Stereotactic Ablative Radiotherapy for Oligometastatic Cancer

(TRITONS Trial)

Recruiting at 1 trial location

Overseen By Tyler Seibert, MD, PhD

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: Tyler Seibert

Disqualifiers: Pregnancy, Interstitial lung disease, others

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

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 4 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 6-8 weeks

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new approach to treating oligometastatic cancer, where cancer has spread to up to 10 different sites in the body. The study compares the effects of adding stereotactic ablative radiotherapy (SABR), a precise type of radiation therapy, to standard cancer treatments versus using standard treatments alone. Researchers aim to determine if adding SABR helps patients live longer without cancer progression, while also assessing its safety and identifying who might benefit most. Suitable participants have a solid tumor that has spread to 1 to 10 locations outside the brain and have begun a new treatment within the last six months. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants a chance to contribute to potentially groundbreaking treatment advancements.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that stereotactic ablative radiotherapy is likely to be safe for humans?

Previous studies have shown that stereotactic ablative radiotherapy (SABR) is generally safe and well-tolerated for people with a small number of cancer spread areas. A review of 21 different trials confirmed SABR as a safe option for these patients. Another study found SABR to be a non-invasive treatment that patients handled well, with few side effects reported. Additionally, research showed that patients receiving SABR had high survival rates and experienced low levels of harmful effects. Overall, past research indicates that SABR is a safe treatment option. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising for oligometastatic cancer?

Researchers are excited about stereotactic ablative radiotherapy (SABR) for oligometastatic cancer because it offers a precise, high-dose radiation treatment that directly targets tumors while minimizing damage to surrounding healthy tissue. Unlike the standard of care, which often involves broader radiation techniques or systemic chemotherapy, SABR delivers focused beams in fewer sessions, potentially leading to quicker results and fewer side effects. This precision could improve patient outcomes by effectively controlling cancer spread with less impact on their overall health and quality of life.

What evidence suggests that stereotactic ablative radiotherapy is effective for oligometastatic cancer?

Research has shown that stereotactic ablative radiotherapy (SABR) is a promising treatment for patients with oligometastatic cancer, characterized by only a few metastatic tumors. In this trial, some participants will receive SABR combined with standard of care (SOC) cancer therapy. Studies have found that SABR, when used with standard care, can extend patients' lives. Specifically, one study found that SABR was 89% effective in controlling tumors in the abdomen for at least a year, meaning the treatment helped stop the tumors from growing or spreading. Additionally, SABR is considered both safe and effective, offering a potential survival advantage over standard care alone. Overall, current evidence suggests that SABR can be a powerful tool in managing cancer with limited spread. ^{3 6 7 8 9}

Who Is on the Research Team?

Tyler Seibert

Principal Investigator

University of California, San Diego

Are You a Good Fit for This Trial?

This trial is for adults with a confirmed solid malignancy and up to 10 metastases, excluding brain lesions. Participants must be healthy enough for standard therapy and SABR, willing to follow study procedures, and use effective contraception if applicable.

Inclusion Criteria

I have used effective birth control for at least a month and will continue during treatment.

I am using effective birth control methods during my treatment.

Provision of signed and dated informed consent form

Exclusion Criteria

I have a tumor larger than 5 cm or a brain tumor larger than 3 cm that hasn't been removed.

I haven't had radiation that would exceed safe levels in this study.

I have fluid buildup due to cancer in my chest or abdomen.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive stereotactic ablative radiotherapy (SABR) plus standard of care therapies or SABR alone

6-8 weeks

Follow-up

Participants are monitored for progression-free survival and toxicity

2 years

What Are the Treatments Tested in This Trial?

Interventions

• Stereotactic Ablative Radiotherapy

Trial Overview The study compares the effectiveness of stereotactic ablative radiotherapy (SABR) combined with standard care versus SABR alone in prolonging the time patients live without disease progression. It's a Phase III trial where participants are randomly assigned to one of the two groups.

How Is the Trial Designed?

