Clinical Trials /

Durvalumab and Tremelimumab With Platinum-based Chemotherapy in Intrahepatic Cholangiocarcinoma (ICC)

NCT04989218

Description:

This pilot trial will be used to assess the activity, safety and feasibility of doublet immunotherapy and platinum-based chemotherapy in resectable intrahepatic cholangiocarcinoma with high risk features. The hypothesis is that the combination of durvalumab/MEDI4736 and tremelimumab (doublet immunotherapy) with platinum-based chemotherapy (gemcitabine and cisplatin) will yield an objective of 52% and improve complete resection rates in intrahepatic cholangiocarcinoma. This will facilitate margin negative resection and ultimately reduce recurrence rates and improve survival. Carrying out this trial in the neoadjuvant setting potentially allows improved overall survival and also provides an opportunity for discovery of biomarkers that may predict response to therapy.

Related Conditions:
  • Intrahepatic Cholangiocarcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Durvalumab and Tremelimumab With Platinum-based Chemotherapy in Intrahepatic Cholangiocarcinoma (ICC)
  • Official Title: An Open-label Window of Opportunity Trial to Evaluate the Activity of Durvalumab (MEDI4736) and Tremelimumab With Platinum-based Chemotherapy (Gemcitabine and Cisplatin) in Intrahepatic Cholangiocarcinoma (ICC)

Clinical Trial IDs

  • ORG STUDY ID: IRB-300005453
  • NCT ID: NCT04989218

Conditions

  • Cholangiocarcinoma

Interventions

DrugSynonymsArms
Novel combination of chemotherapy and immunotherapyCisplatin (Platinol), Gemcitabine (Gemzar), Durvalumab (Imfimzi), TremelimumabNovel combination of chemotherapy and immunotherapy

Purpose

This pilot trial will be used to assess the activity, safety and feasibility of doublet immunotherapy and platinum-based chemotherapy in resectable intrahepatic cholangiocarcinoma with high risk features. The hypothesis is that the combination of durvalumab/MEDI4736 and tremelimumab (doublet immunotherapy) with platinum-based chemotherapy (gemcitabine and cisplatin) will yield an objective of 52% and improve complete resection rates in intrahepatic cholangiocarcinoma. This will facilitate margin negative resection and ultimately reduce recurrence rates and improve survival. Carrying out this trial in the neoadjuvant setting potentially allows improved overall survival and also provides an opportunity for discovery of biomarkers that may predict response to therapy.

Detailed Description

      All enrolled participants will receive the study intervention. Patients will receive up to 4
      cycles of interventional agents prior to surgical resection. They will undergo imaging scans
      after the 2nd and 4th cycle (before surgery) of intervention agents. The short interval of
      scans (6 weeks) allows investigators to identify non responders. These patients may be
      encouraged to come off study and be treated based on the treating oncologist's choice. Since
      the investigational agents include 'standard of care' agents, a good argument can be made
      that these patients would not have benefitted from standard therapy only. Patients with at
      least stable disease after the 2nd treatment cycle will proceed with study interventions.
      However, patients with radiologic progression but who remain clinically stable may be allowed
      to continue treatment if the patient elects to, pending confirmation of progression and after
      a discussion between the investigator and sponsor-investigator.
    

Trial Arms

NameTypeDescriptionInterventions
Novel combination of chemotherapy and immunotherapyExperimentalThis study has one arm. All enrolled patients will receive a combination of a platinum based chemotherapy regimen (gemcitabine and cisplatin) and a combination of two immune check point inhibitors, anti- CTLA4 (Tremelimumab) and anti PDL-1 (durvalumab). Gemcitabine will be administered (gemzar) intravenously, 1000mg/m2 on Day 1 and Day 8 of a 21 day cycle for up to 4 cycles. Cisplatin (Platinol) will be administered intravenously, 25mg//m2 on Day 1 and Day 8 of a 21 day cycle for up to 4 cycles. Tremelimumab will be administered intravenously, 300mg flat dose, on Day 1 of cycle 1 only. Durvalumab will be administered intravenously 1500mg on Day 1 of a 21 day cycle for 4 cycles.
  • Novel combination of chemotherapy and immunotherapy

Eligibility Criteria

        Inclusion Criteria:

        Subject must meet all of the following applicable inclusion criteria to participate in this
        study:

          1. Histologically/cytologically confirmed diagnosed intrahepatic cholangiocarcinoma

          2. Measurable disease based on RECIST 1.1 and have 1 or more radiologic features
             compatible with high risk (for resection and recurrence) but still considered
             technically resectable per multidisciplinary tumor board (Surgical oncologist,
             radiologist and medical oncologist minimum) meeting. High risk features would include
             at least 1 of the following criteria-

             • A large tumor (> 5cm) that would benefit from preoperative tumor shrinkage with
             systemic therapy

               -  T1b-T4 tumor thought to be technically resectable

               -  Multifocal tumors/ a tumor with satellite lesions confined to the same lobe,
                  thought to be technically resectable

               -  Suspicious or involved lymph nodes (N1) thought to be technically resectable

               -  Tumor with any vascular involvement/invasion considered technically resectable

               -  No extrahepatic metastases

          3. Capable of giving signed informed consent which includes compliance with the
             requirements and restrictions listed in the informed consent form (ICF) and in this
             protocol. Written informed consent and any locally required authorization (e.g.,
             Health Insurance Portability and Accountability Act in the US) obtained from the
             patient/legal representative prior to performing any protocol-related procedures,
             including screening evaluations.

