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NSCLC (Non-small Cell Lung Cancer)Phase 2HYPERBOLICNCT07274384

Hyperprogression in PD-L1 ≥ 50% NSCLC: a Biomarker Guided Phase 2 Trial

A Phase 2 study testing chemotherapy plus cemiplimab and Cemiplimab in people with NSCLC (Non-small Cell Lung Cancer) and Hyperprogression, run by Università Vita-Salute San Raffaele.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Official record
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Trial summary

In metastatic NSCLC patients with PD-L1 expression ≥50%, a circulating immature (CD10-) LDNs level of ≥30.5% confers a high risk of hyperprogression (HPD) with first line single-agent immune-checkpoint inhibitors (SA-ICI). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
chemotherapy plus cemiplimab and Cemiplimab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
74 participants
Where
No sites listed yet
Study dates
1 Jan 2026to 1 Jun 2030
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

  • The participant (or legally acceptable representative) has provided documented informed consent to participation to the study and data protection consent form.
  • Male or female aged 18 years or older.
  • ECOG Performance Status of 0 - 2.
  • Pathologically (histologically or cytologically) confirmed diagnosis of stage IV NSCLC (TNM 8th edition), who received no prior systemic treatment for recurrent or metastatic NSCLC. Mixed squamous/non-squamous tumors are eligible.
  • PD-L1 TPS ≥ 50% (by local test).
  • Absence of targetable oncogene alterations (EGFR, ALK, ROS1).
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  • Circulating CD10- LDNs >30.5% at screening. LDNs will be defined as CD11b+CD15+ cells among live PBMC. Flow cytometry raw data will be centrally analyzed by the coordinating center.
  • Measurable disease (RECIST 1.1) on two CT scans performed before randomization. The following criteria must be fulfilled:
  • Participants must have at least one measurable lesion that has not been previously treated with radiotherapy.
  • Chest and abdomen scans are mandatory
  • Availability of measurable disease scans to be anonymized and sent for central independent confirmation by a radiologist of the coordinating center.
  • A minimum 2-week interval and a maximum 12-week interval will be acceptable between the two pre-treatment CT scans.
  • Availability to perform the baseline scan within a maximum 4-week interval before treatment start.
  • Patient's willingness to undergo blood draws to provide plasma and blood samples for analysis according to study objectives.
  • Adequate organ and marrow function as defined below:
  • Absolute neutrophil count > 1.5 x 109/L (1500/mm3)
  • Platelets ≥100 x 109/L (100 000/mm3)
  • Haemoglobin ≥9.0 g/dL (5.59 mmol/L)
  • Estimated glomerular filtration rate (according to CDK-EPI equation): ≥ 60ml/min/1.73 m2 for patients receiving cisplatin; ≥30 ml/min/1.73 m2 for patients receiving carboplatin.
  • Serum bilirubin ≤1.5 x upper limit of normal (ULN). This will not apply to patients with confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of evidence of hemolysis or hepatic pathology) who will be allowed in consultation with their physician.
  • AST and ALT ≤2.5 x ULN.
  • Absence of a known severe hypersensitivity (≥ Grade 3) to any of the study chemotherapy agents and/or cemiplimab and/or to any of their excipients

Who cannot join

  • Any infection requiring hospitalization or treatment with IV anti-infectives within 2 weeks of first dose of study medication
  • Known uncontrolled infection with HIV, hepatitis B or hepatitis C infection, diagnosis of immunodeficiency, and/or tuberculosis (active or latent). No serological testing is required unless mandated by local health authority.
  • Administration of live or live-attenuated vaccines within 30 days before the baseline LDNs assessment. Administration of killed vaccines is allowed. Receipt of COVID-19 vaccination within 1 week of planned start of study medication or for which the planned COVID-19 vaccinations would not be completed 1 week prior to start of study medication.
  • History of interstitial lung disease (eg, idiopathic pulmonary fibrosis or organizing pneumonia), of active, noninfectious pneumonitis that required immune-suppressive doses of glucocorticoids to assist with management.
  • Administration of radiotherapy within 7 days prior to the baseline LDNs assessment.
  • Administration of colony-stimulating factors (e.g., G-CSF, GM-CSF) or recombinant erythropoietin within 28 days prior to the baseline LDNs assessment. Primary prophylaxis with G-CSF and pegylated G-CSF is not allowed. Secondary prophylaxis is not recommended and required case-by-case discussion with the coordinator center before G-CSF administration.
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  • Ongoing or recent evidence of significant autoimmune disease that required treatment with systemic immunosuppressive treatments. The following are not exclusionary: vitiligo, childhood asthma that has resolved, endocrinopathies (such as hypothyroidism or type 1 diabetes) that require only hormone replacement, or psoriasis that does not require systemic treatment.
  • Female patients who are pregnant, breast-feeding, male, or female patients of reproductive potential who are not employing an highly effective method of birth control.
  • Any condition that, in the opinion of the investigator, would interfere with the evaluation of the study drug or interpretation of patient safety or study results.
  • Any concurrent chemotherapy, immunotherapy, biologic or hormonal therapy for cancer treatment (Concurrent use of hormonal therapy for non-cancer-related conditions (e.g., hormone replacement therapy) is acceptable).
  • Allogenic tissue/solid organ transplant.

