IMMUNORARE5: A National Platform of 5 Academic Phase II Trials Coordinated by Lyon University Hospital to Assess the Safety and the Efficacy of the IMMUNOtherapy With Domvanalimab + Zimberelimab Combination in Patients With Advanced RARE Cancers

Study Purpose

Immune checkpoint inhibitors (ICI) have revolutionized the management of advanced cancers. However, most rare cancers have been excluded from this progress due to the lack of clinical trials involving these diseases. After the standard first-line treatment, there are no other validated treatments for most of them. The management of these patients in ≥ 2nd line treatment relies on historic poorly effective regimens. This creates an inequity between patients with frequent cancers beneficiating from medical progresses and approvals of innovative drugs, and patients with rare cancers are still treated with old and toxic drugs. Few available data on case reports and early phase studies indicate a beneficial role of the immunotherapy in rare cancers. The investigators assume that the combination of Domvanalimab and Zimberelimab is more effective than historical standard treatments in patients with 5 types of advanced rare cancers, after failure of at least one line of standard treatment in the advanced setting:

  • - Cohort 1: Peritoneal Mesotheliomas (PM) - Cohort 2: Gestational Trophoblastic Tumors (GTT) - Cohort 3: B3 Thymomas and Thymic Carcinomas (TET) - Cohort 4: Refractory Thyroid Carcinomas (ATC) - Cohort 5: GEP-NET and carcinoid tumors (GEP-NET (Gastroenteropancreatic neuroendocrine tumors)/TCT (Thoracic carcinoid tumor)/UP-NET (Neuroendocrine tumor of unknown primary)) The primary objective is to assess the efficacy of the combination of Domvanalimab and Zimberelimab in terms of progression-free survival rate at 24 weeks (for cohorts 1,3,5), successful hCG (Human Chorionic Gonadotropin) normalisation rate at 24 weeks for cohort 2 and survival rate for cohort 4.
The secondary objectives are to assess the efficacy of the combination of anti-TIGIT (T cell Immunoreceptor with Ig and ITIM domains) and anti-PD-1 (Programmed Death-1) immunotherapies in terms of overall response rate, progression-free survival (cohort 1-3 and 5), resistance-free survival (cohort 2), overall survival (cohorts 1-3 and 5), duration of the response (cohorts 1-3 and 5); and to assess the tolerability of the doublet of immunotherapy in terms of adverse events. Patients will be treated until disease progression or alternatively 2 years in case of complete response (upon discussion with the coordinator of the study, the coordinator of the cohort and the investigator), unacceptable toxicity, or death. At the end of treatment, patients will be followed up for at least 1 year. IMMUNORARE5 is composed of five independent open-label national multicenter single-arm phase II trials, sponsored by Lyon University Hospital, led in collaboration with the corresponding French national reference centers, with a centralized coordination by a dedicated team. Each phase II trial is designed as a two-stage Simon design, with early termination for futility. For each cohort, a null hypothesis (H0) and an alternative hypotheses (H1) regarding the percentages of patients with success has been defined, with 5% one-sided alpha level and 80% power. The trial will be conducted in 15 French Centers with an inclusion period of 36 months

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years and Over
Gender All
More Inclusion & Exclusion Criteria

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.
  • - Hemoglobin ≥ 9.0 g/dL.
  • - 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.
  • - Mixed tumors.
- Contraindication to FOLFOX-4 (DPD deficiency, i.e. uracilemia levels ≥ 16 ng/mL) - Previous administration of oxaliplatin

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT06790706
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 2
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Hospices Civils de Lyon
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

N/A
Principal Investigator Affiliation N/A
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Not yet recruiting
Countries France
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Peritoneal Mesothelioma, Gestational Trophoblastic Tumor, Thymoma and Thymic Carcinoma, Anaplastic Thyroid Carcinomas, Gastroenteropancreatic Neuroendocrine Tumor, Carcinoid Tumor
Arms & Interventions

Arms

Experimental: Cohort 1: Peritoneal mesotheliomas

Patients will receive a combination of Domvanalimab and Zimberelimab.

Experimental: Cohort 2: Gestational trophoblastic tumors

Patients will receive a combination of Domvanalimab and Zimberelimab.

Experimental: Cohort 3: B3 thymomas and thymic carcinomas

Patients will receive a combination of Domvanalimab and Zimberelimab.

Experimental: Cohort 4: Anaplastic thyroid carcinomas

Patients will receive a combination of Domvanalimab and Zimberelimab.

