Study Comparing the Standard Administration of IO Versus the Same IO Administered Each 3 Months in Patients in Response After 6 Months of Standard IO

Last updated: September 11, 2024
Sponsor: UNICANCER
Overall Status: Active - Recruiting

Phase

3

Condition

Neoplasm Metastasis

Head And Neck Cancer

Basal Cell Carcinoma

Treatment

Reduced dose intensity of IO

Clinical Study ID

NCT05078047
UC-IMM-2101
  • Ages > 18
  • All Genders

Study Summary

Immunotherapy (IO), such as treatment with anti-PD-1, PD-L1, or CTLA-4 inhibitors, is a rapidly expanding treatment for multiple metastatic cancers with improved survival for certain cancers. However, the optimal duration of immunotherapies is currently unknown. Our hypothesis is that a reduced dose intensity of IO could be as effective as the current standard treatment in term of prevention of the disease progression. If proved right, this study will have a positive medico-economic impact by reduction of the costs associated with the treatment and the toxicity, and an increase of the patients' quality of life.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Patients must have signed a written informed consent form prior to any trialspecific procedures.

  2. Patient aged ≥18 years old.

  3. Metastatic disease (or locally advanced disease not suitable for local treatment) ofinitial tumor histologically confirmed including: lung cancer, renal cell cancer,head and neck cancer, urothelial carcinoma, triple negative breast cancer, Merkelcancer, hepatocellular carcinoma, melanoma, colorectal carcinoma with microsatelliteinstability [MSI], esophageal squamous cell carcinoma, endometrialcarcinoma,cervical cancer, gastric/gastro-oesophageal junction adenocarcinoma, basalcell carcinoma or squamous skin carcinoma.

  4. Patients in partial or complete response after 6 months of standard immunotherapy (whatever the line of therapy) according to the RECIST or PERCIST v1.0 criteria (confirmed by local radiological assessment). For metastatic melanoma only patients in partial response. Patients with metastaticor advanced cancer treated by immunotherapy as maintenance therapy can be includedwithout any lesion at IO initiation. In this case, response after 6 months ofstandard immunotherapy will be evaluated by the non-appearance of a new lesion.

  5. Eligible to maintain the same standard IO treatment.

  6. Patient with Eastern cooperative oncology group (ECOG) performance status ≤1.

  7. Patients with brain metastases are allowed, provided they are stable according tothe following definitions: treated with surgery or stereotactic radiosurgery andwithout evidence of progression prior to randomization and have no evidence of newor enlarging brain metastases.

  8. Patients treated by IO previously combined with chemotherapy are allowed.

  9. Patients with Tyrosine Kinase Inhibitor (TKI)-IO or pemetrexed-IO or bevacizumab-IOare allowed.

  10. Evidence of post-menopausal status, or negative urinary or serum pregnancy test forpre-menopausal patients.

  11. Both sexually active women of childbearing potential and males (and their femalepartners) patients must agree to use adequate contraception method for the durationof the study treatment and after completing treatment according to the most recentversion of the IO Summary of product characteristics (SmPC).

  12. Patient is willing and able to comply with the protocol for the duration of thetrial including undergoing treatment and scheduled visits, and examinationsincluding follow-up.

  13. Patient must be affiliated to a Social Security System.

Exclusion

Exclusion Criteria:

  1. Metastatic melanoma in complete response.

  2. Metastatic renal cell carcinoma with International Metastatic Renal Cell CarcinomaDatabase (IMDC) favourable-risk treated TKI/IO combination.

  3. Hematologic malignancies (leukaemia, myeloma, lymphoma...)

  4. Active infection requiring systemic therapy.

  5. Patients enrolled in another therapeutic study within 30 days before the inclusionin and during MOIO study.

  6. Patient unable to comply with study obligations for geographic, social, or physicalreasons, or who is unable to understand the purpose and procedures of the study.

  7. Person deprived of their liberty or under protective custody or guardianship.

Study Design

Total Participants: 646
Treatment Group(s): 1
Primary Treatment: Reduced dose intensity of IO
Phase: 3
Study Start date:
March 08, 2022
Estimated Completion Date:
March 07, 2025

Study Description

Immunotherapy (IO) is a rapidly expanding treatment for multiple metastatic cancers with improved survival for certain cancers. For currently approved immunotherapies such as PD-1 / PD-L1 inhibitors and anti-CTLA-4, the rhythm and duration of treatment are recommended until disease progression or unacceptable toxicity. However, the optimal duration of these treatments is currently unknown.

No major dose-dependent effect of anti-PD-1 have been observed and whether the frequency of infusion of IO could improve response or maintain efficacy. Moreover, phase I studies have shown that saturation of the target (PD-1 or PD-L1) can persist far beyond the serum half-life of the IO and 3-monthly infusions of an anti-PD-1 antibody could potentially generate the same level of activity as infusions administered every 2 weeks.

