The majority of patients diagnosed with advanced NSCLC are treated with platinum-doublet chemotherapy regimens, except those harboring specific oncogenic drivers such as epidermal growth-factor-receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements. In the second-line setting, response rates remain low and median survival rarely exceeds 10 months. Over the past few years, several checkpoint inhibitors targeting programmed cell death protein-1 (PD1) or its ligand (PDL1) used as second-line therapies generated evidence of improving survival and, more recently, as first-line NSCLC treatment. Although pembrolizumab (anti-PD1) was recently approved as first-line treatment for patients with at least 50% of their NSCLC cells expressing PDL1, many patients are still not benefiting from this first-line agent. For patients with relapsed NSCLC, atezolizumab (anti-PDL1) prolonged survival compared to docetaxel in the phase II POPLAR and phase III OAK trials. Novel concepts of synergic action between immunotherapy and chemotherapy have emerged recently. However, those types of treatments are given for different durations: chemotherapy is allowed for only a short period (rarely exceeding 6 cycles), while anti-PDL1 can be continued for several months until loss of its clinical benefit. Metronomic chemotherapy is defined as low-dose and frequent chemotherapy administration, without prolonged drug-free breaks. Metronomic administration of oral vinorelbine has been tested against breast cancer and advanced refractory NSCLC. The combination could have immunostimulatory effects: induction of immunogenic cancer-cell death, enhancement of antigen presentation through dendritic cell modulation, increased cancer-cell immunogenicity, preferential depletion of regulatory T cells, modulation of myeloid-derived suppressor cells, enhancement of the cytotoxic activity of immune-effector cells.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
80
Atezolizumab in IV infusions
Vinorelbine capsules
CH Aix en Provence
Aix-en-Provence, France
CHRU de Brest - Hôpital Morvan
Brest, France
CLCC Caen
Caen, France
CH de Créteil
Créteil, France
Ch La Roche Sur Yon
La Roche-sur-Yon, France
CHU de Limoges - Hôpital DUPUYTREN
Limoges, France
CH MEAUX
Meaux, France
CH Pringy
Pringy, France
CH Quimper
Quimper, France
CHU de Rennes
Rennes, France
...and 3 more locations
Occurrence of death or progression of the disease
To evaluate the occurrence of death or progression of the disease
Time frame: 4 months
Emergence of adverse events (Safety and tolerability)
To evaluate the safety outcomes, tolerability, adverse events frequency
Time frame: 12 months
Occurrence of death
To evaluate the occurrence of death over 12 months of follow-up
Time frame: 12 months
Objective Response Rate
To evaluate the objective Response Rate and Disease Control Rate
Time frame: 4 months
Following of the quality of life
The scale EuroQol 5 dimensions (EDQ5) is used to evaluate the quality of life. The EQ-5D scale is a standardised measure of health status to provide a simple, generic measure of health for clinical and economic appraisal, whih is divided by the EQ-5D descriptive system (mobility, self care, usual activities, pain/discomfort, anxiety/depression) and the EQ Visual Analogue scale (EQ VAS). Each dimension has 5 levels (no problems, slight problems, moderate problems, severe problems, and extreme problems).
Time frame: 12 months
Following of the quality of life
The EORTC QLQ-C30 is a questionnaire with 30 questions developed to assess the quality of life of cancer patients. An essential aspect of the "modular" approach to QOL assessment adopted by the EORTC Quality of Life Group is the development of modules specific to tumour site, treatment modality, or a QOL dimension, to be administered in addition to the core questionnaire (EORTC QLQ-C30).
Time frame: 12 months
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