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

Last updated: November 15, 2024
Sponsor: Institut Bergonié
Overall Status: Active - Recruiting

Phase

3

Condition

Lung Cancer

Non-small Cell Lung Cancer

Adenocarcinoma

Treatment

Carboplatin

Pembrolizumab

Pemetrexed

Clinical Study ID

NCT04339218
IB 2019-05
2019-A02477-50
  • Ages > 18
  • All Genders

Study 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.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Histologically or cytologically confirmed non-small lung adenocarcinoma.

  2. Metastatic disease.

  3. Treatment with pembrolizumab in combination with pemetrexed-carboplatin as permarket authorization.

  4. At least two target lesions (RECIST1.1), measurable with CT or MRI :

  5. One target lesion that is amenable for accurate repeated measurements,

  6. One target lesion (15-40 mm) that is amenable for cryoablation treatmentincluding lung, kidney, adrenal, soft tissue and lytic bone lesions. Liver andsclerotic bone lesions are not allowed to be treated by cryoablation.

  7. Age ≥ 18.

  8. Performance status ≤ 2.

  9. Women of childbearing potential must have a negative serum pregnancy test prior toregistration.

  10. Recovery to grade ≤ 1 from any adverse event derived from previous treatment (excluding alopecia)

  11. Patients with a social security in compliance with the French law (Loi Jardé).

  12. Patients must be willing and able to comply with scheduled visits, treatment plan,laboratory tests and other study procedures.

  13. Voluntarily signed and dated written informed consents prior to any study specificprocedure.

Exclusion

Exclusion Criteria:

  1. Squamous cell tumors and other than adenocarcinoma.

  2. Prior systemic treatment for advanced non-small cell lung cancer (except adjuvanttherapy after complete resection).

  3. Current or prior use of immunosuppressive medication including any use of oralglucocorticoids, within 21 days before the first dose of pembrolizumab.

  4. Known contra-indication and/or hypersensitivity to PD1/PD-L1 antagonist and/orcytotoxic therapy.

  5. Known contra-indication to cryoablation.

  6. Abnormal coagulation contraindicating biopsy.

  7. Prior or concurrent malignant disease diagnosed or treated in the last 2 yearsexcept for adequately treated in situ carcinoma of the cervix, basal or squamousskin cell carcinoma or incidentally discovered good prognosis prostate cancer (Tstage < pT3 and Gleason ≤ 7).

  8. Active, uncontrolled bacterial, viral, or fungal infections, requiring systemictherapy.

  9. Subjects who participated in an investigational drug or device study within 28 daysprior to study entry.

  10. Known infection with HIV, hepatitis B, or hepatitis C.

  11. Females who are pregnant or breast-feeding.

  12. Men or women refusing contraception.

  13. 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 thesubject in this study.

  14. Previous enrolment in the present study.

  15. Individuals deprived of liberty or placed under legal guardianship.

Study Design

Total Participants: 214
Treatment Group(s): 4
Primary Treatment: Carboplatin
Phase: 3
Study Start date:
August 28, 2020
Estimated Completion Date:
August 27, 2028

Study 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. Tumor biopsy at inclusion is optional if materiel archived fixed in formalin and embedded in paraffin of diagnostic biopsy is available.

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.

Connect with a study center

  • Institut Bergonié

    Bordeaux, Gironde 33076
    France

    Active - Recruiting

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