A Randomized Phase III Trial of Checkpoint Blockade in Lung Cancer Patients in the Adjuvant Setting Based on Pathologic Response Following Neoadjuvant Therapy (CLEAR)

Status: Recruiting
Location: See all (116) locations...
Intervention Type: Biological, Drug, Procedure
Study Type: Interventional
Study Phase: Phase 3
SUMMARY

This phase III trial compares the effect of adding AZD6738 to durvalumab versus durvalumab alone to increase time without cancer in patients with non-small cell lung cancer, following treatment with chemotherapy and surgery. AZD6738 may stop the growth of tumor cells and may kill them by blocking some of the enzymes needed for cell growth. Durvalumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Adding AZD6738 to durvalumab may increase time without cancer in patients with non-small cell lung cancer, following treatment with chemotherapy and surgery.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• STEP 0: Patient must be \>= 18 years of age

• STEP 0: Patient must have stage II to select stage IIIB (N2 but excluding N3) non-small cell lung cancer (NSCLC) of any histology using International Association for the Study of Lung Cancer (IASLC) 8th edition. Stage is assessed at time of initiating pre-operative chemo-immunotherapy

• STEP 0: Patient must fall into one of the following categories:

‣ Planning to undergo, be currently undergoing, or recently completed any standard of care neoadjuvant chemo-immunotherapy with plans to undergo surgical resection

⁃ Recently completed any standard of care neoadjuvant chemo-immunotherapy AND completed surgical resection and are awaiting pCR status.

⁃ Recently completed any standard of care neoadjuvant chemo-immunotherapy AND completed surgical resection with confirmed non-path complete response (CR) status.

∙ NOTES:

• Patient must have completed at least 3 cycles of neoadjuvant chemo-immunotherapy before surgery in order to be eligible for Step 1 randomization.

• Patients who have completed their surgical resection prior to enrollment in step 0 registration must have their surgery date within a window that will allow initiation of EA5231 treatment (cycle 1 day 1) to commence within 4-12 weeks following surgery

‣ STEP 1: EA5231 CLEAR randomization for patients without a pCR post-surgery. Patient's with pCR after surgery will be offered to enroll in the SWOG study S2414 INSIGHT instead

⁃ STEP 1: Patient must have completed R0 resection after standard of care neoadjuvant chemo-immunotherapy (minimum three cycles completed) for stage II to select stage IIIB (N2 but excluding N3) non-small cell lung cancer (NSCLC) of any histology using IASLC 8th Edition

⁃ STEP 1: Patient must have non-pathological CR status post-surgery. The pathological CR/non-pathological CR status will be determined by local pathology using IASLC criteria and using the surgical sample tissue

⁃ STEP 1: Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 - ≤ 2 (or Karnofsky ≥ 60%)

⁃ STEP 1: Patient must not have any known EGFR or ALK genetic alterations. Mutation negative status will be determined per local institutional practices and consistent with National Comprehensive Cancer Network (NCCN) guidelines

⁃ STEP 1: Patient must have undergone a chest CT after surgery and within 28 days prior to step 1 randomization

⁃ STEP 1: Patient must have recovered from clinically significant adverse events of their most recent therapy/intervention prior to step 1 randomization

⁃ STEP 1: Patient must not have experienced a toxicity that led to the permanent discontinuation of prior immunotherapy

⁃ STEP 1: Patient must not be receiving ongoing steroids at a dose of prednisone 10 mg or higher (or equivalent) at the time of step 1 randomization. Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication) are allowed. Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection) are allowed

⁃ STEP 1: Patient must not have received or have a plan to receive post-operative radiation therapy (PORT)

⁃ STEP 1: Patient must not have a history of treatment-related pneumonitis requiring ongoing steroids or supplemental oxygen use

⁃ STEP 1: Patient must not have a history of interstitial lung disease (ILD)

