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AzTrials

Lung CancerPhase 1RIMNCT02579005

Radio-Immuno-Modulation in Lung Cancer

A Phase 1 study testing Patients with a living donor and Patients with a UCB donor in people with Lung Cancer, run by Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal at 1 site in Canada.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

This project will assess the feasibility of treating advanced cancer using the immune system, without any anti-cancer drug. In this pilot study, the investigators propose combining low-dose radiotherapy, in lung cancer patients, with allogeneic immune cells obtained from a donor. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Lung Cancer
What is being tested?
Patients with a living donor and Patients with a UCB donor
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
24 participants
Where
1 siteCanada
Study dates
20 Apr 2018to Apr 2025
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Advanced lung cancer documented by a histo-pathological analysis;
  • Patients who received at least one line of anti neoplastic therapy;
  • Presence of at least one tumor mass >1 cm and not previously irradiated;
  • Metastases situated in one of the following sites: lung, skeleton, lymph nodes or soft tissue;
  • Presence of at least one not previously irradiated metastasis;
  • Life expectancy greater than 3 months;
  • ECOG performance status ≤ 2.

Who cannot join

  • Second active cancer necessitating treatment;
  • History of autoimmune disease;
  • Patients dependent on immunosuppressive medications, including corticosteroids;
  • Decreased diffusion capacity below 40%, if radiation planned to a lung metastasis;
  • Patients needing urgent radiotherapy.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Hopital Sacre-Coeur

    Montreal, Quebec, H4J 1C5

Other trials in Canada

About this study

Official title: Radio-Immuno-Modulation for Advanced Lung Cancer: a Pilot Study Evaluating Tolerance and Immune Responses

This project will assess the feasibility of treating advanced cancer using the immune system, without any anti-cancer drug. In this pilot study, the investigators propose combining low-dose radiotherapy, in lung cancer patients, with allogeneic immune cells obtained from a donor. The patients will receive radiotherapy directed to one of the patient's tumors, as well as an immunomodulatory drug called cyclophosphamide. Thereafter, they will receive the infusion of donor immune cells.

Read the detailed description

Metastatic lung cancer remains incurable despite numerous studies and treatments tried, including chemotherapy and, more recently, targeted therapies.

Cancer can escape immune surveillance through different mechanisms: low levels of tumor associated antigens (TAA), regulatory T cells, and immunosuppressive cytokines. Non-cytolytic doses of radiation have been shown to reverse some of these pathways in experimental models. It up-regulated the density of the MHC molecules presenting TAA and increased the T cell infiltration of the tumor (1). Patients with lymphoma, liver or prostate cancer were treated with radiotherapy combined with immunotherapy, in the form of a TLR9 agonist, autologous dendritic cells or a prostate-specific antigen vaccine (2, 3, 4). These trials have shown an induction of T cell reactivity against TAA. Another form of immunotherapy, used for patients with refractory hematologic malignancies is allogeneic hematopoietic stem cell transplantation (HSCT) (5). Its success has relied on cell infusions from a donor, demonstrating the immunologic control sustained by allogeneic cells (6).

The approach investigated in this study uses the immune cells from a donor to induce a tumor destruction reaction. This will be amplified by the immunological effects of radiotherapy. Many oncogenes are present in lung cancers and low-dose radiation increases their expression on the surface of the tumor cell. In addition, radiation has the property to stimulate the production of inflammatory cytokines and chemokines in the irradiated site. Finally, the donor's immune cells shall respond physiologically by migrating to the site of inflammation. This will trigger an immune reaction directed against the abnormal cancer cells.

A total of 24 patients are expected to be recruited over the study period, estimated to be 3 years. The allogeneic cells will be obtained from one of two possible donor types. For patients having a living donor, the immune cells will be harvested through a collection procedure called apheresis. The living donor should be a sibling with 3/6 or less HLA compatibility with the patient, at the A, B and DRB1 loci. For patients who do not have such a living donor, allogeneic cells from a cryopreserved umbilical cord blood (UCB) unit will be used.

The treatment course will be the following: low-dose radiotherapy will be delivered to a single tumor site, which could be either the primary tumor or one of its metastases. Low-dose cyclophosphamide will be given to decrease regulatory T cell activity and increase anti-tumor responses. Allogeneic immune cells will be administered thereafter, according to the treatment arm the patient has been assigned.

Conditions
Lung Cancer
Being tested
Patients with a living donor, Patients with a UCB donor
Keywords
Radiation, Immune response, Anti-tumor, Lung Cancer
Medical subject headings
Lung Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Patients with a living donorBiological

    The day of allogeneic cell infusion will be referred to as Day 0 and the n-th day before that, as Day -n. The dose of external radiation will be 15 Gy divided in 3 fractions, from Day -3. Cyclophosphamide, 250 mg/m2 will be given on Day -2. Donors will receive 5 daily doses of GCSF, 10 µg/kg, by subcutaneous injection from Day -4. PBMC will be collected through apheresis on Day 0. A dose of 5 x 10exp7 CD3 cells/kg will be administered. The infused volume will be adjusted to contain this T cell dose.

  • Patients with a UCB donorBiological

    The day of allogeneic cell infusion will be referred to as Day 0 and the n-th day before that, as Day -n. The UCB unit should have at least 4 of 6 HLA compatibility and at least 3 x 10exp6 TNC per kg patient weight. The dose of external radiation will be 15 Gy, divided in 3 fractions, starting on Day -3. Cyclophosphamide, 250 mg/m2 intravenously, will be given on Day -2.