          4. Adult male or female age >18 years at time of study entry

          5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

          6. Life expectancy of > 6 months

          7. Body weight >30 kg

          8. Adequate normal organ and marrow function as defined below:

               -  Hemoglobin ≥ 10.0 g/dL

               -  Absolute neutrophil count (ANC ≥1.5 x 109/L (> 1500 per mm3)

               -  Platelet count ≥100 x 109/L (>75,000 per mm3)

               -  Serum bilirubin ≤1.5 x institutional upper limit of normal (ULN). This will not
                  apply to patients with confirmed Gilbert's syndrome (persistent or recurrent
                  hyperbilirubinemia that is predominantly unconjugated in the absence of hemolysis
                  or hepatic pathology), who will be allowed only in consultation with the sponsor.

               -  AST (SGOT)/ALT (SGPT) ≤2.5 x institutional upper limit of normal Measured
                  creatinine clearance (CL) >60 mL/min or Calculated creatinine clearance CL>60
                  mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976) or by 24-hour
                  urine collection for determination of creatinine clearance

          9. Evidence of post-menopausal status or negative urinary or serum pregnancy test for
             female pre-menopausal patients. Women will be considered post-menopausal if they have
             been amenorrhoeic for 12 months without an alternative medical cause. The following
             age-specific requirements apply:

               -  Women <50 years of age would be considered post-menopausal if they have been
                  amenorrhoeic for 12 months or more following cessation of exogenous hormonal
                  treatments and if they have luteinizing hormone and follicle-stimulating hormone
                  levels in the post-menopausal range for the institution or underwent surgical
                  sterilization (bilateral oophorectomy or hysterectomy).

               -  Women ≥50 years of age would be considered post-menopausal if they have been
                  amenorrhoeic for 12 months or more following cessation of all exogenous hormonal
                  treatments, had radiation-induced menopause with last menses >1 year ago, had
                  chemotherapy-induced menopause with last menses >1 year ago, or underwent
                  surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or
                  hysterectomy).

         10. Patient is willing and able to comply with the protocol for the duration of the study
             including undergoing treatment and scheduled visits and examinations including follow
             up.

         11. Provide archival tumour tissue sample or newly obtained core or excisional biopsy of a
             previously unirradiated tumour lesion. Tissue blocks are preferred but unstained cut
             slides acceptable. In addition, should be open to undergoing a biopsy after at least 2
             cycles of therapy. Patients who do not undergo surgical resection after 4 cycles will
             be advised to undergo another biopsy.

        Exclusion Criteria:

          1. Has had previous local (surgery, radiation, embolizing procedure) or systemic therapy
             for borderline resectable intrahepatic cholangiocarcinoma.

          2. Participation in another clinical study with an investigational product during the
             last 3 months.

          3. Concurrent enrolment in another clinical study, unless it is an observational
             (non-interventional) clinical study or during the follow-up period of an
             interventional study.

          4. Has ampullary cancer, extrahepatic cholangiocarcinoma or gall bladder cancer.

          5. Patients with distant extrahepatic metastatic disease including distant (non-regional
             lymph nodes). NOTE: Regional lymph nodes depend on tumor site; for left sided lesions,
             regional lymph nodes include inferior phrenic, hilar and gastrohepatic lymph nodes.
             For right sided lesions, regional lymph nodes include hilar periduodenal and
             peripancreatic lymph nodes.

          6. Has any other histologic subtype except adenocarcinoma or mixed histology with
             adenocarcinoma/hepatocellular carcinoma.

          7. Any unresolved toxicity NCI CTCAE Grade > 2 from previous anticancer therapy except
             for alopecia, vitiligo and the laboratory values defined in the inclusion criteria.

          8. Patients with Grade ≥ 2 neuropathy will be evaluated on a case-by-case basis after
             consultation with the sponsor-investigator.

          9. Patients with irreversible toxicity not reasonably expected to be exacerbated by
             treatment with durvalumab or tremelimumab may be included only after consultation with
             the sponsor-investigator. Any medical contraindication to the use of platinum-based
             doublet chemotherapy as judged by the treating physician.

         10. . Major surgical procedure (as defined by the Investigator) within 28 days prior to
             the first dose of study drugs.

