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Small-cell Lung CancerPhase 2CISARTNCT06816966

Chemotherapy-immunotherapy-based Split-course Adaptive Hypofractionated Radiotherapy for Extensive-stage SCLC

A Phase 2 study testing split-course adaptive hypofractionated radiotherapy in people with Small-cell Lung Cancer, run by Fujian Medical University Union Hospital at 1 site in China.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

This study is a prospective, single-arm, phase Ⅱ trial evaluating the safety and efficacy of Chemotherapy-immunotherapy-based split-course adaptive hypofractionated radiotherapy for extensive-stage SCLC Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Small-cell Lung Cancer
What is being tested?
split-course adaptive hypofractionated radiotherapy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
35 participants
Where
1 siteChina
Study dates
26 Dec 2023to 31 Oct 2028
Phase
Phase 2
Are there results?
Not yet: the study is under way

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

  • Any pathologic confirmation of ES-SCLC at any site, either primary or metastases.
  • Patients must have measurable disease and 3 or fewer observable liver metastases.
  • If there is a pleural effusion, patients will be eligible if thoracentesis is cytologically negative or if pleural fluid is too small a volume to effectively sample by thoracentesis and does not show increased metabolic activity on CT/PET imaging
  • Age greater than or equal to 18 years.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
  • Adequate normal organ and bone marrow function
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  • The patient or a legally authorized representative must provide study-specific informed consent prior to study entry
  • Life expectancy greater than six (6) months
  • If the autoimmune disease is not active for over 3 years and the patient is not receiving immunosuppressive treatment such as methotrexate or steroids above a dose equivalent to 10 mg prednisone daily, the patient is eligible.
  • Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone are eligible.
  • Patients with controlled type 1 diabetes mellitus on a stable insulin regimen are eligible.
  • Patients with eczema, psoriasis, lichen simplex chronicus or vitiligo with dermatologic manifestations are excluded only if they have active disease with acute exacerbation and on immunosuppressive medications within the 12 months prior to enrollment. They are eligible otherwise.
  • Severe, active co-morbidity defined as follows: Any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of radiation, chemotherapy and ICIs or that may affect the interpretation of the results or render the patient at high risk from treatment complications;
  • Active tuberculosis;
  • Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis; cirrhosis; fatty liver; and inherited liver disease.
  • Patients with past or resolved hepatitis B infection (defined as having a negative hepatitis B surface antigen [HBsAg] test and a positive anti-HBc [antibody to hepatitis B core antigen] antibody test) are eligible.

Who cannot join

  • Metastatic disease invading the liver (> 3 metastases)
  • Patients with malignant pleural and/or pericardial effusions
  • Prior radiotherapy in the thorax that would result in overlapping RT fields
  • Active autoimmune disease, including, but not limited to: systemic lupus erythematosus; rheumatoid arthritis; inflammatory bowel disease (e.g. Crohn's, ulcerative colitis); vascular thrombosis associated with antiphospholipid syndrome; Wegener's granulomatosis; Sjogren's syndrome; Guillain-Barre syndrome; multiple sclerosis; vasculitis; or glomerulonephritis.
  • Known immunosuppressive disease, for example history of bone marrow transplant or chronic lymphocytic leukemia (CLL);
  • Chronic obstructive pulmonary disease (COPD) requiring chronic oral steroid therapy of > 10 mg prednisone daily or equivalent at the time of registration. Inhaled corticosteroids are not exclusionary;
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  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 3 months;
  • History of recent myocardial infarction within 6 months prior to registration.
  • Clinically significant interstitial lung disease;
  • History of allogeneic organ transplant;
  • Patients positive for human immunodeficiency virus (HIV) on effective anti-retroviral therapy with undetectable viral load within 6 months and a stable regimen of highly active anti-retroviral (HAART) HIV-positive patients must have no requirement for concurrent antibiotics or antifungal agents for the prevention of opportunistic infections.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

China1 site
  • Fujian Medical University Union Hospital,

    Fuzhou, Fujian, 350000

Other trials in China

About this study

Official title: Systemic Treatments (Chemotherapy-immunotherapy) Based Split-course Adaptive Hypofractionated Radiotherapy for Extensive-stage SCLC: CISART Study

