Interstitial Photodynamic Therapy Following Palliative Radiotherapy in Treating Patients With Inoperable Malignant Central Airway Obstruction

Malignant Solid Neoplasm Clinical Trial

Official title:

A Phase I/II Study of Interstitial Photodynamic Therapy Following Palliative Radiotherapy for Patients With Inoperable Malignant Central Airway Obstruction

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06306638
• Other study ID #: I-3901323
• Secondary ID: NCI-2024-01239I-
• Status: Not yet recruiting
• Phase: Phase 1/Phase 2
• Start date: July 1, 2024
• Est. completion date: July 1, 2029

Study information

• Verified date: May 2024
• Source: Roswell Park Cancer Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This phase I/II trial studies the side effects of interstitial photodynamic therapy following palliative radiotherapy and how well it works in treating patients with inoperable malignant central airway obstruction. Patients who have advanced stage cancer tumors in the lung can often have the breathing passages to the lung partially or completely blocked. These tumors could be due to lung cancer or other cancers (e.g., renal, breast, kidney, etc.) that spread to the lung. This blockage puts the patient at a higher risk for respiratory failure, post-obstructive pneumonia, and prolonged hospitalizations. Treatment for these patients may include bronchoscopic intervention (such as mechanical removal, stenting, laser cauterization, or ballooning), radiation therapy with and without chemotherapy. While palliative x-ray radiotherapy may help in shrinking the tumor, high dose curative radiotherapy that can ablate (a localized, nonsurgical destruction) the tumor also has high risk to cause significant toxicity, including bleeding, abnormal connections or passageways between organs or vessels and abnormal scar tissue that can also produce airway obstruction. Photodynamic therapy (PDT) is another possible treatment that can provide local control of the tumor. PDT consists of injecting a light sensitive drug (photosensitizer, PS) into the vein, waiting for the PS to accumulate in the tumor, and then activating it with a red laser light. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Giving interstitial photodynamic therapy following palliative radiotherapy may improve tumor response and survival without the serious side effects that are associated with the typical high dose curative x-ray radiotherapy alone in patients with malignant central airway obstruction.

Description:

PRIMARY OBJECTIVES:

I. To test the safety of our image-based treatment planning for image-guided interstitial photodynamic therapy (I PDT) with endobronchial ultrasound (EBUS) following standard of care palliative radiotherapy (p-XRT). (Phase I) II. To assess the efficacy of our image-based treatment planning for image-guided I-PDT following standard of care p-XRT. (Phase II)

SECONDARY OBJECTIVES:

I. To assess objective tumor response. (Phase I) II. To evaluate changes in quality of life. (Phase I and II) III. To measure changes in functional lung capacity. (Phase I and II) IV. To measure the relationship between the measured objective tumor response (at 12 +/- 2 weeks post I-PDT) and changes in therapeutic laser light transmission within the target tumor, as a future dosimetric marker for response. (Phase I and II) V. To assess treatment effects on the immune contexture. (Phase I and II) VII. To monitor progression free survival. (Phase I and II)

OUTLINE: This is a phase I study, followed by a phase II.

PHASE I: Patients are assigned to 1 of 2 cohorts.

COHORT 1: Patients receive visudyne intravenously (IV) over 10 minutes and then undergo I-PDT with EBUS 60-90 minutes after visudyne for up to 3 treatment sessions. Patients undergo blood and tissue sample collection on study. Patients also undergo computed tomography (CT) throughout the trial.

COHORT 2: Patients undergo SOC p-XRT over a single fraction. Patients receive visudyne IV over 10 minutes and then undergo I-PDT with EBUS 60-90 minutes after visudyne for up to 2 treatment sessions at least 12 weeks apart. Patients undergo blood and tissue sample collection on study. Patients also undergo CT throughout the trial.

PHASE II: Patients undergo SOC p-XRT over a single fraction. Patients receive visudyne IV over 10 minutes and then undergo I-PDT with EBUS 60-90 minutes after visudyne for up to 2 treatment sessions at least 12 weeks apart. Patients undergo blood and tissue sample collection on study. Patients also undergo CT throughout the trial.

