Trial Outcomes & Findings for Pembrolizumab Alone or Sequentially Following Single Fraction Non-ablative Radiation to One of the Target Lesions, in Previously Treated Patients With Stage IV NSCLC (NCT NCT02658097)

NCT ID: NCT02658097

Last Updated: 2024-05-03

Results Overview

The Best Overall Response is the best response recorded from the start of the treatment until disease progression (taking as reference for progressive disease the smallest measurements recorded since the treatment started). The anti-tumor activity will be evaluated as an efficacy endpoints based on radiographic (CT or PET/CT). RECIST 1.1 will be applied for evaluation of tumor response. RECIST 1.1 criteria are as follows: Complete Response (CR) is defined as the disappearance of all lesions and pathologic lymph nodes; Partial Response (PR) is ≥ 30% decrease in sum of diameters with no new lesions, no progression of non-target lesions; Stable disease(SD) is defined as no PR - no progressive disease; and Progressive Disease (PD) is defined as ≥ 20% increase compared to smallest sum of diameters in study or progression of non-target lesions or new lesions.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

13 participants

Primary outcome timeframe

From first visit to disease progression, up to 24 months after beginning treatment

Results posted on

2024-05-03

Participant Flow

Participant milestones

Participant milestones
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Overall Study
STARTED
13
Overall Study
COMPLETED
13
Overall Study
NOT COMPLETED
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Pembrolizumab Alone or Sequentially Following Single Fraction Non-ablative Radiation to One of the Target Lesions, in Previously Treated Patients With Stage IV NSCLC

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Age, Customized
40-49 years of age
0 Participants
n=99 Participants
Age, Customized
50-59 years of age
2 Participants
n=99 Participants
Age, Customized
60-69 years of age
3 Participants
n=99 Participants
Age, Customized
70-79 years of age
7 Participants
n=99 Participants
Age, Customized
80-89 years of age
1 Participants
n=99 Participants
Sex: Female, Male
Female
10 Participants
n=99 Participants
Sex: Female, Male
Male
3 Participants
n=99 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=99 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
11 Participants
n=99 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants
n=99 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=99 Participants
Race (NIH/OMB)
Asian
0 Participants
n=99 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
Race (NIH/OMB)
Black or African American
3 Participants
n=99 Participants
Race (NIH/OMB)
White
9 Participants
n=99 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=99 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants
n=99 Participants
Region of Enrollment
United States
13 participants
n=99 Participants
Former Smoker
Former Smoker
13 Participants
n=99 Participants
Former Smoker
Non-smoker
0 Participants
n=99 Participants
Prior Treatment
1 prior treatment
8 Participants
n=99 Participants
Prior Treatment
2 prior treatments
3 Participants
n=99 Participants
Prior Treatment
3 prior treatments
2 Participants
n=99 Participants
Types of prior treatments
Carboplatin/Abraxane
1 number of prior treatments
n=99 Participants
Types of prior treatments
Carboplatin/Pemetrexed
5 number of prior treatments
n=99 Participants
Types of prior treatments
Cisplatin/Alimta
1 number of prior treatments
n=99 Participants
Types of prior treatments
ETOPOSIDE / CARBOPLATIN 21 DAY
1 number of prior treatments
n=99 Participants
Types of prior treatments
Maintenance Pemetrexed
4 number of prior treatments
n=99 Participants
Types of prior treatments
Pemetrexed + Bevacizumab
1 number of prior treatments
n=99 Participants
Types of prior treatments
Rucaparib
2 number of prior treatments
n=99 Participants
Types of prior treatments
SBRT
1 number of prior treatments
n=99 Participants
Sites of Metastatic Disease
Bone site
5 number of sites
n=99 Participants
Sites of Metastatic Disease
Lung site
1 number of sites
n=99 Participants
Sites of Metastatic Disease
Lymph Nodes site
8 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Adrenal Gland site
5 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Contralateral lung site
7 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Kidney site
1 number of sites
n=99 Participants
Sites of Other Metastatic Disease
L supreaspinatus muscle site
2 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Mediastinal LN site
3 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Pleura site
2 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Retoperitoneal LNs site
2 number of sites
n=99 Participants
Sites of Other Metastatic Disease
Rib site
1 number of sites
n=99 Participants