This study is a prospective, single-arm, phase Ⅱ trial evaluating the safety and efficacy of Chemotherapy-immunotherapy-based split-course adaptive hypofractionated radiotherapy for extensive-stage SCLC

Read the detailed description

Small cell lung cancer (SCLC) represents the most aggressive and metastatic form of lung carcinoma, particularly in its extensive stage1. SCLC is initially highly chemotherapy sensitive, yet it is paradoxically characterized by nearly ubiquitous metastatic relapse and secondary chemoresistance2. Despite the incorporation of immune checkpoint inhibitors (ICIs) has led to improvements in survival, the benefit is only modest, with an overall survival (OS) improvement of approximately 3-5 months, and the median OS has yet to surpass two years3. This highlights the need for innovative combination strategies. Although consolidative thoracic radiotherapy (TRT) has shown promise in improving local control and two-year survival in ES-SCLC patients with residual intrathoracic disease after first-line chemotherapy 4-6, the efficacy of TRT remains uncertain in the era of immunotherapy. RAPTOR (NCT04402788) is an ongoing phase Ⅱ/Ⅲ trial evaluating the addition of TRT to the usual maintenance therapy with atezolizumab in ES-SCLC patients with a partial response (PR)/stable disease (SD). Given that TRT is administered exclusively to selected patients who have demonstrated a positive response to first-line treatment without disease progression(PD), a significant proportion of patients are ineligible for TRT due to disease progression. ES-SCLC typically presents with a high tumor burden and bulky thoracic lymph nodes which are the most dominant failure site after chemotherapy or chemoimmunotherapy. According to multiregion sequencing, it is reported that treatment-naive SCLC exhibited clonal homogeneity at distinct tumour sites, whereas a multitude of subclones driven by the most recent common ancestor at clinically overt recurrence, which markedly increases spatial and intratumour heterogeneity7. Considering of initial chemotherapy and radiation sensitivity of SCLC and potential synergistic effects of radiotherapy and immunotherapy, investigator hypothesized that add primary thoracic site RT to first-line chemoimmuntherapy may help killing more clonal tumor cells and enhancing systemic disease control. Whereas it must balance the specific toxicity risks of combined therapy to avoid systemic therapy interruption. Based on the findings of split-course SBRT based on systemic therapy (3S) in for locally advanced rectal cancer(NCT05176964)and borderline resectable pancreatic cancer (NCT04289792) in the institution,this study designed as a single-centre, single- arm, prospective phase Ⅱ trial in subjects with treatment- naïve ES-SCLC to treated with EP regimen chemotherapy, PD-L1/1 inhabitors and split-course hypofractionated radiotherapy (SCHR) as first-line therapy. Patients will be synchronously treated with etoposide/platinum (E/P) doublet plus ICIs and SCHR (4-6 fractions×5 Gy). Chemotherapy and ICIs start on days 1,2,3 and day 8 of every 21-day cycle, respectively. A single dose of 5 Gy radiotherapy may be administered either during a three-day chemotherapy cycle or within a two-day window preceding or following the cycle, taking into account the necessary time for radiotherapy planning and potential scheduling constraints such as weekends.Split-course hypofractionated radiotherapy will be response-adaptively delivered in 4-6 treatments to primary lesion, thoracic lymph nodes in thoracic cavity, adjacent involved supraclavicular and cervical lymph nodes because of shrinkage of bulky tumor. Chemotherapy interval spanning weeks not only allow for greater recovery of normal tissue following an injury from initial bulky-area radiation, but may also maximize potential synergies resulting from concomitant immune-oncology approaches.

Being tested
split-course adaptive hypofractionated radiotherapy
Keywords
Radiation, split, hypofractionated radiotherapy
Medical subject headings
Small Cell Lung Carcinoma

What participants receive

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

  • split-course adaptive hypofractionated radiotherapyRadiation

    Each treatment cycle comprises a solitary radiotherapy session, which allows for its integration with chemotherapy and immunotherapy. The radiotherapy sessions are scheduled at three-week intervals, thereby affording extended recovery periods for normal tissues. An adaptive radiotherapy plan is implemented for each cycle, enabling precise adjustments to the treatment target area in response to the reduction in tumor volume.

