). This will not
apply to patients with confirmed Gilbert's syndrome (persistent or recurrent
hyperbilirubinemia that is predominantly unconjugated in the absence of
hemolysis or hepatic pathology), who will be allowed only in consultation with
their physician.>>
- AST (SGOT)/ALT (SGPT) ≤2.5 x institutional upper limit of normal.
- Measured creatinine clearance (CL) ≥50 mL/min or Calculated creatinine CL≥50
mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976) or by 24-hour
urine collection for determination of creatinine clearance:
Males:
Creatinine CL (mL/min)= Weight (kg) x (140 - Age) divided by 72 x serum creatinine
(mg/dL)
Females:
Creatinine CL (mL/min)= Weight (kg) x (140 - Age) x 0.85 divided by 72 x serum creatinine
(mg/dL)
- Patient is willing and able to comply with the protocol for the duration of the
study including undergoing treatment and scheduled visits and examinations including
follow up.
- Must have a life expectancy of at least 12 weeks
- Female subjects of childbearing potential and non-sterilized male subjects who
intend to be sexually active during the study must agree to use a highly effective
method of contraception from the time of screening, throughout the total duration of
the drug treatment, and during the 90-day post-drug washout period.
- Evidence of post-menopausal status or negative urinary or serum pregnancy test for
female pre-menopausal patients. Women will be considered post-menopausal if they
have been amenorrheic for 12 months without an alternative medical cause. The
following age-specific requirements apply: Women 1 year ago, had
chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical
sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).
Exclusion Criteria:
Patients should not enter the study if any of the following exclusion criteria are
fulfilled:
- Participation in another clinical study with an investigational product during the
last 4 weeks prior to randomization
- Concurrent enrollment in another clinical study, unless it is an observational
(non-interventional) clinical study or during the follow-up period of an
interventional study
- Prior systemic therapy for early-stage NSCLC that is under consideration for
thisstudy.
- Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the
exception of alopecia, vitiligo, clinically non-significant labs values (e.g.,
lymphopenia), and the laboratory values defined in the inclusion criteria
1. Patients with Grade ≥2 neuropathy will be evaluated on a case-by-case basis
after consultation with the Study Physician.
2. Patients with irreversible toxicity not reasonably expected to be exacerbated
by treatment with durvalumab may be included only after consultation with the
Study Physician.
- Any concurrent chemotherapy, IP, biologic, or hormonal therapy for cancer
treatment.Concurrent use of hormonal therapy for non-cancer-related conditions
(e.g., hormone replacement therapy) is acceptable.
- Radiotherapy treatment to more than 30% of the bone marrow or with a wide field of
radiation within 4 weeks of the first dose of study drug
- Major surgical procedure (as defined by the Investigator) within 28 days prior to
the first dose of IP.
- History of allogenic organ transplantation.
- Active or prior documented autoimmune or inflammatory disorders (including
inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with
the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis
syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease,
rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to
this criterion:
1. Patients with vitiligo or alopecia
2. Patients with hypothyroidism (e.g., following Hashimoto syndrome) clinically
stable on hormone replacement
3. Any chronic skin condition that does not require systemic therapy
4. Patients without active disease in the last 5 years may be included but only
after consultation with the Study Physician
5. Patients with celiac disease controlled by diet alone
6. Patients with type 2 DM (insulin dependent or independent) are allowed.
- Uncontrolled intercurrent illness, including but not limited to, ongoing or active
infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable
angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic
gastrointestinal conditions associated with diarrhea, or psychiatric illness/social
situations that would limit compliance with study requirement, substantially
increase risk of incurring AEs or compromise the ability of the patient to give
written informed consent
- History of another primary malignancy except for
1. Malignancy treated with curative intent and with no known active disease ≥2
years before the first dose of IP and of low potential risk for recurrence
2. Adequately treated non-melanoma skin cancer or lentigo maligna without evidence
of disease
3. Adequately treated non-melanoma skin cancer, in situ bladder, gastric, breast,
colon or cervical cancers/dysplasia's, noninvasive colonic polyps, superficial
bladdertumors,
4. Monoclonal B-cell lymphocytosis, or monoclonal gammopathy of undetermined
significance.
- Known to have nodal or distant metastases
- Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) ≥470 ms
- History of active primary immunodeficiency
- Known history of active hepatitis infection, positive hepatitis C virus (HCV)
antibody, hepatitis B virus (HBV) surface antigen (HBsAg) or HBV core antibody
(anti-HBc), at screening. Participants with a past or resolved HBV infection
(defined as the presence of antiHBc and absence of HBsAg) are eligible. Participants
positive for HCV antibody are eligible only if polymerase chain reaction is negative
for HCV RNA
- Known to have tested positive for human immunodeficiency virus (HIV) (positive HIV
1/2 antibodies) or active tuberculosis infection (clinical evaluation that may
include clinical history, physical examination and radiographic findings, or
tuberculosis testing in line with local practice).
- Current or prior use of immunosuppressive medication within 14 days before the first
dose of durvalumab. The following are exceptions to this criterion:
1. Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra
articular injection)
2. Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of
prednisone or its equivalent
3. Steroids as premedication for hypersensitivity reactions (e.g., CT scan
premedication)
- Receipt of live attenuated vaccine within 30 days prior to the first dose of IP.
Note:
Patients, if enrolled, should not receive live vaccine while receiving IP and up to 30
days after the last dose of IP.
- Participant that is pregnant or breastfeeding.
- Known allergy or hypersensitivity to any of the study drugs or any of the study drug
excipients.
- Prior randomization or treatment in a previous durvalumab clinical study regardless
of treatment Arm assignment.
- Prior anti PD-1, PD-L1 and CTLA-4 therapy in the last 2 years
1. Experienced a toxicity that led to permanent discontinuation of prior
immunotherapy.
2. All AEs while receiving prior immunotherapy must have completely resolved or
resolved to baseline prior to screening for this study.
3. Experienced a ≥Grade 3 immune related AE or an immune related neurologic or
ocular AE of any grade while receiving prior immunotherapy. NOTE: Patients with
endocrine AE of ≤Grade 2 are permitted to enroll if they are stably maintained
on appropriate replacement therapy and are asymptomatic.
4. Required the use of additional immunosuppression other than corticosteroids for
the management of an AE, experienced recurrence of an AE if re-challenged, and
currently require maintenance doses of > 10 mg prednisone or equivalent per
day.
- Judgment by the investigator that the patient is unsuitable to participate in the
study and the patient is unlikely to comply with study procedures, restrictions and
requirements.
- Known allergy or hypersensitivity to IP or any excipient.
- Clinically significant active infection requiring systemic therapy
Gender:
All
Minimum age:
18 Years
Maximum age:
N/A
Healthy volunteers:
No
Locations:
Facility:
Name:
University of Iowa
Address:
City:
Iowa City
Zip:
52242
Country:
United States
Status:
Recruiting
Contact:
Last name:
Muhammad Furqan, MD
Phone:
319-356-1527
Email:
muhammad-furqan@uiowa.edu
Contact backup:
Last name:
Alisha Demsky
Phone:
319-384-5461
Email:
alisha-demsky@uiowa.edu
Start date:
October 23, 2023
Completion date:
October 2027
Lead sponsor:
Agency:
Muhammad Furqan
Agency class:
Other
Source:
University of Iowa
Record processing date:
ClinicalTrials.gov processed this data on November 12, 2024
Source: ClinicalTrials.gov page:
https://clinicaltrials.gov/ct2/show/NCT06083454
