Study to Evaluate SBRT for EGFR Mutant NSCLC Patients Receiving Osimertinib (CULTRO) (CULTRO)

August 16, 2023 updated by: Centro de Tratamiento e Investigación sobre Cáncer, Luis Carlos Sarmiento Angulo

Phase II Study to Evaluate the Efficacy and Safety of SBRT as an Adjunctive Intervention for Oligoresidual Disease in EGFR Mutant NSCLC With First-Line Osimertinib Treatment

Phase II Study to Evaluate the Impact of SBRT (Stereotactic Body Radiation Therapy) and/or SRS (Stereotactic Radiosurgery) on Oligoresidual Disease in EGFR Mutation Patients Treated with Osimertinib as First-Line Systemic Intervention. All candidates must exhibit a partial response after 12 weeks of treatment with the third-generation tyrosine kinase inhibitor (alone or in combination with chemotherapy) and a maximum of five (5) residual lesions in a maximum of two (2) organs. The primary outcome will be progression-free survival (PFS), and secondary outcomes will include overall survival (OS), proportion of patients without progression at months 12 and 36, safety, and overall response rate (ORR). Additionally, an exploratory analysis will be conducted on the prognostic value of liquid biopsy (supplementary information), considering baseline presence of mutations (determined by Next Generation Sequencing tests) and reduction or negativization of allelic fraction (AF).

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Phase II study with a single-stage Fleming design based on a normal approximation to the binomial distribution, with a one-sided type I error of 10% and a power of 90% to detect 30 events related to disease progression. Under the alternative hypothesis to detect a 35% improvement in PFS, 35 patients are required to be recruited over 22 months, with a minimum median follow-up of 14 months. An interim analysis will be conducted to determine early termination of the study using a Lan-DeMets monitoring boundary and an O'Brien-Fleming stopping rule. The interim analysis will be performed when 20 out of the expected 30 events have been observed. Employing the O'Brien-Fleming statistic, the critical value for the Z-score in the interim analysis (to stop and reject the null hypothesis) will be 1.054, and the critical value for the Z-score to stop and reject the alternative (futility) will be -0.204.

Study Type

Interventional

Enrollment (Estimated)

35

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Colombia
      • Bogotá, Colombia
        • CTIC - Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo
        • Contact:
        • Contact:
        • Principal Investigator:
          • Luis Rojas, MD
        • Principal Investigator:
          • Andrés Cardona, MD
        • Principal Investigator:
          • Iván Bobadilla, MD
        • Sub-Investigator:
          • Jairo Zuluaga, MD
        • Sub-Investigator:
          • Alejandro González, MD
        • Sub-Investigator:
          • Lucía Viola, MD
        • Sub-Investigator:
          • Stella Martínez, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Be older than 18 years of age.
  • Be capable of giving informed consent to participate in the study.
  • Have histological confirmation compatible with EGFR mutant non-small cell lung cancer (NSCLC) and metastatic disease (with or without histological confirmation of metastatic lesions).
  • Have confirmation of the presence of common EGFR mutations (exon 19 deletion, L858R/exon 21, or G719X) through any locally and internationally accepted standard tests.
  • Have received at least 12 weeks of Osimertinib treatment (with or without the addition of chemotherapy based on FLAURA2 study results after discussion with the investigative team).
  • Have a partial response defined by RECIST 1.1 criteria.
  • Have a maximum of 5 residual tumor lesions in up to 2 organs suitable for treatment with Stereotactic Ablative Radiotherapy (SABR).
  • Have the following imaging and clinical tests within 4 weeks before study entry:
  • Contrast-enhanced brain MRI.
  • Chest/abdomen/pelvis CT scan, with or without bone scan (at the investigator's discretion) if PET-CT was not performed.
  • 18-FDG PET-CT.
  • Spinal MRI for patients with vertebral or paravertebral metastases.
  • Electrocardiogram (EKG) and transthoracic echocardiogram.
  • Complete blood count and standard blood chemistry.
  • Negative pregnancy test for fertile women within 4 weeks prior to starting radiotherapy.
  • Liquid biopsy for assessment of tumor allelic fraction (baseline).
  • ECOG performance status 0-2.
  • All sites of oligoresidual disease must be safely treatable according to the following criteria:
  • All brain lesions must be treatable with SRS.
  • The maximum size for extracranial lesions will be up to 6 cm, with exceptions for bone metastases which may include lesions larger than 6 cm at the discretion of the investigative medical team (e.g., ribs, scapula, or pelvis).
  • Life expectancy >6 months.
  • Not eligible for surgical treatment.
  • Osimertinib treatment must be suspended 48 hours before the start of ablative therapy and cannot be initiated within 48 hours of receiving the last fraction. In patients receiving SBRT for central lung lesions, the suspension time for Osimertinib may be extended up to 5 days before and after ablative therapy.
  • Patients may have previously received treatments such as radiofrequency or microwave ablation for oligoresidual lesions, but imaging must demonstrate that the lesion persists and is treatable with SABR.
  • Metastatic tumor lesions that received initial treatment with radiosurgery cannot be included for SABR treatment.
  • If initial treatment was conventional radiotherapy, SABR could be considered if safe to administer. In this case, the ablative therapy must be discussed by the investigative team.
  • The eligibility and prognosis criteria will be reviewed by the multidisciplinary thoracic tumor board at CTIC Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo.

