Personalized Treatment following Chemoradiotherapy and Immunotherapy for the Treatment of Stage III Non-small Cell Lung Cancer

Inclusion Criteria

• Histologically or cytologically documented NSCLC who present with locally advanced, unresectable stage III disease (version 8 of American Joint Committee on Cancer [AJCC] staging manual)
• Must have received at least 2 doses of weekly platinum based chemotherapy or 1 dose of every 3 weeks platinum-based chemotherapy concurrent with >= 60 Gy definitive radiation therapy to all known tumor sites, and not have known progression of disease. Radiation and chemotherapy must be completed or within 1 week of planned completion
• Must be receiving adjuvant durvalumab following completion of chemotherapy and radiation, and less than 12 weeks has elapsed from their first dose of durvalumab. (Patients may sign consent for study before start of adjuvant durvalumab, but register only after first dose of durvalumab is administered)
• Willing to potentially receive further consolidation chemotherapy with carboplatin and pemetrexed or carboplatin and paclitaxel as specified by the protocol, but not be currently intended to receive additional consolidation chemotherapy apart from this protocol
• Aged 18 years or older
• Weight > 30 kg
• Life expectancy >= 12 weeks
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
• Absolute neutrophil count > 1.0 x 10^9/L (1000/mm^3)
• Platelets > 75 x 109/L (100,000/mm^3)
• Hemoglobin >= 9.0 g/dL (5.59 mmol/L)
• Measured creatinine clearance > 40 mL/min, by either 24 hour urine collection or the Cockcroft Gault formula
• Serum bilirubin =< 1.5 x upper limit of normal (ULN). This will not apply to subjects with confirmed Gilbert’s syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of evidence of hemolysis or hepatic pathology) who will be allowed in consultation with their physician
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 x institutional upper limit of normal (ULN) unless liver metastases are present, in which case it must be =< 5 x ULN
• Ability to understand and the willingness to sign the written Institutional Review Board (IRB) approved informed consent document

Exclusion Criteria

• Involvement in the planning and/or conduct of the study
• Previous enrollment or randomization in the present study
• Participation in another clinical study with an investigational product (i.e., non standard of care) during the last 4 weeks
• Mixed small cell and non small cell lung cancer histology
• Received only sequential chemoradiation therapy for locally advanced NSCLC (must have concurrent chemotherapy together with radiation but may have received additional chemotherapy as well)
• History of another primary malignancy and currently undergoing active treatment (i.e., chemotherapy, hormonal therapy, biologics)
• Current or prior use of immunosuppressive medication within 14 days before enrollment, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid. Systemic steroid administration required to manage toxicities arising from radiation therapy delivered as part of the chemoradiation therapy for locally advanced NSCLC is allowed
• Any unresolved toxicity Common Terminology Criteria for Adverse Events > grade 2 from the prior chemoradiation therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria. * Subjects with grade >= 2 neuropathy will be evaluated on a case by case basis after consultation with the protocol director/principal investigator * Subjects with irreversible toxicity that is not reasonably expected to be exacerbated by treatment with durvalumab may be included (i.e., hearing loss) only after consultation with the protocol director/principal investigator
• Any prior grade >= 3 immune related adverse event (irAE) while receiving any previous immunotherapy agent, or any unresolved irAE > grade 1) that may limit subject from continuing durvalumab during the study
• Recent major surgery within 4 weeks prior to entry into the study (excluding the placement of vascular access) that would prevent administration of study drug
• Active or prior documented autoimmune or inflammatory disorders which could limit the subjects ability to continue durvalumab on the study (including inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis; Graves' disease; rheumatoid arthritis; hypophysitis; uveitis; etc]). The following may be taken in to considerations as exceptions to this criterion: * Vitiligo or alopecia * Hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement * Chronic skin condition not requiring systemic therapy * Those without active disease in the last 5 years may be included, but only after consultation with the study physician * Celiac disease controlled by diet alone
• History of primary immunodeficiency
• History of organ transplant requiring therapeutic immunosuppression
• History of hypersensitivity to durvalumab, carboplatin, pemetrexed or paclitaxel
• Active infection including but not limited to: * Tuberculosis * Hepatitis B [known positive results for HBV surface antigen (HBsAg) within 2 months prior to enrollment]. EXCEPTION: Subjects with a past or resolved HBV infection, defined as the presence of hepatitis B core antibody (anti HBc) and absence of HBsAg are eligible. * Hepatitis C (HCV). EXCEPTION: Subjects positive for HCV antibody are eligible only if polymerase chain reaction is negative for HCV ribonucleic acid (RNA)
• Receipt of live attenuated vaccine within 30 days prior to the first dose of investigational product (IP). Note: Subjects, if enrolled, should not receive live vaccine while receiving the investigational product (IP), and through 30 days after the last dose of IP
• Uncontrolled intercurrent illness, including but not limited to: * Ongoing or active infection requiring intravenous (IV) antibiotics * Symptomatic congestive heart failure * Uncontrolled clinically significant hypertension * Unstable angina pectoris * Clinically significant cardiac arrhythmia * Interstitial lung disease (presence of radiation pneumonitis on computed tomography [CT] scan is allowed) * Serious chronic gastrointestinal conditions associated with diarrhea * Psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring adverse event [AE]s or compromise the ability of the subject to give written informed consent
• Female subjects who are pregnant or breast‑feeding; or subjects of reproductive potential of any gender who are not employing or who do not agree to employ an effective method of birth control prior to trial enrollment