Study groups in NCT02579005
Study groupRoleWhat they receive
Patients with a living donorExperimentalRadiation + PBMC
Receives: Biological: Patients with a living donor
Patients with a UCB donorExperimentalRadiation + UCB
Receives: Biological: Patients with a UCB donor

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of treatment-related adverse events

    Evaluation by follow-up clinic visits, including medical questionnaire, physical exam \& blood tests: complete blood count, electrolytes, renal \& liver function tests. AE will be graded using National Cancer Institute's Common Toxicity Criteria version 3 (7). Evaluations will take place twice a week for the first 2 weeks, weekly for 2 weeks, every 2 weeks for 2 months \& every month for 3 months. It is anticipated that a maximum of 1 of 6 patients will have grade 3 side effects, including nausea, diarrhea, dyspnea, cough, fever, rash.

    Measured: Up to 6 months

Secondary outcomes (4)
  1. Immune responses - T cell infiltration

    Assessment using biopsies done before \& 1-2 weeks after treatment. The block slides will be stained with CD3, CD4, CD8 \& PDL-1 antibodies. T cell density will be expressed as the number of CD4+ and CD8+ cells to tumor cell ratio. The degree of T cell infiltration of the tumors will be assessed by comparing these ratios between pre \& post treatment samples.

    Measured: Up to 1 month

  2. Immune responses - Tumor cell phenotype

    Assessment using biopsies done before \& 1-2 weeks after treatment. Flow cytometry will be used to assess the following tumor markers: HLA, Fas, ICAM-1, PDL-1. The changes in tumor cell phenotypes will be assessed by comparing the mean fluorescence intensity of the above markers between pre \& post treatment samples. The PDL-1 tumor cell expression will also be compared on the block slides between pre \& post treatment samples.

    Measured: Up to 1 month

  3. Immune responses - tumor infiltrating T cell phenotype

    Assessment using biopsies done before \& 1-2 weeks after treatment. Flow cytometry will be used to assess the following markers on tumor infiltrating T cells: CD3, CD4, CD8, CD25 \& Foxp3. The nature and magnitude of T cell infiltration will be assessed by comparing the frequencies of these T cell subsets between pre \& post treatment samples.

    Measured: Up to 1 month

  4. Immune responses - origin of tumor infiltrating T cells

    Assessment using biopsies done 1-2 weeks after treatment. Single cell suspensions will be stained with the following markers for tumor infiltrating T cells: CD3, CD4 and CD8. CD4+ and CD8+ T cells will be isolated by fluorescence-activated cell sorting. Their origin (patient vs donor) will be determined by a chimerism assay. The frequencies of donor-derived cells will be determined by PCR quantification of patient and donor specific VNTR bands.

    Measured: Up to 1 month

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2015 (estimated)
  2. Study start20 Apr 2018
  3. Primary completionOct 2024 (estimated)
  4. Study completionApr 2025 (estimated)

Why it stopped: Lack of ressources

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
24 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02579005
Sponsor's protocol ID
2012-634
Acronym
RIM
Status last verified
Feb 2024
First submitted
7 Oct 2015
Last updated
29 Feb 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hodge JW, Guha C, Neefjes J, Gulley JL. Synergizing radiation therapy and immunotherapy for curing incurable cancers. Opportunities and challenges. Oncology (Williston Park). 2008 Aug;22(9):1064-70; discussion 1075, 1080-1, 1084.

    PubMed 18777956
  • Brody JD, Ai WZ, Czerwinski DK, Torchia JA, Levy M, Advani RH, Kim YH, Hoppe RT, Knox SJ, Shin LK, Wapnir I, Tibshirani RJ, Levy R. In situ vaccination with a TLR9 agonist induces systemic lymphoma regression: a phase I/II study. J Clin Oncol. 2010 Oct 1;28(28):4324-32. doi: 10.1200/JCO.2010.28.9793. Epub 2010 Aug 9.

    PubMed 20697067
  • Chi KH, Liu SJ, Li CP, Kuo HP, Wang YS, Chao Y, Hsieh SL. Combination of conformal radiotherapy and intratumoral injection of adoptive dendritic cell immunotherapy in refractory hepatoma. J Immunother. 2005 Mar-Apr;28(2):129-35. doi: 10.1097/01.cji.0000154248.74383.5e.

    PubMed 15725956
  • Gulley JL, Arlen PM, Bastian A, Morin S, Marte J, Beetham P, Tsang KY, Yokokawa J, Hodge JW, Menard C, Camphausen K, Coleman CN, Sullivan F, Steinberg SM, Schlom J, Dahut W. Combining a recombinant cancer vaccine with standard definitive radiotherapy in patients with localized prostate cancer. Clin Cancer Res. 2005 May 1;11(9):3353-62. doi: 10.1158/1078-0432.CCR-04-2062.

    PubMed 15867235
  • Diaconescu R, Storb R. Allogeneic hematopoietic cell transplantation: from experimental biology to clinical care. J Cancer Res Clin Oncol. 2005 Jan;131(1):1-13. doi: 10.1007/s00432-004-0611-6. Epub 2004 Sep 28.

    PubMed 15565456
  • Baron F, Maris MB, Sandmaier BM, Storer BE, Sorror M, Diaconescu R, Woolfrey AE, Chauncey TR, Flowers ME, Mielcarek M, Maloney DG, Storb R. Graft-versus-tumor effects after allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning. J Clin Oncol. 2005 Mar 20;23(9):1993-2003. doi: 10.1200/JCO.2005.08.136.

    PubMed 15774790
  • 7. Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events v3.0 (CTCAE). Bethesda, MD. National Cancer Insitute, 2006. Available at: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf.

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Patients with a living donor and Patients with a UCB donor in people with Lung Cancer, run by Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: paused, as of the sponsor's last update on 29 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of treatment-related adverse events (time frame: Up to 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02579005, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Feb 2024.

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