Inclusion Criteria:
General inclusion criteria for all cohorts.
- - Histologically proven advanced solid tumors that progressed/resisted after minimum
one line of standard systemic treatment, or resisted during the first-line of
treatment.
- - No indication of curative surgery for this disease at inclusion (For cohort 1 only
(peritoneal mesothelioma), debulking surgery could be considered after minimum 6
months of study treatment in the case of important tumor response)
- Evaluable lesions (target or non-target lesions) for radiological response according
to RECIST 1.1 (cohorts 3, 4, 5), or mRECIST (cohort 1), or assessable for biological
response with serum hCG (cohort 2)
- Patients older than 18 years.
- - Patients with Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1.
- - Patients must be willing to provide an archival tumor tissue block or slides, or
undergo procedure to obtain a new biopsy in absence of medical contraindication (If
either a fresh biopsy or archival material is not available, patient inclusion has
to be discussed and validated with the coordinators of the cohort)
- Patients with adequate bone marrow function measured within 28 days prior to
administration of study treatment:
- Absolute Neutrophil count > 1.5 x 109/L.
- - Platelets count ≥ 100 X 109/L.
- - Patients with adequate renal function: Calculated creatinine clearance ≥ 30 ml/min
according to the local institutional standard method (MDRD preferred)
- Serum bilirubin ≤ 1.5 x UNL (Upper Normal Limit) (< 3 x UNL for patients with known
Gilbert's syndrome), AST/ALT ≤ 2.5 X UNL (≤ 5 X UNL for patients with liver
metastases)
- Life expectancy ≥ 16 weeks.
- - Highly effective contraception for men and childbearing age women.
- - Signed informed consent prior to participating in any study related procedures.
- - Patients affiliated to the French social security system or equivalent.
- - Patient able to comply with the protocol, including follow-up visits and
examinations.
Specific inclusion criteria for each cohort:
- - Cohort 1 (Peritoneal mesothelioma)
- Histologically-confirmed malignant peritoneal mesotheliomas (epithelioid,
sarcomatoid, or biphasic)
- Evidence of progression or recurrence after at least one line of platinum +
pemetrexed based-chemotherapy regimen (Previous treatment with pressurized
intra-peritoneal aerosol chemotherapy (PIPAC) is authorized)
- Cohort 2 (Gestational trophoblastic tumors)
- Gestational trophoblastic tumors (including placenta site trophoblastic tumors
and epithelioid carcinomas) histologically or cytologically-confirmed by a
referent pathologist of the French National Center for Gestational
Trophoblastic Diseases (In exceptional cases, the patients with typical
clinical presentation of gestational trophoblastic tumors with elevated hCG,
and experiencing resistance to polychemotherapy, can be included even if the
gestational trophoblastic tumor was not histologically or
cytologically-confirmed, provided that the French gestational trophoblastic
center has validated the case and the inclusion of the patient)
- Evidence of resistance or relapse after at least one line of polychemotherapy
(e.g. EP low dose, BEP regimen, EMA-CO regimen .
..)
- - Cohort 3 (B3 thymomas and thymic carcinomas)
- B3 thymomas and thymic carcinoma, histologically confirmed by a referent
pathologist of the RYTHMIC network.
- - Evidence of progression or relapse after at least one line of platinum-based
chemotherapy.
- - Cohort 4 (Anaplastic thyroid carcinomas)
- Anaplastic thyroid carcinoma with non-mutated or mutated B-RAF, histologically
or cytologically-confirmed by a referent pathologist of the Tuthyref network.
- - In B-RAF non-mutated anaplastic thyroid carcinomas: Persistent disease at the
first evaluation after chemoradiation or disease progression/relapse after the
end of chemoradiation.
- - In B-RAF mutated anaplastic thyroid carcinoma: evidence of progression after a
standard B-RAF inhibitor.
