A Study of Stereotactic Radiosurgery (SRS) and Standard Treatment in People With Lung Cancer That Has Spread to the Brain

NCT ID: NCT06741085

Last Updated: 2025-10-24

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

PHASE2

Total Enrollment

56 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-13

Study Completion Date

2027-12-31

Brief Summary

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The researchers are doing this study is to find out whether treating brain metastasis with SRS after 3 months of therapy with osimertinib is better than treating with osimertinib alone in people with NSCLC. The researchers will also look at how the study intervention impacts participants' quality of life. The researchers will measure quality of life by having participants complete questionnaires.

Detailed Description

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Patients in both arms of this study will receive standard of care (SOC) systemic therapy which includes a backbone of an FDA-approved CNS-active TKI targeting mutant EGFR, specifically osimertinib.

Conditions

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Non Small Cell Lung Cancer Metastatic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

After 3 months of TKI therapy, eligible patients are randomized to either continuing drug therapy alone with salvage interventions at progression (SOC) vs continuing drug therapy with addition of consolidative SRS of radiographically visible brain lesions (intervention). Randomization will be stratified by receipt of TKI monotherapy vs. TKI combination therapy (e.g. with concurrent chemotherapy) as first line systemic therapy.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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osimertinib and stereotactic radiosurgery (SRS)

Group Type EXPERIMENTAL

osimertinib

Intervention Type DRUG

oral EGFR-TKI

stereotactic radiosurgery (SRS)

Intervention Type RADIATION

0-20mm-18Gy x 1, 21Gy x 1 ,9Gy x 3

20mm or larger- 9Gy x 3, 6Gy x 5, 5Gy x 5

osimertinib alone (standard systemic therapy)

Group Type ACTIVE_COMPARATOR

osimertinib

Intervention Type DRUG

oral EGFR-TKI

Interventions

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osimertinib

oral EGFR-TKI

Intervention Type DRUG

stereotactic radiosurgery (SRS)

0-20mm-18Gy x 1, 21Gy x 1 ,9Gy x 3

20mm or larger- 9Gy x 3, 6Gy x 5, 5Gy x 5

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Non-small cell lung cancer (NSCLC) with somatic activating mutation in EGFR diagnosis, confirmed at enrolling institution
* At least one intact brain metastasis measuring ≥1 cm measurable by RANO-BM at baseline prior to TKI therapy initiation
* Either TKI-naïve or started TKI ≤ 3-months prior (with documented start date and available imaging prior to TKI start)


\- Presence of detectable and non-progressing BM lesions on imaging consistent with viable residual disease

Exclusion Criteria

* Unable to undergo contrast-enhanced MRI brain
* Prior brain-directed radiotherapy
* Evidence of leptomeningeal disease on MRI total spine and/or lumbar puncture cytology. The latter are not mandated by protocol but are rather at the discretion of the treating medical team as clinically indicated.
* Neurologic symptoms or presence of a lesion in the brainstem, motor strip, or other eloquent brain area that is felt to warrant immediate intervention with SRS
* Active hematologic malignancy or a second solid tumor histology with known CNS tropism
* Patients who have undergone a therapeutic craniotomy for resection of one or more symptomatic brain metastasis are ineligible unless one or more additional intact BM remain unresected, and meets size criteria (e.g., a patient with removal of a 3cm symptomatic brain metastasis, but has an additional 1.25cm lesion remaining post-operatively, remains eligible for the study).
* Judgment by the investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements.
* Pregnant women or women who are breastfeeding or of childbearing potential. If the risk of contraception exists, male and female subjects must use highly effective contraception throughout the study and for at least 3 months after last treatment. Highly effective contraception includes either 2 barrier methods (diaphragm, condom by the partner, copper intrauterine device, sponge, or spermicide), or 1 barrier method and 1 hormonal method (any oral, subcutaneous, intrauterine, or intramuscular registered and marketed contraceptive agent that contains an estrogen and/or a progesterone agent)


* Progressive Disease (PD) with multiple lesions and/or other features that would warrant a change in systemic therapy, as determined by the primary treating provider
* Presence of BM not deemed safely treatable with SRS, as determined by a radiation oncologist
* Intracranial Complete Response (CR)
* More than 20 visible residual brain metastases at the time of enrollment (i.e. after initial treatment with TKI). However, no upper limit on the number of visible brain metastases is set at the time of initial diagnosis prior to treatment with TKI. For example, a patient who had 35 visible brain metastases at the time of diagnosis, but after three months of treatment with TKI had 10 visible brain metastases remaining will be eligible for enrollment and randomization
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Memorial Sloan Kettering Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Luke Pike, MD

Role: PRINCIPAL_INVESTIGATOR

Memorial Sloan Kettering Cancer Center

Locations

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BAPTIST ALLIANCE - MCI (Data Collection Only)

Miami, Florida, United States

Site Status RECRUITING

Memorial Sloan Kettering Basking Ridge (All Protocol Activities)

Basking Ridge, New Jersey, United States

Site Status RECRUITING

Memorial Sloan Kettering Monmouth (All Protocol Activities)

Middletown, New Jersey, United States

Site Status RECRUITING

Memorial Sloan Kettering Bergen (All Protocol Activities)

Montvale, New Jersey, United States

Site Status RECRUITING

Memorial Sloan Kettering Suffolk - Commack (All Protocol Activities)

Commack, New York, United States

Site Status RECRUITING

Memorial Sloan Kettering Westchester (All Protocol Activities)

Harrison, New York, United States

Site Status RECRUITING

Memorial Sloan Kettering Cancer Center (All Protocol Activities)

New York, New York, United States

Site Status RECRUITING

Memorial Sloan Kettering Nassau (All Protocol Activities)

Rockville Centre, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Luke Pike, MD

Role: CONTACT

212-639-8157

Helena Yu, MD

Role: CONTACT

646-608-3912

Facility Contacts

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Rupesh Kotecha, MD

Role: primary

786-596-2000

Luke Pike, MD

Role: primary

212-639-8157

Luke Pike, MD

Role: primary

212-639-8157

Luke Pike, MD

Role: primary

212-639-8157

Luke Pike, MD

Role: primary

212-639-8157

Luke Pike, MD

Role: primary

212-639-8157

Luke Pike, MD

Role: primary

212-639-8157

Luke Pike, MD

Role: primary

212-639-8157

Related Links

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http://www.mskcc.org/mskcc/html/44.cfm

Memorial Sloan Kettering Cancer Center

Other Identifiers

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24-378

Identifier Type: -

Identifier Source: org_study_id

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