Randomized phase III trial of concurrent chemoradiation followed by nivolumab or placebo for locally advanced non-small cell lung cancer (NSCLC) (RTOG 3505).

Authors

David Gerber

David E. Gerber

The University of Texas Southwestern Medical Center, Dallas, TX

David E. Gerber , James John Urbanic , Corey J. Langer , Chen Hu , I-Fen Chang , Bo Lu , Benjamin Movsas , Robert Jeraj , Walter John Curran Jr., Jeffrey D. Bradley

Organizations

The University of Texas Southwestern Medical Center, Dallas, TX, University of California, San Diego, Encinitas, CA, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, John Hopkins University, Baltimore, MD, Bristol-Myers Squibb, Cerritos, CA, Vanderbilt University Medical Center, Nashville, TN, Henry Ford Health System, Detroit, MI, Department of Medical Physics, University of Wisconsin, Madison, WI, Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, Washington University School of Medicine in St. Louis, St. Louis, MO

Research Funding

Pharmaceutical/Biotech Company

Background: Despite aggressive therapy with concurrent chemoradiation, fewer than 25% of patients with stage 3 NSCLC achieve 5-year survival and are presumably cured. To date, treatment modifications—including consolidation chemotherapy, maintenance therapy with molecularly targeted agents, concomitant administration of monoclonal antibodies, and escalation of radiation therapy (RT) dose—have not improved these outcomes. Immune checkpoint inhibitors represent an effective treatment for advanced NSCLC and may enhance RT-associated anti-tumor immunity. RTOG 3505 will test whether the addition of the anti-programmed death 1 (PD1) antibody nivolumab after chemoradiation improves overall survival (OS) and progression-free survival (PFS) in this population. Methods: Key eligibility criteria include surgically unresectable stage 3 NSCLC, ECOG 0-1, adequate organ function, available archival tissue, and absence of active autoimmune disease. Patients will receive thoracic RT to 60 Gy with concurrent cisplatin 50 mg/m2 IV on Days 1, 8, 29, and 36, and etoposide 50 mg/m2 IV on Days 1-5 and 29-33. This regimen was selected to (1) minimize risk of pulmonary toxicity and steroid requirements, and (2) optimize timing of immunotherapy. Between 4 and 12 weeks after completion of chemoradiation, eligible patients will be randomized to nivolumab 240 mg IV or placebo every 2 weeks for 1 year. Stratification factors include performance status, histology, and tumor PD-L1 status. Co-primary endpoints are OS and PFS, as determined by central radiology review. Secondary objectives include toxicity assessment, patient-reported outcomes and quality of life, and OS and PFS according to PD-L1 expression. Exploratory objectives include biomarkers to predict treatment efficacy and toxicity. A total of 660 patients will be enrolled to provide ≥90% power to detect (1) a hazard ratio (HR) of 0.7 for OS with two-sided type I error of 0.04, and (2) HR of 0.667 for PFS two-sided type I error of 0.01, allowing a 16.7% drop-out rate before randomization. Clinical trial information: NCT02768558

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Local-Regional Non–Small Cell Lung Cancer

Clinical Trial Registration Number

NCT02768558

Citation

J Clin Oncol 35, 2017 (suppl; abstr TPS8579)

DOI

10.1200/JCO.2017.35.15_suppl.TPS8579

Abstract #

TPS8579

Poster Bd #

313a

Abstract Disclosures