About this study

Official title: Hyperprogression Upon Cemiplimab Alone or With Chemotherapy in PD-L1 ≥ 50% NSCLC: a Biomarker Guided Phase 2 Trial - HYPERBOLIC Trial

In metastatic NSCLC patients with PD-L1 expression ≥50%, a circulating immature (CD10-) LDNs level of ≥30.5% confers a high risk of hyperprogression (HPD) with first line single-agent immune-checkpoint inhibitors (SA-ICI). HPD is defined as a tumor growth rate (TGR) delta ≥50% between pre-treatment and post-treatment, and/or a TGR ratio ≥2. The combination of platinum-based chemotherapy (PCT) with ICI in this setting could prevent the occurrence of HPD and ultimately improve survival outcomes.

This randomized, multicentric, open-label, phase 2 trial will include patients with stage IV NSCL, without targetable oncogene drivers, PD-L1 TPS≥50%, and measurable disease on two CT scans performed before randomization. Participants will be randomized 1:1 to SA-ICI or ICI+PCT. Radiological evaluation will be performed by CT-scan at 6-8 weeks and subsequently according to the local investigators' schedule.

Read more

In the SA-ICI arm, ICI regimen will include cemiplimab. In the PCT+ICI arm, PCT regimens will include both carboplatin or cisplatin + pemetrexed (for non-squamous histology) or paclitaxel (for squamous histology) in combination with cemiplimab.

PCT will be administered for three cycles. In case of stable disease or partial response according to RECIST v.1.1, cemiplimab will be performed as monotherapy from the third cycle until disease progression or unacceptable toxicity. If progression according to RECIST v.1.1 or HPD after three cycles of PCT+ICI, patients will be treated with standard second line therapy as local standard of care.

Read the detailed description

Intervention: PCT plus cemiplimab for 3 cycles followed by cemiplimab in case of absence of PD/HPD. PCT regimens will include both carboplatin (area under the concentration-time curve, 5 mg per milliliter per minute) or cisplatin (75 mg per square meter of body surface area) plus pemetrexed (500 mg per square meter) for non-squamous histology or paclitaxel (200 mg per square meter) for squamous histology. All drugs in the PCT regimens will be administered intravenously every 3 weeks. Cemiplimab 350 mg "flat dose" will be administered intravenously every 3 weeks. Treatment will continue for a maximum of 108 weeks or until progression or unacceptable toxicity.

Comparator: Single-agent cemiplimab. Cemiplimab 350 mg "flat dose" will be administered intravenously every 3 weeks for 108 weeks or until progression or unacceptable toxicity.

Efficacy criteria: The rate of patients experienced HPD or ED will be calculated for both treatment arms.1 HPD is defined as a delta of tumor growth rate (TGR) ≥50% and/or a TGR ratio ≥2. TGR will be computed using RECIST v.1.1 on three consecutive, centrally revised, CT scans (two CT scans before treatment start and one after 7 week ± 5 days from treatment start).

Central review of CT scans will be performed before treatment start and after the first radiological evaluation (before third cycle). RECIST response after the second cycles will be decided according to central review.

ED is defined as tumor-related death within 12 weeks from ICI initiation, in absence of a radiological evaluation performed during ICI.

HPD rate according to definitions proposed by Lo Russo et al., Matos et al.et Saâd-Bouzid et al., will be evaluated as a secondary endpoint.

Efficacy parameters: After the first radiological evaluation performed at 7 weeks ± 5 days from treatment start, subjects will be evaluated by CT scans every 12 weeks ± 28 days according to local investigators' schedule.

CT scans are to be performed until disease progression or until the start of new anticancer treatment, withdrawal of consent, or death, whichever occurs first.