Group I: SABR+SOC Experimental Treatment 1 Intervention

stereotactic ablative radiotherapy (SABR) plus standard of care (SOC) cancer therapy

Group II: SOC Active Control 1 Intervention

standard of care (SOC) cancer therapy

Stereotactic Ablative Radiotherapy is already approved in European Union, United States, United Kingdom for the following indications:

Approved in European Union as Stereotactic Ablative Radiotherapy for:

• Early-stage non-small cell lung cancer
• Liver cancers
• Kidney cancers
• Bone metastasis
• Spinal metastasis
• Prostate cancers

Approved in United States as Stereotactic Ablative Radiotherapy for:

• Early-stage non-small cell lung cancer
• Liver cancers
• Kidney cancers
• Bone metastasis
• Spinal metastasis
• Prostate cancers

Approved in United Kingdom as Stereotactic Ablative Radiotherapy for:

• Early-stage non-small cell lung cancer
• Liver cancers
• Kidney cancers
• Bone metastasis
• Spinal metastasis
• Prostate cancers

Who Is Running the Clinical Trial?

Tyler Seibert

Lead Sponsor

Trials

1

Recruited

300+

University of California, San Diego

Lead Sponsor

Trials

1,215

Recruited

1,593,000+

Published Research Related to This Trial

In a review of stereotactic body radiotherapy (SBRT) plans from 17 centers, it was found that 29% of patient plans compromised target volume coverage to meet organ-at-risk tolerances, highlighting the need for better plan quality metrics that do not rely solely on target coverage.

The study established that the prescription dose spillage (PDS) and modified gradient index (MGI) metrics provide updated guidance for evaluating SBRT plan quality, with PDS values aligning well with existing clinical trial constraints, while MGI values indicated discrepancies that need addressing for optimal treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multi-center evaluation of dose conformity in stereotactic body radiotherapy. Lee, J., Dean, C., Patel, R., et al.[2022]

In a study of 145 patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT), the treatment demonstrated a high local control rate with only 24.1% experiencing disease recurrence over a median follow-up of 65.6 months.

SBRT was associated with low toxicity, as only 3.4% of patients experienced grade 3 adverse events, and no patients suffered from severe (grade 4 or 5) toxicities, indicating that it is a safe treatment option for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Five-year follow-up after stereotactic body radiotherapy for medically inoperable early-stage non-small cell lung cancer: a multicenter study. Guo, Y., Zhu, Y., Zhang, R., et al.[2023]

This phase 1 trial involving 39 eligible patients demonstrated that stereotactic body radiotherapy (SBRT) is safe for treating patients with 3 to 4 metastases or 2 metastases close together, with no treatment-related deaths reported.

Although no dose-limiting toxicities were observed, there were instances of late grade 3 adverse events, highlighting the importance of long-term follow-up for patients receiving SBRT for oligometastatic disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Safety of Stereotactic Body Radiotherapy for the Treatment of Patients With Multiple Metastases: Findings From the NRG-BR001 Phase 1 Trial. Chmura, S., Winter, KA., Robinson, C., et al.[2023]

Stereotactic body radiotherapy (SBRT) was safely implemented for 15 patients with early-stage lung cancer and lung oligometastases, achieving a high locoregional control rate of 93.3% after a median follow-up of 17 months.

The treatment involved careful planning and quality assurance, with doses ranging from 40 to 60 Gy delivered in 5-8 fractions, ensuring dosimetric accuracy and adherence to organ-at-risk constraints.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Setting up a lung stereotactic body radiotherapy service in a tertiary center in Eastern India: The process, quality assurance, and early experience. Shrimali, RK., Saha, A., Arun, B., et al.[2022]

In a study of 40 patients with EGFR wild-type oligometastatic non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT), the median overall survival was 40 months, indicating that SBRT can be an effective treatment option for this patient group.

The study found that high-dose radiation (BED10 ≥100 Gy) was associated with better progression-free survival compared to lower doses, and the treatment was well-tolerated, with no severe toxicities reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing efficacy and safety of stereotactic body radiation therapy for oligometastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) wild type. Hu, X., Li, H., Liu, H., et al.[2022]

In a phase II trial involving 26 patients with oligometastatic non-small-cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) showed a 60% overall metabolic response rate, with 30% of patients achieving complete metabolic remission.

