An Open-label, Multi-center, Phase 2 Study of Chemo-immunotherapy Followed by Reduced-dose Hypo-fractionated RT and Maintenance Immunotherapy for Stage III Unresectable Non -Small-cell Lung Carcinoma (NSCLC).
Aim of this phase 2 study is to evaluate the safety and the efficacy of the combination of induction chemotherapy plus durvalumab followed by reduced-dose hypo-fractionated thoracic RT (concurrent with durvalumab) and durvalumab maintenance for stage 3 unresectable NSCLC patients candidate to sequential chemo-RT.
• Capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
• Provision of signed and dated, written ICF prior to any mandatory study specific procedures, sampling, and analyses.
• Age
• 18 years or older at the time of signing the ICF. Type of patient and disease characteristics
• Histologically- or cytologically-documented NSCLC with locally-advanced, unresectable Stage III disease (according to the IASLC Staging Manual Version 8 \[IASLC 2016\]). Positron emission tomography (PET)/CT, MRI of the brain, and endobronchial ultrasound with biopsy are highly encouraged at diagnosis.
• Patients with measurable disease assessed at baseline by CT/MRI will be entered in this study.
• Must have a life expectancy of at least 12 weeks at enrolment.
• WHO/ECOG PS 0-1.
• Patient not eligible for concurrent chemo radiation according to investigator assessment
• Adequate organ and marrow function at enrollment as defined below. These parameters should be achieved without augmentation by growth factors, transfusions, or infusions within 28 days of screening unless required for SoC:
∙ Haemoglobin ≥9.0 g/dL;
‣ Absolute neutrophil count \>1.0 × 109/L;
‣ Platelet count \>75 × 109/L;
‣ Serum bilirubin ≤1.5 × upper limit of normal (ULN). This will not apply to patients with confirmed Gilbert's syndrome, who will be allowed in consultation with their physician.
‣ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × ULN.
‣ Measured creatinine clearance \>40 mL/min or calculated creatinine clearance \>40 mL/min as determined by Cockcroft-Gault (using actual body weight) (Cockcroft and Gault 1976).
• Males:
• Creatinine clearance (mL/min) = \[Weight (kg) × (140 - Age)\] / 72 × serum creatinine (mg/dL)
• Females:
• Creatinine clearance (mL/min) = \[Weight (kg) × (140 - Age) × 0.85\] / 72 × serum creatinine (mg/dL)
⁃ Body weight \>30 kg at enrollment
⁃ Male or female. Reproduction
⁃ Evidence of post-menopausal status, or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:
• Women \<50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
∙ Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses \>1 year ago, had chemotherapy-induced menopause with last menses \>1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy, or hysterectomy).