Durvalumab(MEDI4736)/Tremelimumab in Combination With Gemcitabine/Cisp

Condition Intervention Phase
Biliary Tract Neoplasms
Drug: Durvalumab
Drug: Tremelimumab
Drug: Gemcitabine
Drug: Cisplatin
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: Biomarker-oriented Study of Durvalumab(MEDI4736)/Tremelimumab in Combination With Gemcitabine/Cisplatin in Chemotherapy-naïve Biliary Tract Cancer

Resource links provided by NLM:

MedlinePlus related topics: Cancer
Drug Information available for: Cisplatin Gemcitabine Gemcitabine hydrochloride
Genetic and Rare Diseases Information Center resources: Biliary Tract Cancer
U.S. FDA Resources

Further study details as provided by Seoul National University Hospital:

Primary Outcome Measures:
Response rate [ Time Frame: 6 weeks ]
According to RECIST v1.1 criteria

Secondary Outcome Measures:
Disease control rate [ Time Frame: 6 weeks ]
Progression-free survival [ Time Frame: 6 weeks ]
Duration of response [ Time Frame: 1 year ]
Overall survival [ Time Frame: 1 year ]
Quality-of-life [ Time Frame: 1 year ]
EORTC QLQ-BIL21

Overall response rate [ Time Frame: 6 week ]
According to immune-related response criteria

Toxicity [ Time Frame: 6 week ]
CTCAE V4.1

Estimated Enrollment: 31
Anticipated Study Start Date: March 2017
Estimated Study Completion Date: March 2019
Estimated Primary Completion Date: December 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Durvalumab/Tremelimumab+chemotherapy
Durvalumab and Tremelimumab in combination with gemcitabine/cisplatin.
Drug: Durvalumab
Durvalumab 1.12 g iv on D1 every 3 weeks
Other Name: MEDI4736
Drug: Tremelimumab
Tremelimumab 75mg iv on D1 every 3 weeks
Drug: Gemcitabine
Gemcitabine 1000 mg/m2 iv on D1& D8 every 3 weeks
Drug: Cisplatin
Cisplatin 25 mg/m2 iv on D1& D8 every 3 weeks

Detailed Description:

