Atezolizumab + Pirfenidone for Non-Small Cell Lung Cancer

Recruiting at 1 trial location

Overseen By KUCC Navigator

Age: 18+

Sex: Any

Trial Phase: Phase 1 & 2

Sponsor: University of Kansas Medical Center

Must not be taking: Strong CYP1A2 inhibitors

Disqualifiers: Uncontrolled diabetes, Unstable angina, Active auto-immune diseases, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

Duration: Up to 2 years

25 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if adding the drug pirfenidone to atezolizumab (an immunotherapy drug) can improve treatment for people with advanced non-small cell lung cancer. Researchers seek to discover if this combination can enhance the body's ability to fight tumors and increase treatment effectiveness. The trial seeks participants with stage 4 or recurring non-small cell lung cancer who have previously received certain immunotherapies or chemotherapy. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering participants the opportunity to be among the first to receive this new combination therapy.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you cannot use strong CYP1A2 inhibitors or systemic antibacterial or antifungal agents during the study.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that treatments using atezolizumab can extend the lives of patients with advanced non-small cell lung cancer. Proper care can manage most side effects, making it generally safe. The FDA has approved atezolizumab for certain cancers, indicating its safety for those uses.

The combination of atezolizumab and pirfenidone remains under investigation. While detailed safety information for this combination is not yet widely available, atezolizumab alone has demonstrated promising results with manageable side effects. This trial is in the early stages, so the safety of adding pirfenidone is still under study. Researchers will closely monitor participants to manage any side effects. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising?

Atezolizumab combined with Pirfenidone is unique because it offers a dual approach to treating non-small cell lung cancer (NSCLC). Atezolizumab, an immune checkpoint inhibitor, helps the immune system recognize and attack cancer cells by blocking the PD-L1 protein. Meanwhile, Pirfenidone, though primarily used for pulmonary fibrosis, has anti-inflammatory and anti-fibrotic properties that may enhance the cancer-fighting effects of Atezolizumab. Researchers are excited because this combination could potentially improve outcomes by both boosting immune response and reducing tumor-supportive environments, offering a novel strategy compared to traditional treatments like chemotherapy or radiation.

What evidence suggests that adding pirfenidone to atezolizumab might be an effective treatment for non-small cell lung cancer?

Research shows that atezolizumab, a checkpoint inhibitor, can extend the lives of people with advanced non-small cell lung cancer (NSCLC). This trial examines whether adding pirfenidone to atezolizumab enhances its effectiveness. Checkpoint inhibitors like atezolizumab boost the immune system's ability to attack cancer cells. Previous studies have found that these drugs improve outcomes for patients with stage IV NSCLC. The trial aims to increase the drugs' ability to kill cancer cells and reduce the cancer's resistance to treatment. Early results suggest this combination might enhance the treatment's effectiveness against cancer. ^{1 2 3 5 6}

Who Is on the Research Team?

Chao H. Huang

Principal Investigator

The University of Kansas

Are You a Good Fit for This Trial?

Adults with stage 4 or recurrent non-small cell lung cancer (NSCLC) who've had certain prior treatments can join. They must be able to take oral meds, have good organ function and a life expectancy of at least 6 months. Smokers over one pack/day, those with recent serious illnesses, uncontrolled HIV, or active pneumonitis are excluded.

Inclusion Criteria

I can take pills by mouth.

I am able to care for myself and perform daily activities.

I am 18 or older with confirmed non-small cell lung cancer.

Exclusion Criteria

I've had severe side effects from previous immunotherapy.

You smoke more than 20 cigarettes a day.

My HIV is not under control.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Atezolizumab IV every 3 weeks and Pirfenidone orally with increasing doses until progression

Up to 2 years

Every 3 weeks (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 year

What Are the Treatments Tested in This Trial?

Interventions

• Atezolizumab
• Pirfenidone

Trial Overview The trial is testing if combining pirfenidone with atezolizumab improves treatment outcomes for NSCLC patients who've seen their cancer return after initial therapy. It aims to see if this combo can boost anti-tumor effects and overcome resistance to treatment.

How Is the Trial Designed?