⁃ STEP 1: Patient must not have diagnosis of ataxia telangiectasia

⁃ STEP 1: Patient must not have history of active primary immunodeficiency

⁃ STEP 1: Patient must not have history of allogenic organ transplantation

⁃ STEP 1: Patient must have body weight \> 30 kg

⁃ STEP 1: Patient must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the treatment regimens being used. All patients of childbearing potential must have a blood test or urine study within 14 days prior to Step 1 randomization to rule out pregnancy. A patient of childbearing potential is defined as anyone, regardless of whether they have undergone tubal ligation, who meets the following criteria:

• Has achieved menarche at some point

• Has not undergone a hysterectomy or bilateral oophorectomy

• Has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)

‣ STEP 1: Patient must not expect to conceive or father children by using highly accepted and effective method(s) of contraception or by abstaining from sexual intercourse for the duration of their participation in the study. Patients of childbearing potential must use at least 1 highly effective method of contraception in addition to a condom and continue to use it throughout their time on protocol treatment. Male patients must use a condom plus spermicide throughout their time on while on protocol treatment. In addition, all patients must continue contraception use for at least 6 months after the last dose of protocol treatment. Patients must also not breastfeed while on protocol treatment and for at least 6 months after the last dose of protocol treatment. Patients must not donate sperm while on protocol treatment and for 6 months after the last dose of protocol treatment

⁃ STEP 1: Patient must not donate blood while on protocol treatment

⁃ STEP 1: Patient must have the ability to understand and the willingness to sign a written informed consent document. Patients with impaired decision-making capacity (IDMC) who have a legally authorized representative (LAR) or caregiver and/or family member available will also be considered eligible

⁃ STEP 1: Leukocytes ≥ 3,000/mcL (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Hemoglobin ≥ 9.0 g/dL (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Absolute neutrophil count (ANC) ≥ 1,500/mcL (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Platelets ≥ 100,000/mcL (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Total bilirubin ≤ institutional upper limit of normal (ULN) (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) ≤ 3.0 × institutional ULN (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Creatinine clearance ≥ 50 mL/min (estimated using Cockcroft-Gault method or measured) (these labs must be obtained ≤ 28 days prior to step 1 randomization)

⁃ STEP 1: Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of step 1 randomization are eligible for this trial

⁃ STEP 1: For patients with known chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated

⁃ STEP 1: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load

⁃ STEP 1: Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial

⁃ STEP 1: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better

⁃ STEP 1: Patient must not have received live attenuated vaccine within 30 days prior to the step 1 randomization, while on protocol treatment and within 30 days after the last dose of durvalumab

