Thoracic Radiotherapy Plus Durvalumab in Elderly and/or Frail NSCLC Stage III Patients Unfit for Chemotherapy

NCT ID: NCT04351256

Last Updated: 2025-12-05

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 51 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-05-20
• Study Completion Date: 2026-06-30

Brief Summary

This is a randomized, open-label, multicenter, phase II trial investigating the combination of thoracic radiotherapy plus Durvalumab in patients with locally advanced, unresectable NSCLC (stage III) that are unfit for chemotherapy (e.g. due to age and/or frailty).

Detailed Description

This trial investigates the feasibility and treatment efficacy when combining durvalumab treatment with either conventionally fractionated (CON-group) or hypofractionated thoracic radiotherapy (HYPO-group) in previously untreated NSCLC stage III patients prone to radiotherapy only.

A safety lead-in phase with stop-and-go design will precede full enrollment into the HYPO-group.

Tumor tissue as well as blood and stool samples will be collected for future biomarker analysis.

It is hypothesized that TRT combined with concurrent durvalumab administration in patients with unresectable stage III NSCLC, who are not amenable to sequential radio-/chemotherapy

1. is safe and feasible,

2. will improve treatment efficacy by a synergistic effect of checkpoint inhibition and the photon-induction of immunostimulatory pathways.

3. will have an effect on the immunological characteristics of the tumor, the microenvironment, and the systemic immune response, such as upregulation of PD-L1 or secretion of stimulatory cytokines and recruitment and priming of immunocompetent cells, which might then mediate the "abscopal effect" beyond the irradiated targets.

Conditions

NSCLC, Stage III

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arm A (HYPO group)

• Durvalumab at a fixed dose of 1,500 mg as an IV infusion over 1 hour, on day 1, to be repeated every 4 weeks (Q4W) for a maximum of 12 cycles
• Thoracic radiation therapy (TRT): hypofractionated thoracic radiotherapy consisting of 20 x 2,75 Gy (55 Gy) within 4 weeks (+9 days)

Group Type: EXPERIMENTAL

Durvalumab Injection [Imfinzi]

Intervention Type: DRUG

Durvalumab fixed dose of 1,500 mg

Thoracic Radiotherapy (TRT) hypofractionated

Intervention Type: RADIATION

Hypofractionated TRT consisting of 20 x 2,75 Gy (55 Gy) within 4 weeks

Arm B (CON group)

• Durvalumab at a fixed dose of 1,500 mg as an IV infusion over 1 hour, on day 1, to be repeated every 4 weeks (Q4W) for a maximum of 12 cycles
• Thoracic radiation therapy (TRT): conventional fractions of 30 x 2 Gy (60 Gy) within 6 weeks (+9 days)

Group Type: ACTIVE_COMPARATOR

Durvalumab Injection [Imfinzi]

Intervention Type: DRUG

Durvalumab fixed dose of 1,500 mg

Thoracic Radiotherapy (TRT) conventionally

Intervention Type: RADIATION

Conventionally fractionated TRT consisting of 30 x 2 Gy (60 Gy) within 6 weeks

Interventions

Durvalumab Injection [Imfinzi]

Durvalumab fixed dose of 1,500 mg

Intervention Type: DRUG

Thoracic Radiotherapy (TRT) conventionally

Conventionally fractionated TRT consisting of 30 x 2 Gy (60 Gy) within 6 weeks

Intervention Type: RADIATION

Thoracic Radiotherapy (TRT) hypofractionated

Hypofractionated TRT consisting of 20 x 2,75 Gy (55 Gy) within 4 weeks

Intervention Type: RADIATION

Eligibility Criteria

Inclusion Criteria

1. Fully-informed written consent and locally required authorization (European Union [EU] Data Privacy Directive in the EU) obtained from the patient/legal representative prior to performing any protocol-related procedures, including screening evaluations.

2. Age ≥ 18 years.

3. Histologically documented diagnosis of unresectable stage III NSCLC.

4. Non-feasibility of sequential chemo-/radiotherapy as determined by the site's multi-disciplinary tumor board; if there is no tumor board, then this decision will be made by the investigator in consultation with a radiation oncologist, if the investigator is not a radiation oncologist; or by the investigator in consultation with an oncologist, if the investigator is not an oncologist.

5. Fulfills at least one of the following criteria:

• Performance status (PS) 2 (ECOG scale)
• ECOG 1 and CCI ≥ 1
• Age ≥ 70 years

6. Must have a life expectancy of at least 12 weeks.

7. FEV1 ≥ 40%

8. DLCO or DLCO/VA (Hb-corrected, if available) ≥ 40%

9. FVC or VC ≥ 70%

10. At least one measurable site of disease as defined by RECIST 1.1

11. Adequate bone marrow and renal function including the following:

• Hemoglobin ≥ 9.0 g/dL;
• absolute neutrophil count ≥ 1.0 x 103/L;
• platelets ≥75x 109/L;
• Calculated creatinine clearance ≥30 mL/min as determined by the Cockcroft-Gault equation

12. Adequate hepatic function (with stenting for any obstruction, if required) including the following:

• Serum bilirubin ≤ 1.5 x institutional upper limit of normal (ULN);
• AST (SGOT) / ALT (SGPT) ≤ 2.5x institutional ULN

13. Female patients with reproductive potential must have a negative urine or serum pregnancy test within 7 days prior to start of trial.

14. Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients.

15. The patient is willing and able to comply with the protocol for the duration of the study, including hospital visits for treatment and scheduled follow-up visits and examinations.

Exclusion Criteria

1. Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) clinical study, or during the follow-up period of an interventional study.

2. Participation in another clinical study with an investigational product within 21 days prior to the first dose of the study treatment.

3. Prior immunotherapy or use of other investigational agents, including prior treatment with an anti-Programmed Death receptor-1 (PD-1),anti-Programmed Death-1 ligand-1 (PD-L1), anti-PD-L2, or anti-cytotoxic T-lymphocyte associated antigen-4 (anti-CTLA-4) antibody, therapeutic cancer vaccines.

4. History or current radiology suggestive of interstitial lung disease.

5. Oxygen-dependent medical condition.

6. Any concurrent chemotherapy, investigational product (IMP), biologic, or hormonal therapy for cancer treatment. Concurrent use of hormonal therapy for non-cancer related conditions (eg, hormone replacement therapy) is acceptable.

7. Prior thoracic radiotherapy within the past 5 years before the first dose of study drug.

8. Major surgery (as defined by the Investigator) within 4 weeks prior to enrollment into the study; patients must have recovered from effects of any major surgery. Note: Local non-major surgery for palliative intent is acceptable.

9. Active or prior documented autoimmune or inflammatory disorders (except inflammatory bowel disease [e.g. ulcerative colitis or Crohn's disease]; ( including diverticulitis [with the exception of diverticulosis], celiac disease, systemic lupus erythematosus, Sarcoidosis, or Wegener's syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis). The following are exceptions to this criterion:

• Patients with vitiligo or alopecia
• Patients with hypothyroidism (e.g., following Hashimoto's disease) stable on hormone replacement
• Any chronic skin condition that does not require systemic therapy
• Patients without active disease in the last 5 years may be included but only after consultation with the study physician.

10. Active, uncontrolled inflammatory bowel disease [e.g. ulcerative colitis or Crohn's disease]. Patients in stable remission for more than 1 year may be included.

11. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, uncontrolled cardiac arrhythmia, interstitial lung disease, gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent.

12. History of another primary malignancy except for:

• Malignancy treated with curative intent and with no known active disease ≥ 3 years before the first dose of IMP and of low potential risk for recurrence
• Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Thoraxklinik-Heidelberg gGmbH

OTHER

Sponsor Role: collaborator

AstraZeneca

INDUSTRY

Sponsor Role: collaborator

Institut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Farastuk Bozorgmehr, Dr. med.

Role: PRINCIPAL_INVESTIGATOR

Dept. of Thoracic Oncology Thoraxklinik at Heidelberg University

Locations

Universitätsklinikum Aachen

Aachen, , Germany

DRK Kliniken Berlin-Mitte

Berlin, , Germany

Kliniken der Stadt Köln gGmbH, Lungenklinik Merheim

Cologne, , Germany

Universitätsmedizin Göttingen

Göttingen, , Germany

Onkodok GmbH

Gütersloh, , Germany

Thoraxklinik am Universitätsklinikum Heidelberg

Heidelberg, , Germany

Lungenklinik Hemer, Pneumologie und Thorakale Onkologie

Hemer, , Germany

Vincentius-Diakonissen-Kliniken gAG

Karlsruhe, , Germany

Klinikum Ludwigsburg

Ludwigsburg, , Germany

Universitätsmedizin Mainz

Mainz, , Germany

Kliniken Maria Hilf GmbH

Mönchengladbach, , Germany

Gemeinschaftspraxis für Hämatologie und Onkologie

Münster, , Germany

Sana Klinikum Offenbach GmbH

Offenbach, , Germany

Pi.Tri-Studien GmbH

Offenburg, , Germany

Countries

Germany

References

Bozorgmehr F, Chung I, Christopoulos P, Krisam J, Schneider MA, Bruckner L, Mueller DW, Thomas M, Rieken S. Thoracic radiotherapy plus Durvalumab in elderly and/or frail NSCLC stage III patients unfit for chemotherapy - employing optimized (hypofractionated) radiotherapy to foster durvalumab efficacy: study protocol of the TRADE-hypo trial. BMC Cancer. 2020 Aug 26;20(1):806. doi: 10.1186/s12885-020-07264-8.

Reference Type: DERIVED

PMID: 32842974 (View on PubMed)

Other Identifiers

2019-002192-33

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

AIO-YMO/TRK-0319

Identifier Type: OTHER

Identifier Source: secondary_id

ESR-18-13893

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2024-513948-28-00

Identifier Type: CTIS

Identifier Source: secondary_id

TRADE-hypo

Identifier Type: -

Identifier Source: org_study_id