Group I: Treatment Experimental Treatment 1 Intervention

Atezolizumab (Tecentriq) intravenous (IV) 1200mg flat dose day 1 then every 3 weeks. Pirfenidone (Esbriet) orally (PO) with food according to this schedule: Days 1-14: 267 milligrams (mg) orally three times per day (PO TID) Days 15-29: 534 mg PO TID Days 30 onward until progression: 801 mg PO TID

Atezolizumab is already approved in United States, European Union for the following indications:

Approved in United States as Tecentriq for:

• Melanoma
• Hepatocellular carcinoma
• Small cell lung cancer
• Non-small cell lung cancer
• Urothelial carcinoma

Approved in European Union as Tecentriq for:

• Melanoma
• Hepatocellular carcinoma
• Small cell lung cancer
• Non-small cell lung cancer
• Urothelial carcinoma

Who Is Running the Clinical Trial?

University of Kansas Medical Center

Lead Sponsor

Trials

527

Recruited

181,000+

parkview cancer institute

Collaborator

Trials

1

Recruited

30+

Published Research Related to This Trial

Atezolizumab, the first anti-PD-L1 monoclonal antibody approved by the FDA, has shown promising efficacy in treating metastatic triple-negative breast cancer, supported by data from the Phase III IMpassion130 trial.

The review highlights the pharmacodynamic and pharmacokinetic properties of atezolizumab, emphasizing its safety and effectiveness in various cancers, including small-cell lung cancer and renal cell cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab for use in PD-L1-positive unresectable, locally advanced or metastatic triple-negative breast cancer. Mavratzas, A., Seitz, J., Smetanay, K., et al.[2020]

Atezolizumab, an immune checkpoint inhibitor, has been shown to significantly prolong overall survival in patients with advanced non-small cell lung cancer (NSCLC) who have previously received chemotherapy, based on results from the phase II POPLAR and phase III OAK trials.

The treatment is particularly effective in patients with higher PD-L1 expression, demonstrating higher objective response rates, and it has a manageable safety profile with a low incidence of immune-related adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab: A Review in Previously Treated Advanced Non-Small Cell Lung Cancer. Blair, HA.[2020]

Atezolizumab combined with chemotherapy showed promising efficacy in treating advanced, treatment-naïve non-small-cell lung cancer (NSCLC), with overall response rates of 36% to 68% across different chemotherapy regimens in a study of 76 patients.

The treatment was generally well tolerated, although common severe side effects included neutropenia and anemia, indicating a manageable safety profile for this combination therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term survival follow-up of atezolizumab in combination with platinum-based doublet chemotherapy in patients with advanced non-small-cell lung cancer. Liu, SV., Camidge, DR., Gettinger, SN., et al.[2022]

Atezolizumab, a PD-L1 blocking antibody, shows higher rates of objective response, progression-free survival, and overall survival when used as a first-line therapy in chemotherapy-naïve patients with metastatic non-small cell lung cancer (NSCLC), compared to its use in later treatment lines.

The review included 15 ongoing studies, with 5 reporting results, indicating that atezolizumab is being explored in various treatment combinations and settings, suggesting its potential as a versatile first-line treatment option for NSCLC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab for the First-Line Treatment of Non-small Cell Lung Cancer (NSCLC): Current Status and Future Prospects. Ryu, R., Ward, KE.[2023]

Atezolizumab is a monoclonal antibody that targets PD-L1, which is being developed for treating various blood cancers and solid tumors, showing promise in cancer immunotherapy.

It has already been approved in the US as a second-line treatment for urothelial carcinoma and is pending approval for non-small cell lung cancer, highlighting its potential efficacy in these conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab: First Global Approval. Markham, A.[2019]

In a clinical trial, combining chemotherapy with the PD-L1 inhibitor atezolizumab showed improved outcomes for patients with advanced squamous non-small cell lung cancer, including longer progression-free survival and a higher objective response rate.

The combination therapy was effective regardless of the PD-L1 expression level in patients, suggesting a broad applicability of this treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Squamous NSCLC Improves with Atezolizumab Plus Chemo. [2022]

Atezolizumab monotherapy demonstrated a manageable safety profile in Chinese patients with previously treated advanced non-small cell lung cancer (NSCLC), with serious adverse events occurring in 25.7% of patients and immune-related adverse events in 47.5%.

The treatment showed clinically meaningful efficacy, with a median overall survival of 15.31 months and a 24-month overall survival rate of 37.4%, while specific gene mutations and the presence of CD8+ TILs were associated with better responses to the therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of atezolizumab in Chinese patients with previously treated locally advanced or metastatic non-small cell lung cancer: An open-label, single-arm, multicenter study. Xu, Y., Huang, Z., Chang, J., et al.[2023]

Atezolizumab significantly improves overall survival (OS) and progression-free survival (PFS) in patients with advanced non-small cell lung cancer (NSCLC) compared to chemotherapy, based on a meta-analysis of 7 randomized clinical trials involving 4,859 patients.

