Scientific article
English

Rationale and Design of the AUSTRAL trial : An Open-Label, Multicenter, Phase II Study Evaluating Radiotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Stage III NSCLC Patients With Thoracic Relapses and/or Oligometastases After the PACIFIC Regimen

Published inClinical lung cancer, vol. 26, no. 8, p. e633-e638
Publication date2025-12
First online date2025-07-12
Abstract

Non-small-cell lung cancer (NSCLC) is a leading cause of death for cancer worldwide. Standard treatment for patients for whom surgical resection is not feasible is concurrent (PACIFIC regimen) or sequential (PACIFIC-like regimen) chemoradiotherapy with platinum-based doublet chemotherapy followed by durvalumab maintenance. The progression-free survival (PFS) rate after the PACIFIC regimen was 55.3% at 12 months, with the primary site of recurrence being intrathoracic. In retrospective studies, a relevant proportion of patients presented a combination of intrathoracic failure and limited extra-thoracic metastatic disease. For patients with local progression only, or with loco-regional progression and limited metastatic burden, the use of chemotherapy or other agents without the addition of a local therapy may represent a missed opportunity for a second curative intent treatment approach. The AUSTRAL trial, a phase II, interventional, multicenter, single-arm, study (ClinicalTrials.gov identifier, NCT06680050) aims to investigate the combination of thoracic irradiation ± Stereotactic Body Radiation Therapy (SBRT) to oligometastatic sites followed, after 2 to 4 weeks, by durvalumab and ceralasertib, administered until progression or severe toxicity. The study population will include 21 stage III NSCLC patients with loco-regional relapse after >12 months from the end of CRT ± ≤3 metastatic lesions following PACIFIC/PACIFIC-like regimens. The study will last approximately 40 months and involve 7 Italian and 2 Swiss sites. Primary hierarchical endpoints are safety, assessed by the continuous toxicity monitoring approach, and efficacy, assessed by PFS. Secondary endpoints are objective response rate (ORR), 6- and 12-month PFS and OS rate.

Keywords
  • Clinical trial
  • Immunotherapy
  • NSCLC
  • Radiation treatment
  • Humans
  • Carcinoma, Non-Small-Cell Lung / therapy
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Lung Neoplasms / mortality
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chemoradiotherapy / methods
  • Female
  • Male
  • Pyrimidines / therapeutic use
  • Pyrimidines / administration & dosage
  • Neoplasm Staging
  • Middle Aged
  • Clinical Trials, Phase II as Topic
  • Aged
  • Survival Rate
  • Multicenter Studies as Topic
Citation (ISO format)
FILIPPI, Andrea Riccardo et al. Rationale and Design of the AUSTRAL trial : An Open-Label, Multicenter, Phase II Study Evaluating Radiotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Stage III NSCLC Patients With Thoracic Relapses and/or Oligometastases After the PACIFIC Regimen. In: Clinical lung cancer, 2025, vol. 26, n° 8, p. e633–e638. doi: 10.1016/j.cllc.2025.07.006
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Article (Published version)
accessLevelRestricted
Identifiers
Journal ISSN1525-7304
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