Feasibility of Primer Shot Radiotherapy for Non-small Cell Lung Cancer - PRIMER

Not Applicable

Recruiting

• Conditions: Patients With Non-small-cell Lung Cancer

• Registration Number: NCT06528743
• Lead Sponsor: The Netherlands Cancer Institute

Brief Summary

Intro/rationale: Radiotherapy employs uniform, equally spaced weekday fractions that do not account for changes in tumor radiosensitivity. However, radiobiological characteristics evolve during the radiotherapy schedule as reoxygenation increases radiosensitivity. In tumor-response simulations and preclinical experiments, it was superior to prime the tumor with one radiotherapy fraction, followed by a treatment break permitting mitotic cell death and reoxygenation of tumor cells.

Objective: To determine the safety and feasibility of primer shot fractionation for NSCLC.

Study design: A prospective non-randomized feasibility trial to test the safety of primer shot fractionation in a 3+3 phase with increasing treatment breaks, followed by an expansion cohort.

Study population: Patients with NSCLC stage 2-4, referred for palliative radiotherapy of the primary tumor and possibly (lymph node) metastases. Patients are allowed to receive systemic treatments, except for VEGFR-inhibitors. The 3+3 phase is followed by an expansion phase of 22 patients.

Intervention: All treatments are 5x6 Gy to all targets. Patients receive an increasing primer shot treatment break. In the 3+3 phase, the break between the first and the second radiotherapy fraction is: 1, 2 and 3 weeks. The maximum tolerated break length will be used for the expansion cohort.

Main study parameters/endpoints: The main study endpoint is the ability of patients to finish the radiotherapy schedule as planned. Secondary endpoints are tumor response at the end of treatment and 3 months thereafter, and acute toxicity.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Based on simulations and preclinical data, primer shot treatment breaks increase tumor control. However, the increased overall treatment time could potentially increase the chance a patient drops out before the radiotherapy schedule is finished. Because of the gradually prolonged break, this risk is relatively small and acceptable for this population. Additionally, patients are asked to fill in PRO-CTCAE lung subset questionnaires at the start of treatment and during follow-up. They will also receive 1 additional CT with contrast at fraction 5.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2024-07-26
• Study First Submitted QC: 2024-07-26
• Study First Posted: 2024-07-30
• Study Start: 2024-08-08
• Status Verified: 2025-01
• Last Update Submitted: 2025-01-02
• Last Update Posted: 2025-01-06
• Primary Completion: 2028-08-01
• Study Completion: 2029-08-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 34

Inclusion Criteria

• Age ≥ 18 years
• NSCLC (either pathology proven or sufficient clinical suspicion to be treated as NSCLC), referred for palliative radiotherapy of at least the primary tumor site.
• Stage 2-4
• WHO performance score 0-2.
• Provision of signed, written and dated IC prior to any study specific procedures.

Exclusion Criteria

• Interstitial lung disease
• Treatment with vascular endothelial growth factor receptor (VEGFR) inhibitors
• Prior thoracic radiotherapy (>20 Gy EQD2 a/b 3) overlapping with the current planning target volume

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Primary Outcome Measures

Name	Time	Method
the ability of patients to finish the radiotherapy schedule	5 weeks	The study is powered to find a decrease of response from 99% to no less than 84.15% (relative decrease of 15%).

Secondary Outcome Measures

Name	Time	Method
Tumor response	at the end of treatment and after 3 months	the relative volume change after radiotherapy vs the CTRT.
treatment associated ≥ grade 2 non-hematologic toxicity according to the NCI Common Terminology Criteria of Adverse Events (CTCAE version 5.0) (from the first radiotherapy fraction until 6 months after radiotherapy)	from the first radiotherapy fraction until 6 months after radiotherapy
Patient-reported outcome patient-reported outcome- Common Terminology Criteria of Adverse Events (PRO)-CTCAE	up to 1 year after radiation.

Trial Locations

Locations (1)

Het Nederlands Kanker Instituut-Antoni van Leeuwenhoek Ziekenhuis Stichting; 🇳🇱 Amsterdam, Netherlands