Stereotactic Body Radiation Therapy for Inoperable Locally-advanced Non-small Cell Lung Cancer
Overview
- Phase
- Phase 1
- Intervention
- Stereotactic Body Radiation Therapy (SBRT)
- Conditions
- Non-small Cell Lung Cancer
- Sponsor
- Memorial Sloan Kettering Cancer Center
- Enrollment
- 39
- Locations
- 8
- Primary Endpoint
- maximum tolerated dose (Cohort A)
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
The purpose of this study is to determine if the use of exploratory immunologic biomarkers, functional MRI images can serve as early predictors for response of NSCLC. It also will provide important information on the perceived side effects from a patient perspective. Patients may participate if they have tumors ≥3 cm without lymph node involvement (for which chemotherapy is not part of the standard of care). Patients will only receive stereotactic body radiation therapy (SBRT) per standard dose guidelines.
Investigators
Eligibility Criteria
Inclusion Criteria
- •All patients:
- •Histologically confirmed non-small cell lung cancer
- •Medically or technically inoperable as per thoracic surgeon or patient's preference not to undergo surgical resection
- •Age ≥ 18 years
- •Women of childbearing potential must have a negative blood pregnancy test
- •Ability to provide written informed consent
- •Stage IIA-IIIA (TanyN1M0 or T2b-4N0M0) Selected patients with single station N2 nodal involvement in close proximity to the primary tumor target may be considered eligible at the discretion of the PI if all normal tissue guidelines can be met
- •Eligible for chemo-therapy
- •Karnofsky Performance Status ≥70%
- •Men and women of childbearing potential must be willing to use effective contraception while on treatment and for at least 3 months thereafter
Exclusion Criteria
- •All patients:
- •Prior radiation therapy to the lungs
- •Prior surgery or chemotherapy for this presentation of lung cancer (history of prior lung cancer that has been treated and deemed inactive by the clinician is acceptable. Recurrent tumors may be treated on protocol as long as SBRT will be the definitive treatment.)
- •N2-3 lymph node involvement based on PET/EBUS-FNA/mediastinoscopy (Any N2 disease that is more than just minimal single station involvement is excluded)
- •Direct tumor extension into including aorta or pulmonary artery
- •Chronic corticosteroid use equivalent to ≥ prednisone 10 mg daily
- •Prior treatment with a CD137 agonist, ipilimumab, or the CTLA-4 inhibitor, or PD-1/PDL-1 inhibitor
- •Unstable congestive heart failure
- •Continuous oxygen use
- •Patients meeting the following exclusion criteria will be excluded from the functional MRI portion only:
Arms & Interventions
A) >5cm,Chemo eligible (closed to accrual)
Patients will receive five fractions of either 8, 10, or 12 Gy to the gross tumor only. Following SBRT patients will be evaluated by their medical oncologist for consideration of adjuvant chemotherapy, starting 6-8 weeks post-RT. All patients will be followed for one year. Patients will be assessed for toxicity by their radiation oncologist at 4 to 6 weeks post-RT and during chemotherapy by their medical oncologist. Follow up after completion of all treatment will consist of CT chest scans at 6 and 12 months post-SBRT and toxicity assessments every 3 months from the end of SBRT for one year.
Intervention: Stereotactic Body Radiation Therapy (SBRT)
A) >5cm,Chemo eligible (closed to accrual)
Patients will receive five fractions of either 8, 10, or 12 Gy to the gross tumor only. Following SBRT patients will be evaluated by their medical oncologist for consideration of adjuvant chemotherapy, starting 6-8 weeks post-RT. All patients will be followed for one year. Patients will be assessed for toxicity by their radiation oncologist at 4 to 6 weeks post-RT and during chemotherapy by their medical oncologist. Follow up after completion of all treatment will consist of CT chest scans at 6 and 12 months post-SBRT and toxicity assessments every 3 months from the end of SBRT for one year.
Intervention: cisplatin or carboplatin-based
B) 3-5cm OR Chemo ineligible
Using intensity-modulated radiation therapy (IMRT) or volumetric arc therapy (VMAT), the choice of which is determined by the radiation oncologist, patients will be treated in \< 5 fractions every other day. The total treatment dose will be between 45 and 54 Gy in \< 5 fractions per standard of care. All patients will be followed for one year. Patients will be assessed for toxicity by their radiation oncologist at 4 to 6 weeks post-RT and during chemotherapy at the discretion of their medical oncologist. Follow up after completion of all treatment will consist of CT chest scans at 6 and 12 months post-SBRT and toxicity assessments every 3 months from the end of SBRT for one year. FDG PET/CT scans and Pulmonary Function Tests (PFTs) will be obtained at 3 months and 9 months after SBRT.
Intervention: Stereotactic Body Radiation Therapy (SBRT)
Outcomes
Primary Outcomes
maximum tolerated dose (Cohort A)
Time Frame: 2 years
standard 3+3 dose-escalation scheme
Secondary Outcomes
- ≥ grade 4 or persistent ≥ grade 3 late toxicities (Cohorts A & B)(≥3 months post SBRT)
- overall survival (Cohorts A & B)(2 years)