A phase III clinical trial of adjuvant chemotherapy vs chemo-immunotherapy for stage IB-IIIA completely resected non-small cell lung cancer (NSCLC) patients_NADIM-ADJUVANT
Overview
- Phase
- Phase 3
- Intervention
- Not specified
- Conditions
- Not specified
- Sponsor
- Fundacion GECP
- Enrollment
- 210
- Locations
- 28
- Primary Endpoint
- The primary objective is to evaluate the disease-free survival (DFS): defined as the length of time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time.
- Status
- Active, not recruiting
- Last Updated
- last year
Overview
Brief Summary
The primary objective is to evaluate the disease-free survival (DFS): defined as the length of time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time
Detailed Description
This is an open-label, randomised, two-arm, phase III, multicentre clinical trial.The total sample size is 210 and 105 per arm. The population to be included are stage IB-IIIA, completely resected, non-small cell lung cancer patients. Patients randomised to the experimental arm will receive Nivolumab 360mg + Paclitaxel 200mg/m2 + Carboplatin AUC5 for 4 cycles every 21 days (+/- 3 days) as adjuvant treatment followed by maintenance adjuvant treatment for 6 cycles with Nivolumab 480 mg Q4W (+/- 3 days). Patients randomized to the control arm will receive Paclitaxel 200mg/m2 + Carboplatin AUC5 for 4 cycles every 21 days (+/- 3 days) followed by 2 observation visits. The primary objective is to evaluate the disease-free survival (DFS): defined as the length of time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time. Patient accrual is expected to be completed within 3.5 years, excluding a run-in-period of 3 months. Treatment and follow-up are expected to extend the study duration to a total of 8.5 years. Patients will be followed 5 years after adjuvant treatment or observation phase. The study will end once survival follow-up has concluded.
Investigators
Mariano Provencio
Scientific
Fundacion GECP
Eligibility Criteria
Inclusion Criteria
- •Patients diagnosed of primary non-small cell lung cancer, histologically confirmed.
- •Correct hematological, hepatic and renal function
- •Patient consent must be obtained in the appropriate manner as established in the applicable local and regulatory requirements
- •Patients must be accessible for treatment and follow-up
- •Women of childbearing potential, including women who had their last menstrual period in the last 2 years, must have a negative serum or urine pregnancy test within 3 days before randomization.
- •All sexually active men and women of childbearing potential must use a highly effective contraceptive method (two barrier methods or a barrier method plus a hormonal method) during the study treatment and for a period of at least 5 months for females and 7 months for males following the last administration of trial drugs
- •Patients should be classified postoperatively in stage IB (=4cm), II or IIIA according to pathological criteria and according to 8th version of the International Association for the Study of Lung Cancer Staging Manual in Thoracic Oncology
- •Complete surgical resection of the primary NSCLC is also essential. Surgeons are strongly advised to dissect of all accessible lymph node levels, as established in the European Society of Thoracic Surgeons guide. Consequently, at the end of the surgical intervention it is recommended to have dissected of a minimum of 3 specific mediastinal gan-glionic lobe stations (N2), one of which should include station 7, and at least threeN1 lymph nodes (including those resected with the tumor piece)
- •The surgical intervention may consist of a lobectomy, sleeve resection, bilobectomy or pneu-monectomy, as determined by the responsible surgeon based on intraoperative findings. Patients who have had only segmentectomies or wedge resections are not considered eligible for participation in this study except if R0 resection can be confirmed.
- •Preoperative (neoadjuvant) use of platinum-based chemotherapy or other types of chemotherapy are not accepted.
Exclusion Criteria
- •Patients with a history of other malignant diseases, with the exception of the following: or properly treated non-melanotic skin cancer or cancer in situ treated with curative intent or other malignancies treated with curative intent and without signs of disease for a period of> 3 years after the end of the treatment and which, in the opinion of the doctor in charge of their treatment, do not present a substantial risk of relapse of the previous malignant disease
- •Patients in whom R0 resection cannot be confirmed
- •Partients with an active, known or suspected autoimmune disease. Participants with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll
- •Partients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization. Inhaled or topical steroids, and adrenal replacement steroid doses > 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease
- •Any positive test result for hepatitis B virus or hepatitis C virus indicating presence of virus, e.g. Hepatitis B surface antigen (HbsAg, Australia antigen) positive, or Hepatitis C antibody (anti-HCV) positive (except if HCV-RNA negative)
- •History of allergy or hypersensitivity to any of the study drug components
- •Prior anti-PD1/L1 treatment
- •Patients with ALK, STKB11 o KEAP1 known mutations before inclusion in this trial
- •Patients with adenocarcinoma NSCLC must be tested for the common EGFR mutations before inclusion. Patients with any known EGFR mutation cannot be enrolled in the study
- •Patients with a combination of microcytic and non-small cell lung cancer, a carcinoid lung tumor
Outcomes
Primary Outcomes
The primary objective is to evaluate the disease-free survival (DFS): defined as the length of time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time.
The primary objective is to evaluate the disease-free survival (DFS): defined as the length of time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time.
Secondary Outcomes
- Overall survival (OS): defined as the time between the date of randomization and the date of death. OS will be censored on the last date a participant was known to be alive
- Safety and tolerability: will be measured by incidence of AE, SAE, immune-related AEs, deaths, and laboratory abnormalities. Adverse events will be graded according to CTCAE v5.0