The effectiveness of atezolizumab varies based on clinical and molecular features, with better outcomes observed in younger patients, those with wild-type EGFR, and active or previous smokers, highlighting the importance of personalized treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Atezolizumab for Advanced Non-Small Cell Lung Cancer Based on Clinical and Molecular Features: A Meta-Analysis. Liu, W., Huo, G., Chen, P.[2022]

Atezolizumab therapy significantly improves overall survival (median OS of 11.2 months) in patients with previously treated advanced non-small cell lung cancer (NSCLC), demonstrating its efficacy in a diverse patient population.

The treatment has a manageable safety profile, with serious adverse events occurring in only 8.0% of patients and no new safety signals identified, indicating it is a viable option for patients often excluded from clinical trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Final results from TAIL: updated long-term efficacy of atezolizumab in a diverse population of patients with previously treated advanced non-small cell lung cancer. Ardizzoni, A., Azevedo, S., Rubio-Viqueira, B., et al.[2022]

Atezolizumab significantly improved overall survival in patients with previously treated non-small-cell lung cancer compared to docetaxel, with median survival times of 13.8 months versus 9.6 months, respectively.

The safety profile of atezolizumab was favorable, with only 15% of patients experiencing grade 3 or 4 adverse events, compared to 43% in the docetaxel group, indicating it may be a safer treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Rittmeyer, A., Barlesi, F., Waterkamp, D., et al.[2022]

Atezolizumab is an FDA-approved treatment for advanced bladder cancer that works by blocking the PD-L1/PD-1 immune checkpoint, enhancing T-cell immunity against tumors.

In clinical trials, atezolizumab showed a 15% objective response rate in patients whose cancer progressed after chemotherapy, and a 24% response rate in chemotherapy-naïve patients, with a favorable safety profile compared to other second-line treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab: A PD-L1-Blocking Antibody for Bladder Cancer. Inman, BA., Longo, TA., Ramalingam, S., et al.[2022]

Atezolizumab significantly improves overall survival in patients with metastatic non-small cell lung cancer (mNSCLC), with median survival times of 13.8 months in the atezolizumab group compared to 9.6 months in the docetaxel group in the OAK trial.

The treatment has an acceptable safety profile, with common side effects including fatigue and decreased appetite, and serious immune-related adverse events occurring in a small percentage of patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

U.S. Food and Drug Administration Approval Summary: Atezolizumab for Metastatic Non-Small Cell Lung Cancer. Weinstock, C., Khozin, S., Suzman, D., et al.[2022]

Citations

1. ascopubs.org ascopubs.org/doi/10.1200/JCO.2024.42.16_suppl.e15197

Preliminary results of atezolizumab and pirfenidone in non- ... Background: Checkpoint inhibitors (CPI) targeting the PD1/PD-L1 axis improved outcomes for stage IV non-small cell lung cancer (NSCLC).

2. asco.org asco.org/abstracts-presentations/ABSTRACT343669

Combination of atezolizumab and pirfenidone in second- ... Background: Checkpoint inhibitors (CPI) targeting the PD1/PD-L1 axis significantly improved patient outcomes in stage IV non-small cell lung cancer (NSCLC).

3. clinicaltrials.gov clinicaltrials.gov/study/NCT04467723

Combination of Atezolizumab and Pirfenidone in Second- ... The purpose of this study is to see if adding pirfenidone to atezolizumab will increase anti tumor activity and reduce treatment resistance in stage 4 and ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9716834/

updated long-term efficacy of atezolizumab in a diverse ... In patients with previously treated advanced or metastatic non-small cell lung cancer (NSCLC), atezolizumab therapy improves survival with manageable safety.

5. withpower.com withpower.com/trial/phase-2-carcinoma-non-small-cell-lung-11-2021-e89b8

Atezolizumab + Pirfenidone for Non-Small Cell Lung Cancer Research shows that Atezolizumab, when used with chemotherapy, can improve survival and response rates in patients with advanced non-small cell lung cancer.

6. genentech-clinicaltrials.com genentech-clinicaltrials.com/en/trials/cancer/lung-cancer/a-study-to-investigate-the-safety-and-efficacy-of-atezo-57444.html

Clinical trial for Non-Small Cell Lung Cancer (NSCLC)-Gen... A Study to Investigate the Safety and Efficacy of Atezolizumab in Previously-Treated Patients With Locally Advanced or Metastatic Non-Small Cell Lung Cancer.