The treatment resulted in a median progression-free survival (PFS) of 11.2 months and an overall survival (OS) of 23 months, indicating that SBRT is an effective local treatment option for patients with limited metastatic disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase II study of stereotactic body radiotherapy to primary tumor and metastatic locations in oligometastatic nonsmall-cell lung cancer patients. Collen, C., Christian, N., Schallier, D., et al.[2022]

Stereotactic body radiotherapy (SBRT) is effective for treating stage I lung cancer, achieving local control rates similar to those of surgical resection while minimizing side effects to surrounding healthy tissues.

SBRT is being explored for treating oligometastatic disease, although current evidence of its clinical benefits is limited; ongoing international studies aim to clarify its effectiveness and potential combinations with other therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy for oligometastatic disease. Hanna, GG., Landau, D.[2018]

Stereotactic body radiotherapy (SBRT) for ultra-central lung tumors shows high efficacy, with pooled local control rates of 92% at 1 year and 89% at 2 years, based on a systematic review of 27 studies involving 1183 treated targets.

While SBRT is effective, it carries risks of severe toxicity, with a 6% incidence of grade 3-4 toxicities and a 4% incidence of treatment-related deaths, highlighting the importance of careful patient selection and treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy for Ultra-Central lung Tumors: A systematic review and Meta-Analysis and International Stereotactic Radiosurgery Society practice guidelines. Yan, M., Louie, AV., Kotecha, R., et al.[2023]

In a study of 145 patients with multiple pulmonary metastases treated with stereotactic body radiotherapy (SBRT), the overall survival (OS) was 23.5 months, indicating that SBRT is effective for this condition.

The study found no increase in the risk of early death or severe toxicity (grade 4 or 5) associated with multiple SBRT treatments, suggesting a strong safety profile for this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy (SBRT) for multiple pulmonary oligometastases: Analysis of number and timing of repeat SBRT as impact factors on treatment safety and efficacy. Klement, RJ., Hoerner-Rieber, J., Adebahr, S., et al.[2018]

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK603676/

Stereotactic Ablative Radiotherapy for the Treatment of ... - NCBI The current clinical evidence suggests that SABR plus SOC may offer survival benefits for patients with oligometastatic cancer compared to SOC alone. However, ...

2. ascopubs.org ascopubs.org/doi/10.1200/GO.23.00275

Stereotactic Ablative Radiotherapy in Oligometastatic ... Stereotactic ablative body radiotherapy (SABR) comes to the fore as a safe and effective treatment for patients with a limited number of metastases.

3. jamanetwork.com jamanetwork.com/journals/jamaoncology/fullarticle/2820082

Stereotactic Ablative Radiotherapy for Gynecological ... This cohort study evaluates the outcomes of stereotactic ablative radiotherapy in patients with oligometastatic and oligoprogressive ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S016781402500043X

1-year efficacy results after MR-guided risk-adapted ... The SOFT study provides MR-guided SABR for 121 patients with abdominal metastases. We achieved a high one-year local control rate of 89.0% using MR-guided SABR.

5. journal-of-hepatology.eu journal-of-hepatology.eu/article/S0168-8278(24)00154-5/abstract

Efficacy of stereotactic ablative radiotherapy in patients ... According to this study, SABR is an effective and safe treatment option for oligometastatic HCC, yielding excellent local tumor control and ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7689573/

Safety and Survival Rates Associated With Ablative ... The findings of this study suggest that stereotactic ablative radiotherapy is generally safe and well tolerated in the oligometastatic setting.

7. jamanetwork.com jamanetwork.com/journals/jamaoncology/fullarticle/2773455

Safety and Survival Rates Associated With Ablative ... This meta-analysis reviews 21 trials of stereotactic ablative radiotherapy administered to patients with oligometastatic cancer.

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0936655524001092

Treatment Outcomes of Stereotactic Ablative Body ... This study confirmed that SABR was a safe, non-invasive treatment option for patients with extracranial OM and OP diseases originated from primary breast cancer ...

9. thelancet.com thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30537-4/abstract

Stereotactic ablative body radiotherapy in patients with ... In patients with extracranial oligometastatic cancer, use of SABR was associated with high overall survival and low toxicity. 'The study findings complement ...