The SAVED LUNG study is a pilot Phase I trial evaluating safety and feasibility of observation versus standard-of-care surgery in operable Stage II-III (excluding N3) NSCLC patients (PD-L1 ≥50%) who achieve complete clinical response following neoadjuvant platinum-doublet chemotherapy and immunotherapy. Participants are randomized to observation or surgery after rigorous restaging, with primary endpoints focusing on safety and feasibility. Secondary objectives include rates of cross-over to surgery, event-free survival, and overall survival, while exploratory endpoints examine ctDNA clearance and its association with clinical response.
After neoadjuvant therapy, all participants undergo intensified re-staging invasive and non-invasive modalities to assess for complete clinical response: * Chest CT; * PET/CT scan; * Bronchoscopy; * EBUS; * EUS; * Re-biopsy of lesions that were deemed to be positive for cancer; this includes re-biopsies of all positive lymph nodes and transthoracic needle aspiration of tumors. Participants with complete clinical response defined by absence of disease as measured by all the above modalities will be randomized 1:1 to either observation or surgery. Only patients with complete clinical response will proceed to the randomization stage of the trial. Block randomization will occur 1:1 with two participants per block. All other patients will remain on study and undergo therapy as per standard-of-care and will have follow-up on study. Both groups will have blood collected for ctDNA at this stage. For participants in the surgery arm, the blood sample will be 3 weeks after surgery, while participants in surveillance only arm will have the blood sample 3 weeks after randomization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
14
Patients randomized to this arm will forego standard-of-care thoracic surgery and will undergo strict surveillance based on serial radiological follow-up and ctDNA monitoring
Patients randomized to this arm will undergo standard-of-care thoracic surgery and undergo post-operative surveillance with serial radiological follow-up and ctDNA monitoring
Centre hospitalier de l'Université de Montréal (CHUM)
Montreal, Quebec, Canada
Safety
Adverse events will be determined as type and grade using the CTCAE v5.0.
Time frame: From randomization through 5 years of follow-up
Feasibility
Recruitment rate will be defined as the total number of patients recruited (consented) out of the total number of patients approached.
Time frame: First two years of the study
Complete clinical response
Defined by absence of cancer in all of the following evaluations: * Chest CT; * PET/CT scan; * Bronchoscopy; * EBUS; * EUS; * Re-biopsy of lesions that were deemed to be positive for cancer; this includes re-biopsies of all positive lymph nodes and transthoracic needle aspiration of tumors.
Time frame: Restaging 3 weeks after completion of neoadjuvant therapy (3 cycles of nivolumab and platinum-doublet chemotherapy)
Cross-over to surgery
Defined as occurrence of surgery for lung cancer in the observation arm
Time frame: From randomization through 5 years of follow-up
Event-free survival (EFS) at 12 months
Defined as the proportion of patients remaining event-free at 12 months, from the time of randomization. Patients who are alive without a documented progression will be censored at the time of their last disease evaluation.
Time frame: 12 months following randomization
Overall survival (OS) at 12 months
Defined as the proportion of patients alive at 12 months, from the time of randomization.
Time frame: 12 months following randomization
Circulation tumor DNA (ctDNA) clearance
Defined as presurgery change from detectable levels of ctDNA before cycle 1 to undetectable ctDNA before surgery.
Time frame: 3 weeks post-randomization (surveillance arm) or 3 weeks post-surgery (standard-of-care surgery arm)
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