Per RECIST 1.1, the partial and complete response should be confirmed by a repeat tumor imaging assessment not less than 4 weeks from the date the response was first documented.

The enrollment period will last 48 months. The approximate duration of the active study assessments for each patient, including the screening phase, will be 3 months (the time required to confirm HPD occurrence or not). The duration of the active portion of the study will be 48 months, followed by and additional 3 months of follow-up, for a total of 51 months. In both arms, patients will receive treatment for a maximum of 108 weeks or until disease progression or unacceptable toxicity occurs. After the active portion of the study is completed, all patients will be followed for survival.

Being tested
chemotherapy plus cemiplimab, Cemiplimab
Keywords
lung, cancer, hyperprogression, chemotherapy, immunotherapy, carboplatin, cisplatin, pemetrexed, paclitaxel, cemiplimab, risk, immune-checkpoint inhibitors, ldns, CD10-, nsclc, PD-L1, randomized, open-label, Lung Immune Prognostic Index, recist
Medical subject headings
Carcinoma, Non-Small-Cell Lung, Neoplasms, Disease Progression

What participants receive

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

  • chemotherapy plus cemiplimabCombination product

    Also called cemiplimab, carboplatin, cisplatin, pemetrexed

    Combination of platinum-based chemotherapy (PCT) with ICI. PCT regimens will include both carboplatin or cisplatin plus pemetrexed (for non-squamous histology) or paclitaxel (for squamous histology) in combination with cemiplimab. PCT will be administered for three cycles.

  • CemiplimabDrug

    Also called libtayo

    single-agent immune-checkpoint inhibitors

Study groups in NCT07274384
Study groupRoleWhat they receive
single-agent immune-checkpoint inhibitorsActive comparatorsingle-agent immune-checkpoint inhibitors (SA-ICI) (Cemiplimab)
Receives: Drug: Cemiplimab
PCT regimens + immune-checkpoint inhibitorsExperimentalPCT regimens will include both carboplatin or cisplatin plus pemetrexed (for non-squamous histology) or paclitaxel (for squamous histology) in combination with cemiplimab
Receives: Combination Product: chemotherapy plus cemiplimab

What is being measured

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

  1. HPD rate

    HPD rate, defined as the proportion of patients with a delta of TGR ≥50% or a TGR ratio ≥2 at 7 weeks ± 5 days from randomization

    Measured: up to HPD, end of treatment for a maximum of 108 weeks whichever comes first

  2. ED rate

    ED rate: who died without undergoing a scan after treatment initiation.

    Measured: up to ED, end of treatment for a maximum of 108 weeks whichever comes first

Secondary outcomes (4)
  1. Overall survival (OS)

    To compare the activity of cemiplimab+PCT relative to cemiplimab alone.

    Measured: up to HPD, ED, end of treatment for a maximum of 108 weeks whichever comes first

  2. Progression free survival (PFS)

    To compare the activity and efficacy of cemiplimab+PCT relative to cemiplimab alone

    Measured: up to HPD, ED, end of treatment for a maximum of 108 weeks whichever comes first

  3. Objective response rate (ORR)

    To compare the activity of cemiplimab+PCT relative to cemiplimab alone.

    Measured: up to HPD, ED, end of treatment for a maximum of 108 weeks whichever comes first

  4. Number of participants with treatment-related adverse events as assessed by CTCAE v5.0

    Summary of adverse events (AE), with a focus on TRAEs coded based upon the Medical Dictionary for Regulatory Activities (MedDRA) and graded based upon CTCAE, ver. 5.0.

    Measured: up to 90 days after the last dose of study treatment

Timeline

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

  1. First posted10 Dec 2025
  2. Study start1 Jan 2026 (estimated)
  3. Primary completion31 Dec 2029 (estimated)
  4. Study completion1 Jun 2030 (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
Randomised
Intervention model
Parallel groups
Model description
randomized, open-label
Masking
None (open label)
Enrolment
74 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07274384
Sponsor's protocol ID
2025-521583-35-00
Other IDs
2025
Acronym
HYPERBOLIC
Status last verified
Nov 2025
First submitted
17 Sep 2025
Last updated
10 Dec 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing chemotherapy plus cemiplimab and Cemiplimab in people with NSCLC (Non-small Cell Lung Cancer) and Hyperprogression, run by Università Vita-Salute San Raffaele.

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 22 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: opening soon, as of the sponsor's last update on 10 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

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?

HPD rate (time frame: up to HPD, end of treatment for a maximum of 108 weeks whichever comes first). 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?
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 Dec 2025.

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