Rational #1. The incidence of biliary tract cancer (BTC) is higher in Korea than the West. (Korea: 10 new cases/100,000 population every year, the West:1-2 cases/100,100 population every year). Therefore, to conduct clinical study of BTC in Korea is very feasible and efficient.
Rational #2 The Gemcitabine/cisplatin is the current standard of care in 1st-line treatment for advanced BTC ((N Engl J Med 2010; 362 (14): 1273-81). No one-targeted therapy has been approved in BTC, yet. The overall survival of advanced BTC with cytotoxic chemotherapy is only 8-10 months, in general. Therefore, there is a huge unmet medical need.
Rational #3 In recent sequencing data of BTC showed the BTC patients with the worse prognosis had significant enrichment of hypermutated tumors and a characteristic elevation in the expression of immune checkpoint molecules. According, immune-modulating therapies also be potentially promising options for these patients (Nat Genet. 2015 Sep;47(9):1003-10.)
Rational #4 In PDL1 (+) BTC, anti-PD1 Ab shows promising activity as a monotherapy (Bang YJ, et al. ECC/ESMO 2015) In one clinical study of pembrolizumab, 37 out of 89 BTC patients (41.6%) showed the PDL1 (+) tumor. Among 24 PDL1 (+) patients who were enrolled and treated with pembrolizumab, 50% were Asian, 62.5% had ECOG 1, 16.7% had gallbladder cancer, 80% were at the 3rd-line or later setting. Four patients showed PR (3 from Seoul National University Hospital), 4 patients SD, which led the overall response rate of 17.4%. A total 40% of patients showed tumor shrinkage. The decreases in tumor size were generally maintained over time. This study gives us the evidence that immune checkpoint inhibitor is working on BTC likewise other solid tumors.
Rational #5 In recent studies have shown the combination of CTLA4 inhibitor with anti-PD1/PDL1 agents shows the enhanced clinical activities, especially, regardless of PDL1 status. This combination strategy is being actively under test in many solid tumors.
Rational #6 Certain chemotherapeutic drugs stimulate cancer-specific immune responses by inducing immunogenic cell death and other effector mechanisms (Immunity 2013, Annu Rev Immunol 2013) With the cytotoxic chemotherapy, the PDL-1 is induced and this increased expression of PDL1 contributes the resistance to cytotoxic chemotherapy. Successful eradication of tumors by immunogenic chemotherapy requires removal of immunosuppressive IgA+, PDL1+plasmocytes (Nature 2015). More importantly, still vast majorities of dynamic changes of immune system by cytotoxic chemotherapy are unanswered. These support that the combination of cytotoxic chemotherapy with immuno-oncology agents including immune checkpoint inhibitors might be efficacious and needed.
Rational #7 The advantages of “Immunotherapy and cytotoxic chemotherapy” combination are; 1) can explore science on the dynamic immunologic changes by cytotoxic chemotherapy and its overcome by immunotherapy 2) easy way to be incorporated in the current clinical practice 3) can be applied to variety of tumor types such as NSCLC, urothelial cancer. 4) relatively affordable than “immunotherapy and targeted agent” combination. Durvalumab/Tremelimumab in combination of cytotoxic chemotherapy has not been tested, especially in BTC.
Primary efficacy endpoint is response rate. In BTC, the response rate of 1st-line gemcitabine/cisplatin chemotherapy is about 20% (20% in BT22 clinical trial, 25% in ABC-02 clinical trial). Therefore, we set H0 as 20%, and H1 as 40%. Using 75% of power and a-error of 0.05, a total 28 patients will be needed. When we assume the drop-out rate of 10%, a total of 31 patients will be enrolled.

Eligibility

Ages Eligible for Study: 18 Years and older (Adult, Senior)
Sexes Eligible for Study: All
Accepts Healthy Volunteers: No
Criteria
Inclusion Criteria:

Histologically proven BTC, including intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, gallbladder cancer, ampulla of vater cancer
Unresectable or recurrent
chemotherapy -naïve for their unresectable or recurrent cancer (Previous expose to adjuvant chemotherapy is allowed)
should have measurable lesion
ECOG 0, 1
Without previous expose to immune-oncology agents including anti-CTLA4, anti-PD1, anti-PDL1, etc
Adequate organ function : ANC>1500/mm3, platelet>100K/mm3, HgB>9 g/Dl, bilirubin<1.5 x ULN, ALT/AST<2.5 X UNL, (in case of liver metastasis, <5 Xunl), Cr<1.5 mg/Dl
Informed consent
Exclusion Criteria:

Previous treatment for unresectable or recurrent cancer
Under immunosuppressive agents higher than equivalent dose of prednisone 10mg/day
Uncontrolled disease such as current active infection, congestive heart failure, uncontrolled hypertension, unstable angina, arrhythmia, interstitial lung disease
Current active pulmonary tuberculosis
Current active hepatitis B or hepatitis C (simple carrier is allowed)
anti-HIV (+)
Pregnant, breast-feeding women
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT03046862

Contacts
Contact: Oh ohdoyoun@snu.ac.kr

Locations
Korea, Republic of
Seoul National University Hospital
Seoul, Korea, Republic of, 110-744
Sponsors and Collaborators
Seoul National University Hospital
Investigators
Principal Investigator: Do youn Oh, MD, PhD Seoul National University Hospital
More Information

Responsible Party: Do-Youn Oh, Professor, Seoul National University Hospital
ClinicalTrials.gov Identifier: NCT03046862 History of Changes
Other Study ID Numbers: BTC-1st MEDITREME
Study First Received: February 6, 2017
Last Updated: February 7, 2017
Individual Participant Data
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No