Impact of Radiotherapy-Immunotherapy Timing in NSCLC Brain Metastases ((RT-ICI))
Immune Microenvironment-driven Radiotherapy-immunotherapy Combined With Time-series Strategy for NSCLC Brain Metastases: an Exploratory Study Based on a Clinical Cohort.
The goal of this observational study is to learn about the effects of the timing of radiation therapy and immunotherapy in adults with non-small cell lung cancer (NSCLC) that has spread to the brain. The main questions it aims to answer are:
- Does the timing of the two treatments change how long the brain tumor stays stable and how long participants live?
- What medical problems do participants have when receiving these treatments at different times?
- How does the timing of treatments affect the body's immune system?
Researchers will compare participants who receive radiation and immunotherapy 30 days or less apart to those who receive them more than 30 days apart to see if the timing affects the treatment's success and safety.
Participants already receiving radiation and immunotherapy as part of their regular medical care will:
- Allow researchers to collect information about their treatment, health, and medical imaging during regular checkups.
- Give a small blood sample during their routine blood draws.
- Have standard magnetic resonance imaging (MRI) scans of their brain.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Rongrong Zhou, MD, PHD
- Telefonnummer: +8613875898127
- E-Mail: zhourr@csu.edu.cn
Studieren Sie die Kontaktsicherung
- Name: Weihua Liao, MD, PHD
- Telefonnummer: +8613973126486
- E-Mail: ouwenliao@163.com
Studienorte
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Hunan
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Changsha, Hunan, China
- Xiangya Hospital of Central South University
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Kontakt:
- Rongrong Zhou, MD, PHD
- Telefonnummer: +8613875898127
- E-Mail: zhourr@csu.edu.cn
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Kontakt:
- Weihua Liao, MD, PHD
- Telefonnummer: +8613973126486
- E-Mail: ouwenliao@163.com
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Unterermittler:
- Xianjing Chu, MD
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Probenahmeverfahren
Studienpopulation
Beschreibung
Inclusion Criteria:
- Age ≥ 18 years; no gender restriction;
- Histologically or cytologically confirmed NSCLC, with brain metastases confirmed by contrast-enhanced cranial MRI;
- Scheduled to receive radiotherapy combined with a PD-1/PD-L1 inhibitor, in accordance with real-world clinical treatment plans;
- Negative for driver gene mutations, or positive for mutations but with documented failure of prior targeted therapy;
- ECOG Performance Status score of 0-2, with an estimated life expectancy of ≥ 3 months;
- Voluntarily signs the informed consent form and agrees to cooperate with blood/imaging data collection and follow-up procedures.
Exclusion Criteria:
- History of whole-brain radiotherapy, stereotactic radiotherapy for brain metastases, or brain surgery;
- Presence of contraindications to MRI or inability to tolerate gadolinium-based contrast agents (e.g., severe hepatic or renal insufficiency);
- Presence of active autoimmune disease requiring systemic treatment, or requirement for long-term use of high-dose immunosuppressive agents;
- Pregnant or lactating women;
- Other circumstances deemed by the investigator to involve severe complications or render the patient unsuitable for enrollment.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
Anzahl der Gruppen / Kohorten
Kohorten und Interventionen
Gruppe / KohorteGruppe / Kohorte |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Non-small cell lung cancer brain metastases
This cohort comprises adult patients (aged 18 years and older) with histologically or cytologically confirmed (NSCLC who have brain metastases confirmed by contrast-enhanced head MRI. Participants in this cohort are scheduled to receive standard-of-care radiotherapy combined with PD-1/PD-L1 immune checkpoint inhibitors based on real-world clinical treatment plans. Eligible participants must have an ECOG performance status of 0 to 2, an expected survival of at least 3 months, and be either driver-gene negative or have experienced disease progression following prior targeted therapies. The cohort strictly excludes patients who have a history of WBRT, SRS for brain metastases, or brain surgery. Additionally, individuals with contraindications to MRI (or intolerance to gadolinium contrast agents), active autoimmune diseases requiring systemic treatment or long-term high-dose immunosuppressants, and pregnant or lactating women are excluded. |
Participants in this observational study receive standard-of-care radiotherapy for brain metastases combined with PD-1/PD-L1 immune checkpoint inhibitors. The specific radiotherapy parameters (e.g., technique, target volume, and dose) and immunotherapy details (e.g., specific drug type, dosage, and administration schedule) are entirely determined by the treating physicians or multidisciplinary team (MDT) based on current clinical guidelines and real-world practice. This study does not assign, alter, or proactively intervene in any treatment plans. What distinguishes the exposure in this study is the specific tracking and categorization of the real-world timing interval and administration sequence between radiotherapy and immunotherapy (e.g., synchronous vs. asynchronous, radiation-first vs. immunotherapy-first), aiming to evaluate how these naturally occurring temporal variations impact clinical outcomes and immune status. |
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Intracranial Progression-Free Survival (iPFS)
Zeitfenster: Up to approximately 2 years (Assessed every 2-3 months in the first year, and every 3-6 months thereafter until disease progression or death).