Experimental: Cohort 5: GEP-NET & carcinoid tumors

Patients will receive a combination of Domvanalimab and Zimberelimab together with an induction treatment of intravenous FOLFOX-4.

Interventions

Drug: - DOMVANALIMAB + ZIMBERELIMAB

Patients will be treated with intravenous Domvanalimab at flat dose of 1200 mg + intravenous Zimberelimab at flat dose of 360 mg, administered every 3 weeks (Q3W, one cycle = 3 weeks).

Drug: - DOMVANALIMAB + ZIMBERELIMAB + FOLFOX-4

Patients will be treated with intravenous Domvanalimab at flat doses of 1600 mg + intravenous Zimberelimab at flat dose of 480 mg, administered every 4 weeks (Q4W), together with an induction treatment of intravenous FOLFOX-4 (Oxaliplatin 85 mg/m2 IV, L-folinic acid 200 mg/m2 IV, and fluorouracil 400 mg/m2 IV bolus on Day 1, fluorouracil 2400 mg/m2 IV continuous infusion over 46-48 hours starting on Day 1) given every 2 weeks, for 4 months (one cycle = 4 weeks).

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

International Sites

Angers, France

Status

Address

Institut de Cancerologie de l'Ouest , medical oncology department

Angers, , 49055

Site Contact

Judith RAIMBOURG, MD

[email protected]

0240679900 #+33

Bordeaux, France

Status

Address

Institut Bergonié, medical oncology department

Bordeaux, , 33076

Site Contact

Sophie COUSIN, MD

[email protected]

0556333333 #+33

Bron, France

Status

Address

Hospices Civils de Lyon, Thoracic Oncology Department, Louis Pradel Hospital

Bron, , 69500

Site Contact

Michael DURUISSEAUX, Prof, MD/PhD

[email protected]

0478857700 #+33

Lille, France

Status

Address

Centre Hospitalier Universitaire de Lille, medical oncology department

Lille, , 59037

Site Contact

Pauline PARENT, MD

[email protected]

0320445461 #+33

Lyon, France

Status

Address

Hospices Civils de Lyon, Medical Oncology Department, Edouard Herriot Hospital

Lyon, , 69003

Site Contact

Thomas WALTER, Prof; MD/PhD

[email protected]

0472117398 #+33

Marseille, France

Status

Address

AP-HM, TIMONE Hospital, medical oncology department

Marseille, , 13009

Site Contact

Pascale TOMASINI, MD

[email protected]

0491384644 #+33

Marseille, France

Status

Address

Institut Paoli-Calmettes Marseille, medical oncology department

Marseille, , 13009

Site Contact

Cécile VICIER, MD

[email protected]

0491223847 #+33

Montpellier, France

Status

Address

Institut Régional du Cancer de Montpellier, medical oncology department

Montpellier, , 34298

Site Contact

Diego TOSI, MD

[email protected]

0467612304 #+33

Paris, France

Status

Address

Institut Curie, thoracic oncology department

Paris, , 75005

Site Contact

Nicolas GIRARD, Prof, MD/PhD

[email protected]

0156616250 #+33

Paris, France

Status

Address

AP-HP, Tenon Hospital, medical oncology department

Paris, , 75020

Site Contact

Mathieu JAMELOT, MD

[email protected]

0156016143 #+33

Pierre-Bénite, France

Status

Address

Hospices Civils de Lyon, Medical Oncology Department, Lyon SUD Hospital

Pierre-Bénite, , 69310

Site Contact

Benoit YOU, Prof; MD/PhD

[email protected]

0478864385 #+33

Rennes, France

Status

Address

Centre Eugène Marquis, medical oncology department

Rennes, , 35042

Site Contact

Thibault DE LA MOTTE ROUGE, MD

[email protected]

0299252969 #+33

Strasbourg, France

Status

Address

Insitut de Cancérologie Strasbourg Europe, medical oncology department

Strasbourg, , 67200

Site Contact

Lauriane EBERST, MD

[email protected]

0368767168 #+33

Toulouse, France

Status

Address

ONCOPOLE Claudius Regaud, IUCT-Oncopole, medical oncology department

Toulouse, , 31059

Site Contact

Victor SARRADIN, MD

[email protected]

0531155996 #+33

Villejuif, France

Status

Address

Institut Gustave Roussy, medical oncology department

Villejuif, , 94805

Site Contact

Julien HADOUX, MD

[email protected]

0142116361 #+33

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