Official Title
Biomarker Discovery Study to Identify Patients With Advanced Urothelial Cancer Benefitting From Pembrolizumab Treatment
Brief Title
Biomarkers in Urothelial Cancer Patients Treated With Pembrolizumab
Protocol ID
NCT03263039
Lead Sponsor
Erasmus Medical Center
Brief Summary
In the RESPONDER study, the role of the immune evasive mechanisms combined with genomic
characterization will be explored in urothelial cancer patients treated with second-line
treatment with pembrolizumab.
Combined profiling of immune and molecular status is novel and may contribute to improved
patient stratification and provide rationale for future treatment strategies containing
pembrolizumab.
Detailed Description
Antibodies that target the crosstalk between immune and cancer cells by inhibiting
programmed death 1 (PD-1, Pembrolizumab and Durvalumab) or programmed death-ligand 1
(PD-L1, Atezolizumab) have shown promising results as second-line treatments in phase II
studies with response rates of about 30%.
Although urothelial cancer is prone to immune checkpoint blockade, better understanding
of the underlying mechanisms is necessary to improve patient selection. The efficacy of
immune checkpoint inhibitors in urothelial cancer may be affected by both tumor specific
and environmental factors. In order to improve the efficacy of immunotherapy in
urothelial cancer, drivers of local immune suppression need to be identified.
In this prospective translational multicenter study, clinical data, peripheral blood and
sequential tumor biopsies are collected from urothelial cancer patients treated with
second-line treatment with pembrolizumab to identify the role of immune evasive
mechanisms combined with genomic characterization. A pre-treatment tumor biopsy and blood
sample will be obtained and subsequently whole genome sequencing and whole genome RNA
sequencing is performed. Both tumor tissue as well as peripheral blood will be
investigated for immune and molecular profiling. A biopsy will also be taken after start
of treatment (at 6 weeks) and at progression (optional)
For future research projects, longitudinal blood samples will be collected for isolation
of immune cells, cytokine/chemo-attractants and circulating tumor DNA (ctDNA).
Study Period
-
Enrollment Count
80 participants
Eligibility Criteria
Inclusion Criteria:
1. Should have signed informed consent for CPCT-02 (this is another clinical trial,
NCT01855477)
2. Be willing and able to provide written informed consent for the trial.
3. Be >= 18 years of age on day of signing informed consent.
4. Have histologically or cytologically-confirmed urothelial cancer that is not
amenable to curative treatment with local and/or systemic therapies.
5. Have progressive disease after platinum containing chemotherapy as defined by:
1. Disease progression after treatment with a platinum-containing regimen for
recurrent (disease not amenable to curative treatment)/metastatic disease
2. Recurrence/progression within 12 months of prior therapy containing platinum
6. Have measurable disease based on RECIST 1.1. Tumor lesions located in a previously
irradiated area are considered measurable if progression has been demonstrated in
these lesions.
7. Be willing to provide tissue from a newly obtained core or excisional biopsy of a
tumor lesion. Newly-obtained is defined as a specimen obtained up to 6 weeks (42
days) prior to initiation of treatment on Day 1. Subjects for whom newly-obtained
samples cannot be provided (e.g. inaccessible or subject safety concern) may submit
an archived specimen only upon agreement from the Sponsor.
8. Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG)
Performance Scale.
9. Demonstrate adequate organ function according to screening labs, which should be
performed within 10 days of treatment initiation.
10. Female subject of childbearing potential should have a negative urine or serum
pregnancy within 72 hours prior to receiving the first dose of study medication. lf
the urine test is positive or cannot be confirmed as negative, a serum pregnancy
test will be required.
11. Female subjects of childbearing potential must be willing to use an adequate method
of contraception as outlined in protocol - Contraception, for the course of the
study through 120 days after the last dose of study medication.
Note: Abstinence is acceptable if this is the usual lifestyle and preferred
contraception for the subject.
12. Male subjects of childbearing potential must agree to use an adequate method of
contraception as outlined in protocol- Contraception, starting with the first dose
of study therapy through 120 days after the last dose of study therapy.
Note: Abstinence is acceptable if this is the usual lifestyle and preferred contraception
for the subject.
Exclusion Criteria:
1. Treatment with an investigational agent and received study therapy or used an
investigational device within 4 weeks of the first dose of treatment.
2. Has a diagnosis of immunodeficiency or is receiving high dose systemic steroid
therapy (defined as >=; 20 mg prednisone or equivalent per day) or any other form of
immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
3. Has a known history of active TB (Tuberculosis Bacillus).
4. Hypersensitivity to pembrolizumab or any of its excipients.
5. Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study
Day 1 or who has not recovered (i.e., :S Grade 1 or at baseline) from adverse events
due to agents administered more than 4 weeks earlier.
6. Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy
within 2 weeks prior to study Day 1 or who has not recovered (i.e., :S Grade 1 or at
baseline) from adverse events due to a previously administered agent
- Note: Subjects with Grade 2 neuropathy are an exception to this criterion and
may qualify for the study.
- Note: If subject received major surgery, they must have recovered adequately
from the toxicity and/or complications from the intervention prior to starting
therapy.
7. Has a known additional malignancy that is progressing or requires active treatment
Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of
the skin that has undergone potentially curative therapy or in situ cervical cancer.
8. Has known active central nervous system (CNS) metastases and/or carcinomatous
meningitis. Subjects with previously treated brain metastases may participate
provided they are stable (without evidence of progression by imaging for at least
four weeks prior to the first dose of trial treatment and any neurologic symptoms
have returned to baseline), have no evidence of new or enlarging brain metastases,
and are not using high dose steroids (defined as >=; 20 mg prednisone or equivalent
per day) for at least 7 days prior to trial treatment. This exception does not
include carcinomatous meningitis which is excluded regardless of clinical stability.
9. Has active autoimmune disease that has required systemic treatment in the past 2
years (i.e. with use of disease modifying agents, corticosteroids or
immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or
physiologic corticosteroid replacement therapy for adrenal or pituitary
insufficiency, etc.) is not considered a form of systemic treatment.
10. Has known history of, or any evidence of active, (non-infectious) pneumonitis that
required steroids, evidence of interstitial lung disease or active, non-infectious
pneumonitis.
11. Has an active infection requiring systemic therapy.
12. Has a history or current evidence of any condition, therapy, or laboratory
abnormality that might confound the results of the trial, interfere with the
subjects participation for the full duration of the trial, or is not in the best
interest of the subject to participate, in the opinion of the treating investigator.
13. Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.
14. Is pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the trial, starting with the prescreening or screening visit
through 120 days after the last dose of trial treatment.
15. Has received prior therapy with an anti-PD-1, anti-PD-L 1, or anti- PD-L2 agent.
16. Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
17. Has a known history ofor is positive for hepatitis B (hepatitis B surface antigen
[HBsAg] reactive) or hepatitis C (hepatitis C virus [HCV] RNA [qualitative] is
detected). Note: Without known history, testing needs to be performed to determine
eligibility.
Hepatitis C antibody (Ab) testing is allowed for screening purposes in countries
where HCV RNA is not part of standard of care.
18. Has received a live vaccine within 30 days of planned start of study therapy. Note:
Seasonal influenza vaccines for injection are generally inactivated flu vaccines and
are allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live
attenuated vaccines, and are not allowed
Filters
Transitional Cell Carcinoma of the Bladder
Biomarkers
PHASE2
UNKNOWN
ADULT
OLDER_ADULT