A Platform Study of Novel Agents in Combination With Radiotherapy in NSCLC

NCT ID: NCT04550104

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE1

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-17

Study Completion Date

2028-03-31

Brief Summary

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CONCORDE is a multi-institution, multi-arm, Phase IB study that will determine the recommended phase II dose (RP2D) and safety profiles of different DNA damage repair inhibitors (DDRis) when given in an open label fashion in combination with fixed dose curative intent radiotherapy (RT) in patients with stage IIB/IIIA/IIIB NSCLC, followed by up to 12 months of consolidation durvalumab immunotherapy in selected study arms. The RP2D will be evaluated by incorporating the number of observed dose limiting toxicities (DLTs) into a time to event continuous reassessment method (TiTE- CRM) model within each of the experimental arms. TiTE-CRM is used here to take into account longer-term toxicities up to 13.5 months post start of radiotherapy and use these to inform dose escalation decision making.

Detailed Description

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Radiotherapy is an effective treatment for patients with non-small cell lung cancer (NSCLC) that has not spread beyond the chest area. Radiotherapy is used as a curative treatment but unfortunately for most patients the cancer can return. Radiotherapy kills cells by damaging their DNA. Cells have the ability to repair that damage, especially the cells of normal tissue. If DNA repair can be prevented radiotherapy should be more effective causing the cancer cells to die.

The study will use new drugs that affect how cells repair DNA damage, called DNA damage response inhibitors (DDRi). These will be given together with radiotherapy to hopefully improve the effectiveness of radiotherapy, followed by up to 12 months of durvalumab immunotherapy in selected study arms to develop the trial in line with the standard of care for NSCLC. The study will try to find out the most effective and safe dose of this combination treatment. This will be a clinical trial where patients due to have radiotherapy, with the hope of successful treatment that could lead to cure from their cancer or extension of life, will be offered entry onto the study. All patients will receive their radiotherapy, with 3 out of every 4 people also receiving a single DDRi drug alongside this. Both patients and study doctors will know prior to the start of the actual treatment whether a DDRi will be given, and if so which one; no placebos will be used. The patients will be followed closely to check for side effects and to assess how their cancer is responding to treatment. Blood samples will be taken to monitor treatment progress and to try to predict which patients are most likely to benefit from this type of combined treatment.

Conditions

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Non Small Cell Lung Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The trial is designed as a randomised Phase I dose escalation platform study, using the TiTE CRM design to find the RP2D of each DDRi with RT combination. At the time of patient identification the treating centre will be informed of the allocated study arm following a pre-specified prioritisation schedule. Consenting participants will be randomised between DDRi with RT or RT only. Patients are not randomised between experimental arms nor will endpoints be compared between experimental arms. RT only participants will be pooled across the platform to provide contemporary data on toxicity.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Radiotherapy only

Group Type ACTIVE_COMPARATOR

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

Olaparib + radiotherapy

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

Olaparib Oral Tablet [Lynparza]

Intervention Type DRUG

Oral tablet

AZD1390 + radiotherapy

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

AZD1390

Intervention Type DRUG

Oral tablet

Ceralasertib (AZD6738) + radiotherapy + Consolidation durvalumab

This study arm will include up to 12 months of consolidation durvalumab for eligible participants following the completion of radiotherapy +/- DDRi.

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

Ceralasertib

Intervention Type DRUG

Oral Tablet

Durvalumab

Intervention Type DRUG

1500mg iv infusion

AZD5305 + radiotherapy + Consolidation durvalumab

This study arm will include up to 12 months of consolidation durvalumab for eligible participants following the completion of radiotherapy +/- DDRi.

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

AZD5305

Intervention Type DRUG

Oral Tablet

Durvalumab

Intervention Type DRUG

1500mg iv infusion

RT + consolidation durvalumab

Group Type ACTIVE_COMPARATOR

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

Durvalumab

Intervention Type DRUG

1500mg iv infusion

Arm D - did not proceed

Arm D - did not proceed

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

Interventions

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Radiotherapy

Administered as 30 fractions of 2Gy. Total 60 60Gy. Administered once daily monday to friday.