PRIMARY outcome

Timeframe: From first visit to disease progression, up to 24 months after beginning treatment

The Best Overall Response is the best response recorded from the start of the treatment until disease progression (taking as reference for progressive disease the smallest measurements recorded since the treatment started). The anti-tumor activity will be evaluated as an efficacy endpoints based on radiographic (CT or PET/CT). RECIST 1.1 will be applied for evaluation of tumor response. RECIST 1.1 criteria are as follows: Complete Response (CR) is defined as the disappearance of all lesions and pathologic lymph nodes; Partial Response (PR) is ≥ 30% decrease in sum of diameters with no new lesions, no progression of non-target lesions; Stable disease(SD) is defined as no PR - no progressive disease; and Progressive Disease (PD) is defined as ≥ 20% increase compared to smallest sum of diameters in study or progression of non-target lesions or new lesions.

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Number of Patients With Each Response as Measured by RECIST 1.1
Complete Response
0 Participants
Number of Patients With Each Response as Measured by RECIST 1.1
Partial Response
4 Participants
Number of Patients With Each Response as Measured by RECIST 1.1
Progressive Disease
2 Participants
Number of Patients With Each Response as Measured by RECIST 1.1
Stable Disease
5 Participants
Number of Patients With Each Response as Measured by RECIST 1.1
Not Evaluable
2 Participants

SECONDARY outcome

Timeframe: From first visit to disease progression, up to 24 months after beginning treatment

Progression free survival, PFS is defined as the time from initiation of study drug post-SFRT, until the first documented, confirmed progression of disease. PFS will also be measured and report from the initiation of study drug, pre-SFRT.

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Median Time of Progression Free Survival
3.5 months
Interval 1.4 to
N/A implies Not Reached; the upper side of the confidence interval has not been reached by the end of the follow up period.

SECONDARY outcome

Timeframe: From first visit to disease progression, up to 24 months after beginning treatment

Overall Survival, OS will be measure from the initiation of study therapy

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Median Time of Overall Survival
9.2 months
Interval 2.6 to
N/A implies Not Reached; the upper side of the confidence interval has not been reached by the end of the follow up period.

SECONDARY outcome

Timeframe: From first visit to disease progression, up to 24 months after beginning treatment

Local Control with SFRT: The target lesion selected for SFRT will be followed for local control. For the purpose of the study, local control will be defined as a complete response, partial response, or stable disease within the planning target volume.

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Number of Patients With Local Control of Disease With SFRT
9 Participants

SECONDARY outcome

Timeframe: From first visit to disease progression, up to 24 months after beginning treatment

Local Control with SFRT: The target lesion selected for SFRT will be followed for local control. For the purpose of the study, local control will be defined as a complete response, partial response, or stable disease within the planning target volume. The duration of local control will be measured from the time of SBRT treatment fraction.

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Duration of Local Control of Disease With SFRT
13 months
Standard Deviation 11

OTHER_PRE_SPECIFIED outcome

Timeframe: From first visit to 30 days after disease progression, up to 25 months after beginning treatment

For patients receiving SFRT to lung lesions, the development of grade 3 or greater pneumonitis that is probably or definitely attributable to either SFRT or pembrolizumab within the follow-up period will be monitored

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Number of Patients With Pneumonitis
1 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: From first visit to 30 days post treatment, up to 25 months

From first visit to disease progression, up to 25 months after beginning treatment. Median (95% CI) overall survival by PD-L1 status in months.

