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Atezolizumab Plus 8 Gy Single-fraction Radiotherapy for Advanced Oligoprogressive NSCLC



Oktober 2020

Letztes Update:


Indikation (Clinical Trials):
Carcinoma, Non-Small-Cell Lung


Erwachsene (18+)

Phase 2

Oncology Institute of Southern Switzerland

Ente Ospedaliero Cantonale, Bellinzona, Istituto Cantonale di Patologia, Clinical Trial Unit Ente Ospedaliero Cantonale,


Luciano Wannesson, MD
Principal Investigator
Oncology Institute of Southern Switzerland


(1 von 1)

Oncology Institute of Southern Switzerland
6500 Bellinzona
SwitzerlandRekrutierend» Google-Maps
Luciano Wannesson, MD
Phone: +41 (0)91 811 87 56
» Ansprechpartner anzeigen


Detailed Description:

Atezolizumab will be administered at a fixed dose of 1,200 mg by intravenous infusion every

21 days on an outpatient basis according to the its approved prescribing information.

Palliative radiation therapy will be delivered concomitant to the 2nd dose of atezolizumab as

a single fraction of 8 Gy to all eligible metastatic and primary sites.


Inclusion Criteria:

- Signed Informed Consent Form

- Histologically or cytologically confirmed diagnosis of metastatic (Stage IV)

- NSCLC as per the American Joint Committee on Cancer (AJCC) 8th edition

- No sensitizing EGFR mutation (L858R or exon 19 deletions), ALK fusion oncogene or ROS1

rearrangement detected

- Progressing to one line of chemotherapy defined as follows:

1. A platinum-doublet.

2. In case of patients being ineligible for platinum-containing regimens but

otherwise compliant with the other inclusion-exclusion criteria of the present

study, at least one line of mono-chemotherapy is required.

3. As an exception, patients with oligoprogression to anti PD-1 agents alone for

whom the investigator considers local treatment of metastases and continuation of

immunotherapy appropriate (i.e. would not be eligible for 2nd line treatment) may

be enrolled without a previous line of chemotherapy. In this case, approval by

the Project Leader is necessary.

- Progressing to an anti-PD-1 agent, either associated to chemotherapy or as monotherapy

(e.g., pembrolizumab or nivolumab)

- Patients with treated, asymptomatic central nervous system (CNS) metastases are

eligible, provided they meet all of the following criteria:

1. Measurable disease outside CNS.

2. Only supratentorial and cerebellar metastases allowed (i.e., no metastases to

midbrain, pons, medulla or spinal cord).

3. No ongoing requirement for corticosteroids as therapy for CNS disease;

anticonvulsants at a stable dose allowed.

4. No stereotactic radiation within 7 days or whole-brain radiation within 14 days

prior to initiating study treatment.

5. No evidence of interim progression between the completion of CNS-directed therapy

and the screening radiographic study.

- Patients with new asymptomatic CNS metastases detected at the screening scan must

receive radiation therapy and/or surgery for CNS metastases. Following treatment,

these patients may then be eligible without the need for an additional brain scan

prior to initiating study treatment, if all other criteria are met, including clinical

confirmation of no evidence of interim disease progression

- Measurable disease by RECIST v1.1. Previously irradiated lesions can only be

considered as measurable disease if disease progression has been unequivocally

documented at that site since radiation and the previously irradiated lesion is not

the only site of disease.

- Oligoprogressive disease defined as follows:

1. A minimum of 1 and a maximum of 4 progressing lesions (with up to 3 total organs

and 3 lesions per organ, except skeletal lesions) as assessed by a Positron

Emission Tomography-Computed Tomography (PET-CT) scan (contrast enhanced).

2. Definition of progression is made by RECIST 1.1 criteria (new lesions or

increased pre-existing ones).

3. Patients with additional non-progressing lesions according to RECIST 1.1 are

accepted, but non-progressing lesions according to RECIST 1.1 with 6% to 19%

increase in diameter, should also be included in the radiation scheme, provided

the limit of lesions/diameter/organs is observed.

- Adequate hematologic and end organ function, defined by the laboratory results

obtained within 14 days prior to initiating study treatment (see §7.1 of the protocol

for full details).