Locations
United States
Arkansas
NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
RECRUITING
Jonesboro
California
Cedars Sinai Medical Center
RECRUITING
Los Angeles
Torrance Memorial Physician Network - Cancer Care
RECRUITING
Torrance
Connecticut
Hartford Hospital
RECRUITING
Hartford
Midstate Medical Center
RECRUITING
Meriden
The Hospital of Central Connecticut
RECRUITING
New Britain
Delaware
Helen F Graham Cancer Center
RECRUITING
Newark
Medical Oncology Hematology Consultants PA
RECRUITING
Newark
Idaho
Kootenai Health - Coeur d'Alene
RECRUITING
Coeur D'alene
Kootenai Clinic Cancer Services - Post Falls
RECRUITING
Post Falls
Kootenai Clinic Cancer Services - Sandpoint
RECRUITING
Sandpoint
Illinois
Illinois CancerCare-Bloomington
RECRUITING
Bloomington
Illinois CancerCare-Canton
RECRUITING
Canton
Illinois CancerCare-Carthage
RECRUITING
Carthage
Northwestern University
RECRUITING
Chicago
Cancer Care Specialists of Illinois - Decatur
RECRUITING
Decatur
Decatur Memorial Hospital
RECRUITING
Decatur
Northwestern Medicine Cancer Center Kishwaukee
RECRUITING
Dekalb
Illinois CancerCare-Dixon
RECRUITING
Dixon
Crossroads Cancer Center
RECRUITING
Effingham
Illinois CancerCare-Eureka
RECRUITING
Eureka
Illinois CancerCare-Galesburg
RECRUITING
Galesburg
Northwestern Medicine Cancer Center Delnor
RECRUITING
Geneva
Northwestern Medicine Glenview Outpatient Center
RECRUITING
Glenview
Northwestern Medicine Grayslake Outpatient Center
RECRUITING
Grayslake
Illinois CancerCare-Kewanee Clinic
RECRUITING
Kewanee
Northwestern Medicine Lake Forest Hospital
RECRUITING
Lake Forest
Illinois CancerCare-Macomb
RECRUITING
Macomb
Northwestern Medicine Oak Brook
RECRUITING
Oak Brook
Northwestern Medicine Orland Park
RECRUITING
Orland Park
Illinois CancerCare-Ottawa Clinic
RECRUITING
Ottawa
Illinois CancerCare-Pekin
RECRUITING
Pekin
Illinois CancerCare-Peoria
RECRUITING
Peoria
Illinois CancerCare-Peru
RECRUITING
Peru
Illinois CancerCare-Princeton
RECRUITING
Princeton
Southern Illinois University School of Medicine
RECRUITING
Springfield
Springfield Clinic
RECRUITING
Springfield
Springfield Memorial Hospital
RECRUITING
Springfield
Northwestern Medicine Cancer Center Warrenville
RECRUITING
Warrenville
Illinois CancerCare - Washington
RECRUITING
Washington
Kansas
Cancer Center of Kansas - El Dorado
RECRUITING
El Dorado
Cancer Center of Kansas - Newton
RECRUITING
Newton
Cancer Center of Kansas - Wellington
RECRUITING
Wellington
Ascension Via Christi Hospitals Wichita
RECRUITING
Wichita
Cancer Center of Kansas - Wichita
RECRUITING
Wichita
Cancer Center of Kansas-Wichita Medical Arts Tower
RECRUITING
Wichita
Cancer Center of Kansas - Winfield
RECRUITING
Winfield
Massachusetts
Lahey Hospital and Medical Center
RECRUITING
Burlington
Lahey Medical Center-Peabody
RECRUITING
Peabody
Baystate Medical Center
RECRUITING
Springfield
Michigan
Trinity Health IHA Medical Group Hematology Oncology - Brighton
RECRUITING
Brighton
Trinity Health IHA Medical Group Hematology Oncology - Canton
RECRUITING
Canton
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
RECRUITING
Chelsea
Cancer Hematology Centers - Flint
RECRUITING
Flint
Genesee Hematology Oncology PC
SUSPENDED
Flint
Genesys Hurley Cancer Institute
RECRUITING
Flint
Hurley Medical Center
RECRUITING
Flint
University of Michigan Health - Sparrow Lansing
RECRUITING
Lansing
Trinity Health Saint Mary Mercy Livonia Hospital
RECRUITING
Livonia
Trinity Health Saint Joseph Mercy Oakland Hospital
RECRUITING
Pontiac
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
RECRUITING
Ypsilanti
Minnesota
Mercy Hospital
RECRUITING
Coon Rapids
Abbott-Northwestern Hospital
RECRUITING
Minneapolis
Park Nicollet Clinic - Saint Louis Park
RECRUITING
Saint Louis Park
United Hospital
RECRUITING
Saint Paul
Missouri
Saint Francis Medical Center
RECRUITING
Cape Girardeau
Mercy Hospital South
