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    Clinical Trial Results:
    A PHASE II PROSPECTIVE IMMUNE NEOADJUVANT THERAPY STUDY OF DURVALUMAB (MEDI4736) IN EARLY STAGE NON-SMALL CELL LUNG CANCER

    Summary
    EudraCT number
    2016-001849-15
    Trial protocol
    FR  
    Global end of trial date
    28 Aug 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Aug 2022
    First version publication date
    11 Aug 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    IFCT-1601 IONESCO
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03030131
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    IFCT
    Sponsor organisation address
    10 rue de la Grange-Batelière, Paris, France, 75009
    Public contact
    Contact, IFCT, 33 156811045, contact@ifct.fr
    Scientific contact
    Contact, IFCT, 33 156811045, contact@ifct.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    06 May 2021
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Aug 2019
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To assess the impact of neo-adjuvant therapy with durvalumab given by intravenous infusion for one month on the complete resection (R0).
    Protection of trial subjects
    Algorithms for management of adverse events were provided in the protocol.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    24 Apr 2017
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 50
    Worldwide total number of subjects
    50
    EEA total number of subjects
    50
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    35
    From 65 to 84 years
    15
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 50 patients were recruited from April 2017 to August 2019 in 20 sites, of whom 46 met the eligibility criteria and received durvalumab.

    Pre-assignment
    Screening details
    Histologically confirmed NSCLC, classified as stage IB (only ≥4 cm), IIA, IIB, or IIIA non N2. Brain imaging, FDG-PET and a thoraco abdominopelvic CT scan were performed within one month prior to inclusion. Patients ≥18 years old with an ECOG performance status score of 0 1 were eligible. Pre therapeutic tissue was required.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Durvalumab
    Arm description
    Monotherapy arm
    Arm type
    Experimental

    Investigational medicinal product name
    Durvalumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    750 mg at D1, D15 and D29 over 60 minutes

    Number of subjects in period 1
    Durvalumab
    Started
    50
    Completed
    43
    Not completed
    7
         Protocol deviation
    4
         Lack of efficacy
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial (overall period)
    Reporting group description
    -

    Reporting group values
    Overall trial (overall period) Total
    Number of subjects
    50 50
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (full range (min-max))
    61.0 (46.0 to 80.4) -
    Gender categorical
    Units: Subjects
        Female
    15 15
        Male
    35 35
    Smocking status
    Units: Subjects
        Smockers
    47 47
        Never smockers
    3 3
    ECOG performance status
    Units: Subjects
        PS 0
    40 40
        PS 1
    10 10
    Histology
    Units: Subjects
        Adenocarcinoma
    25 25
        Squamous cell carcinoma
    21 21
        Other
    4 4
    Stage
    Units: Subjects
        IB
    5 5
        IIA
    14 14
        IIB
    29 29
        IIIA
    1 1
        Other stages
    1 1
    Histological evidence
    Units: Subjects
        Yes
    49 49
        No
    1 1
    Cytological evidence
    Units: Subjects
        Yes
    12 12
        No
    38 38
    Diagnosis
    Units: Subjects
        Echoendoscopy
    6 6
        Fibroscopy
    24 24
        Fibroscopy + Echoendoscopy
    1 1
        Transthoracic puncture
    19 19
    Smocking details
    Units: Pack Year
        median (full range (min-max))
    40.0 (2 to 100) -
    Weight
    Units: kilogram(s)
        median (full range (min-max))
    74 (44 to 101) -

    End points

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    End points reporting groups
    Reporting group title
    Durvalumab
    Reporting group description
    Monotherapy arm

    Subject analysis set title
    ITT population
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All included patients

    Subject analysis set title
    Safety population - Durvalumab
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All patients who had received at least one dose of durvalumab

    Subject analysis set title
    Efficacy population - Durvalumab
    Subject analysis set type
    Per protocol
    Subject analysis set description
    Eligible patients without any major deviations from the inclusion/exclusion criteria

    Subject analysis set title
    Efficacy population - Durvalumab and surgery
    Subject analysis set type
    Per protocol
    Subject analysis set description
    all eligible patients who had received at least one dose of durvalumab and who undergone surgery

    Primary: Surgical Resection R0

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    End point title
    Surgical Resection R0 [1]
    End point description
    Patient percentage of surgical resection R0 after a maximum of 3 cycles of immune therapy
    End point type
    Primary
    End point timeframe
    2 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Not applicable as the study was single arm
    End point values
    Durvalumab
    Number of subjects analysed
    46
    Units: % of participants
    number (confidence interval 95%)
        Complete resection (R0)
    89.1 (80.1 to 98.1)
        Microscopically incomplete resection (R1)
    4.3 (0.0 to 10.2)
        Not evaluable/Not done
    6.5 (0.0 to 13.7)
    No statistical analyses for this end point

    Secondary: Delay Between Surgery and Start of Treatment

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    End point title
    Delay Between Surgery and Start of Treatment
    End point description
    End point type
    Secondary
    End point timeframe
    After 28 days (3 cycles of immune therapy maximum)
    End point values
    Durvalumab
    Number of subjects analysed
    43
    Units: Days
        median (full range (min-max))
    37.0 (29 to 46)
    No statistical analyses for this end point

    Secondary: Response Rate (RECIST 1.1)

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    End point title
    Response Rate (RECIST 1.1)
    End point description
    Response Rate include patient with complete response (disappearance of all target lesions) or partial response (at least a 30% decrease in the sum of diameters of target lesions since inclusion) as evaluated with Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1).
    End point type
    Secondary
    End point timeframe
    After 28 days (3 cycles of immune therapy maximum)
    End point values
    Durvalumab
    Number of subjects analysed
    46
    Units: % of participants
        Partial response
    4
        Stable disease
    36
        Progressive disease
    6
    No statistical analyses for this end point

