Phase I/II Study of Combined Treatment With Cemiplimab (Anti-PD-1) and Dupilumab (Anti-IL-4R) in Patients With Early-stage, Resectable NSCLC
Overview
- Phase
- N/A
- Intervention
- Cemiplimab
- Conditions
- Non-Small Cell Lung Cancer
- Sponsor
- Centre hospitalier de l'Université de Montréal (CHUM)
- Enrollment
- 24
- Locations
- 1
- Primary Endpoint
- Safety
- Status
- Not Yet Recruiting
- Last Updated
- last year
Overview
Brief Summary
This phase 1b/2a study evaluates the safety, feasibility, and efficacy of combining dupilumab (anti-IL-4Rα) and cemiplimab (anti-PD-1) in patients with early-stage, resectable NSCLC. Phase 1b focuses on safety and feasibility, using a 3+3 design to monitor dose-limiting toxicities (DLTs), while Phase 2a assesses the major pathological response (MPR) rate with a Simon's two-stage minimax design. Secondary endpoints include event-free survival, overall survival, and translational objectives such as deep immune monitoring from patient samples, with the trial expected to enroll 24 patients at CHUM over five years.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Histological confirmation of NSCLC is required before treatment (however, patients with a smoking history and radiographic findings suggestive of NSCLC may consent prior to biopsy to combine research and diagnostic procedures.
- •Age ≥ 18 years.
- •ECOG performance status 0-1
- •Determined to be a surgical candidate for tumor resection by a multidisciplinary team.
- •Women of childbearing potential and men must use approved contraception during the study and for 4 months post-treatment. Pregnancy or suspected pregnancy must be reported immediately.
- •Adequate organ and marrow function.
- •Pre-treatment biopsies are mandatory, and tumors must be T1b or larger (\>1cm) and amenable to biopsy as determined by a multidisciplinary team.
- •Patients must consent to provide blood at designated study time points.
- •Patients must consent to core needle biopsies (at least 3 samples, as deemed safe by the performing surgeon/radiologist) prior to treatment initiation
Exclusion Criteria
- •History of autoimmune disorders or use of immunomodulatory drugs (including dupilumab) within 2 months prior to treatment initiation.
- •Active autoimmune disease requiring systemic treatment in the past year, excluding replacement therapies like thyroxine or insulin.
- •Use of immunosuppressive drugs or systemic steroids within 7 days prior to treatment, except chronic steroids ≤10mg prednisone or equivalent.
- •No smoking history or confirmed tissue or ctDNA evidence of actionable driver alterations (e.g. EGFR mutation, ALK, or ROS1 rearrangements)
- •Prior chemotherapy or radiotherapy for another primary tumor, or prior locoregional therapy to the target lesion. Therapy for a different cancer is acceptable.
- •Metastatic disease where surgery would not have curative intent.
- •Uncontrolled illness, including active infections requiring antibiotics, symptomatic heart failure, unstable angina, or psychiatric/social conditions impeding study compliance.
- •Pregnancy or nursing, due to potential harm to the fetus or infant.
- •Progressive malignancy requiring active treatment, except for certain stable cancers treated with curative intent
- •HIV infection with detectable viral load or not on a stable HAART regimen
Arms & Interventions
Neoadjuvant cemiplimab and dupilumab combination therapy
Neoadjuvant immunotherapy administered prior to thoracic surgery
Intervention: Cemiplimab
Neoadjuvant cemiplimab and dupilumab combination therapy
Neoadjuvant immunotherapy administered prior to thoracic surgery
Intervention: Dupilumab
Outcomes
Primary Outcomes
Safety
Time Frame: First 30 days after immunotherapy
(Phase 1b) Determine the safety (dose-limiting toxicities) of combined treatment with anti-IL-4R-alpha (dupilumab) and anti-PD-1 (cemiplimab) in patients with early-stage, resectable NSCLC.
Major pathological response (MPR) rate
Time Frame: Day of surgery
(Phase 2a) Assess efficacy of combined cemiplimab and dupilumab in patients with early stage, resectable NSCLC. Efficacy is defined as percentage of patients achieving major pathological response (MPR), i.e. 90% or greater tumor necrosis at time of resection.
Secondary Outcomes
- Overall survival (OS)(For up to 5 years or until death)
- Rate of curative-intent surgery(Day of surgery)
- Tolerability(For up to 5 years or until death)
- Event-free survival (EFS)(For up to 5 years or until death)
- Pathological complete response (pCR) rate(Day of surgery)