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| Name | Class |
|---|---|
| Bristol-Myers Squibb | INDUSTRY |
| Brava | INDUSTRY |
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A total of 112 patients with locally advanced cervical cancer will be randomized 1:1 to standard therapy with cisplatin-based chemoradiation or nivolumab-ipilimumab induction followed by cisplatin-based chemoradiation. The primary outcome will be 3-year disease-free survival.
Patients with adenocarcinoma or squamous cell carcinoma of the cervix, FIGO Stage IB2-IB3 node positive or Stage IIB-IVA will be randomized to conventional cisplatin-based chemo-radiation or to 4 cycles of induction immunotherapy with nivolumab 1mg/kg and ipilimumab 3mg/kg every 3 weeks, followed by cisplatin chemo-radiation with concurrent nivolumab 240mg every 2 weeks. Primary outcome will be 3-year progression-free survival.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Chemoradiation | Active Comparator | Traditional radiation therapy with a target of 45 Gy in 25 1.8Gy fractions with concurrent weekly cisplatin 40mg/m2/week or carboplatin AUC 2/week |
|
| Immunotherapy | Experimental | 4 cycles of induction therapy with nivolumab 1mg/kg and ipilimumab 3mg/kg every 3 weeks followed by traditional radiation therapy with a target of 45 Gy in 25 1.8Gy fractions with concurrent weekly cisplatin 40mg/m2/week (or carboplatin AUC 2/week) with concurrent nivolumab 240mg every 2 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nivolumab 40 mg in 4 ml Injection | Drug | Nivolumab 1mg/kg every 3 weeks for 4 cycles prior to radiation and 240mg every 2 weeks with concurrent radiation |
|
| Measure | Description | Time Frame |
|---|---|---|
| 3-year progression-free survival | No evidence of disease recurrence/regrowth after 3 years of follow-up | 3 years |
| Measure | Description | Time Frame |
|---|---|---|
| 3-year overall survival | Rate of survival 3 years after the end of chemoradiation | 3 years |
| Objective response rate | RECIST response |
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Inclusion Criteria:
Exclusion Criteria:
Laboratory values that fall into:
WBC count (WBC) < 2000/μL ;
Neutrophil count < 1500/μL;
Platelet count < 100 x 103/μL;
Hemoglobin level < 9.0 g/dL;
Serum creatinine > 1.5 x upper limit of normal (ULN) unless creatinine clearance is
≥ 40 mL/min (measured or calculated using the Cockcroft-Gault formula);
Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT): > 3.0 x ULN;
Total bilirubin > 1.5 x ULN (except participants with Gilbert Syndrome who must have a total bilirubin level of < 3.0 x ULN);
Any positive test result for hepatitis B virus or hepatitis C virus that indicates the presence of the virus, for example, positive Hepatitis B surface antigen (HBsAg, Australia antigen) or Hepatitis C antibodies (anti- HCV) positive (unless the HCV-RNA is negative).
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Diogo Bugano, MD | Contact | +55-11-2151-0240 | diogo.gomes@einstein.br |
| Name | Affiliation | Role |
|---|---|---|
| Fernando Maluf, MD | Hospital Israelita Albert Einstein | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CRIO -Centro Regional Integrado de Oncologia | Recruiting | Fortaleza | Ceará | 60335-480 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19001332 | Background | Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008 Dec 10;26(35):5802-12. doi: 10.1200/JCO.2008.16.4368. Epub 2008 Nov 10. | |
| 31487218 |
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Prospective randomized trial, stratified by center, disease stage and type of radiation
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|
| Ipilimumab 200 MG in 40 ML Injection | Drug | Ipilimumab 3mg/kg every 3 weeks for 4 cycles prior to radiation |
|
|
| Chemoradiation | Radiation | Radiation to a dose of 45Gy over 25 1.8Gyfractions and brachytherapy with concurrent weekly cisplatin 40mg/m2/w or carboplatin AUC 2/w |
|
|
| 90 days after the end of chemoradiation |
| Response duration | Time from maximum response to disease progression | Through study completion, an average of 3 year |
