Phase II Study to Evaluate the Efficacy and Safety of SBRT as an Adjunctive Intervention for Oligoresidual Disease in EGFR Mutant NSCLC With First-Line Osimertinib Treatment
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- EGF-R Positive Non-Small Cell Lung Cancer
- Sponsor
- Centro de Tratamiento e Investigación sobre Cáncer, Luis Carlos Sarmiento Angulo
- Enrollment
- 35
- Locations
- 1
- Primary Endpoint
- Progression-Free Survival
- Status
- Not yet recruiting
- Last Updated
- 2 years ago
Overview
Brief 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.
Investigators
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.
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).
Outcomes
Primary Outcomes
Progression-Free Survival
Time Frame: Month 12
Time from the initiation of systemic treatment (Osimertinib) to disease progression or death. This outcome is not influenced by second-line interventions and allows for the estimation of the relative efficacy of the treatment and its Hazard Ratio (HR)
Secondary Outcomes
- Progression-Free Time (PFT)(Month 12)
- Overall Response Rate (ORR)(Month 12)
- Adverse Events and Safety(Month 12)
- Overall Survival (OS)(Month 12)