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This study (phase I clinical trial and expansion cohorts) will evaluate safety and efficacy of combination of atezolizumab and tiragolumab, with concomitant or sequential SBRT for four oligometastatic cancer cohorts. This study will allow to developpe one or several randomized Phase II clinical trials for the more promising indications
This study will be composed of 2 stepms. First step will be a phase I with the aim to establish the recommended safety scheme of administration (concomitant or sequential) of tiragolumab + atezolizumab + SBRT. The phase I will enrolled only patients from the cohort 1 (metastatic non-small cell lung cancer).
The second step will be an expansion cohorts phase at the recommended scheme of administration. The second step will enrolled patients from 4 different cohorts (metastatic non-small cell lung cancer, metastatic bladder cancer, metastatic renal cell carcinoma, metastatic head and neck carcinoma).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Atezolizumab + Tiragolumab + SBRT | Experimental | Atezolizumab + Tiragolumab (every 21 days during 24 months or until progression) + SBRT (treatment will be delivered on 5 days). The combination of SBRT and Immunotherapies will be performed using to different schemes. For the 6 first inclusions the combination will use a sequential scheme. If the safety criteria are respected the following patients will be able to be treated by concomitant scheme. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Atezolizumab 60 MG/1 ML Intravenous Solution [TECENTRIQ] | Drug | Treatment given every 21 days during 24 months or until progression |
|
| Measure | Description | Time Frame |
|---|---|---|
| Phase I : to evaluate safety of SBRT | Using the following DLTs (DLT are defined by the following events related to study treatments (SBRT and/or tiragolumab, atezolizumab) :
| The first 5 weeks (35 days) after the first dose of study treatment for sequential administration (3X8 Gy of radiotherapy and 3 dosing of immunotherapy) |
| Phase I : to evaluate safety of SBRT | Using the following DLTs (DLT are defined by the following events related to study treatments (SBRT and/or tiragolumab, atezolizumab) :
| the first 4 weeks (28 days) after the first dose of study treatement for concomitant administration (3X8 Gy of radiotherapy and 3 dosing of immunotherapies) |
| Measure | Description | Time Frame |
|---|---|---|
| Expansion phase : The 6-month progression free survival (PFS) rate after SBRT, atezolizumab and tiragolumab combination. | Evaluation by analysis of PFS. PFS is defined as the time from inclusion to the first occurrence of disease progression, as determined by the investigator according to RECIST v1.1 and iRECIST, or death from any cause, whichever occurs first.It will be evaluated at 6 months. | During 6 months after inclusion |
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Inclusion Criteria:
Cohort 1 : patient with metastatic non small lung cancer / tumor without oncogenic addiction (EGFR/ALK/ROS/BRAF) which progress after platin based chemotherapy and immunotherapy given as sequential or concomitant therapy.
Cohort 2 : Bladder cancer / Patient with progression following platin based therapy or without maintenance with anti PD1/PD-L1. Patient have to recieve Enfortumab Vedotin before inclusion if the treatment is available. Unless indication by the investigator Cohort 3 : Renal cell carcinoma / Second-line therapy after an anti-angiogenic plus immunotherapy or immunotherapy.
Cohort 4 : Head and neck carcinoma / First line locoregional or metastatic recurrence
Hemoglobin ≥ 9 g/dl (participants may have received prior red blood cell [RBC] transfusion, if clinically indicated); absolute neutrophil count (ANC) ≥ 1.5 G/l, platelet count ≥ 100 G/l, white blood cell count ≥ 2.5 G/l (or within local laboratory normal limits) and lymphocyte count ≥ 0.75 G/l Alkaline phosphatase (AP), alanine aminotransferase (ALT) and aspartate aminotransferase (ASP) ≤ 2.5 x upper limit of normality (ULN) (≤ 5 x ULN in case of extensive skeletal involvement for AP exclusively and ≤ 5 x ULN in case of liver metastasis for AST and ALT).
Total bilirubin ≤ 1.5 x ULN, (3 x ULN for gilbert disease) Albumin ≥ 25 g/l. Serum creatinine ≤ 1.5 x ULN or calculated creatinine clearance (CrCl) ≥ 30 ml/min (according to Cockcroft and Gault formula).