- For female patients of childbearing potential agreement to remain abstinent (refrain

from heterosexual intercourse) or to use highly effective form(s) of contraceptive

methods that result in a failure rate of < 1% per year when used consistently and

correctly during the treatment period and for at least 5 months after the last dose of


Exclusion Criteria:

- Cancer-specific exclusion criteria

- Patients with an ECOG Peformance status >2

- Active or untreated CNS metastases as determined by Computed

- Tomography (CT) or magnetic resonance imaging (MRI) evaluation of the brain during

screening and prior radiographic assessments

- Uncontrolled hypercalcemia (>1.5 mmol/L ionized calcium or >3 mmol/L of corrected

serum calcium) or symptomatic hypercalcemia requiring continued use of bisphosphonate

therapy or denosumab (see §7.1 of the protocol for exceptions).

- NCI CTCAE Grade 3 or higher toxicities due to any prior therapy (e.g., radiotherapy)

(excluding alopecia), which have not shown improvement and are strictly considered to

interfere with current study medication, with special focus on prior toxicity to

anti-PD1 agents.

General medical exclusion criteria

- Women who are pregnant or lactating, or intending to become pregnant during the study.

Women of childbearing potential including women who have had a tubal ligation, must

have a negative serum pregnancy test result within 14 days prior to initiation of

study drug.

- History of autoimmune disease (see §7.1 of the protocol for exceptions).

- Known positivity for human immunodeficiency virus (HIV) (see §7.1 of the protocol for

further details).

- Known active hepatitis B (chronic or acute; defined as having a positive hepatitis B

surface antigen [HBsAg] test at screening) or known active hepatitis C (see §7.1 of

the protocol for further details).

- Severe infections within 4 weeks prior to initiating study treatment, including but

not limited to hospitalization for complications of infection, bacteremia, or severe


- Significant cardiovascular disease, such as New York Heart Association (NYHA) cardiac

disease (Class II or greater), myocardial infarction within 3 months prior to

initiating study treatment, unstable arrhythmias, or unstable angina.

a) Patients with known coronary artery disease, congestive heart failure not meeting

the above criteria, or left ventricular ejection fraction (LVEF) <50% must be on a

stable medical regimen that is optimized in the opinion of the treating physician, in

consultation with a cardiologist if appropriate.

- Major surgical procedure other than for diagnosis within 4 weeks prior to initiating

study treatment or anticipation of need for a major surgical procedure during the

course of the study.

- Prior allogeneic bone marrow transplantation or solid organ transplant.

Exclusion criteria related to atezolizumab

- History of severe allergic, anaphylactic, or other hypersensitivity reactions to

chimeric or humanized antibodies or fusion proteins.

- Oral or IV antibiotic treatment. Patients will thus need to have recovered from any

infection requiring antibiotics. Patients receiving prophylactic antibiotics (e.g.,

for prevention of a urinary tract infection or to prevent chronic obstructive

pulmonary disease exacerbation) are eligible.

- Administration of a live, attenuated vaccine within 4 weeks before initiating study

treatment or anticipation that such a live attenuated vaccine will be required during

the study

a) Influenza vaccination is allowed, but should be given during influenza season.

However, patients must not receive live, attenuated influenza vaccine (e.g., FluMist®)

within 4 weeks prior to initiating study treatment, at any time during the study or

within 5 months after the last atezolizumab dose.

- Prior treatment with CD137 agonists or anti-PD-L1 therapeutic antibodies.

- Patients who have had prior anti-cytotoxic T lymphocyte-associated antigen 4

(CTLA-4) treatment may be enrolled, provided the following requirements are met:

1. Minimum of 6 weeks from the last dose of anti-CTLA-4

2. No history of severe immune related adverse effects from anti-CTLA-4 (NCI CTCAE

Grade 3 and 4)

- Treatment with systemic corticosteroids or other immunosuppressive medications

(including but not limited to prednisone, dexamethasone, cyclophosphamide,

azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF]


- Patients with history of allergic reaction to IV contrast requiring steroid

pretreatment should have baseline and subsequent tumor assessments done by MRI.

Exclusion criteria related to radiotherapy

- Previously irradiated lesions having received the maximum permissible dose.


Primary outcome:

1. Objective Response Rate (Time Frame - 3 months):
Percentage of patients with a complete response or partial response

Secondary outcome:

1. Overall Survival (Time Frame - 12 months):
Time in months from the first day of study treatment to the date of death

2. Progression Free-Survival (Time Frame - 12 months):
Time in months from the first day of study treatment until the first evidence of tumour progression

Geprüfte Regime

  • Atezolizumab (Tecentriq):
    Intravenous infusion every 21 days, until disease progression, intolerance or loss of clinical benefit.


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