A Randomized Phase III Trial of Stereotactic Ablative Radiotherapy for Patients With Up to 10 Oligometastases and a Synchronous Primary Tumor.

Metastatic Tumor Clinical Trial

— SABR-SYNC  

Official title:

A Randomized Phase III Trial of Stereotactic Ablative Radiotherapy for Patients With Up to 10 Oligometastases and a Synchronous Primary Tumor.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05717166
• Other study ID #: ReDA 13176
• Status: Recruiting
• Phase: Phase 3
• Start date: October 6, 2023
• Est. completion date: April 2029

Study information

• Verified date: October 2023
• Source: Lawson Health Research Institute
• Contact: David Palma, MD, PhD
• Phone: 519-685-8650
• Email: David.Palma[@]lhsc.on.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is a phase III multi-institutional randomized trial. Patients will be randomized in a 1:2 ratio between current standard of care treatment (Arm 1) vs. standard of care treatment + SABR (Arm 2) to sites of known disease.

Patients will be stratified by two of the strongest prognostic factors, based on a large multi-institutional analysis3: histology (Group 1: hormone-sensitive prostate cancer, breast, or renal; Group 2: all others), and number of metastases (Group 1: 1-3; Group 2: 4-10).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 180
• Est. completion date: April 2029
• Est. primary completion date: April 2029
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age 18 years or older

• Willing to provide informed consent

• Karnofsky performance status > 60

• Life expectancy > 6 months

• Histologically confirmed malignancy with metastatic disease detected on imaging. Biopsy of metastasis is preferred, but not required.

• Total number of metastases 1-10 at the time of enrollment, with a primary tumor also present

• Restaging completed within 12 weeks prior to randomization (see section 5.1)

• For patients receiving thoracic radiotherapy, the enrolling physician must confirm there are no computed tomography (CT) changes suggestive of fibrotic interstitial lung disease (ILD) (i.e. reticular changes, traction bronchiectasis, or honeycombing) reported on any prior CT scans. If any are present, the patient must be assessed by a respirologist to rule out ILD prior to enrollment.

Exclusion Criteria:

• Serious medical comorbidities precluding radiotherapy. These include ILD in patients requiring thoracic radiation, Crohn's disease in patients where the gastrointestinal (GI) tract will receive radiotherapy, or ulcerative colitis where the bowel will receive radiotherapy and connective tissue disorders such as lupus or scleroderma.

• For patients with liver metastases, moderate/severe liver dysfunction (Child Pugh B or C); please see the Child-Pugh score calculator.

• Substantial overlap with a previously treated radiation volume. Prior radiotherapy in general is allowed, as long as the composite plan meets dose constraints herein. For patients treated with radiation previously, biological effective dose calculations should be used to equate previous doses to the tolerance doses listed in Appendix 1. All such cases must be discussed with a member of the study steering committee.

• Malignant pleural effusion

• Inability to treat all sites of disease

• Brain metastasis > 3 cm in size or a total volume of brain metastases greater than 30 cc.

• Metastasis in the brainstem

• Clinical or radiologic evidence of spinal cord compression

• Metastatic disease that invades any of the following: GI tract (including esophagus, stomach, small or large bowel), or skin

• Pregnant or lactating women

Related Conditions & MeSH terms

• Metastatic Tumor
• Neoplasm Metastasis

Intervention

Radiation:
• Palliative Radiotherapy
Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions.

Drug:
• Chemotherapy
Pre-specified based on the standard of care approach for that patient.
• Hormone therapy
Pre-specified based on the standard of care approach for that patient.
• Immunotherapy
Pre-specified based on the standard of care approach for that patient.
• Targeted Systemic Therapy
Pre-specified based on the standard of care approach for that patient.

Other:
• Observation
Pre-specified based on the standard of care approach for that patient.

Radiation:
• Stereotactic Ablative Radiotherapy
The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board. Preferred doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions (every second day), and 35 Gy in 5 fractions (daily).

Procedure:
• Surgery
Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists. The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board. Because of the convenience in using SABR for all lesions, non-SABR modalities should only be used if they are likely to provide a benefit over SABR.

Other:
• Radiofrequency Therapy (RFA)
Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

Radiation:
• Fractionated Radiation
Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists. Tumors in the esophagus, stomach, small intestine or colon should be treated with either fractionated radiation or a lower SABR dose (e.g. 25 Gy in 5 fractions) to minimize the risk of perforation.

Locations

Country	Name	City	State
Canada	London Regional Cancer Program of the Lawson Health Research Institute	London	Ontario
Canada	Centre Hospitalier de l'Université de Montréal-CHUM	Montréal	Quebec
Canada	BC Cancer - Centre for the North	Prince George	British Columbia

Sponsors (1)

Lead Sponsor	Collaborator
David Palma

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Overall Survival	Time from randomization to death from any cause, or date of last follow-up, whichever occurs first.	Approximately end of year 6 (Study Completion)
Secondary	Quality of Life (QOL) assessed with the Functional Assessment of Cancer Therapy: General (FACT-G).		Quality of Life outcomes to be collected for the first 2 years (3, 6, 12, 18, 24 months)
Secondary	Quality of Life (QOL) assessed with the Functional Assessment of Cancer Therapy: The EuroQol 5-Dimension 5-Level (EQ-5D-5L).		Quality of Life outcomes to be collected for the first 2 years (3, 6, 12, 18, 24 months)
Secondary	Toxicity assessed by the Common Toxicity Criteria for Adverse Events (CTCAE) version 5 for each organ treated (e.g. liver, lung, bone).		Toxicity outcomes to be collected for the first 2 years (Last week of treatment, in 6 weeks, in 3, 6, 12, 18, 24 months)
Secondary	Time to next systemic therapy	The time from randomization until commencement of any systemic anti-cancer therapy, or date of last follow-up, whichever occurs first.	From randomization to year 6 (study completion).
Secondary	Receipt of additional radiation during follow-up	Will be collected for SABR (as a binary endpoint; yes/no), and non-SABR (yes/no).	During year 6 (follow-up year).