IRAM: Phase II Trial Assessing the Efficacy of Immuno-Radiation Abscopal Effect in Patients With Metastatic Cancers

Sponsor

Institut de Cancérologie de la Loire (Other)

Overall Status

Withdrawn

CT.gov ID

NCT03323424

Collaborator

Saint-Louis Hospital, Paris, France (Other), Gustave Roussy, Cancer Campus, Grand Paris (Other)

Enrollment

Locations

Arms

Anticipated Duration (Months)

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The proposed theory is based on combination of radiation therapy with usual targeted therapies capable of ADCC (Antibody-Dependant Cell Cytotoxicity). This association could enhance in a additive/synergistic way the benefic impact of immune system activation on tumor control. Stereotactic Body Radio-Therapy (SBRT) will be combined with the first line chemotherapy for metastatic breast, colorectal or VADS (upper aerodigestive tract) cancers. The IRAM study objective is to highlight a possible abscopal effect of this combination for metastatic cancer patients.

Condition or Disease	Intervention/Treatment	Phase
Metastatic Breast Cancer Metastatic Colorectal Cancer Metastatic Head and Neck Cancer	Radiation: Systemic treatment + Stereotactic Body Radio-Therapy (SBRT) Other: Systemic treatment	Phase 2

Detailed Description

Nowadays, metastatic cancer treatment is evolving with systemic treatments (target therapies and immunotherapies). Combinations and new therapeutic schemes have recently boosted the interest for an effect called "abscopal". This effect is based on the immune-stimulating effect of high doses ionizing radiations, but also on synergistic association with systemic treatment with immunologic mechanisms. This effect could enhance the tumor local control, but also its distant control.

Numerous preclinical evidences as well as some clinical case reports described the abscopal effect.

Ongoing clinical studies are investigating with radiotherapy abscopal effect alone, or associated with immunotherapies (anti-CTLA-4, PD-1 or PDL-1). The present study proposes a new association, based on an original biological rational. The proposed theory is based on combination of radiation therapy with usual targeted therapies capable of ADCC (Antibody-Dependant Cell Cytotoxicity). This association could enhance in an additive/synergistic way the benefic impact of immune system activation on tumor control.

In the present study, Stereotactic Body Radio-Therapy (SBRT) will be combined to the standard systemic treatment for first line treatment of metastatic breast, colorectal and VADS (upper aerodigestive tract) cancers. Indeed, these treatments have in common the use of target therapies capable of ADCC.

The IRAM study objective is to highlight a possible abscopal effect of this combination for metastatic cancer patients.

Study Design

Study Type:

Interventional

Actual Enrollment :

0 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Phase II Trial Assessing the Efficacy of Immuno-Radiation Abscopal Effect in Patients With Metastatic Cancers (IRAM)

Anticipated Study Start Date :

Jan 1, 2019

Anticipated Primary Completion Date :

Feb 1, 2021

Anticipated Study Completion Date :

Feb 1, 2026

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Systemic treatment + Stereotactic Body Radio-Therapy (SBRT) Patients with metastatic breast, colorectal or head or neck cancers and corresponding with the inclusion criteria will receive a systemic treatment, according to the usual practice, but also a Stereotactic Body Radio-Therapy (SBRT).	Radiation: Systemic treatment + Stereotactic Body Radio-Therapy (SBRT) According to the usual practice, patients will receive their systemic treatment, composed of : Taxane + trastuzumab +pertuzumab for metastatic breast cancers; FOLFOX or FOLFIRI + cetuximab for metastatic colorectal cancers; 5FU-Platine + cetuximab for metastatic head and neck cancers; for six cycles and a maintenance of the targeted therapy until progression or unacceptable toxicity. If progression occurs before the 6th cycles, patients could receive a different line of treatment, according to the usual practice. In addition to the systemic treatment, patients randomized into this experimental group will receive a SBRT of 45Gy in 3 fractions for hepatic and pulmonary metastasis, 27Gy in 3 fractions for bone metastasis and 33 Gy in 3 fractions for intra-cranial metastasis.
Active Comparator: Systemic treatment Patients with metastatic breast, colorectal or head or neck cancers and corresponding with the inclusion criteria will receive a systemic treatment, according to the usual practice.	Other: Systemic treatment According to the usual practice, patients will receive their systemic treatment, composed of : Taxane + trastuzumab +pertuzumab for metastatic breast cancers; FOLFOX or FOLFIRI + cetuximab for metastatic colorectal cancers; 5FU-Platine + cetuximab for metastatic head and neck cancers; for six cycles and a maintenance of the targeted therapy until progression or unacceptable toxicity. If progression occurs before the 6th cycles, patients could receive a different line of treatment, according to the usual practice.

Arm

Intervention/Treatment

Experimental: Systemic treatment + Stereotactic Body Radio-Therapy (SBRT)

Patients with metastatic breast, colorectal or head or neck cancers and corresponding with the inclusion criteria will receive a systemic treatment, according to the usual practice, but also a Stereotactic Body Radio-Therapy (SBRT).

