This is a multi-center, multi-arm open-label phase Ib/II clinical study assessing the efficacy of concurrent lurbinectedin in combination with radiotherapy in patients with locally advanced, resectable, high-grade sarcomas.
PRIMARY OBJECTIVES: Phase Ib: I. To determine the safety and tolerability of neoadjuvant lurbinectedin * in combination with preoperative 2 weeks of hypofractionated radiation for extremity and trunk sarcoma, or * with 6 weeks of conventionally fractionated radiation for retroperitoneal sarcoma II. To determine the maximum tolerated dose (MTD) for neoadjuvant lurbinectedin in combination with preoperative external beam radiation therapy (EBRT) in patients with sarcoma. Phase II: I. To estimate the efficacy of neoadjuvant lurbinectedin in combination with preoperative EBRT (hypofractionated or conventionally fractionated), according to endpoint defined by sarcoma type and location: * Cohort 1: extremity and trunk sarcoma (HFRT) * Cohort 2: Extremity myxoid liposarcoma (HFRT) * Cohort 3: Retroperitoneal sarcoma (CFRT course) SECONDARY OBJECTIVES: I. Time to disease progression (local or distant recurrence). II. Overall response rate (ORR) pre-operative as measured by RECIST 1.1 or a later tool for monitoring disease progression. III. Overall survival. IV. To grade radiation related skin toxicity overlying the tumor area. V. To determine long term major wound healing complications with the use of this combination in all cohorts. EXPLORATORY OBJECTIVES: I. To evaluate changes in monocyte, macrophage, T cell, and RNA expression levels over time. OUTLINE: Participants will receive neoadjuvant lurbinectedin concurrent with radiation therapy. Non-investigational surgery will be performed 4-6 weeks from the end of radiation therapy. Participants with localized disease at the time of study enrollment will be on surveillance on-study for 2 years. Post-operatively participants will be followed every 12 +/- 4 weeks for approximately 2 years from the end of treatment. Participants with known metastatic disease will be followed until progression, toxicity and thereafter for 2 years.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Given intravenously (IV)
Conventionally fractionated radiotherapy or external beam radiation
Non-investigational surgical procedure on tumor tissue
Proportion of participants with dose-limiting toxicities (DLTs) (Phase 1b)
The proportion of participants with reported DLTs will be reported for
Time frame: 4 weeks
Maximum Tolerated Dose (MTD) (Phase 1b)
MTD is defined as the highest dose at which no more than one instance of dose limiting toxicity (DLT) is observed among 1 of 6 participants treated.
Time frame: Up to 6 months
Pathological necrosis rate (Phase 2, Cohort 1)
Pathological necrosis rate, defined as the proportion of participants with \>=95% pathological necrosis.
Time frame: Up to 12 weeks
Local control rate (Phase 2, Cohort 2)
Local control rate is defined as the proportion of participants with \>=50% of the resected sample showing any histological treatment effect.
Time frame: Up to 12 weeks
Overall response rate (Phase 2, Cohort 3)
Overall response rate is defined as the proportion of participants with a confirmed complete response (CR) or partial response (PR) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
Time frame: Up to 12 weeks
Median time to disease progression (TTP)
Time to progression is defined as the time from first day of study treatment to first documented occurrence of disease progression (including local and distant recurrences). Participants without progression will be censored at their last disease evaluation will be reported.
Time frame: Up to 2 years
Overall Response Rate (ORR)
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The proportion of pre-operative participants with a confirmed CR or PR as measured by RECIST 1.1 or a later tool for monitoring disease progression will be reported.
Time frame: Up to 12 weeks
Median Overall Survival (OS)
The median overall survival time is defined as the time from first day of study treatment to death due to any cause will be reported. Participants who are still alive will be censored at their last date known to be alive.
Time frame: Up to 2 years
Incidence of radiation related skin toxicity
Incidence of radiation related skin toxicity by grade as classified by the NCI CTCAE version 5.0 and additionally assessed by radiation oncologists will be reported.
Time frame: Up to 6 months
Proportion of participants requiring wound care
The proportion of participants requiring secondary operation under general or regional anesthesia for wound repair, invasive procedure without general or regional anesthesia (mainly aspiration of seroma), readmission for wound care such as intravenous antibiotics, or persistent deep packing for 120 days (4 months) or longer will be reported.
Time frame: Up to 4 months after non-investigational surgery