After completion of study treatment, patients are followed up at 30 days and 8, 12, and 24 weeks.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 39
• Est. completion date: July 1, 2029
• Est. primary completion date: July 1, 2029
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age >= 18 years of age

• Eligibility checklist before registration requires review of case by the interventional pulmonologist/s and radiation oncologist/s to approve anatomic feasibility of an airway intervention and palliative radiotherapy

• Patients with pathologic diagnosis of inoperable solid malignancy involving extrabronchial tumor growth that causes airway obstruction and not amenable to curative radiotherapy. All patients will have tumors requiring bronchoscopic intervention with endobronchial ultrasound (EBUS) at the time of I-PDT

• Participants have at least one measurable lesion which is also the target lesion for Response Evaluation Criteria in Solid Tumors (RECIST) measurement

• Patients amenable to receive standard of care palliative radiotherapy to the target tumor, as determined by the radiation oncologist/s

• Amenable to high resolution chest CT (with or without contrast due to known allergy) with 0.625-1.25 mm slice thickness and slice interval 0.5-1 mm

• Tumor is accessible and amenable to I-PDT, as determined by the interventional pulmonologist/s

• Have an Eastern Cooperative Oncology Group (ECOG) performance status of = 3

• Platelets = 100,000 cells/mm^3 (International System of Units [SI] units 100 x 10^9/L)

• International normalized ratio (INR) < 1.5 and activated partial thromboplastin time (aPTT) < 1.5 x ULN. PTT or aPTT per institutional standards for participating external sites

• Participants of child-bearing potential must agree to use adequate contraceptive methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study entry and for 3 months after receiving the study drug. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately

• Participant or legal representative must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure

Exclusion Criteria:

• Pregnant or nursing female participants

• Co-existing ophthalmic disease likely to require slit-lamp examination within the next 30 days following I-PDT treatment

• Any condition which in the investigator's opinion deems the participant an unsuitable candidate to receive the I-PDT

• CT imaging suggestive of target tumor invasion into a major blood vessel (typically proximal to segmental vessels)

• Known hypersensitivity/allergy to porphyrin

• Patients who are not cleared by the anesthesiologist to undergo an advanced bronchoscopy procedure under general anesthesia

• Patients diagnosed with porphyria

• Patients with known allergy to eggs

• Patients unwilling or unable to follow protocol requirements

Related Conditions & MeSH terms

• Airway Obstruction
• Malignant Solid Neoplasm

Intervention

Procedure:
• Biospecimen Collection
Undergo blood and tissue sample collection
• Computed Tomography
Undergo CT
• Endobronchial Ultrasound Bronchoscopy
Undergo EBUS
• Interstitial Photodynamic Therapy
Undergo I-PDT

Radiation:
• Palliative Radiation Therapy
Undergo palliative radiation therapy

Other:
• Physical Performance Testing
Ancillary studies
• Questionnaire Administration
Ancillary studies

Drug:
• Verteporfin
Given IV

Locations

Country	Name	City	State
United States	Roswell Park Cancer Institute	Buffalo	New York

Sponsors (1)

Lead Sponsor	Collaborator
Roswell Park Cancer Institute

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Incidence of >= grade 3 adverse events (Phase I)	Will will be associated with treatment related adverse events .grade 3 (with attribution of 'possible', 'probable' or 'definite'. Will be assessed using National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 (NCI CTCAE v 5.0).	Within 30 days post interstitial photodynamic therapy (I-PDT)
Primary	Overall tumor response (Phase II)	Will be assessed by complete response (CR) or partial response (PR) defined by the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v 1.1) criteria.	At 12 weeks post I-PDT
Secondary	Overall tumor response (Phase I)	Will be assessed by CR or PR defined by the RECIST v 1.1 criteria.	At 12 weeks post I-PDT
Secondary	Quality of life (Phase I and II)	Will be monitored using the Functional Assessment of Cancer Therapy-Lung. This 36 item self-reported quality of life questionnaire measures responses across six domains: physical well-being, social/family well-being, relationship with doctor, emotional well-being, functional well-being, and additional concerns. This scale was chosen because multiple studies support its validity and use in clinical trials of lung cancer.	At study enrollment, immediately prior to p-XRT and I-PDT, and at 4 and 12 weeks
Secondary	Functional lung capacity (Phase I and II)	Will be measured with the six-minute walk test.	At study entry (baseline), 30 days and 12 weeks
Secondary	Change in the therapeutic laser light transmission (Phase I and II)	Will be measured with our light dosimetry system.	Up to 5 years
Secondary	Association between immune markers and tumor response (Phase I and II)	will be measured with flow cytometry in fresh blood samples collected prior and 30 days after the I-PDT.	Prior and 30 days after the I-PDT
Secondary	Progression free survival (Phase I and II)	Will be summarized using standard Kaplan-Meier methods.	Time from date of study treatment to the time of first observed disease progression (RECIST 1.1 criteria) at the treated tumor site or, death due to any cause, assessed up to 5 years