This is a pilot study of neoadjuvant 'immunoradiation' (durvalumab or durvalumab plus tremelimumab) administered every 4 weeks for 2 doses, concurrently with standard thoracic radiation (RT) (45Gy in 25 fractions), with one dose of immunotherapy alone delivered in the pre-surgical window, prior to surgical resection, for patients with stage IIIA NSCLC that is deemed resectable with a lobectomy by a thoracic surgeon. If preliminary safety of the durvalumab/thoracic RT combination is established, a second cohort investigating the combination of durvalumab/tremelimumab/thoracic RT prior to surgical resection will be opened. After surgical resection, patients may receive standard adjuvant chemotherapy, as deemed appropriate by the treating investigator.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
9
1500mg via IV infusion every 4 weeks for up to 3 doses/cycles
75mg via IV infusion every 4 weeks
5 days per week in once daily fractionation, 1.8-2.0 Gy per fraction
patients may proceed to surgery post drug and radiation intervention for lung lobectomy
patients may or may not proceed to adjuvant chemotherapy post trial drug and radiation intervention and surgery
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, United States
Princess Margaret Cancer Centre
Toronto, Ontario, Canada
Toxicities as Measured by Number of Participants Experiencing Adverse Events
Number of participants experiencing adverse events as defined by CTCAE v4.0.
Time frame: 3 months post surgery
Feasibility of Preoperative Immunoradiation
Number of participants with stage III resectable NSCLC who received durvalumab or durvalumab plus tremelimumab concurrently with thoracic radiation (RT) in the pre-surgical window prior to surgical resection, for whom planned surgical resection was not delayed.
Time frame: Up to 3 years
Surgical Morbidity and Mortality
Number of participants who experience post-operative death. Calculated through log-rank test and Cox proportional hazards (PH) model. The values in the table represent the number of participants who experienced post-operative death.
Time frame: Up to 3 months post-surgery
Percentage of Participants With Pathologic Response
Percentage of participants with major pathologic response (MPR), partial response (PR) or no response (NR), where MPR is \>90% reduction in tumor cells, PR = 10-90% or NR = 0-10%. The percentage of patients whose tumor samples achieve MPR, PR and NR will be tabulated.
Time frame: Up to 3 years
Percentage of Participants With Radiologic Response
Percentage of participants with complete response (CR), partial response (PR), progressive disease (PD), and stable disease (SD) as defined by RECIST 1.1 and immune-related RECIST criteria when treated with preoperative immunoradiation followed by surgery. CR = disappearance of all target lesions, PR is =\>30% decrease in sum of diameters of target lesions, PD is \>20% increase in sum of diameters of target lesions, SD is \<30% decrease or \<20% increase in sum of diameters of target lesions.
Time frame: Up to 3 years
Duration of Response as Measured by Recurrence-free Survival
Time from first evidence of response until recurrence when treated with preoperative immunoradiation followed by surgery. Calculated through log-rank test and Cox proportional hazards (PH) model.
Time frame: Up to 3 years
Overall Survival
Number of months alive after treatment with preoperative immunoradiation followed by surgery. Calculated through log-rank test and Cox proportional hazards (PH) model.
Time frame: Up to 3 years
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