- - Cohort 5 (GEP-NET and carcinoid tumors)
- Histologically or cytologically-confirmed well-differentiated neuroendocrine
tumor (WHO classification as NET G1, G2 or G3), or typical/atypical carcinoid
tumor (according to WHO classification for thoracic NETs), from
gastroenteropancreatic, thoracic (thymus or lung) or unknown primary origin.
- - Indication of oxaliplatin-based regimen treatment.
- - Evidence of progression or relapse after at least 1 line of systemic treatment,
such as somatostatine analog, or targeted agents such as everolimus or
sunitinib, or chemotherapy without oxaliplatin, or peptide receptor
radionuclide therapy.
Exclusion Criteria:
General exclusion criteria for all cohorts:
- - Previous treatment with immune checkpoint inhibitors (including anti-TIGIT,
anti-PD1, anti-PD-L1, anti-CTLA4), or other types of immunotherapy.
- - Active or prior documented autoimmune or immune-related disorders (Stevens-Johnson
syndrome, immune-related myocarditis, immune-related pneumonitis, immune-related
colitis, immune-related hepatitis, immune mediated dermatologic adverse reactions,
immune-mediated nephritis).
(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 and no treatment
for the last 5 years may be included but only after consultation with the
coordinator of the cohort)
- - Medical condition that requires chronic systemic steroid therapy, or any other forms
of immunosuppressive medication.
(For example, patients with autoimmune disease that
requires systemic steroids or immunosuppression agents should not to be included.
Replacement therapy (eg., thyroxine, or physiologic corticosteroid replacement
therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of
systemic treatment.)
- - Uncontrolled intercurrent illness, including but not limited to, congestive heart
failure; respiratory distress; liver failure; allergy; psychiatric illness/social
situations that would limit compliance with study requirement according to the
investigator, or that substantially increase risk of incurring AEs or compromise the
ability of the patient to give written informed consent.
- - Patients with a second primary cancer, except for: adequately treated non-melanoma
skin cancer, curatively treated in-situ cancer of the cervix, or other hematological
or solid cancers curatively treated with no evidence of disease for ≥ 3 years.
- - All subjects with meningeal involvement.
- - Untreated or symptomatic Central nervous system (CNS) metastases.
(Patients are
eligible if the following criteria are met:
- - CNS lesions are asymptomatic and previously treated.
- - Patient does not require ongoing steroid treatment.
- - Imaging demonstrates stability of disease 28 days from last treatment for CNS
metastases.
)
- - Patients receiving any systemic chemotherapy, radiotherapy (except for palliative
reasons), within 6 weeks from the last dose prior to study treatment (or at least 5
half-lives depending on the defined characteristics of the agents used).
The patient
can receive a stable dose of bisphosphonates for bone metastases, before and during
the study as long as these were started at least 4 weeks prior to treatment with
study drug.
- - Treatment with other investigational agents prone to interact with outcomes of the
trial upon to investigator opinion.
- - Bowel occlusive syndrome, inflammatory bowel disease, immune colitis, or other
gastro-intestinal disorders that do not allow oral medication such as malabsorption.
- - Active HIV, HBV or HCV infection.
- - Prior organ transplantation, including allogeneic stem cell transplantation
(excluding autologous bone marrow transplant).
- - Ongoing participation in any other clinical trial who may interfere with the present
study in the judgment of the investigator.
- - Patients under tutorship or guardianship.
Specific exclusion criteria by cohort:
- - Cohort 1 (Peritoneal mesothelioma)
- Planned cytoreductive surgery or PIPAC within 6 months of study treatment in
order to be able to assess the primary endpoint.
- - Cohort 3 (B3 thymomas and thymic carcinomas)
- Neuroendocrine tumors.
- - Any mixed histology with A/AB/B2 component.
- - Any paraneoplastic syndrome.
- - Positivity to anti RACh antibodies.
- - Cohort 5 (GEP-NET and carcinoid tumors)
- Poorly differentiated neuroendocrine carcinomas.
- Contraindication to FOLFOX-4 (DPD deficiency, i.e. uracilemia levels ≥ 16
ng/mL)
- Previous administration of oxaliplatin