Multicenter Randomized Phase II Trial of Neoadjuvant Radioimmunotherapy Versus Chemoimmunotherapy in Patients With Clinical Stages IB-III (N2) Non-small Cell Lung Cancer
The goal of this clinical trial is to learn if Cemiplimab with chemotherapy or Cemiplimab with stereotactic body radiation therapy (SBRT) works as treatment for stages IB, II, and III (N2) Non-Small Cell Lung Cancer (NSCLC). Before surgery to remove their lung cancer, participants will take: 1. Cemiplimab with chemotherapy (Arm A) every 3 weeks for up to 3 doses, OR 2. Cemiplimab every 3 weeks for up to 3 doses with SBRT (Arm B). SBRT will be given on day 1 before taking cemiplimab, then SBRT alone on day 2 and day 3. Four to 12 weeks following surgery, participants in both Arm A and Arm B will receive treatment with cemiplimab for one year.
• Patients with histologically or cytologically proven clinical stages IB, II, and III(N2) NSCLC (according to AJCC version 8) eligible for surgical resection with curative intent. Patients with 2 synchronous NSCLC are allowed.
• Measurable disease, as defined by RECIST v1.1.
• Known PD-L1 expression.
• No known EGFR mutations or ALK fusions.
• Written informed consent and HIPAA obtained from the subject prior to performing any protocol-related procedures.
• Age \> 18 years at time of study entry.
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
• No prior therapy for lung cancer
• Adequate organ and bone marrow function as defined below:
‣ Absolute neutrophil count (ANC) ≥1.5 x10(3)/uL
⁃ Platelets ≥75 x10(3)/uL
⁃ Hemoglobin ≥9 g/dL
⁃ Serum creatinine ≤1.5 X upper limit of normal (ULN) OR calculated CrCl ≥50 ml/min (using the Cockcroft-Gault formula).
⁃ Serum total bilirubin ≤1.5 X ULN, except in patients with clinically documented Gilbert's Syndrome where ≤3x the ULN is permitted
⁃ Aspartate aminotransferase (AST)/ Alanine aminotransferase (ALT) ≤3 X ULN
⁃ WOCBP\* must have a negative serum (beta-hCG) at screening.
• \*WOCBP are defined as women who are fertile following menarche until becoming postmenopausal, unless permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy, and bilateral oophorectomy.
• \- A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high FSH level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy. However, in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient to determine the occurrence of a postmenopausal state. The above definitions are according to the CTFG guidance. Pregnancy testing and contraception are not required for women who are post-menopausal or with documented permanent sterilization.
∙ Male study patients with WOCBP partners are required to use condoms unless they are vasectomized or practice sexual abstinence.
∙ Vasectomized partner or vasectomized study patient must have received medical assessment of the surgical success.
∙ Periodic abstinence (calendar, symptothermal, post-ovulation methods), withdrawal (coitus interruptus), spermicides only, and LAM are not acceptable methods of contraception. Female condom and male condom should not be used together.
⁃ WOCBP must agree not to donate eggs (ova, oocytes) for the purposes of assisted reproduction during the entire trial and until 6 months after last treatment.
⁃ All men must agree not to donate sperm during the trial and for 6 months after receiving the last therapy dose.