Inhaled Budesonide for REcurrence Prevention and Adjuvant THerapy in Checkpoint Inhibitor Pneumonitis

NCT06860542 | Recruiting Phase 2 DMC

• 1 other identifier: IBREATHCIP
• Study Type: interventional
• Target: 94
• Locations: 1 country
• Sites: 1

Brief Summary

The introduction of immune checkpoint inhibitors (immunotherapy) that stimulate our immune system to recognize and attack cancer cells has been one of the most exciting advances in oncology over the last decade. These medications are now employed across almost half of cancer types and settings, however they come with a cost. In some patients, instead of attacking cancer cells alone, the stimulated immune system damages healthy tissues (immune related adverse events), with one of the most severe and potentially deadly such complications being immune attack on the lungs, or checkpoint inhibitor pneumonitis (CIP). When treated promptly with oral or intravenous steroids, acute CIP improves in many cases, however for approximately one-fifth of patients the lung inflammation is difficult to control, resulting in recurrent shortness of breath, the need for extended courses of oral or intravenous steroids, impacting quality of life and cancer therapy decisions. The goal of the trial is to assess whether use of inhaled steroids, a type of medication commonly used in asthma patients, for one year after a first diagnosis of CIP may help the lung inflammation resolve and not return, without the repeated use of oral or intravenous medications that carry more side effects.

Conditions

Pneumonitis; Immune-related Adverse Event

Keywords

Immune-related Adverse Event; Checkpoint Inhibitor Pneumonitis

Outcome Measures

Primary Outcomes (1)

• Assess efficacy of inhaled budesonide in reducing the development of refractory or recurrent Checkpoint Inhibitor Pneumonitis (RR-CIP) after initial episode of >/grade 2 CIP

  Compare incidence of refractory or recurrent Checkpoint inhibitor pneumonitis (RR-CIP) after initial episode of \>/grade 2 CIP with or without addition of inhaled budesonide to usual care.

  1 year

Secondary Outcomes (4)

• Assess steroid toxicities after development of >/grade 2 Checkpoint inhibitor pneumonitis (CIP)

  1 year

• Compare systemic steroids requirements in patients after development of >/grade 2 Checkpoint inhibitor pneumonitis (CIP)

  1 year

• Assess the impact of adjuvant inhaled budesonide on time to improvement of initial episode of Checkpoint inhibitor pneumonitis (CIP)

  1 year

• Compare Patient Reported Outcomes (PROs) in patients after initial episode of Checkpoint inhibitor pneumonitis (CIP)

  1 year

Study Arms (2)

Arm 1- Usual care

ACTIVE COMPARATOR

The comparison arm will be usual care (UC) for Checkpoint Inhibitor Pneumonitis (CIP); recommended guideline management consists of systemic steroids 1-2mg/kg via oral (grade 2) or IV (grade 3/4) until clinical improvement, then taper over 6 weeks (grade 2) or 8 weeks (grade 3/4). Final CIP management decisions at treating physicians discretion.

Other: Arm 1- Usual care

Arm 2- Budesonide (Pulmicort® Turbuhaler®) + Usual care

EXPERIMENTAL

Budesonide (Pulmicort® Turbuhaler®) 800ug inhaled twice daily (BID) will be taken in addition to usual care for 36 weeks. Checkpoint Inhibitor Pneumonitis (CIP) flare/recurrence will be treated as initial episode/per guidelines.

Drug: Arm 2- Budesonide (Pulmicort® Turbuhaler®) + Usual care

Interventions

Arm 1- Usual care OTHER

The comparison arm will be usual care (UC) for Checkpoint inhibitor pneumonitis (CIP) (steroids).

Also known as: Comparator arm

Arm 1- Usual care

Arm 2- Budesonide (Pulmicort® Turbuhaler®) + Usual care DRUG

Budesonide (Pulmicort® Turbuhaler®) 800ug inhaled twice daily (BID) will be taken in addition to usual care for 36 weeks.

