Assessment of Precision Irradiation in Early NSCLC and Interstitial Lung Disease (ASPIRE-ILD)

Assessment of Precision Irradiation in Early NSCLC and Interstitial Lung Disease (ASPIRE-ILD): A Phase II Trial

This is a prospective phase II study of Stereotactic Ablative Radiotherapy (SABR) in patients with Non-Small Cell Lung Cancer (NSCLC) and co-existent Interstitial Lung Disease (ILD), to determine oncologic and toxicity outcomes. Patients will be divided into 3 separate cohorts based on the ILD-GAP index.

Study Overview

• Status: Active, not recruiting
• Conditions: Non Small Cell Lung Cancer; Interstitial Lung Disease
• Intervention / Treatment: Radiation: Stereotactic Ablative Radiotherapy

Detailed Description

For patients with ILD and concurrent early-stage lung cancer who are not candidates for surgery, data showing high rates of toxicity have led to a difficult clinical dilemma, since there are few alternate treatment options. The option of delivering no treatment whatsoever, which avoids any risk of treatment-related toxicity, is associated with a high risk of death due to the lung cancer itself.

Stereotactic ablative radiotherapy (SABR) is a newer radiotherapy approach which uses modern radiotherapy planning and targeting technologies to precisely deliver larger, ablative doses of radiotherapy. SABR has been associated with high rates of local control. A major advantage of SABR is that in general, the toxicity profile is very favorable, even in patients with substantial co-morbid conditions.

It is possible that currently-used doses and fractionations of SABR, when given with strict planning criteria to minimize the risk of lung toxicity, have only a modest risk of treatment-related toxicity and represent the best possible approach.

This study will examine SABR versus a historical control of untreated stage I non-small cell lung cancer with Overall survival (OS) as the endpoint. OS was selected as it objectively reflects the potential benefits of treatment (i.e. extended survival), the harms of treatment (grade 5 toxicity), and the natural history of the ILD disease process itself.

• Study Type: Interventional
• Enrollment (Estimated): 39
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 1Z2
      • Alberta Health Services, Cross Cancer Institude
  • Ontario
    • London, Ontario, Canada, N6A 4L6
      • London Regional Cancer Program of the Lawson Health Research Institute
    • Toronto, Ontario, Canada, M4N 3M5
      • Sunnybrook Health Sciences Centre
    • Toronto, Ontario, Canada, M5G 2M9
      • UHN Princess Margaret Cancer Centre
  • Quebec
    • Montréal, Quebec, Canada, H2X 0A9
      • CHUM Université de Montréal
• United Kingdom
  • Edinburgh, United Kingdom, EH4 2XU
    • Edinburgh Cancer Centre, Western General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Stage T1-2, N0, M0 (AJCC Staging, 8th Edition - i.e. tumor size ≤ 5 cm) prior to registration.
• Not a candidate for surgical resection, determined by any of the following:
• Consultation with a thoracic surgeon
• Discussion at Multidisciplinary Team (MDT) rounds with a surgeon present
• Patient refusal of surgery
• Pathologically (histologically or cytologically) proven diagnosis of non-small cell lung cancer (NSCLC) is not required, but strongly recommended.
• If the risk of biopsy is unacceptable, pathologic confirmation is not required providing there is growth over time on Computed Tomography (CT) imaging and/or Fluorodeoxyglucose (FDG) avidity that is strongly suggestive of a primary NSCLC.
• Eastern Cooperative Oncology Group (ECOG) performance status 0-3;
• Age ≥ 18;
• Life expectancy > 6 months
• Fibrotic interstitial lung disease of any subtype, as diagnosed by a respirologist/pulmonologist.

Exclusion Criteria:

• Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 2 years (e.g., carcinomas in situ of the breast, oral cavity, or cervix are permissible); previous lung cancer, if the patient is disease-free for a minimum of 2 years is permitted.
• Prior thoracic radiotherapy
• Plans for the patient to receive other local therapy while on this study, except at disease progression;
• Plans for the patient to receive systemic therapy (including standard chemotherapy or biologic targeted agents), while on this study, except at disease progression. Patients are allowed to receive anti-fibrotic agents used in the treatment of IPF or non-IPF fibrotic ILD (e.g. nintedanib, pirfenidone), or steroids, if those are part of their current ILD treatment regimen. Other immunosuppressive drugs such as mycophenolate, azathioprine, cyclophosphamide, and rituximab must be stopped for 2 weeks prior and 2 weeks after treatment.
• Active pregnancy
• Concurrent administration of any drugs with known radiosensitive effects (e.g. Methotrexate).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment Arm: Stereotactic Ablative Radiotherapy; Stereotactic ablative radiotherapy for early non-small cell lung cancer and interstitial lung disease	Radiation: Stereotactic Ablative Radiotherapy; Stereotactic ablative radiotherapy for early non-small cell lung cancer and interstitial lung disease