    Secondary: Major Pathological Response

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    End point title
    Major Pathological Response
    End point description
    Major Pathological Response is defined as ≤10% remaining viable tumour cells (RVT).
    End point type
    Secondary
    End point timeframe
    2 months
    End point values
    Durvalumab
    Number of subjects analysed
    46
    Units: % of participants
        RVT ≤10%
    8
        RVT >10%
    35
        Unknown
    3
    No statistical analyses for this end point

    Secondary: Disease-Free Survival (DFS)

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    End point title
    Disease-Free Survival (DFS)
    End point description
    Time from the date of inclusion to the date of first documented disease relapse or the occurrence of a new invasive primary malignancy or death from any cause
    End point type
    Secondary
    End point timeframe
    18 months
    End point values
    Durvalumab
    Number of subjects analysed
    46
    Units: % of participants
    number (confidence interval 95%)
        12-month DFS
    78.3 (63.4 to 87.7)
        12-month DFS - RVT ≤10%
    100 (100 to 100)
        12-month DFS - RVT >10%
    77.1 (59.5 to 87.9)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    Time from the inclusion to the date of death of any cause, or censored at their last known alive date
    End point type
    Secondary
    End point timeframe
    18 months
    End point values
    Durvalumab
    Number of subjects analysed
    46
    Units: % of participants
    number (confidence interval 95%)
        12-month OS
    89.1 (75.8 to 95.3)
        12-month OS - RVT ≤ 10 %
    100 (100 to 100)
        12-month OS - RVT > 10 %
    88.6 (72.4 to 95.6)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were collected for a patient from the date of signature of inform consent form, during treatment period and until 100 days after the last dose of study treatment. Deaths were collected until data analysis.
    Adverse event reporting additional description
    The maximal grade of adverse events was collected by cycle of treatment.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21
    Reporting groups
    Reporting group title
    Safety population
    Reporting group description
    -

    Serious adverse events
    Safety population
    Total subjects affected by serious adverse events
         subjects affected / exposed
    19 / 48 (39.58%)
         number of deaths (all causes)
    8
         number of deaths resulting from adverse events
    Blood and lymphatic system disorders
    Haemolytic anaemia
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Death
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Chest pain
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory distress
         subjects affected / exposed
    4 / 48 (8.33%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    Tracheal stenosis
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung disorder
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemoptysis
         subjects affected / exposed
    2 / 48 (4.17%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Haemothorax
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tracheal fistula
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Bronchial fistula
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Chylothorax
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory failure
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Skin and subcutaneous tissue disorders
    Subcutaneous emphysema
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urinary retention
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haematuria
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Endocrine disorders
    Adrenal insufficiency
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Pain in extremity
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Pneumonia bacterial
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Sepsis
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung infection
         subjects affected / exposed
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety population
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    47 / 48 (97.92%)
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    17 / 48 (35.42%)
         occurrences all number
    25
    Chest pain
         subjects affected / exposed
    12 / 48 (25.00%)
         occurrences all number
    18
    Pain
         subjects affected / exposed
    4 / 48 (8.33%)
         occurrences all number
    4
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    4
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    6 / 48 (12.50%)
         occurrences all number
    7
    Nausea
         subjects affected / exposed
    6 / 48 (12.50%)
         occurrences all number
    7
    Constipation
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    3
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    14 / 48 (29.17%)
         occurrences all number
    23
    Cough
         subjects affected / exposed
    12 / 48 (25.00%)
         occurrences all number
    26
    Haemoptysis
         subjects affected / exposed
    6 / 48 (12.50%)
         occurrences all number
    9
    Respiratory distress
         subjects affected / exposed
    5 / 48 (10.42%)
         occurrences all number
    6
    Pneumothorax
         subjects affected / exposed
    4 / 48 (8.33%)
         occurrences all number
    4
    Lung disorder
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    5
    Rash
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    3
    Renal and urinary disorders
    Urinary retention
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    3
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    4 / 48 (8.33%)
         occurrences all number
    4
    Back pain
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    4
    Musculoskeletal chest pain
         subjects affected / exposed
    3 / 48 (6.25%)
         occurrences all number
    4
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    5 / 48 (10.42%)
         occurrences all number
    9

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    06 Jun 2017
    A first substantial modification was done in order: • to adapt the protocol to the 8th edition of the UICC TNM classification • to delete “Drug-induced liver injury” from serious adverse events lists • to add a section for the management of myocarditis and similar toxicities
    16 May 2018
    A second substantial modification was done in order: • to extent inclusion criteria to stage IIIA non-N2 NSCLC • to make frozen tissue collection optional
    08 Jan 2019
    A third substantial modification was done in order to: • to clarify and update inclusion criteria specifying the size of the tumor • to delete the exclusion criteria about ECG that is no longer required. • to add a central review of all patients before inclusion. • to add a suspension of inclusions after the 57th patients in order to perform a statistical analysis of tolerance data (90-days postoperative). In addition, a definitive discontinuation of the study was planned in case of occurrence of a new death (any cause combined) occurring within 90 days of surgery. • to add collection of feces before starting study treatment.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    28 Aug 2019
    Enrolment was stopped on August 28, 2019 at the request of the independent committee due to excessive 90-day postoperative mortality, with 4 unexpected deaths (8.7% of the 46 eligible patients).
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    The main study limitation was the small sample size, due to the premature ending of the trial. Another limitations were the prevalence of risk factors in the study population and finally, the heterogenity due to the involvement of 20 active centers.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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