Phase II Evaluation of Overall Survival in Relapsed Stage III NSCLC with Durvalumab and Chemotherapy Post-Chemoradiotherapy and Durvalumab Maintenance

Trial ID: 2024-520081-65-00
Protocol: CONDOR
Sponsor: Fondazione Ricerca Traslazionale

Trial statistics

science

test molecule

location_city

research sites

public

country

medical_information

disease

person_search

investigators

Diseases & Conditions

Non-small cell lung cancer stage III

Objectives

The primary objectives of this Phase II clinical trial are to evaluate the efficacy of **durvalumab** in prolonging overall survival (OS) in patients with relapsed stage III non-small-cell lung cancer (NSCLC) who have been pretreated with chemoradiotherapy and durvalumab. Specifically, the study aims to: 1) assess whether durvalumab, when added to single-agent chemotherapy, extends survival in patients who progress during durvalumab maintenance therapy (Cohort A); and 2) determine if durvalumab improves survival in patients who relapse after completing durvalumab maintenance therapy for stage III disease (Cohort B). These objectives are clinically relevant as they address the potential of durvalumab to enhance treatment outcomes in a population with limited therapeutic options, thereby potentially improving survival rates in this challenging clinical scenario.

Participants

The clinical trial involves participants diagnosed with **non-small cell lung cancer (NSCLC)**, specifically those with recurrent or metastatic disease that relapsed during or after completion of chemoradiotherapy with curative intent and maintenance durvalumab for stage III disease. The study population includes both male and female subjects, aged 18 years and older, with an **Eastern Cooperative Oncology Group (ECOG)** performance status of 0 or 1, indicating they are fully active or restricted in physically strenuous activity but ambulatory. Participants must have a life expectancy of at least 16 weeks and demonstrate normal organ and bone marrow function. The trial does not include a vulnerable population. The sponsor has not provided the total number of participants. Selection criteria require participants to have evidence of disease progression during durvalumab maintenance or at the end of planned treatment, with tumor tissue available for biomarker testing. Lifestyle considerations such as diet and physical activity are not specified, but participants must be capable of complying with the protocol, including treatment, scheduled visits, and examinations. The trial requires participants to provide signed informed consent, ensuring compliance with the study's requirements and restrictions.

Plans and Procedures

The clinical trial is a **Phase II** study designed to evaluate overall survival (OS) in two cohorts of patients with relapsed stage III **non-small cell lung cancer (NSCLC)** who have been pretreated with chemoradiotherapy and **durvalumab**. The trial employs a randomized, double-blind, controlled design to ensure the reliability and validity of the results. The estimated duration of the trial is from April 29, 2021, to September 30, 2026, with participant involvement expected to last up to 12 months, depending on individual response and treatment tolerance.

Participants will undergo a series of study visits, beginning with an inclusion (screening) visit to confirm eligibility based on criteria such as body weight, organ function, and disease progression status. Following successful screening, participants will be randomized into one of two cohorts. Cohort A will investigate whether durvalumab prolongs survival when added to single-agent chemotherapy, while Cohort B will assess survival improvement after chemoimmunotherapy in patients relapsing post-durvalumab maintenance therapy. Regular follow-up visits will be scheduled to monitor treatment efficacy, safety, and any adverse events, with assessments including progression-free survival (PFS) and objective response rate (ORR).

The end-of-study visit will occur at the conclusion of the treatment period or upon early termination, which may be necessitated by factors such as disease progression, unacceptable toxicity, or withdrawal of consent. Participants are required to comply with the protocol, including scheduled visits and examinations, throughout the study duration. The primary endpoint is overall survival in both cohorts, with secondary endpoints including PFS, ORR, and safety profiles according to treatment and biomarker analysis. The trial aims to provide valuable insights into the efficacy of durvalumab in combination with chemotherapy for NSCLC patients.

Treatment

The clinical trial involves the administration of **durvalumab**, marketed under the name **IMFINZI**, which is a **concentrate for solution for infusion**. The pharmaceutical form is a solution for infusion, and it is administered intravenously. The concentration of the solution is 50 mg/mL. The maximum daily dose is 1500 mg, and the maximum total dose is also 1500 mg. The treatment period is limited to a maximum of 12 months. **Durvalumab** is a monoclonal antibody that targets the PD-L1 protein, and it is classified under the ATC code L01FF03. The active substance is derived from a protein of other origin, and it is not a pediatric formulation. The product is manufactured by AstraZeneca AB and holds the marketing authorization number EU/1/18/1322/001.