Intervention Type RADIATION

Olaparib Oral Tablet [Lynparza]

Oral tablet

Intervention Type DRUG

AZD1390

Oral tablet

Intervention Type DRUG

Ceralasertib

Oral Tablet

Intervention Type DRUG

AZD5305

Oral Tablet

Intervention Type DRUG

Durvalumab

1500mg iv infusion

Intervention Type DRUG

Other Intervention Names

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AZD2281 AZD6738

Eligibility Criteria

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Inclusion Criteria

1. Histologically or cytologically confirmed NSCLC (patients where the local MDT agree the diagnosis is NSCLC after review of the available pathology and imaging at MDT can be enrolled after discussion with the CI).
2. Not suitable for concurrent chemoradiotherapy/surgery due to tumour or patient factors
3. Stage IIB and III (TNM 8th Edition).
4. Planned to receive RT at curative intent doses (i.e., 60Gy) as part of treatment plan (either with or without induction chemotherapy).
5. Patient considered suitable for radical RT by the local lung cancer multidisciplinary team and a clinical oncologist.
6. If chemotherapy has been given previously, the maximum interval between the last day of chemotherapy and the start of RT \<10 weeks.
7. Age ≥18
8. Life expectancy estimated to be greater than 6 months.
9. Karnofsky Performance status ≥70.
10. MRC dyspnoea score \<3.
11. Forced expiratory volume in one second (FEV1) ≥35% predicted and diffusing capacity of the lungs for carbon monoxide (DLCO or TLCO) ≥35% predicted.
12. Patient must be fully informed about the study and have signed the informed consent form.
13. Patient must be willing and able to comply with the protocol, have mental capacity and (if relevant) use effective contraception throughout treatment and for 4 months for women of childbearing potential, and 6 months for men after treatment completion. Treatment is defined as including the last dose of durvalumab or DDRi in the consolidation phase.
14. Adequate organ function as defined in master protocol.
15. Patient has a body weight of \>30kg.


1. A minimum of 4 and a maximum of 8 weeks\* have elapsed following completion of RT
2. Any toxicities from RT have resolved to grade 1. If patient has pneumonitis following RT treatment, this must be asymptomatic (grade 1). If pneumonitis is ≥2 or requiring steroids, then participant is not eligible
3. Karnofsky Performance status ≥70
4. The laboratory requirements set out in Table 1 of the master protocol are met
5. Patient has no known hypersensitivity to the excipients of durvalumab
6. Patient has body weight of \>30kg \*Investigators should ideally aim to start consolidation treatment within 6 weeks, following the receipt of the CT scan results to rule out progression.

Exclusion Criteria

1. Mixed non-small cell and small cell tumours.
2. Confirmed progressive disease during induction chemotherapy.
3. Participation in a study of an investigational agent or using an investigational device within 4 weeks prior to the anticipated start of treatment.
4. Current or previous malignant disease which may impact on a patient's estimated life expectancy (other than NSCLC).
5. History of interstitial pneumonitis.
6. Prior thoracic radiotherapy.
7. Prior treatment with pneumotoxic drugs, e.g. busulfan, bleomycin, within the past year. If prior therapy in lifetime, then exclude if history of pulmonary toxicities from administration. Patients who have received treatment with nitrosoureas (e.g., carmustine, lomustine) in the year before study entry without experiencing lung toxicity are allowed on study.
8. Mean resting corrected QT interval (QTcF) \>470 msec obtained from 3 electrocardiograms.
9. Received a prior autologous or allogeneic organ or tissue transplantation.
10. Patients unable to swallow orally administered medications or chronic gastrointestinal (GI) disease likely to interfere with absorption of IMP in the opinion of the treating investigator (e.g. malabsorption syndrome, resection of the small bowel, poorly controlled inflammatory bowel disease etc.).
11. Grade 2 or higher peripheral sensory neuropathy.
12. Known positive test for human immunodeficiency virus, active hepatitis B or C infection.
13. Positive pregnancy test (at eligibility assessment for women of childbearing potential) or breast-feeding women.
14. Patients with persistent toxicities (\>CTCAE grade 2) caused by previous cancer therapy, excluding alopecia.
15. Patients with myelodysplastic syndrome (MDS)/acute myeloid leukaemia (AML) or with features suggestive of MDS/AML.
16. Major surgery within 2 weeks of confirmation of eligibility.
17. Patients considered a poor medical risk by the investigator due to a serious, uncontrolled medical disorder, non-malignant system disease or active uncontrolled infection. Examples include, but are not limited to, uncontrolled ventricular arrhythmia, uncontrolled hypertension, uncontrolled atrial fibrillation, active bleeding, recent (within 3 months) myocardial infarction, major seizure, active COVID-19, any psychiatric disorder that prohibits obtaining informed consent.
18. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease (e.g., ulcerative colitis or Crohn's disease), systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome (granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc.