         11. History of allogenic organ transplantation.

         12. Active or prior documented autoimmune or inflammatory disorders (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 are exceptions to this
             criterion:

             • Patients with vitiligo or alopecia

             • Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone
             replacement

               -  Any chronic skin condition that does not require systemic therapy

               -  Patients without active disease in the last 5 years may be included but only
                  after consultation with the study physician

               -  Patients with celiac disease controlled by diet alone

         13. Uncontrolled intercurrent illness, including but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable
             angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic
             gastrointestinal conditions associated with diarrhoea, or psychiatric illness/social
             situations that would limit compliance with study requirement, substantially increase
             risk of incurring AEs or compromise the ability of the patient to give written
             informed consent.

         14. History of active primary immunodeficiency.

         15. History of another primary malignancy except for

             • Malignancy treated with curative intent and with no known active disease ≥3 years
             before the first dose of IP and of low potential risk for recurrence

             • Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of
             disease

             • Adequately treated carcinoma in situ without evidence of disease

         16. Active infection including tuberculosis (clinical evaluation that includes clinical
             history, physical examination and radiographic findings, and TB testing in line with
             local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result),
             Patients 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, Patients
             positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction
             is negative for HCV RNA. Testing for HIV is not required at screening but patients
             with known HIV disease will be excluded from the study.

         17. Current or prior use of immunosuppressive medication within 14 days before the first
             dose of durvalumab or tremelimumab. The following are exceptions to this criterion:

             • Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra
             articular injection)

               -  Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of
                  prednisone or its equivalent

               -  Steroids as premedication for hypersensitivity reactions (e.g., CT scan
                  premedication)

         18. Receipt of live attenuated vaccine within 30 days prior to the first dose of study
             drug. NOTE: Patients, if enrolled, should not receive live vaccine whilst receiving
             study drug and up to 30 days after the last dose of study drug.

         19. Female patients who are pregnant or breastfeeding or male or female patients of
             reproductive potential who are not willing to employ effective birth control from
             screening to 90 days after the last dose of durvalumab monotherapy or180 days after
             the last dose of durvalumab + tremelimumab combination therapy.

         20. Known allergy or hypersensitivity to any of the study drugs or any of the study drug
             excipients.

         21. Prior randomization or treatment in a previous durvalumab and/or tremelimumab clinical
             study regardless of treatment arm assignment.

         22. Has had severe hypersensitivity (≥ Grade 3) to anti -PD1/PDL1 or anti-CTLA4 therapy
             and/or any of their excipients in the past.

         23. Patients who have received prior anti-PD-1, anti-PD-L1 or anti-CTLA-4:

             • Must not have experienced a toxicity that led to permanent discontinuation of prior
             immunotherapy. All AEs while receiving prior immunotherapy must have completely
             resolved or resolved to baseline prior to screening for this study.

               -  Must not have experienced a ≥Grade 3 immune related AE or an immune related
                  neurologic or ocular AE of any grade while receiving prior immunotherapy. NOTE:
                  Patients with endocrine AE of ≤Grade 2 are permitted to enrol if they are stably
                  maintained on appropriate replacement therapy and are asymptomatic.

               -  Must not have required the use of additional immunosuppression other than
                  corticosteroids for the management of an AE, not have experienced recurrence of
                  an AE if re-challenged, and not currently require maintenance doses of > 10 mg
                  prednisone or equivalent per day.

         24. Judgment by the investigator that the patient is unsuitable to participate in the
             study and the patient is unlikely to comply with study procedures, restrictions and
             requirements.

             -
      
Maximum Eligible Age:89 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Evaluate the objective response rate (ORR) based of the rate of partial and complete responses to the combination of intervention agents
Time Frame:Assessments will occur after 2 cycles (6 weeks) of receiving treatment and after 4 cycles (12 weeks) of receiving treatment or before surgical resection, whichever happens first.
Safety Issue:
Description:We will obtain computerized tomography (CT) and/or magnetic resonance imaging (MRI) scans to assess the response to the intervention agents. We are interested in determining the percentage of patients who achieve a complete response of partial response

Secondary Outcome Measures

Measure:Determine the rate of completion of preoperative therapy
Time Frame:Baseline through 16 weeks of treatment
Safety Issue:
Description:We will assess the percentage of patients who receive all 4 cycles of preoperative therapy
Measure:Determine the safety of the combination of intervention agents by assessing the percentage of patients who experience dose limiting toxicities or develop adverse reactions
Time Frame:Baseline through 16 weeks of treatment
Safety Issue:
Description:Adverse reactions will be monitored and documented based on the National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0. The percentage of patients who experience different grades of adverse events will be assessed
Measure:Determine changes in the tumor mRNA gene expression pattern, phenotype of circulating cytotoxic T cells, and changes in circulating markers of immunogenic cell death following treatment with intervention agents
Time Frame:Baseline through 24 months
Safety Issue:
Description:We will compare the differences in the patterns between the responders and the non responders.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:University of Alabama at Birmingham

Trial Keywords

  • Durvalumab
  • Tremelimumab
  • Platinum-based chemotherapy
  • Gemcitabine
  • Cisplatin

Last Updated

August 4, 2021