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival	Time from enrollment to death from any cause	4 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Toxicity as measured by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0		8 years
Progression-Free Survival		8 years
Local Control as determined via radiographic evidence		8 years
Cough Severity as reported by the participant via 10 cm analogue Cough Severity Scale	Cough severity will be reported by participants via a scale, where a score of 100 is no cough and a score of 0 is the worst cough ever.	8 years
Rates of Acute-Exacerbation of Idiopathic Pulmonary Fibrosis (IPF)		8 years
Rates of Acute-Exacerbation of ILD		8 years
Quality of Life measured by the Functional Assessment of Cancer Therapy - Lung questionnaire	The Functional Assessment of Cancer Therapy - Lung (FACT-L ) is a standardized questionnaire used to measure quality of life. The questionnaire consists of 5 scales measuring 37 items in total. Categories of the 5 scales are: physical well-being, social/family well-being, emotional well-being, functional well-being, and additional concerns related to symptoms, cognitive function, and regret of smoking. The score for each item in the scale ranges from 0 to 4, where 0 is not at all and 4 is very much. The scores from each scale are added up, and can be combined to provide a total score.	8 years
Changes in ILD Severity measured by High Resolution Computed Tomography (HRCT)		8 years
Changes in Pulmonary Function Tests		8 years
Exploratory Quantitative Analysis of High Resolution Computed Tomography (HRCT) Features		8 years
Analysis of Outcomes for Patients Eligible for Study Who Decline Radiotherapy		8 years
Quality of Life measured by the EuroQOL Group EQ-5D-5L questionnaire	The EQ-5D-5L is a standardized questionnaire used to measure quality of life and health. The first section includes 5 categories: mobility, self-care, usual activities (e.g. work, family), pain/discomfort, and anxiety/depression. Each category contains 5 statements ranging from no problems to extreme problems, where no problems is assigned a code of 1 and extreme problems is assigned a code of 5. Participants are asked to select the statement that best describes their health that day. No score is generated, rather a 5 digit code is generated based on the response provided, which can then be combined into a data set and interpreted in a variety of ways. The second section includes a 20 cm analogue scale from 0 to 100, where 100 is the best health ever imagined and 0 is the worst health imagined. The participant will mark a score on the scale representing the state of their health on that day.	8 years

Collaborators and Investigators

• Sponsor: Lawson Health Research Institute
• Collaborators: University of British Columbia; Western University, Canada; London Health Sciences Centre
• Investigators: Study Chair: David Palma, MD, London Health Sciences Centre, Lawson Health Research Institute; Study Chair: Alexander Louie, MD, London Health Sciences Centre, Lawson Health Research Institute; Study Chair: Chris Ryerson, MD, University of British Columbia

Publications and helpful links

General Publications

• Palma DA, Chen H, Bahig H, Gaede S, Harrow S, Laba JM, Qu XM, Rodrigues GB, Yaremko BP, Yu E, Louie AV, Dhaliwal I, Ryerson CJ. Assessment of precision irradiation in early non-small cell lung cancer and interstitial lung disease (ASPIRE-ILD): study protocol for a phase II trial. BMC Cancer. 2019 Dec 11;19(1):1206. doi: 10.1186/s12885-019-6392-8.

Study record dates

Study Major Dates

• Study Start (Actual): September 20, 2018
• Primary Completion (Actual): January 11, 2022
• Study Completion (Estimated): September 20, 2026

Study Registration Dates

• First Submitted: March 7, 2018
• First Submitted That Met QC Criteria: March 29, 2018
• First Posted (Actual): April 2, 2018

Study Record Updates

• Last Update Posted (Actual): February 29, 2024
• Last Update Submitted That Met QC Criteria: February 27, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Stereotactic; Radiation; Ablative
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Interstitial
• Other Study ID Numbers: ASPIRE-ILD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No