Study groups in NCT06816966
Study groupRoleWhat they receive
Chemotherapy-immunotherapy-based split-course adaptive hypofractionated radiotherapyExperimentalEach cycle of chemotherapy and immunotherapy is synchronized with a 5 Gy dose of radiotherapy, which is precisely targeted at the gross tumor located within the thoracic cavity. The delineation of the target is adaptively adjusted based on the volumetric reduction of the tumor observed at each treatment session.
Receives: Radiation: split-course adaptive hypofractionated radiotherapy

What is being measured

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

  1. 6-month Progression-Free Survival rate

    6-month Progression-Free Survival rate from consent.

    Measured: Time from consent to any documented progression or death due to any cause, whichever occurs first, assessed up to 6 months.

  2. Safety

    For each patient, the maximum severity reported for both immune mediated and non-immune mediated adverse events will be used in the summaries. Adverse events will be summarized regardless of relationship to protocol treatment as assessed by the investigator. All adverse events, adverse events leading to withdrawal, interruption or modification of protocol treatment, grade >= 3 adverse events, and serious adverse events will be summarized. Deaths and cause of death will be summarized. The rate of treatment-related adverse events using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE, version [v.]5.0) will be reported with the frequency and severity (e.g., type, grade, and attribution). All adverse events will be classified by the relationship to treatment.

    Measured: Up to 6 months

Secondary outcomes (2)
  1. Overall survival

    Time from consent to any documented death due to any cause.

    Measured: Up to 2 years

  2. Failure pattern

    Record the first site of recurrence based on this treatment modality.

    Measured: Up to 2 years

Timeline

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

  1. First posted10 Feb 2025
  2. Study start26 Dec 2023
  3. Primary completion31 Oct 2026 (estimated)
  4. Study completion31 Oct 2028 (estimated)

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 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
35 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06816966
Sponsor's protocol ID
2023YF056-02
Acronym
CISART
Status last verified
Jan 2025
First submitted
16 Jan 2025
Last updated
10 Feb 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Survial and safety Survival data, adverse events and failure patterns.

Publications

  • Jeremic B, Shibamoto Y, Nikolic N, Milicic B, Milisavljevic S, Dagovic A, Aleksandrovic J, Radosavljevic-Asic G. Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study. J Clin Oncol. 1999 Jul;17(7):2092-9. doi: 10.1200/JCO.1999.17.7.2092.

    PubMed 10561263
  • Slotman BJ, van Tinteren H, Praag JO, Knegjens JL, El Sharouni SY, Hatton M, Keijser A, Faivre-Finn C, Senan S. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet. 2015 Jan 3;385(9962):36-42. doi: 10.1016/S0140-6736(14)61085-0. Epub 2014 Sep 14.

    PubMed 25230595
  • Horn L, Mansfield AS, Szczesna A, Havel L, Krzakowski M, Hochmair MJ, Huemer F, Losonczy G, Johnson ML, Nishio M, Reck M, Mok T, Lam S, Shames DS, Liu J, Ding B, Lopez-Chavez A, Kabbinavar F, Lin W, Sandler A, Liu SV; IMpower133 Study Group. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018 Dec 6;379(23):2220-2229. doi: 10.1056/NEJMoa1809064. Epub 2018 Sep 25.

    PubMed 30280641
  • Bernabe-Caro R, Chen Y, Dowlati A, Eason P. Current and Emerging Treatment Options for Patients With Relapsed Small-cell Lung Carcinoma: A Systematic Literature Review. Clin Lung Cancer. 2023 May;24(3):185-208. doi: 10.1016/j.cllc.2023.01.012. Epub 2023 Feb 8.

    PubMed 36907793
  • Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021 Jan 14;7(1):3. doi: 10.1038/s41572-020-00235-0.

    PubMed 33446664

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing split-course adaptive hypofractionated radiotherapy in people with Small-cell Lung Cancer, run by Fujian Medical University Union Hospital at 1 site in China.

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 16 inclusion and 11 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: enrolling by invitation, as of the sponsor's last update on 10 Feb 2025. 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 China. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

6-month Progression-Free Survival rate (time frame: Time from consent to any documented progression or death due to any cause, whichever occurs first, assessed up to 6 months.). The study lists 2 primary outcomes in all. 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 NCT06816966, which also lists 5 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 10 Feb 2025.

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