RECRUITING
St Louis
Mississippi
Baptist Memorial Hospital and Cancer Center-Golden Triangle
RECRUITING
Columbus
Baptist Cancer Center-Grenada
RECRUITING
Grenada
Baptist Memorial Hospital and Cancer Center-Union County
RECRUITING
New Albany
Baptist Memorial Hospital and Cancer Center-Oxford
RECRUITING
Oxford
Baptist Memorial Hospital and Cancer Center-Desoto
RECRUITING
Southhaven
Montana
Billings Clinic Cancer Center
RECRUITING
Billings
Benefis Sletten Cancer Institute
RECRUITING
Great Falls
Community Medical Center
RECRUITING
Missoula
New Hampshire
New Hampshire Oncology Hematology PA-Concord
RECRUITING
Concord
Solinsky Center for Cancer Care
RECRUITING
Manchester
New York
Glens Falls Hospital
RECRUITING
Glens Falls
Montefiore Medical Center-Einstein Campus
RECRUITING
The Bronx
Ohio
Aultman Health Foundation
RECRUITING
Canton
Oklahoma
University of Oklahoma Health Sciences Center
RECRUITING
Oklahoma City
Oregon
Providence Newberg Medical Center
RECRUITING
Newberg
Providence Willamette Falls Medical Center
RECRUITING
Oregon City
Providence Portland Medical Center
RECRUITING
Portland
Providence Saint Vincent Medical Center
RECRUITING
Portland
Pennsylvania
Lehigh Valley Hospital-Cedar Crest
RECRUITING
Allentown
Lehigh Valley Hospital - Muhlenberg
RECRUITING
Bethlehem
Bryn Mawr Hospital
RECRUITING
Bryn Mawr
Pocono Medical Center
RECRUITING
East Stroudsburg
UPMC Hillman Cancer Center Erie
RECRUITING
Erie
UPMC Cancer Centers - Arnold Palmer Pavilion
RECRUITING
Greensburg
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
RECRUITING
Harrisburg
Lehigh Valley Hospital-Hazleton
RECRUITING
Hazleton
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
RECRUITING
Mechanicsburg
Riddle Memorial Hospital
RECRUITING
Media
UPMC Hillman Cancer Center - Monroeville
RECRUITING
Monroeville
Paoli Memorial Hospital
RECRUITING
Paoli
University of Pennsylvania/Abramson Cancer Center
RECRUITING
Philadelphia
University of Pittsburgh Cancer Institute (UPCI)
RECRUITING
Pittsburgh
UPMC-Saint Clair Hospital Cancer Center
RECRUITING
Pittsburgh
Reading Hospital
RECRUITING
West Reading
Lankenau Medical Center
RECRUITING
Wynnewood
Tennessee
Baptist Memorial Hospital and Cancer Center-Collierville
RECRUITING
Collierville
Baptist Memorial Hospital and Cancer Center-Memphis
RECRUITING
Memphis
Virginia
University of Virginia Cancer Center
RECRUITING
Charlottesville
Wisconsin
Langlade Hospital and Cancer Center
RECRUITING
Antigo
ThedaCare Regional Cancer Center
RECRUITING
Appleton
Gundersen Lutheran Medical Center
RECRUITING
La Crosse
Aspirus Medford Hospital
RECRUITING
Medford
ProHealth D N Greenwald Center
RECRUITING
Mukwonago
ProHealth Oconomowoc Memorial Hospital
RECRUITING
Oconomowoc
Aspirus Cancer Care - James Beck Cancer Center
RECRUITING
Rhinelander
Aspirus Cancer Care - Stevens Point
RECRUITING
Stevens Point
UW Cancer Center at ProHealth Care
RECRUITING
Waukesha
Aspirus Regional Cancer Center
RECRUITING
Wausau
Aspirus Cancer Care - Wisconsin Rapids
RECRUITING
Wisconsin Rapids
Time Frame
Start Date: 2025-08-07
Estimated Completion Date: 2028-06-30
Participants
Target number of participants: 630
Treatments
Active_comparator: Arm A (Durvalumab)
Starting 4-12 weeks after surgery, patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan and blood sample collection throughout the study and may undergo echocardiography as clinically indicated.
Experimental: Arm B (Durvalumab and AZD6738)
Starting 4-12 weeks after surgery, patients receive AZD6738 PO BID on days 1-7 and durvalumab IV over 60 minutes on day 8 of each cycle. Cycles repeat every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan and blood sample collection throughout the study and may undergo echocardiography as clinically indicated.
Sponsors
Leads: National Cancer Institute (NCI)

This content was sourced from clinicaltrials.gov