|
Defined as the time from study enrollment (or completion of baseline assessment) to the first documented intracranial disease progression according to the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria via blinded independent central review, or death from any cause.
|
Up to approximately 2 years (Assessed every 2-3 months in the first year, and every 3-6 months thereafter until disease progression or death).
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Intracranial Objective Response Rate (iORR)
Zeitfenster: Up to approximately 2 years.
|
The proportion of patients achieving an intracranial Complete Response (CR) or Partial Response (PR) per RANO-BM criteria.
Responses must be confirmed by consecutive imaging assessments at least 4 weeks apart.
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Up to approximately 2 years.
|
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Overall Survival (OS)
Zeitfenster: Up to approximately 2 years.
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Defined as the time from study enrollment to death from any cause.
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Up to approximately 2 years.
|
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Duration of Response (DOR)
Zeitfenster: Up to approximately 2 years.
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For patients achieving confirmed CR or PR, defined as the time from the first documented objective response to the first documented disease progression or death from any cause.
|
Up to approximately 2 years.
|
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Best Overall Response (BOR)
Zeitfenster: Up to approximately 2 years.
|
The best disease response recorded from the start of the study treatment until disease progression or recurrence.
|
Up to approximately 2 years.
|
|
Intracranial Disease Control Rate (iDCR)
Zeitfenster: At 24 weeks
|
The proportion of patients who achieve CR, PR, or Stable Disease (SD) maintained for at least a specified time period (e.g., 24 weeks).
|
At 24 weeks
|
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Incidence of Grade ≥3 Immune-Related Adverse Events (irAEs)
Zeitfenster: From enrollment up to 1 years after the last dose of immunotherapy.
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Evaluated and tracked according to the NCI CTCAE v5.0 and specific irAE management guidelines to assess the safety of different treatment sequences.
|
From enrollment up to 1 years after the last dose of immunotherapy.
|
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Incidence of Radiation Necrosis and Severe Brain Edema
Zeitfenster: Up to approximately 2 years.
|
Dynamic monitoring and evaluation of the occurrence of radiation necrosis and Grade ≥3 radiation-induced brain edema, utilizing RANO-BM and related imaging criteria.
|
Up to approximately 2 years.
|
Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Parasagittal Dura (PSD) Volume
Zeitfenster: Baseline and follow-up MRI assessments up to approximately 2 years.
|
Quantitative measurement of the parasagittal dura (PSD) volume derived from contrast-enhanced 7.0T MRI.
PSD volume will be calculated using standardized image segmentation and volumetric analysis procedures and reported in cubic millimeters (mm³).
|
Baseline and follow-up MRI assessments up to approximately 2 years.
|
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Meningeal Lymphatic Drainage Rate
Zeitfenster: Baseline and follow-up MRI assessments up to approximately 2 years.
|
Quantitative assessment of meningeal lymphatic drainage efficiency measured using contrast-enhanced 7.0T MRI.
Drainage rate will be calculated according to predefined imaging analysis protocols and expressed as a percentage or kinetic parameter reflecting lymphatic drainage function.
|
Baseline and follow-up MRI assessments up to approximately 2 years.
|
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Meningeal Lymphatic Vessel Diameter
Zeitfenster: Baseline and follow-up MRI assessments up to approximately 2 years.
|
Mean diameter of visualized meningeal lymphatic vessels measured on contrast-enhanced 7.0T MRI using standardized image analysis methods and reported in millimeters (mm).
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Baseline and follow-up MRI assessments up to approximately 2 years.
|
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Deep Cervical Lymph Node (dCLN) Inflow Rate
Zeitfenster: Baseline and follow-up MRI assessments up to approximately 2 years.
|
Quantitative assessment of contrast agent inflow into deep cervical lymph nodes measured using contrast-enhanced 7.0T MRI.
The inflow rate will be used as an indicator of meningeal lymphatic drainage function.
|
Baseline and follow-up MRI assessments up to approximately 2 years.
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- 2026051108
- ZXQ2026B05 (Andere Zuschuss-/Finanzierungsnummer: Central South University)
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Beschreibung des IPD-Plans
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