INR ≤ 1.5 x ULN aPTT ≤ 1.5 X ULN Serum calcium within normal laboratory ranges,
Criteria to confirm inclusion:
Exclusion Criteria:
Congestive heart failure ≥ New York Heart Association (NYHA) class 2,
Participants with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone are eligible, Participants with controlled Type I diabetes mellitus on a stable insulin regimen are eligible, Participants with eczema, psoriasis, lichen simplex chronicus, or vitiligo with only dermatologic manifestations <10% of the skin (e.g., participants with psoriatic arthritis would be excluded) are eligible.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| François FG GHIRINGHELLI, Professor | Contact | 03.80.73.77.76 | FGhiringhelli@cgfl.fr | |
| Céline CM MIRJOLET, PhD | Contact | 03.80.73.75.00 poste 80.75 | CMirjolet@cgfl.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Georges François Leclerc (CGFL) | Recruiting | Dijon | Bourgogne-Franche-Comté | 21000 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37946136 | Derived | Roussot N, Fumet JD, Limagne E, Thibaudin M, Hervieu A, Hennequin A, Zanetta S, Dalens L, Fourrier T, Galland L, Jacob P, Bertaut A, Rederstorff E, Chevalier C, Ghirardi S, Gilbert E, Khoukaz A, Martin E, Nicolet C, Quivrin M, Thibouw D, Vulquin N, Truc G, Rouffiac M, Ghiringhelli F, Mirjolet C. A phase I study of the combination of atezolizumab, tiragolumab, and stereotactic body radiation therapy in patients with metastatic multiorgan cancer. BMC Cancer. 2023 Nov 9;23(1):1080. doi: 10.1186/s12885-023-11534-6. |
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| Tiragolumab | Drug | Treatment given every 21 days during 24 months or until progression |
|
| Stereotactic body radiation therapy (SBRT) | Radiation | Radiothérapy is delivered as a hypofractionated schedule of 3 doses of 8Gy (idealy on Monday, Wednesday and Friday, or 3 sessions over a week, respecting at least 24 hours between each fraction) |
|
| Expansion cohort : The long term safety of SBRT, atezolizumab and tiragolumab antibodies combination | Evaluation by analysis of AAE. Will be evaluated with acute and late adverse events (AAEs) according to CTCAE 5.0 Treatment safety evaluation will be based on adverse event (AE) occurrence, the use of concomitant treatments, changes occuring in the course of treatment, observed during physical examination, in the vital signs (arterial pressure, pulse and body temperature), in electrocardiogram (ECG) and biological and clinical examinations (biochemistry, haematology). | Throughout the treatment period (24 months) |
| Expansion cohort : overall survival (OS) following SBRT, atezolizumab and tiragolumab combination | Evaluation by analysis of Overall survival. Overall survival is defined as the time from inclusion to death to any cause | Until the patient dies |
| Expansion cohort : Overall Response rate (ORR) and Non progression rate (NPR) following SBRT, atezolizumab and tiragolumab combination | Evaluation by analysis of ORR. ORR is evaluated from the first two evaluation scanner images carried out at 8-9 and 16-18 weeks after time from inclusion (CT-scan forecast after the 3rd and the 6th cure) as determined by the investigator according to RECIST v1.1 and iRECIST. | 18 weeks after inclusion |
| Expansion cohort : The Duration of Response (DOR) and non progression duration (NPD) following SBRT, atezolizumab and tiragolumab combination | Evaluation by analysis of duration of Response (DOR). DOR is defined as time from documentation of disease complete or partial response to disease progression, defined according to RECISTv1.1 and iRECIST. Non Progression duration (NPD) is defined as time from documentation of disease complete response, partial response or stable disease to disease progression, defined according to RECISTv1.1 and iRECIST. | Throughout the treatment period (24 months) |
| Expansion cohort : To evaluate abscopal effect | Un-irradiated metastasis volume(s) is evaluated from scanner images | Throughout the treatment period (24 months) |
| ID | Term |
|---|---|
| D002289 | Carcinoma, Non-Small-Cell Lung |
| D001749 | Urinary Bladder Neoplasms |
| D002292 | Carcinoma, Renal Cell |
| D006258 | Head and Neck Neoplasms |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D002283 | Carcinoma, Bronchogenic |
| D001984 | Bronchial Neoplasms |
| D008175 | Lung Neoplasms |
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D014571 | Urologic Neoplasms |
| D014565 | Urogenital Neoplasms |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D001745 | Urinary Bladder Diseases |
| D014570 | Urologic Diseases |
| D052801 | Male Urogenital Diseases |
| D000230 | Adenocarcinoma |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
| D007680 | Kidney Neoplasms |
| D007674 | Kidney Diseases |
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| ID | Term |
|---|---|
| C000594389 | atezolizumab |
| C000730814 | Tiragolumab |
| D016634 | Radiosurgery |
| ID | Term |
|---|---|
| D011878 | Radiotherapy |
| D013812 | Therapeutics |
| D013238 | Stereotaxic Techniques |
| D019635 | Neurosurgical Procedures |
| D013514 | Surgical Procedures, Operative |
| D008919 | Investigative Techniques |
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