Resumen

El propósito de este estudio es evaluar la eficacia y seguridad de pembrolizumab en combinación con quimiorradioterapia concurrente seguida de pembrolizumab con placebo de olaparib (Brazo 1) o con olaparib (Brazo 2), en comparación con quimiorradioterapia concurrente seguida de durvalumab (Brazo 3), en participantes con CPNCP localmente avanzado, irresecable. Los brazos 1 y 2 seguirán un diseño doble ciego y el Brazo 3 será abierto. Las hipótesis primarias son: 1. Pembrolizumab con quimiorradioterapia concurrente seguido de pembrolizumab con olaparib es superior a quimiorradioterapia concurrente seguida de durvalumab en cuanto a supervivencia libre de progresión (SLP) y supervivencia global (SG). 2. Pembrolizumab con quimiorradioterapia concurrente seguido de pembrolizumab es superior a quimiorradioterapia concurrente seguida de durvalumab en cuanto a SLP y SG.

Elegibilidad

Edad mínima: 18 YearsSexo: ALL

Criterios de inclusión

Has pathologically (histologically or cytologically) confirmed diagnosis of NSCLC
Has Stage IIIA, IIIB, or IIIC NSCLC by American Joint Committee on Cancer Version 8
Is unable to undergo surgery with curative intent for Stage III NSCLC
Has no evidence of metastatic disease indicating Stage IV NSCLC
Has measurable disease as defined by RECIST 1.1
Has not received prior treatment (chemotherapy, targeted therapy or radiotherapy) for Stage III NSCLC; participants who have received neoadjuvant and/or adjuvant therapy for early stage disease are not eligible
Has provided a tumor tissue sample (tissue biopsy \[core, incisional, or excisional\])
Has an Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1 assessed within 7 days prior to the first administration of study intervention
Has a life expectancy of at least 6 months
A male participant must agree to use contraception and refrain from donating sperm during the intervention period and for at least the time needed to eliminate each study intervention after the last dose of study intervention unless confirmed to be azoospermic (vasectomized or secondary to medical cause). The length of time required to continue contraception for each study intervention is as follows: Olaparib, platinum doublet, and radiotherapy: 90 days
A female participant is eligible to participate if she is not pregnant, not breastfeeding, and agrees to use contraception and refrain from donating eggs (ova, oocytes) to others or freeze/store for her own use for the purpose of reproduction during the treatment period and for at least the time needed to eliminate each study intervention after the last dose of study intervention and agrees to abstain from breastfeeding during the study intervention period and for at least 120 days after the last dose of study intervention. The length of time required to continue contraception for each study intervention is as follows: Pembrolizumab: 120 days; Olaparib, platinum doublet, and radiotherapy: 180 days
Has a negative highly sensitive pregnancy test (\[urine or serum\] as required by local regulations) within 24 hours for urine or within 72 hours for serum before the first dose of study intervention. If a urine test cannot be confirmed as negative (e.g., an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
Has had her medical history, menstrual history, and recent sexual activity reviewed by the investigator to decrease the risk for inclusion of a woman with an early undetected pregnancy.
Has adequate pulmonary function tests
Has adequate organ function
Has provided written informed consent

Criterios de exclusión

Has small cell lung cancer or a mixed tumor with presence of small cell elements
Has myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) or has features suggestive of MDS/AML
Has had documented weight loss \>10% (from baseline) in the preceding 3 months
Has received prior radiotherapy to the thorax, including radiotherapy to the esophagus, mediastinum, or for breast cancer
Has received prior therapy with an anti-programmed cell death 1 (ant-PD-1), anti-programmed cell death ligand 1 (anti-PD-L1), or anti- programmed cell death ligand 2 (anti-PD-L2) agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor
Has received prior therapy with olaparib or with any other polyadenosine 5'diphosphoribose (polyADP ribose) polymerization (PARP) inhibitor
Has had major surgery \<4 weeks prior to the first dose of study treatment (except for placement of vascular access)
Is expected to require any other form of antineoplastic therapy, while on study
Has received a live or live attenuated vaccine within 30 days before the first dose of study intervention; administration of killed vaccines is allowed
Has received colony-stimulating factors (e.g., granulocyte colony-stimulating factor \[GCSF\], granulocyte-macrophage colony-stimulating factor \[GM-CSF\] or recombinant erythropoietin) within 28 days prior to the first dose of study treatment
Is currently receiving either strong (phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John's Wort) or moderate (e.g. bosentan, efavirenz, modafinil) inducers of CYP3A4 that cannot be discontinued for the duration of the study
Is currently receiving either strong (eg, itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate (eg. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil) inhibitors of cytochrome P450 (CYP)3A4 that cannot be discontinued for the duration of the study
Is unable to interrupt aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), other than an aspirin dose ≤1.3 grams per day, for at least 2 days before, during, and for at least 2 days after administration of pemetrexed
Is unable/unwilling to take folic acid, vitamin B12, and dexamethasone during administration of pemetrexed
Has received an investigational agent or has used an investigational device within 4 weeks prior to study treatment
The presence of uncontrolled, potentially reversible cardiac conditions, as judged by the investigator or has congenital long QT syndrome
Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of study intervention
Has a known additional malignancy that is progressing or has required active treatment within the past 5 years with the exception of basal cell carcinoma of the skin, squamous cell carcinoma of the skin, superficial bladder cancer, or carcinoma in situ (excluding carcinoma-in situ-of the bladder) that have undergone potentially curative therapy
Has severe hypersensitivity (≥Grade 3) to study intervention and/or any of its excipients
Has an active autoimmune disease that has required systemic treatment in past 2 years
Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease
Has an active infection requiring systemic therapy
Has a known history of human immunodeficiency virus (HIV) infection
Has a known history of Hepatitis B or known active Hepatitis C virus infection
Has active tuberculosis (TB; Mycobacterium tuberculosis) and is receiving treatment
Has a history or current evidence of any condition, therapy, laboratory abnormality or other circumstance that might confound the results of the study, or interfere with the participant's participation for the full duration of the study, such that it is not in the best interest of the participant to participate, in the opinion of the treating investigator
Is considered a poor medical risk due to a serious, uncontrolled medical disorder or nonmalignant systemic disease in the opinion of the treating investigator
Has a known psychiatric or substance abuse disorder that would interfere with the participant's ability to cooperate with the requirements of the study
Is unable to swallow orally administered medication or has a gastrointestinal disorder affecting absorption
Has had an allogenic tissue/solid organ transplant

IV infusion

Resumen

Elegibilidad

Criterios de inclusión

Criterios de exclusión

Intervenciones

Pembrolizumab

Olaparib

Placebo for olaparib

Etoposide

Carboplatin

Cisplatin

Paclitaxel

Pemetrexed

Thoracic Radiotherapy

Durvalumab

Ubicaciones

Clinica Adventista Belgrano-Oncology ( Site 4002)

Instituto Médico Río Cuarto ( Site 4003)

Patrocinadores