Exclusion Criteria:

  • Severe comorbidities contraindicating radiation therapy.
  • Bone metastases in the femur with a high risk of fracture.
  • Complete response to Osimertinib treatment (no oligoresidual disease for ablative treatment).
  • Inability to treat all oligoresidual lesions with ablative intent.
  • History of pneumonitis or functionally limiting interstitial lung disease. It may be considered limiting if the patient is unable to perform DLCO maneuvers or if adjusted DLCO is less than 35% of predicted, PaO2 at Bogotá altitude with FiO2 21% is less than or equal to 50 mmHg.
  • Clinical or radiological evidence of symptomatic spinal cord compression.
  • Dominant brain metastatic disease requiring surgical management (e.g., imminent herniation or hydrocephalus).
  • Candidate for a clinical trial with an experimental drug.
  • Inability to receive Osimertinib with minimal adherence.
  • Oligoresidual involvement in peritoneum, pleura, or bone marrow (non-measurable disease).
  • Leptomeningeal involvement (presumed based on imaging findings or confirmed by cerebrospinal fluid cytology).
  • Pregnant or breastfeeding women.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Radiation
A total of 35 patients diagnosed and treated at CTIC Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo.
Radiation: Stereotactic Body Radiation Therapy SBRT
This is a non-randomized Phase II study in which all patients receive the experimental treatment with Stereotactic Ablative Radiotherapy (SABR) to residual tumor lesions (up to 5 residual metastatic lesions in a maximum of 2 organs) following 12 weeks of systemic treatment with Osimertinib. The study aims to enroll 35 patients diagnosed and treated at CTIC Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo.
Other Names:
  • Stereotactic radiosurgery SRS

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression-Free Survival
Time Frame: Month 12
Time from the initiation of systemic treatment (Osimertinib) to disease progression or death. This outcome is not influenced by second-line interventions and allows for the estimation of the relative efficacy of the treatment and its Hazard Ratio (HR)
Month 12

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall Response Rate (ORR)
Time Frame: Month 12
Proportion of patients with partial or complete response following the implementation of SBRT. This measurement does not include stable disease
Month 12
Overall Survival (OS)
Time Frame: Month 12
Time from diagnosis, the first day of systemic treatment, and implementation of SBRT to death from any cause or last follow-up
Month 12
Progression-Free Time (PFT)
Time Frame: Month 12
Time from the execution of SBRT to objective tumor progression, excluding death
Month 12
Adverse Events and Safety
Time Frame: Month 12
Adverse events will be graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5 from the National Cancer Institute (NCI) US
Month 12

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Centro de Tratamiento e Investigación sobre Cáncer, Luis Carlos Sarmiento Angulo

Investigators

  • Principal Investigator: Luis Rojas, MD, Centro de Tratamiento e Investigación sobre Cáncer, Luis Carlos Sarmiento Angulo

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

November 1, 2023

Primary Completion (Estimated)

November 1, 2026

Study Completion (Estimated)

November 1, 2028

Study Registration Dates

First Submitted

July 28, 2023

First Submitted That Met QC Criteria

August 16, 2023

First Posted (Actual)

August 21, 2023

Study Record Updates

Last Update Posted (Actual)

August 21, 2023

Last Update Submitted That Met QC Criteria

August 16, 2023

Last Verified

August 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CTIC001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The current study is intended to be published, even if prematurely terminated. The publication may encompass all or part of the following variations: online publication of a synopsis, abstract and/or presentation at a scientific conference, or publication of a complete scientific article.

IPD Sharing Time Frame

5 years

IPD Sharing Access Criteria

Email to PI

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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