Radiation: Systemic treatment + Stereotactic Body Radio-Therapy (SBRT)

According to the usual practice, patients will receive their systemic treatment, composed of : Taxane + trastuzumab +pertuzumab for metastatic breast cancers; FOLFOX or FOLFIRI + cetuximab for metastatic colorectal cancers; 5FU-Platine + cetuximab for metastatic head and neck cancers; for six cycles and a maintenance of the targeted therapy until progression or unacceptable toxicity. If progression occurs before the 6th cycles, patients could receive a different line of treatment, according to the usual practice. In addition to the systemic treatment, patients randomized into this experimental group will receive a SBRT of 45Gy in 3 fractions for hepatic and pulmonary metastasis, 27Gy in 3 fractions for bone metastasis and 33 Gy in 3 fractions for intra-cranial metastasis.

Active Comparator: Systemic treatment

Patients with metastatic breast, colorectal or head or neck cancers and corresponding with the inclusion criteria will receive a systemic treatment, according to the usual practice.

Other: Systemic treatment

Outcome Measures

Primary Outcome Measures

Survival rate without progression for patients with metastatic breast cancer [18 months]
The rate of survival without progression according to the RECIST (v1.1) criteria for patients with metastatic breast cancer will be calculated at 18 months after the beginning of the systemic treatment.
Survival rate without progression for metastatic head and neck cancer [6 months]
The rate of survival without progression according to the RECIST (v1.1) criteria for patients with head and neck cancer will be calculated at 6 months after the beginning of the systemic treatment.
Survival rate without progression for patients with metastatic colorectal cancer [9 months]
The rate of survival without progression according to the RECIST (v1.1) criteria for patients with colorectal cancer will be calculated at 9 months after the beginning of the systemic treatment.

Secondary Outcome Measures

Response rate on predetermined metastatic abscopal sites [3 months]
The response rate on predetermined metastatic abscopal sites will be evaluated at 3 months after the beginning of the systemic treatment according to the RECIST v1.1 criteria.
Response rate on the irradiated site [3 months]
The response rate on the irradiated site will be evaluated at 3 months after the beginning of the systemic treatment according to the RECIST v1.1 criteria.
Progression-free survival (PFS) [5 years]
The median PFS according to the RECIST v1.1 criteria will be reported at 5 years after the beginning of the systemic treatment.
Overall survival (OS) [5 years]
The OS will be reported at 5 years after the beginning of the systemic treatment.
Toxicity of the treatments combination [6 cycles]
During the first line of systemic treatment (six cycles of treatment maximum), the number and the grade (CTCAE v4.4) of toxicities related to the systemic treatment /Radiation therapy combination will be reported.
Toxicity of the treatments combination [5 years]
Sub-group analysis will be performed following the 3 binary stratification criteria: total number of metastasis, localization of the irradiated metastasis and irradiated volume.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Patients with a metastatic breast adenocarcinoma HER2+, a metastatic squamous carcinoma of VADS, or a colorectal adenocarcinoma with a wild status for RAS (NRAS and KRAS)
Patient presenting at least two measurable metastases (according to the RECIST v1.1 criteria):
At least one eligible to SBRT (hepatic, pulmonary, bone or intra-cranial metastasis, with a diameter between 1 and 4cm)
At least one non irradiated measurable metastasis
Performance Status corresponding to 0, 1, or 2
Realisation of a PET (Positron Emission Tomography)-Scanner and a TAP (Thoraco-AbdominoPelvic)-Scanner 30 days maximum before inclusion
Informed consent patient
Patients affiliated to a social security scheme.

Exclusion Criteria:

Patient presenting a known non-indication or contraindication to the first line treatment administered
Pregnant or nursing women
Patient with an another cancer during the 5 last years, excepting basocellular carcinoma, and skin epidermoid carcinoma
Patient presenting a non-controlled pain linked to the cancer
Patient presenting a non-controlled hypercalcemia or symptomatic hypercalcemia needing an ongoing use of bisphosphonates or denosumab.
Patient presenting an inflammatory pathology or active autoimmune pathology or history of.
Patient having received one or more vaccines during the 4 weeks preceding the beginning of the systemic treatment.
Patient currently using corticosteroids or other immune-suppressors during the two weeks before inclusion, and any other situation where this kind of treatments could be necessary during the study.
Patient deprive of liberty or under administrative supervision, patients with an impossible take care supervision for psychological or geographical reasons.
Stereotactic Body Radio-Therapy (SBRT) must not include metastases localized in the 3 centimeters of the structure previously irradiated.
Patient presenting serious active comorbidities defined by the protocol.
Known seropositivity to the HIV

Contacts and Locations

Locations

	Site	City	Country	Postal Code
1	Clinique Claude Bernard	Albi	France	81000
2	Centre Léonard de Vinci	Dechy	France	59507
3	Centre Hospitalier Privé Saint Gregoire	Saint-Grégoire	France	35760
4	CHU de St-Etienne	Saint-Priest-en-Jarez	France	42270
5	Institut de Cancérologie Lucien Neuwirth	Saint-Priest-en-Jarez	France	42270
6	Centre Marie Curie	Valence	France	26000