Cryoablation in Combination (or Not) With Pembrolizumab and Pemetrexed-carboplatin in 1st-line Treatment for Patients With Metastatic Lung Adenocarcinoma

  • STATUS
    Recruiting
  • End date
    Aug 14, 2025
  • participants needed
    214
  • sponsor
    Institut Bergonié
Updated on 14 November 2021

Summary

This study aims to compare the one-year survival benefit of the association of cryoablation-pembrolizumab-pemetrexed-carboplatin versus pembrolizumab-pemetrexed-carboplatin in metastatic lung adenocarcinoma patients.

This is a multicenter, prospective, open-labeled, 2-arm comparative randomized (1:1) phase III trial.

Patients will be randomized with a 1:1 ratio into:

  • Arm A (experimental arm): cryoablation of one visceral lesion or bone metastasis excluding liver and sclerotic bone metastases combined with pembrolizumab and pemetrexed-carboplatin prescribed as per market authorization.
  • Arm B (standard arm): pembrolizumab and pemetrexed-carboplatin prescribed as per market authorization.

Pembrolizumab and pemetrexed-carboplatin will be prescribed and administered at the dose recommended by market authorization.

Cryoablation treatment should be performed within 6 weeks after the first administration of pembrolizumab. No treatment switching permitted.

Description

Upon signature of the informed consent and verification of the screening results, eligible participants will be randomized between two therapeutic strategies:

  • Arm A (experimental arm): cryoablation of visceral lesion or bone metastasis excluding liver and sclerotic bone metastases combined with pembrolizumab and pemetrexed-carboplatin prescribed as per market authorization.
  • Arm B (standard arm): pembrolizumab and pemetrexed-carboplatin prescribed as per market authorization.

Pembrolizumab treatment should begin no later than 7 days after randomization. The cryoablation treatment should be performed within 6 weeks after the first administration of pembrolizumab.

RECIST v1.1 tumour assessment:Tumour response will be defined and assessed as per the Response Evaluation Criteria in Solid Tumors (RECIST v1.1).

  • A comprehensive workup will be performed at baseline and every 9 weeks.
  • The same method will be used to evaluate each identified lesion both at baseline and throughout the study.
  • Treatment will be administered as long as no disease progression or unacceptable toxicity is found, or as long as no other reasons for treatment discontinuation are met.
  • Assessment of efficacy will be essentially based on a set of measurable lesions identified at baseline as target lesions and followed until disease progression and following the RECIST v1.1 criteria.
  • Confirmation of response at least 4 weeks later is not required in this randomized study where response is not the primary endpoint.

SAFETY :Patients will be evaluable for safety if they have received at least one treatment administration. Safety profile will be continuously followed during treatment up to 90 days after the last immunotherapy treatment administration or until the start of a new antitumor therapy or until 12 months of treatment, whichever occurs first.

STUDY PROCEDURES :

Blood sample will be collected at baseline (Day 1: before treatment initiation), Day 1 cycle 2 (Day 21 +/- 3 days), Day 1 cycle 3 (Day 42 +/- 3 days) and progression.

Patients will be asked to provide samples of biopsy tissue at screening (prior to anticancer agent with immunomodulatory activity treatment initiation), during treatment (day 42 +/- 3 days) and at disease progression as follows.

Only for consented patient (optional), stool sample will be collected at baseline (Day 1: before treatment initiation).

All randomized patients will be followed up until death or the end of the follow-up period, defined as 36 months after randomization, whichever occurs first. For all patients, treatments regimen, tumor response during and/or after treatment, survival follow-up will be collected on study database:

  • Every 3 months until loco-regional relapse or metastasis evidence, death or until the date of study termination, whichever occurs first,
  • Every 6 months after loco-regional relapse or metastasis evidence, until death or until the date of study termination, whichever occurs first.

Details
Condition Lung Adenocarcinoma, Cryotherapy Effect
Treatment carboplatin, Pembrolizumab, Pemetrexed, Cryoablation
Clinical Study IdentifierNCT04339218
SponsorInstitut Bergonié
Last Modified on14 November 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Histologically or cytologically confirmed non-small lung adenocarcinoma
Metastatic disease
Treatment with pembrolizumab in combination with pemetrexed-carboplatin as per market authorization
At least two target lesions (RECIST1.1), measurable with CT or MRI
One target lesion that is amenable for accurate repeated measurements
One target lesion (15-40 mm) that is amenable for cryoablation treatment including lung, kidney, adrenal, soft tissue and lytic bone lesions. Liver and sclerotic bone lesions are not allowed to be treated by cryoablation
Age 18
Performance status 2
Women of childbearing potential must have a negative serum pregnancy test prior to registration
Recovery to grade 1 from any adverse event derived from previous treatment (excluding alopecia)
Patients with a social security in compliance with the French law (Loi Jard)
Patients must be willing and able to comply with scheduled visits, treatment plan, laboratory tests and other study procedures
Voluntarily signed and dated written informed consents prior to any study specific procedure

Exclusion Criteria

Squamous cell tumors and other than adenocarcinoma
Prior systemic treatment for advanced non-small cell lung cancer (except adjuvant therapy after complete resection)
Current or prior use of immunosuppressive medication including any use of oral glucocorticoids, within 21 days before the first dose of pembrolizumab
Known contra-indication and/or hypersensitivity to PD1/PD-L1 antagonist and/or cytotoxic therapy
Known contra-indication to cryoablation
Abnormal coagulation contraindicating biopsy
Prior or concurrent malignant disease diagnosed or treated in the last 2 years except for adequately treated in situ carcinoma of the cervix, basal or squamous skin cell carcinoma or incidentally discovered good prognosis prostate cancer (T stage < pT3 and Gleason 7)
Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy
Subjects who participated in an investigational drug or device study within 28 days prior to study entry
Known infection with HIV, hepatitis B, or hepatitis C
Females who are pregnant or breast-feeding
Men or women refusing contraception
Concomitant disease or condition that could interfere with the conduct of the study, or that would, in the opinion of the investigator, pose an unacceptable risk to the subject in this study
Previous enrolment in the present study
Individuals deprived of liberty or placed under legal guardianship
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Additional screening procedures may be conducted by the study team before you can be confirmed eligible to participate.

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If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

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Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

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