1. Progressive disease during RT or at the end of RT treatment response assessment.
2. Participant declines treatment in the consolidation phase.
3. Patients who have received prior anti-PD-1 or anti PD-L1 treatment.
4. Major surgery within 4 weeks of confirmation of eligibility for consolidation phase.
5. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab.
6. Patients considered a poor medical risk by the investigator due to a serious, uncontrolled medical disorder, non-malignant system disease, active GI infection or active uncontrolled infection.
7. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease e.g., colitis or Crohn's disease), systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Manchester

OTHER

Sponsor Role collaborator

Newcastle University

OTHER

Sponsor Role collaborator

University of Oxford

OTHER

Sponsor Role collaborator

The Leeds Teaching Hospitals NHS Trust

OTHER

Sponsor Role collaborator

Beatson West of Scotland Cancer Centre

UNKNOWN

Sponsor Role collaborator

University of Glasgow

OTHER

Sponsor Role collaborator

Velindre NHS Trust

OTHER_GOV

Sponsor Role collaborator

University College London Hospitals

OTHER

Sponsor Role collaborator

Queen's University, Belfast

OTHER

Sponsor Role collaborator

University of Sheffield

OTHER

Sponsor Role collaborator

University of Leeds

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Alastair Greystoke, MB ChB, MSc, PhD

Role: PRINCIPAL_INVESTIGATOR

Newcastle University

Corinne Faivre-Finn, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Manchester

Locations

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Belfast City Hospital

Belfast, , United Kingdom

Site Status RECRUITING

Birmingham Heartlands Hospital

Birmingham, , United Kingdom

Site Status RECRUITING

Addenbrooke's Hospital

Cambridge, , United Kingdom

Site Status RECRUITING

Velindre Cancer Centre

Cardiff, , United Kingdom

Site Status RECRUITING

The Royal Marsden Hospital Chelsea

Chelsea, , United Kingdom

Site Status RECRUITING

Western General Hospital

Edinburgh, , United Kingdom

Site Status RECRUITING

St James's University Hospital

Leeds, , United Kingdom

Site Status RECRUITING

The Clatterbridge Cancer Centre

Liverpool, , United Kingdom

Site Status RECRUITING

St Bartholomew's Hospitals

London, , United Kingdom

Site Status RECRUITING

University College Hospital London

London, , United Kingdom

Site Status RECRUITING

The Christie NHS Foundation Trust

Manchester, , United Kingdom

Site Status RECRUITING

Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust

Newcastle upon Tyne, , United Kingdom

Site Status RECRUITING

Weston Park Hospital

Sheffield, , United Kingdom

Site Status RECRUITING

The Royal Marsden Sutton

Sutton, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Jamie B Oughton, MPhil

Role: CONTACT

Phone: 0113 343 1494

Email: [email protected]

Facility Contacts

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Role: primary

CTRU CONCORDE

Role: primary

Role: primary

Role: primary

Role: primary

Role: primary

Role: primary

CTRU CONCORDE

Role: primary

CTRU CONCORDE

Role: primary

Role: primary

Role: primary

Alastair Greystoke

Role: primary

Role: primary

Role: primary

References

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Faivre-Finn C, Brown S, Ryan A, Greystoke A; CONCORDE Investigators. The UK at the Forefront of Innovative Drug-Radiotherapy Combination Clinical Trials: Introducing the CONCORDE Platform. Clin Oncol (R Coll Radiol). 2020 Jun;32(6):358-362. doi: 10.1016/j.clon.2020.02.003. Epub 2020 Feb 24. No abstract available.

Reference Type BACKGROUND
PMID: 32107107 (View on PubMed)

Walls GM, Oughton JB, Chalmers AJ, Brown S, Collinson F, Forster MD, Franks KN, Gilbert A, Hanna GG, Hannaway N, Harrow S, Haswell T, Hiley CT, Hinsley S, Krebs M, Murden G, Phillip R, Ryan AJ, Salem A, Sebag-Montefoire D, Shaw P, Twelves CJ, Walker K, Young RJ, Faivre-Finn C, Greystoke A. CONCORDE: A phase I platform study of novel agents in combination with conventional radiotherapy in non-small-cell lung cancer. Clin Transl Radiat Oncol. 2020 Sep 22;25:61-66. doi: 10.1016/j.ctro.2020.09.006. eCollection 2020 Nov.

Reference Type BACKGROUND
PMID: 33072895 (View on PubMed)

Walker K, Hinsley S, Phillip R, Oughton JB, Murden G, Chalmers AJ, Faivre-Finn C, Greystoke A, Brown SR; CONCORDE Investigators. Implementation of the Time-to-Event Continuous Reassessment Method Design in a Phase I Platform Trial Testing Novel Radiotherapy-Drug Combinations-CONCORDE. JCO Precis Oncol. 2022 Nov;6:e2200133. doi: 10.1200/PO.22.00133.

Reference Type DERIVED
PMID: 36446040 (View on PubMed)

Other Identifiers

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2020-000206-28

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

282001

Identifier Type: OTHER

Identifier Source: secondary_id

A28890

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

MO20/118073

Identifier Type: -

Identifier Source: org_study_id