In silico modeling studies have suggested that alternate scheduling with IO couldn't compromise the efficacy of the treatment. Indeed, prolonged half-lives of IO drugs, time-varying clearance plus plasma concentrations far above the threshold associated with maximal target-engagement, suggest that the rhythm of administration of IO could be slowed down.

Without substantial international data for responding patients, apart metastatic melanoma in complete response, patients and physicians are afraid of stopping treatment, by fear of relapse. Over-treatment with IO may be toxic and inefficient. The rising cost of cancer care in the era of immunotherapy is of great concern for public and private payers around the world.

Chronic administration has important consequences for patients and health systems, with multiple medical visits and the risk of chronic, progressive and sometimes fatal toxicities induced by immunotherapy.

This is a pragmatic and strategic study challenging the routine practice which compares for the first time in a randomized phase III study, the standard administration of IO versus the same agent administered each three months in patients with metastatic cancer in partial or complete response after 6 months of standard IO ( except melanoma in CR).

If our hypothesis of non-inferiority of PFS with a reduced dose intensity of IO is verified, this could replace standard treatment and have a positive medico-economic impact, allowing, on the one hand, a reduction of the costs associated with the treatment and the toxicity, and on the other hand, an increase of the patients' quality of life.

Connect with a study center

  • Institut de cancérologie de l'Ouest

    Angers, 49055
    France

    Active - Recruiting

  • Clinique Sainte Catherine

    Avignon, 84918
    France

    Active - Recruiting

  • Centre Hospitalier de la Côte Basque

    Bayonne, 64109
    France

    Active - Recruiting

  • CHU Besançon

    Besançon, 25030
    France

    Site Not Available

  • CHU Bordeaux - Hôpial Saint André

    Bordeaux,
    France

    Active - Recruiting

  • CH Boulogne sur Mer

    Boulogne-sur-Mer,
    France

    Site Not Available

  • Centre François Baclesse

    Caen, 14076
    France

    Active - Recruiting

  • Centre Jean Perrin

    Clermont-Ferrand, 63000
    France

    Active - Recruiting

  • CHU Henri Mondor

    Créteil, 94010
    France

    Active - Recruiting

  • Centre Hospitalier Intercommunal

    Créteil, 94010
    France

    Active - Recruiting

  • Centre Georges François Leclerc

    Dijon, 21079
    France

    Active - Recruiting

  • GH Mutualiste de Grenoble

    Grenoble,
    France

    Site Not Available

  • CHD Vendée

    La Roche-sur-Yon,
    France

    Site Not Available

  • Centre Oscar Lambret

    Lille,
    France

    Active - Recruiting

  • Clinique Chenieux

    Limoges, 87000
    France

    Active - Recruiting

  • Centre Léon Bérard

    Lyon,
    France

    Active - Recruiting

  • Hospices Civils de Lyon

    Lyon, 69310
    France

    Active - Recruiting

  • Hôpital La Timone -APHM

    Marseille, 13385
    France

    Site Not Available

  • Centre Antoine Lacassagne

    Nice, 06189
    France

    Active - Recruiting

  • CHU Nîmes/Institut de cancérologie du Gard

    Nîmes,
    France

    Active - Recruiting

  • Hôpital Cochin APHP

    Paris,
    France

    Active - Recruiting

  • Hôpital Européen Georges Pompidou

    Paris, 75015
    France

    Site Not Available

  • Hôpital Pitié Salpêtrière

    Paris, 75013
    France

    Site Not Available

  • Hôpital Saint Antoine APHP

    Paris,
    France

    Active - Recruiting

  • Hôpital Saint Louis

    Paris, 75010
    France

    Active - Recruiting

  • Institut Curie

    Paris, 75005
    France

    Site Not Available

  • CHU Poitiers

    Poitiers, 86000
    France

    Active - Recruiting

  • Insitut Godinot

    Reims, 51726
    France

    Site Not Available

  • Centre Eugene Marquis

    Rennes, 35042
    France

    Active - Recruiting

  • CHI Elbeuf

    Saint-Aubin-lès-Elbeuf,
    France

    Active - Recruiting

  • Institut Curie

    Saint-Cloud, 92210
    France

    Site Not Available

  • Institut de cancérologie de l'Ouest

    Saint-Herblain, 44805
    France

    Active - Recruiting

  • Centre Hospitalier Mémorial de Saint-Lô

    Saint-Lô,
    France

    Active - Recruiting

  • Clinique Mutualiste de l'Estuaire

    Saint-Nazaire,
    France

    Active - Recruiting

  • ICANS

    Strasbourg, 67200
    France

    Active - Recruiting

  • Hôpital Foch

    Suresnes, 92151
    France

    Active - Recruiting

  • HIA Sainte Anne

    Toulon,
    France

    Active - Recruiting

  • IUCT

    Toulouse, 31059
    France

    Active - Recruiting

  • CHU Bretonneau

    Tours, 37044
    France

    Active - Recruiting

  • Centre Gustave Roussy

    Villejuif,
    France

    Site Not Available

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