In this study, **durvalumab** is evaluated for its efficacy in prolonging survival in patients with relapsed stage III non-small-cell lung cancer (NSCLC) who have been pretreated with chemoradiotherapy. The trial consists of two cohorts: Cohort A investigates the addition of **durvalumab** to single-agent chemotherapy in patients progressing during **durvalumab** maintenance, while Cohort B evaluates its effect on survival in patients relapsing after completing **durvalumab** maintenance therapy. The study does not involve any non-experimental treatments such as standard-of-care therapy, placebo, or comparator treatment. Participant compliance with the dosing schedule is monitored throughout the trial to ensure adherence to the treatment protocol.

Efficacy

Efficacy in this clinical trial will be assessed using several key endpoints. The primary endpoint is **Overall Survival (OS)** in both Cohort A and Cohort B. Secondary endpoints include **Progression-Free Survival (PFS)**, **Objective Response Rate (ORR)**, and the safety and incidence of adverse events (AEs) in each cohort according to treatment. Additionally, PFS and OS will be evaluated in relation to specific biomarkers, including PD-L1, ERCC1, SLFN11, STK11, KEAP1, p53 expression, DNA repair genes (such as BRCA 1-2 mutations), and tumor mutational burden.

The trial is designed to investigate whether **durvalumab** prolongs survival in patients with relapsed stage III non-small-cell lung cancer (NSCLC) who have been pretreated with chemoradiotherapy. The study will assess the efficacy of durvalumab when added to single-agent chemotherapy in patients progressing during durvalumab maintenance (Cohort A) and in patients relapsing after completing durvalumab maintenance therapy (Cohort B). The trial will follow a structured schedule for measuring and collecting data on these endpoints, although specific timepoints for assessments are not detailed in the provided information.

Inclusion and Exclusion Criteria

check_circle

Inclusion Criteria

Body weight >30kg
Recurrent or metastatic NSCLC relapsed during or after completion of chemoradiotherapy with curative intent and maintenance durvalumab for stage III disease. Patients are eligible if they receive at least two cycles of platinum- based chemotherapy or radical radiotherapy.
Tumor tissue available for biomarker testing.
Evidence of disease progression during durvalumab maintenance or at the end of planned treatment. Patients who have interrupted planned durvalumab treatment after at least 6 months for reasons other than toxicity or progression (e.g. patient’s choice, logistic reasons, intercurrent acute illnesses) are eligible. Patients progressing during the first three months of Durvalumab are not eligible.
Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.
Age >18 years at time of study entry.
Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. Written informed consent and any locally required authorization obtained from the patient/legal representative prior to performing any protocol-related procedures, including screening evaluations.
Life expectancy of at least 16 weeks.
Patients must have normal organ and bone marrow function measured within 28 days prior to administration of study treatment as defined below: • Haemoglobin ≥10.0 g/dL with no blood transfusion in the past 28 days • Absolute neutrophil count (ANC) ≥1.5 × 109 /L • Platelet count ≥100 × 109/L • Serum bilirubin ≤1.5 x institutional upper limit of normal (ULN). This will not apply to patients with confirmed Gilbert’s syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of hemolysis or hepatic pathology), who will be allowed only in consultation with their physician. • AST (SGOT)/ALT (SGPT) ≤2.5 x institutional upper limit of normal unless liver metastases are present, in which case it must be ≤5x ULN. • creatinine clearance estimated of ≥51 mL/min using the Cockcroft-Gault equation or based on a 24 hour urine test: Males: Creatinine CL (mL/min) = Weight (kg) x (140 – Age) 72 x serum creatinine (mg/dL) Females: Creatinine CL (mL/min) = Weight (kg) x (140 – Age) x 0.85 72 x serum creatinine (mg/dL)
Female patients should be using adequate contraceptive measures (highly effective method of contraception are present in table 3 of protocol “Highly Effective Methods of Contraception (<1% Failure Rate)”), should not be breastfeeding, from the time of screening throughout the total duration of the drug treatment and the drug washout period (90 days after the last dose of durvalumab monotherapy), or they must totally/truly abstain from any form of sexual intercourse. Females of childbearing potential are defined as those who are not surgically sterile (ie, bilateral salpingectomy, bilateral oophorectomy, or complete hysterectomy) or post-menopausal.
Postmenopausal or evidence of non-childbearing status for women of childbearing potential: negative urine or serum pregnancy test within 28 days of study treatment and confirmed prior to treatment on day 1. Postmenopausal is defined as: • Amenorrheic for 1 year or more following cessation of exogenous hormonal treatments. • Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) levels in the post- menopausal range for women under 50. • radiation-induced oophorectomy with last menses >1 year ago. • chemotherapy-induced menopause with >1 year interval since last menses. • surgical sterilisation (bilateral oophorectomy or hysterectomy) 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. • 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.
Male patients must use a condom during treatment when having sexual intercourse with a pregnant woman or with a woman of childbearing potential. Female partners of male patients should also use a highly effective form of contraception if they are of childbearing potential.