Arm 2- Budesonide (Pulmicort® Turbuhaler®) + Usual care

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients must be 18 years of age, or older on the day of signing informed consent and be willing and able to provide written informed consent/assent and, in the opinion of the Investigator, comply with protocol tests and procedures
• Patients require histologically confirmed solid tumour undergoing immune checkpoint inhibitor (ICI) therapy
• Diagnosis of first documented diagnosis of Checkpoint Inhibitor Pneumonitis (CIP) made per European Society for Medical Oncology (ESMO)/American Society for Medical Oncology (ASCO) guidelines with severity \>/grade 2 by Common Terminology Criteria for Adverse Events (CTCAE)v5.0
• a. Per ASCO/ESMO consensus guidelines, workup must include a compatible clinical picture, plus/minus supporting radiographic evidence (chest x-ray or preferably computed tomography (CT)), combined with clinical and/or microbiologic ruling out of alternative etiologies including infections or pulmonary disease progression. This includes a negative COVID test. Bronchoscopic sampling is not required, but can be considered.
• Be able to effectively operate and use budesonide delivery method (Turbuhaler®), either independently or with aid of caregiver who anticipates being able to do so throughout trial period
• Have adequate organ function, as judged by enrolling clinician
• Females of childbearing potential have a negative urine or serum pregnancy test prior to study day 1. Patients of childbearing potential are those who have not been surgically sterilized or have not been free of menses for at least 1 year
• Females of childbearing potential are willing to use contraception or abstain from heterosexual sexual contact for the course of the study

You may not qualify if:

• Diagnosis of interstitial lung disease (ILD) active (clinically and radiologically evident) within last year prior to diagnosis of CIP
• Current (within last two weeks), active (not medically able or unwilling to discontinue prior to treatment start) and regular (2 or more times per week) use of inhaled steroids (for any indication) or systemic (\>10mg prednisone equivalent) corticosteroids (for indication other than CIP) at time of randomization
• Receiving systemic, non-chemotherapy immunosuppressive agent at time of randomization (hydroxychloroquine is acceptable)
• Use of a medication with significant interaction with inhaled budesonide (HIV protease inhibitors, ketoconazole or other potent CYP3A4 inhibitors), unless deemed required and safe by co-investigator.
• Known poorly controlled diabetes, defined as A1c \>10, prior to initiation of steroids for CIP
• History of active and unstable systemic disease, including heart failure New York Heart Association (NYHA) III or IV, cirrhosis with Child Pugh B or C, Renal Failure with creatinine clearance (CrCl) \<30 per Cockcroft-Gault formula, or other unstable life limiting condition as determined by trial investigators
• Current or prior participation in a study of an investigational agent or device within 4 weeks of randomization
• History or current evidence of any condition, therapy, or laboratory abnormalities which might confound trial results, interfere with the patient's participation for the full duration of the trial, or otherwise causing it to be not in the best interest of the patient to participate in the trial, in the opinion of the treating investigator.
• Is or has an immediate family member (e.g., spouse, parent/legal guardian, sibling or child) who is directly involved with this trial, unless prospective ethics board approval (by chair or designee) is given allowing exception to this criterion for a specific patient
• Breastfeeding is not permitted during the duration of trial participation.

Sponsors & Collaborators

• AHS Cancer Control Alberta: lead

Study Sites (1)

Arthur J.E. Child Comprehensive Cancer Centre

Calgary, Alberta, T2N 5G2, Canada

RECRUITING

MeSH Terms

Conditions

Pneumonia

Condition Hierarchy (Ancestors)

Respiratory Tract Infections; Infections; Lung Diseases; Respiratory Tract Diseases

Central Study Contacts

Alexander Watson, MD

CONTACT

587-231-5098; alexander.watson@cancercarealberta.ca

Amy Abel

CONTACT

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Budesonide (Pulmicort® Turbuhaler®) 800ug inhaled twice daily (BID) will be taken in addition to usual care for 36 weeks. Checkpoint inhibitor pneumonitis (CIP) flare/recurrence will be treated as initial episode/per guidelines. The comparison arm will be usual care (UC) for CIP; recommended guideline management consists of systemic steroids 1-2mg/kg via oral (grade 2) or intravenous (IV) (grade 3/4) until clinical improvement, then taper over 6 weeks (grade 2) or 8 weeks (grade 3/4). Final CIP management decisions at treating physicians discretion.

Study Record Dates

• First Submitted: February 24, 2025
• First Posted: March 6, 2025
• Study Start: February 10, 2026
• Primary Completion (Estimated): December 1, 2029
• Study Completion (Estimated): December 1, 2030
• Last Updated: March 23, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)