The main aim is to identify and describe biomarkers in different sample types related to chemoradiation followed by durvalumab treatment for stage III PD-L1 negative and positive non-small cell lung cancer (NSCLC) patients' eligible for curatively intended chemoradiation. The hypothesis is that clinical differences in course of disease reflect underlying biological characteristics.
This is an open, multinational, phase 2 trial to investigate the Properties of cancer cells before, during and after treatment with the investigational study drug durvalumab in patients with locally advanced non-small celled lung cancer (NSCLC). Both patients with high and low PD-L1 expression are allowed to participate. Durvalumab (PD-L1 inhibitor) will be administered after a period with standardtreatment with chemotherapy and radiationtherapy (chemoradiotherapy) for around 7 weeks. After maximum 5 weeks break after chemoradiotherapy, durvalumab will be given in the same dose to all patients for up to 12 months. The follow-up include a safety follow-up for up to five years, followed by a survival follow-up for up to a total of ten years. The main aim is to identify and describe biomarkers in different sample types related to chemoradiation followed by durvalumab treatment for stage III PD-L1 negative and positive non-small cell lung cancer (NSCLC) patients' eligible for curatively intended chemoradiation. The hypothesis is that clinical differences in course of disease reflect underlying biological characteristics.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Included patients will receive durvalumab (fixed dose, 1500mg Q4W) until progressive disease and no clinical benefit, intolerable toxicity or patient's wish, for a maximum duration of 12 months. Treatment with durvalumab should start \<5 weeks after last radiotherapy dosing.
North Estonia Medical Centre
Tallinn, Estonia
Oulu University Hospital
Oulu, Finland
Tampere University Hospital
Tampere, Finland
Turku University Hospital
Turku, Finland
National Cancer Institute
Vilnius, Lithuania
Haukeland universitetssykehus
Bergen, Norway
Oslo University Hospital
Oslo, Norway
Stavanger University Hospital
Stavanger, Norway
Universitetssykehuset i Nord-Norge
Tromsø, Norway
St. Olavs Hospital
Trondheim, Norway
Impact of tumour mutational burden (TMB) measured in the tumour tissue and blood samples, on the hazard.
Analyses of TMB in tumour tissue. Patients with high Tumour Mutational Burden, TMB (\> 8.5 mutations per megabase) have a hazard ratio equal to or less than 0.55 as compared to patients with low TMB. Tumor tissue will be analysed in regard to TMB, and several different cut-offs will be evaluated.
Time frame: Throughout study, up to 5 years
Predict assosiation between Tumour Mutational Burden, TMB, measured in tumour tissue and blood samples and clinical response
To investigate different levels of TMB in tumor tissue compared to blood samples, as predictors for development of clinical response
Time frame: Through study, up to 5 years
Specific RNA profiles predict response to treatment
Transcriptome characterization (RNA-sequencing) on tumour material to investigate this
Time frame: Through study, up to 5 years
Impact of Molecular profiles in urine on response to treatment
To investigate urine for predictive biomarkers (ctDNA, miRNA)
Time frame: Through study, up to 5 years
Analysis of pre-treatment and under-treatment samples may identify biomarkers for predicting which patients will benefit from treatment with durvalumab after chemoradiation
Analyses of biomarkers in tumour tissue.
Time frame: Through study, up to 5 years
The durvalumab treatment following chemoradiation will induce T cell responses against antigens expressed in each patient´s tumor.
Immunological response assessment performed on tumour material from participants.
Time frame: Through study, up to 5 years
A possible change in PD-L1 status will be explored
Immunohistochemistry of PD-L1 assessed on tumour tissue.
Time frame: Through study, up to 5 years
The durvalumab treatment following chemoradiation has acceptable safety and tolerability in NSCLC patients, as assessed by Patient Reported Outcome measurements.
Patient reported outcome measurements by standardized Tools; EORTC-QLQ-C30 and LC13.
Time frame: Through study, up to 5 years
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