Safety results of NRG-LU004: Phase I trial of accelerated or conventionally fractionated radiotherapy combined with durvalumab in PD-L1–high locally advanced non-small cell lung cancer.

Authors

null

Steven H. Lin

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Steven H. Lin , Stephanie L. Pugh , Anne S. Tsao , Martin Joseph Edelman , Anthony Doemer , Charles B. Simone II, Saumil Gandhi , Sai Bikkina , Nagla Fawzy Abdel Karim , Xinglei Shen , Shahed N Badiyan , Kristin Ann Higgins , Arnab Chakravarti , Maria Werner-Wasik , John M Schellenkamp , Rebecca Paulus , Jeffrey D. Bradley

Organizations

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, NRG Oncology Statistics and Data Management Center, Philadelphia, PA, The University of Texas MD Anderson Cancer Center, Houston, TX, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, Henry Ford Health System, Clinton Twp, MI, Hospital of the University of Pennsylvania, Philadelphia, PA, University of Texas MD Anderson Cancer Center, Houston, TX, Wayne State University-Karmanos Cancer Institute, Detroit, MI, Augusta University Medical Center, Augusta, GA, University of Kansas Cancer Center, Westwood, KS, Washington University, St. Louis, MO, Winship Cancer Institute of Emory University, Atlanta, GA, The Ohio State University, Columbus, OH, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, Montana Cancer Consortium, Billings, MT, Emory University School of Medicine, Atlanta, GA

Research Funding

U.S. National Institutes of Health

Background: In advanced non-small cell lung cancer (NSCLC), high Programmed-Death-1 Ligand (PD-L1) (>50%) expression demonstrate superior response and survival with immune checkpoint inhibitors compared to chemotherapy. We hypothesize that it is safe and feasible to substitute durvalumab instead of chemotherapy concurrently with radiotherapy (RT) in patients with Locally Advanced-NSCLC (LA-NSCLC) and high PD-L1. Methods: NRG-LU004 (NCT03801902) is a Phase I study for patients with stage II-III unresectable or inoperable, LA-NSCLC with PD-L1> 50% (Dako 22C3 or Ventana SP263) expression. There were safety and expansion phases with a primary endpoint of safety. Patients started with 1500 mg durvalumab Q4 weeks and thoracic RT within 2 weeks from 1st infusion. Durvalumab continued once a month up to 1 year. In the safety cohort, 6 patients in cohort 1 were treated with accelerated fractionated RT (ACRT) to 60 Gy in 15 fractions, followed by a required safety hold for 90 days. During cohort 1 safety hold, cohort 2 patients were treated with conventional RT 60 Gy in 30 fractions (CONV) followed by a 60-day safety hold. A cohort advanced to the expansion phase to enroll 6 more patients if safety criteria (0-1 patients with a dose limiting toxicity [DLT]) were met. If both cohorts were deemed safe, patients would be randomized 1:1 to ACRT or CONV with safety defined as < 4 of 12 evaluable patients per arm experiencing a DLT. Feasibility was defined as at least 80% of patients in each arm receiving at least 80% of the planned dose of durvalumab during the first 8 weeks. Results: 24 evaluable patients enrolled between January 2019 and June 2021. No DLTs were reported in cohort 1, and 1 (unrelated bronchopulmonary hemorrhage leading to discontinuation of durvalumab) in cohort 2. Both safety cohorts advanced to the expansion phase. All but one patient (CONV) received RT per protocol/with an acceptable variation. At the time of analysis, 24% had received all 13 cycles of durvalumab. For the ACRT cohort, there were 4 grade 3, 1 grade 4 (lymphopenia), and 1 grade 5 AE (lung infection, assessed as unrelated to therapy). For CONV, there were 8 grade 3, 0 grade 4, and 1 grade 5 AE (respiratory failure, unrelated to therapy). For feasibility, 10 of 12 (85%) patients in the ACRT cohort received the second dose of durvalumab (2 not received due to shingles and unrelated death), while 9 of 12 (75%) of the CONV cohort received the second dose (reasons for not receiving: viral hepatitis, bronchopulmonary hemorrhage, and respiratory failure, all assessed as unrelated to therapy). Conclusions: Chemotherapy-free thoracic RT approaches (ACRT or CONV RT) are safe, when given with concurrent durvalumab in patients with PD-L1 high LA-NSCLC. A trial to compare immunoradiotherapy and consolidation durvalumab to standard chemoradiation and consolidation durvalumab is planned. Clinical trial information: NCT03801902.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Discussion 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

NCT03801902

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 8513)

DOI

10.1200/JCO.2022.40.16_suppl.8513

Abstract #

8513

Poster Bd #

140

Abstract Disclosures