| To evaluate health related quality of life (HRQoL): defined as the change from baseline of disease-related symptoms and quality of life of patients undergoing treatment Nivolumab-ipilimumab and Chemoradiation for Cervical Cancer | Evaluate health related quality of life using the instrument EORTC QLQ-C30 v3 based on European Organization for Research and Treatment of Cancer (EORTC). The EORTC QLQ-C30 v3 questionnaire, consisting of 30 questions covering 15 domains, divided into three distinct scales: state scale global health and quality of life (it has only one domain, global health measure); functional scale (physical function, role performance, emotional function, cognitive function and social function domains); and symptom scale (fatigue, nausea and vomiting, pain, dyspnea, insomnia, loss of appetite, constipation, diarrhea and financial difficulties). The scores on each scale range from 0 - 100. The global and functional health scales indicate better quality of life as their score approaches 100. For the symptoms scale, the analysis is inverse, with better performance for quality of life when the scores approach the score minimum (zero). | Baseline (time from screening - before starting treatment) and at the end of treatment (56 days after the last dose of radiotherapy). |
| Evaluate health related quality of life using supplemental cervical cancer module (EORTC CX24) to evaluate patients submitted to treatment with Nivolumab-ipilimumab and Chemoradiation for Cervical Cancer. | The EORTC - CX24 questionnaire contains 24 questions, divided into three multiple-item scales and six single-item scales, of which 11 refer to symptoms (questions 31-37, 39 and 41-43), three about body image. (questions 45-47), four questions on sexual/vaginal function (questions 50-53), one on lymphedema (question 38), one for evaluation of peripheral neuropathy (question 40), one for evaluation of menopausal symptoms (question 44) ), one on sexual concerns (question 48), one on sexual activity (question 49) and one on sexual pleasure (question 54). The answers are transformed into a score from 0 - 100 and calculated separately for each scale. | Baseline (time from screening - before starting treatment) and at the end of treatment (56 days after the last dose of radiotherapy). |
| Treatment-related toxicity | Treatment-related toxicity according to CTCAE version 4.0 (Common Toxicity Criteria for Adverse Events ) | Through study completion, an average of 3 year |
| Clinica AMO | Recruiting | Salvador | Estado de Bahia | 41810-011 | Brazil |
|
| Hospital das Clinicas da UFMG | Not yet recruiting | Belo Horizonte | Minas Gerais | 30130-100 | Brazil |
|
| Hospital Erasto Gaertner | Not yet recruiting | Curitiba | Paraná | 81520-060 | Brazil |
|
| Multi Oncoclinicas Recife | Recruiting | Recife | Pernambuco | 50070-460 | Brazil |
|
| Hospital São Lucas - PUCRS | Not yet recruiting | Porto Alegre | Rio Grande do Sul | 90610-001 | Brazil |
|
| Universidade Federal de Roraima | Recruiting | Boa Vista | Roraima | 69310-000 | Brazil |
|
| CEPON - Florianópolis | Not yet recruiting | Florianópolis | Santa Catarina | 88034-000 | Brazil |
|
| Hospital de Amor | Not yet recruiting | Barretos | São Paulo | 14784-400 | Brazil |
|
| Hospital De Base de São José do Rio Preto - CIP São José | Not yet recruiting | São José do Rio Preto | São Paulo | 15090-000 | Brazil |
|
| INCA - Instituto Nacional do Cancer | Not yet recruiting | Rio de Janeiro | 20230-130 | Brazil |
|
| AC Camargo Cancer Center | Not yet recruiting | São Paulo | 01509-001 | Brazil |
|
| Hospital Municipal Vila Santa Catarina | Recruiting | São Paulo | 04378-500 | Brazil |
|
| Hospital Israelita Albert Einstein | Recruiting | São Paulo | 05652-900 | Brazil |
|
| Naumann RW, Hollebecque A, Meyer T, Devlin MJ, Oaknin A, Kerger J, Lopez-Picazo JM, Machiels JP, Delord JP, Evans TRJ, Boni V, Calvo E, Topalian SL, Chen T, Soumaoro I, Li B, Gu J, Zwirtes R, Moore KN. Safety and Efficacy of Nivolumab Monotherapy in Recurrent or Metastatic Cervical, Vaginal, or Vulvar Carcinoma: Results From the Phase I/II CheckMate 358 Trial. J Clin Oncol. 2019 Nov 1;37(31):2825-2834. doi: 10.1200/JCO.19.00739. Epub 2019 Sep 5. |
| 31924334 | Background | Santin AD, Deng W, Frumovitz M, Buza N, Bellone S, Huh W, Khleif S, Lankes HA, Ratner ES, O'Cearbhaill RE, Jazaeri AA, Birrer M. Phase II evaluation of nivolumab in the treatment of persistent or recurrent cervical cancer (NCT02257528/NRG-GY002). Gynecol Oncol. 2020 Apr;157(1):161-166. doi: 10.1016/j.ygyno.2019.12.034. Epub 2020 Jan 7. |
| ID | Term |
|---|---|
| D002583 | Uterine Cervical Neoplasms |
| ID | Term |
|---|---|
| D014594 | Uterine Neoplasms |
| D005833 | Genital Neoplasms, Female |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D002577 | Uterine Cervical Diseases |
| D014591 | Uterine Diseases |
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |
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| ID | Term |
|---|---|
| D000077594 | Nivolumab |
| D007267 | Injections |
| D000074324 | Ipilimumab |
| D059248 | Chemoradiotherapy |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D003131 | Combined Modality Therapy |
| D011878 | Radiotherapy |
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