Liver Toxicity in Lung Cancer Patients Treated With Immune-checkpoint Inhibitors.

NCT ID: NCT04595734

Last Updated: 2022-01-21

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 500 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-01-07
• Study Completion Date: 2025-01-06

Brief Summary

Immune-checkpoint inhibitors have recently become available as a new therapy for a variety of cancers. This drugs function by boosting the anti-cancer immune response, but unfortunately, may cause off-target, non-specific immune activation, resulting in liver and gut toxicity. In order to understand the development of liver immune-related adverse events we aim to collect full clinicopathological data from patients with advanced lung cancer treated with immune-checkpoint inhibitors at Blacktown, Westmead and Nepean Hospitals. Patients treated with standard chemotherapy will be used as a control group.

This study aims to establish clinical risk factors that can predict the occurrence of liver immune-related adverse events in patients with advanced lung cancer treated with immune-checkpoint inhibitors. Such predictors may assist in the stratification of patients based on their risk for development liver toxicity as a result of immunotherapy, allowing early cessation/modification of treatment prior to the development of severe adverse reactions. In addition, this retrospective study will aim to determine the significance of pre-existing liver damage on the development of liver adverse events as well as establish a timeline defining the development of adverse events in the liver.

Detailed Description

BACKGROUND AND RATIONALE.

Lung cancer is the most common cause of cancer-related mortality worldwide. This year alone 12,817 new lung cancer cases were registered in Australia, the mortality rate of which being 46% within 5 years. Chemotherapy is still considered the first-line treatment, however recent clinical trials have established that with treatment monoclonal antibodies known as immune-checkpoint inhibitors shows higher efficacy in terms of overall survival and progression-free survival. Despite higher efficacy, immune-checkpoint inhibitors can cause a number of immune-related adverse events which may force patients to cease treatment. Among these side effects, liver toxicity occurs rapidly and is asymptomatic in the early stages. These facts underscore the necessity of stratifying patients based on their risk of developing liver toxicity. We aim to predict liver toxicity early on in therapy using data collected from routine clinical testing.

STUDY AIMS / OBJECTIVES.

This retrospective study aims to answer following research questions:

1. Does pre-existing liver fibrosis/cirrhosis influence the development of liver immune-related adverse events?

2. What is the first time-point and subsequent timeline of liver immune-related adverse events occurrence and progression?

3. What clinical markers predict immunotherapy related toxicity?

STUDY DESIGN.

This is non-interventional retrospective study that plans to collect data from patients with stage IV lung cancer treated at Blacktown, Westmead and Nepean Hospitals. The main goal of this study is to establish statistically significant clinical predictors of liver toxicity in patients treated with immune-checkpoint inhibitors. Full clinicopathological data will be collected from hospital medical electronic databases. We will prioritise the examination of liver function blood tests in order to establish the first timepoint of liver function abnormalities and correlate them to pre-treatment blood results.

STUDY PROCEDURES.

This retrospective study will be conducted in 3 steps

1. Collection of full clinicopathological data of patients with advanced lung cancer treated at Blacktown, Westmead and Nepean Hospitals .

2. Blood tests results will be collected according to the following scheme: (1) The day prior to treatment commencement (baseline); (2) every 28th day for patients treated with tyrosine kinase inhibitors; (3) the last day of each therapeutic cycle for patients treated with immune-checkpoint inhibitors or platinum-doublet chemotherapy or combination.

3. Statistical analysis using SPSS v23 and STATA v16 software.

DATA COLLECTION:

1. Clinicopathological data

• ID
• Age
• Sex
• Clinical diagnosis
• Histological diagnosis
• TNM stage
• Date of diagnosis
• Date of treatment commencement
• Therapeutic regimen
• Cycling regime
• Date of death
• Cardiovascular comorbidities
• Neurologic comorbidities
• Respiratory comorbidities
• Endocrine comorbidities
• Gastrointestinal comorbidities
• Renal comorbidities
• Smoking status (pack/years)
• Eastern Cooperation Oncology Group performance status (ECOG PS)
• Programmed death ligand 1 (PD-L1) expression (%)
• Genetic mutations
• FibroScan data

2. Data from blood tests

• Red blood cells (RBC)
• Red blood cells distribution weight (RDW)
• Haematocrit
• Haemoglobin
• Mean corpuscular volume (MCV)
• Mean corpuscular haemoglobin (MCH)
• Mean corpuscular haemoglobin concentration (MCHC)
• Platelets
• White blood cells (WBC)
• Neutrophils
• Lymphocytes
• Monocytes
• Eosinophils
• Basophils
• Sodium
• Potassium
• Bicarbonate
• Estimated glomerular filtration rate
• Urea
• Creatinine
• Glucose
• Serum protein
• Total globulin
• Albumin
• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Gamma glutamyltransferase (GGT)
• Alkaline phosphatase (ALP)
• Total bilirubin
• C-reactive protein
• Iron
• Transferrin
• Ferritin

3. Statistical considerations:

• All variables will be analysed using descriptive statistics
• Mann-Whitney test will be used for estimating differences in liver functional tests between two groups and to evaluate the significance of pre-existing liver damage (counted by APRI and Fib-4 scores) on the development of liver immune-related adverse events
• Multivariate regression for establishment significant predictors of liver toxicity

Conditions

Lung Cancer Stage IV; Lung Cancer, Non-small Cell; Hepatitis

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Interventions

No intervention due to observational methods of study

No intervention due to observational methods of study

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. - Advanced lung cancer (stage IV)

2. - Treatment - immune-checkpoint inhibitors or chemotherapy

3. - Data is fully available for the whole period of observation

Exclusion Criteria

1. - Radiologically reported liver metastases

2. - Concurrent treatment with both therapeutic regimes

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Western Sydney

OTHER

Sponsor Role: collaborator

Western Sydney Local Health District

OTHER

Sponsor Role: lead

Responsible Party

Golo Ahlenstiel

Professor of Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Golo Ahlenstiel, Professor

Role: PRINCIPAL_INVESTIGATOR

Blacktown Hospital, Western Sydney Local Health District

Locations

Westmead Hospital

Sydney, New South Wales, Australia

Site Status: RECRUITING

Blacktown Hospital

Sydney, New South Wales, Australia

Site Status: RECRUITING

Nepean Hospital

Sydney, New South Wales, Australia

Site Status: RECRUITING

Countries

Australia

Central Contacts

Golo Ahlenstiel, Professor

Role: CONTACT

Golo.Ahlenstiel@health.nsw.gov.au

+61 432 303 547

Dmitrii Shek, Dr

Role: CONTACT

Dmitri.Shek@health.nsw.gov.au

+61 412 035 533

Facility Contacts

Bo Gao, Dr

Role: primary

Bo.Gao@health.nsw.gov.au

Golo Ahlenstiel, Professor

Role: primary

Golo.Ahlenstiel@health.nsw.gov.au

Deme Karikios, Dr

Role: primary

Deme.Karikios@health.nsw.gov.au

Other Identifiers

2019/PID14816

Identifier Type: -

Identifier Source: org_study_id