NBTXR3 and Radiation Therapy for the Treatment of Inoperable Recurrent Non-small Cell Lung Cancer

Inclusion Criteria

• Biopsy proven locoregional recurrent NSCLC after prior definitive radiation therapy, or patients that have imaging characteristics highly suggestive of recurrence but no pathologic or cytologic diagnosis. Pathologic diagnosis will be confirmed during the procedure to inject NBTXR3, prior to injecting the drug. If pathologic diagnosis cannot be established, the procedure will be aborted and the patient will be considered a screening failure. For stage IV patients, oligometastatic disease should be confirmed at screening. Oligomestastatic disease is defined as ≤ 3 cancer lesions, not including the primary tumor
• Participant is deemed medically inoperable by the investigator or treating physician
• Overlap between recurrent disease in need of treatment and prior radiation treatment field as determined by treating radiation oncologist * As a general reference, recurrent disease within 50% isodose line of prior radiation treatment field would be considered significant * Radiation treatment received more than 6 months prior to enrollment
• Amenable to undergo bronchoscopic (endobronchial ultrasound [EBUS], cone-beam computed tomography [CBCT]) or computed tomography (CT)-guided injection of NBTXR3 as per investigator or treating physician * Up to 4 lung lesions may be injected with NBTXR3, including the primary tumor, involved lymph node(s), and/or metastatic lesion(s) * At least 1 injected lesion should be located within a reirradiation field * All injected lesions must be radiated
• The target lesion(s) should be measurable on cross sectional imaging (Response Evaluation Criteria in Solid Tumors [RECIST] version [v]1.1 and immune-related [ir]RECIST), * Nodal target lesions must be >= 15 mm (short axis) based on CT (slice thickness of 5 mm or less) or magnetic resonance imaging (MRI)
• Age >= 18 years
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2
• COHORT I: Adequate laboratory values to receive radiation as determined by the principal investigator or treating physician
• Hemoglobin >= 8.0 g/dL (at screening for cohort II)
• Absolute neutrophil count (ANC) >= 1,500/mm^3 (at screening for cohort II)
• Platelet count >= 100,000/mm^3 (at screening for cohort II)
• Creatinine =< 1.5 x upper limit of normal (ULN) (at screening for cohort II)
• Calculated (Calc.) creatinine clearance > 45 mL/min (at screening for cohort II)
• Total bilirubin =< 2.0 mg/dL (at screening for cohort II)
• Aspartate aminotransferase (AST) / alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) (at screening for cohort II)
• Serum albumin >= 3.0 g/dL (at screening for cohort II)
• Negative urine or serum pregnancy test =< 7 days of NBTXR3 injection in all female participants of child-bearing potential
• Signed informed consent form (ICF) indicating that participant understands the purpose of, and procedures required for, the study and is willing to participate in the study
• English speaking or Non-English speaking subjects

Exclusion Criteria

• At screening, past medical history of: * Interstitial lung disease, except drug-induced ILD, specifically immunotherapy induced pneumonitis that has been resolved * Any grade 4 thoracic radiation related toxicity * Unresolved radiation related ** Esophagitis ** Pneumonitis ** Bronchopulmonary hemorrhage * Any grade ** Esophageal perforation ** Radiation associated airway necrosis ** Bronchoesophageal fistula ** Tracheoesophageal fistula ** Spinal cord myelopathy
• Has received any approved or investigational anti-neoplastic or immunotherapy agent within 2 weeks prior to NBTXR3 injection
• Use of concurrent systemic therapy (chemotherapy, immunotherapy, targeted therapy) or patient participation on another therapeutic clinical trial
• Active malignancy, in addition to locoregional recurrent NSCLC, with the exception of definitively treated and relapse free within 1 year from diagnosis of non-melanoma skin cancer or cervical cancer in situ; definitively treated non-metastatic prostate cancer; or patients with another primary malignancy who are definitely treated and relapse free with at least 2 years elapsed since the diagnosis of the other primary malignancy
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, renal failure, cardiac arrhythmia, or psychiatric illness that would limit compliance with treatment
• Known active, uncontrolled (high viral load) human immunodeficiency virus (HIV) or hepatitis B or hepatitis C infection
• Female patients who are pregnant or breastfeeding
• Women of child-bearing potential and their male partners who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period. Acceptable methods of contraception are those that, alone or in combination, result in a failure rate of < 1% per year when used consistently and correctly
• Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments
• Cognitively impaired subjects