HALT: targeted therapy with or without dose-intensified radiotherapy in oligo-progressive disease in oncogene addicted lung tumours
McDonald, F. Guckenberger, M. Popat, S. Faivre-Finn, Corinne Andratschke, N. Riddell, A. Hanna, G. Franks, K. Harrow, S. Miles, E.
McDonald, F.
Guckenberger, M.
Popat, S.
Faivre-Finn, Corinne
Andratschke, N.
Riddell, A.
Hanna, G.
Franks, K.
Harrow, S.
Miles, E.
Citations
Altmetric:
Abstract
Introduction: Following initial response to TKI, advanced NSCLC
patients with actionable mutations will ultimately develop
treatment resistance. In a proportion of patients (15–40%), limited
progression (≤3 lesions) is initially observed, termed oligoprogressive
disease (OPD). Optimal management of these patients is uncertain,
with subsequent systemic therapy options limited in the UK. The
potential benefit offered by SBRT to ablate OPD sites prior to change
in systemic therapy is an important question to address. HALT
is designed to assess whether SBRT treatment to OPD sites can
increase the time patients derive clinical benefit from TKI therapy
until further disease progression
Methods: HALT is a randomised, multi-centre, phase II/III trial
with seamless transition to phase III incorporated. International
participation is established via a UK-led (ICR, NCRI Lung CSG,
RTTQA) intergroup collaboration with European coordinating groups
(EORTC and SAKK). Eligible patients (Stage IV NSCLC, actionable
mutation, initial TKI response prior to OPD) are randomised 2:1 to
SBRT and continued TKI or continued TKI alone. Follow-up aligned
with routine care at 3 monthly intervals until change in systemic
therapy is clinically indicated, with imaging and toxicity assessment
at each visit.
Results: HALT opened for recruitment November 2017; 19 centres
(14 UK; 5 non-UK) are open to date (30/09/2019) with 43 patients
registered and 26 randomised. A virtual MDT comprising trial
clinicians and radiologists convenes remotely to confirm eligibility
(OPD; SBRT suitability). Of 43 patients registered vMDT review has
been performed for 37 (6 screen fails prior to vMDT review); 26
patients randomised and 11 confirmed ineligible via vMDT.
Conclusion: The vMDT remains an important novel aspect of the
trial, ensuring robust patient selection ahead of randomisation.
As the first randomised trial assessing the benefit of SBRT in this
patient population, HALT will provide valuable treatment efficacy
and safety information, informing the design of an international
phase III trial.
Affiliation
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
McDonald F, Guckenberger M, Popat S, Faivre-Finn C, Andratschke N, Riddell A, et al. HALT: targeted therapy with or without dose-intensified radiotherapy in oligo-progressive disease in oncogene addicted lung tumours. Lung Cancer. 2020;139:S92-S