cancel

Exclusion Criteria

No evidence of disease progression.
Patients receiving any systemic chemotherapy or radiotherapy (except for palliative reasons) within 3 weeks prior to study treatment.
Patients not pretreated with durvalumab with curative intent.
Patients treated with non-radical radiotherapy or with non- conventional radiotherapy.
More than 4 cycles of platinum-based chemotherapy.
Rapid progressors. Progressors within first 3 month of treatment will be excluded from this trial.
Any clinical reason that makes the patient ineligible to receive any investigator’s choice single-agent chemotherapy regimen (for patients enrolled in cohort A).
Any clinical reason that makes the patient ineligible to receive any investigator’s choice platinum-based doublet chemotherapy regimen (for patients enrolled in cohort B).
Persistent toxicities (>Common Terminology Criteria for Adverse Event (CTCAE) grade 2) caused by previous cancer therapy, excluding alopecia
Patients with myelodysplastic syndrome/acute myeloid leukaemia or with features suggestive of MDS/AML.
Disease progression within the first three months of Durvalumab therapy.
Tumor tissue not available.
Evidence of EGFR mutations or ALK or ROS1 rearrangements.
Performance status >1 (ECOG).
Brain metastases unless both asymptomatic and pretreated. A scan to confirm the absence of brain metastases is not required. The patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 4 weeks prior to treatment.
Diagnosis of another cancer in the last 3 years, except for in situ carcinoma of cervix, breast and bladder or skin carcinoma (squamous or basaloid).
Patient with spinal cord compression. unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days prior to enrolment.
Leptomeningeal disease.
Resting ECG indicating uncontrolled, potentially reversible cardiac conditions, as judged by the investigator (eg., unstable ischemia, uncontrolled symptomatic arrhythmia, congestive heart failure, QTcF prolongation >500 ms, electrolyte disturbances, etc.), or patients with congenital long QT syndrome.
Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Patients with indwelling catheters (e.g., PleurX) are allowed.
Malignancies other than NSCLC within 5 years prior to enrollment, with the exception of those with a negligible risk of metastasis or death (e.g., expected 5-year OS> 90%) treated with expected curative outcome (such as adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer treated surgically with curative intent, ductal carcinoma in situ treated surgically with curative intent, grade 1 endometrial carcinoma).
Known hypersensitivity or allergy to any component of the Durvalumab formulation.
History of autoimmune disease, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis. Patients with: 1) history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone, 2) controlled Type I diabetes mellitus who are receiving a stable dose of insulin regimen and eczema, psoriasis, lichen simplex chronicus of vitiligo with dermatologic manifestations only in less than 10% of body surface area, well controlled at baseline and only requiring low potency topical steroids are eligible for this study.
Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection. Examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 3 months) myocardial infarction, uncontrolled major seizure disorder, unstable spinal cord compression, superior vena cava syndrome, extensive interstitial bilateral lung disease on High Resolution Computed Tomography (HRCT) scan or any psychiatric disorder that prohibits obtaining informed consent.
Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication.
History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug- induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan. History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
Positive test for HIV.
Patients with active hepatitis B (chronic or acute; defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) or hepatitis C. Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as the presence of hepatitis B core antibody [HBc Ab] and absence of HBsAg) are eligible. HBV DNA must be obtained in these patients prior to randomization. Patients positive for hepatitis C virus (HCV) antibody are eligible only if PCR is negative for HCV RNA.
Active tuberculosis
Concomitant use of known strong CYP3A inhibitors (eg. itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (eg. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil). The required washout period prior to starting study treatment is 2 weeks.
Concomitant use of known strong (eg. phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John’s Wort) or moderate CYP3A inducers (eg. bosentan, efavirenz, modafinil). The required washout period prior to starting study treatment is 5 weeks for enzalutamide or phenobarbital and 3 weeks for other agents
Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery.
Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT).
Pregnancy or breast-feeding women.