This is an interventional study, to assess feasibility and safety of durvalumab (MEDI4736) in neo-adjuvant setting in patients with resectable NSCLC. Additional analyses of potential imaging biomarkers, e.g. Zr-89 labelled durvalumab (MEDI4736), ex vivo In-111-oxine labelled CD8+ T-cells and high-resolution immune cell imaging, in relation to immunotherapy induced immune responses on quantitative immune histochemical analysis of the resected tumor specimen, will be performed.
This is an interventional study in 20 patients with resectable non-small cell lung cancer who will receive 2 courses of durvalumab (MEDI4736) in the neo-adjuvant setting, followed by surgery with curative intent. Experimental imaging procedures include 1) Zr-89-labelled durvalumab (MEDI4736) scan prior to neo-adjuvant treatment to determine accessibility and intra-tumoral distribution of durvalumab (MEDI4736) and 2) (first cohort) injection of ex vivo \[111In\]-oxine labelled autologous CD8+ T-cells 48 hours prior to surgery, or (second cohort) injection of \[89Zr\]-Df-crefmirlimab prior to surgery. The scan is scheduled on the day of surgery and after surgery, the resected tumor specimen with ex vivo \[111In\]-oxine labelled or in vivo \[89Zr\]-Df-crefmirlimab labelled CD8+ T-cells in situ, is fixated for high-resolution ex vivo imaging on a preclinical U-SPECT scanner and quantitative histopathological analysis, next to standard histopathological evaluation. Total duration of the study is maximum 42 days (from injection therapeutic dose durvalumab (MEDI4736) to surgery).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Patients will undergo a Zr-89 labelled durvalumab (MEDI4736) PET/CT and dedicated perfusion-CT prior to treatment with durvalumab (MEDI4736) and in- and ex-vivo In-111-oxine or in-vivo \[89zr\]-Df-crefmirlimab labelled CD8+ T-cells after two courses of treatment, prior to surgery.
Patients will receive two courses of durvalumab (MEDI4736)at a fixed dose of 750mg Q2W intravenously, prior to scheduled resection of NSCLC.
Radboud University Medical Center
Nijmegen, Netherlands
Safety of neo-adjuvant durvalumab: number of NCI CTCAE v 5.0 grade ≥3
Demonstrate safety of two courses durvalumab (MEDI4736) 750 mg at two weeks interval in neo-adjuvant setting. Safety is defined as the number of NCI CTCAE v 5.0 grade ≥3 toxicity related to neo-adjuvant durvalumab (MEDI4736).
Time frame: 14 days
Feasibility of neo-adjuvant durvalumab: successful completion of curative surgery
Demonstrate feasibility of two courses durvalumab (MEDI4736) 750 mg at two weeks interval in neo-adjuvant setting. Feasibility is defined as successful completion of curative surgery within 42 days after start of neo-adjuvant treatment with durvalumab (MEDI4736) (= day 1).
Time frame: 42 days
Imaging related_response on CE-CT
Objective responses measured on contrast enhanced CT (RECIST1.1, immune related response criteria (irRC))
Time frame: 42 days
Imaging related_pathological response
The rate of (major and complete) pathological responses as previously defined.
Time frame: 42 days
Imaging related_correlation with Zr89-labelled durvalumab
Correlate the presence and localisation of TILs with the intra-tumoral distribution of Zr-89-labelled durvalumab (MEDI4736).
Time frame: 42 days
Imaging related_correlation with perfusion-CT
Correlate the presence and localisation of TILs and Zr-89-labelled durvalumab (MEDI4736) with (changes in) perfusion parameters on contrast-enhanced CT.
Time frame: 42 days
Biomarker related_future correlation with other biomarkers
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Exploration of In-111-oxine or \[89Zr\]-Df-crefmirlimab labelled T-cells U-SPECT or PET findings with other potential biomarkers (not yet defined) for response to immune therapy and the number of immune therapy related conversions from VATS to open surgical procedures
Time frame: 42 days
Biomarker related_correlation with immune profiling
Correlate the presence of TILs with multi-dimensional immune profiling by flow cytometry of freshly isolated peripheral blood lymphocytes.
Time frame: 42 days
Clinical care related_evaluation of VATS conversions
Evaluate the number of VATS conversions after neo-adjuvant durvalumab (MEDI4736).
Time frame: 42 days
Clinical care related_number of patients with postoperative complications
Asses postoperative complications
Time frame: 42 days
Clinical care related_hospital stay
Asses length of hospital stay
Time frame: 42 days
Clinical care related_mortality
Asses 30 and 90 day mortality
Time frame: 30 and 90 days
Clinical care related_evaluation of patient related outcomes
Patient related outcome measurements (PROMS) will be evaluated based on the EORTC-QLQ-C30 (quality of life) questionnaire (in Dutch) at baseline, prior to surgery, at first post-operative visit and follow-up. The QLQ-C30 is composed of both multi-item scales and single-item measures. These include five functional scales, three symptom scales, a global health status / QoL scale, and six single items. Each of the multi-item scales includes a different set of items - no item occurs in more than one scale. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / QoL represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems.
Time frame: 42 days
Clinical care related_determination of recurrence-free survival
Determine recurrence-free survival by landmarking analysis, based on time since surgery.
Time frame: 42 days
Clinical care related_determination of overall survival
Determine overall survival by landmarking analysis, based on time since surgery.
Time frame: 42 days