Outcome measures

Outcome measures
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 Participants
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Changes in PD-L1
Negative PD-L Status
7.1 months
Interval 4.7 to
N/A implies Not Reached; the upper side of the confidence interval has not been reached by the end of the follow up period.
Changes in PD-L1
Positive PD-L Status
13 months
Interval 2.1 to
N/A implies Not Reached; the upper side of the confidence interval has not been reached by the end of the follow up period.

Adverse Events

Single Fraction Radiation Therapy (SFRT) + Pembrolizumab

Serious events: 5 serious events
Other events: 10 other events
Deaths: 9 deaths

Serious adverse events

Serious adverse events
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 participants at risk
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
Gastrointestinal disorders
Abdominal pain
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Edema Cerebral
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Dyspnea
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Pleural Effusion
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
General disorders
Death NOS
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
General disorders
Fever
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Psychiatric disorders
Confusion
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Injury, poisoning and procedural complications
Fall
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Renal and urinary disorders
Acute kidney injury
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Respitory Failure
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Colitis
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Syncope
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.

Other adverse events

Other adverse events
Measure
Single Fraction Radiation Therapy (SFRT) + Pembrolizumab
n=13 participants at risk
200mg Pembrolizumab by IV infusion on day 1 of each 3 week cycle. 8Gy will be given in a single fraction on the first day of treatment Pembrolizumab: 200mg Pembrolizumab by IV infusion Single Fraction Radiation Therapy: 8Gy radiation therapy will be given in a single fraction on the first day of treatment
General disorders
Fatigue
30.8%
4/13 • Number of events 5 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Hypoalbuminemia
46.2%
6/13 • Number of events 8 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Blood and lymphatic system disorders
Anemia
38.5%
5/13 • Number of events 6 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Esophagitis
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Tracheal Mucositis
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Arthralgia
7.7%
1/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Endocrine disorders
Hypothyroidism
15.4%
2/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Hyponatremia
38.5%
5/13 • Number of events 5 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Skin and subcutaneous tissue disorders
Rash Maculo-Papular
15.4%
2/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Dysphasia
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
White blood cell decrease
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Dry Mouth
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Myalgia
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Nausea
15.4%
2/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Headache
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Injury, poisoning and procedural complications
Fall
15.4%
2/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Seizure
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Generalized muscle weakness
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Memory impairment
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Hypermagnesemia
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Encephalopathy
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Hypocalcemia
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
Lymphocyte count decreased
30.8%
4/13 • Number of events 4 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
Alkaline phosphatase increased
15.4%
2/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Chest wall pain
7.7%
1/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Epistaxis
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
General disorders
Edema limbs
15.4%
2/13 • Number of events 3 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
Creatinine increased
15.4%
2/13 • Number of events 6 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Anorexia
15.4%
2/13 • Number of events 3 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Dysphagia
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Hypokalemia
23.1%
3/13 • Number of events 5 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Dizziness
15.4%
2/13 • Number of events 6 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Pneumonitis
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Pleural Effusion
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Diarrhea
15.4%
2/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Cough
15.4%
2/13 • Number of events 3 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
Aspartate aminotransferase increased
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Infections and infestations
Lung Infection
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Nervous system disorders
Stroke
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
Platelet count decreased
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Bone pain
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Renal and urinary disorders
Acute Kidney Injury
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Metabolism and nutrition disorders
Hyperglycemia
15.4%
2/13 • Number of events 3 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Respiratory, thoracic and mediastinal disorders
Dyspnea
7.7%
1/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Pain in extremity
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Investigations
Weight Loss
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Musculoskeletal and connective tissue disorders
Muscle cramp
7.7%
1/13 • Number of events 2 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Gastrointestinal disorders
Vomiting
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.
Infections and infestations
Sinusitis
7.7%
1/13 • Number of events 1 • Adverse events were collected up until 30 days after the final dose of study drug was administered to each participant.

Additional Information

Dr. Nathan Pennell

Cleveland Clinic, Case Comprehensive Cancer Center

Phone: 1-866-223 8100

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place