Atezolizumab Trial in Endometrial Cancer - AtTEnd

Endometrial Cancer Clinical Trial

— AtTEnd  

Official title:

Phase III Double-blind Randomized Placebo Controlled Trial of Atezolizumab in Combination With Paclitaxel and Carboplatin in Women With Advanced/Recurrent Endometrial Cancer

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03603184
• Other study ID #: IRFMN-EN-7556
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: October 2, 2018
• Est. completion date: May 2025

Study information

• Verified date: March 2024
• Source: Mario Negri Institute for Pharmacological Research
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Atezolizumab is an engineered humanised monoclonal immunoglobulin G1 antibody that binds selectively to PD-L1 and prevents its interaction with PD-1 and B7-1.

In May 2016 atezolizumab was approved by the FDA for patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following any platinum-containing chemotherapy, or within 12 months of receiving chemotherapy before surgery (neoadjuvant) or after surgery (adjuvant); in October 2016 it was approved by the FDA for patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy, and have progressed on an appropriate FDA-approved targeted therapy if their tumor has EGFR or ALK gene abnormalities. Finally, in April 2017 atezolizumab was granted accelerated approval by FDA for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma who are not eligible for cisplatin chemotherapy. Combinations of atezolizumab with chemotherapeutic agents and/or targeted therapies were studied in different solid tumors such as melanoma, NSCLC, renal cell carcinoma and colorectal carcinoma. From these studies the AE profile of atezolizumab combinations were consistent with that of the individual agents.

Finally, preliminary results of a Phase Ia study of Atezolizumab (NCT01375842) monotherapy in relapsed endometrial cancer were reported as abstract at ASCO 2017. Fifteen patients were evaluated for safety and efficacy with a minimum follow-up of 11.2 months. No G4-5 related AEs occurred. Regarding efficacy ORR was 13% [2/15] by RECIST. Atezolizumab seemed to have a favorable safety profile, with durable clinical benefit in some patients. Further studies with atezolizumab are warranted given its promising results in advanced endometrial cancer and the limited efficacy of current treatment options.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 550
• Est. completion date: May 2025
• Est. primary completion date: January 2025
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

I-1. Newly diagnosed, histologically-confirmed with residual disease after surgery either measurable or evaluable, or inoperable stage III-IV endometrial carcinoma/carcinosarcoma, after diagnostic biopsy, and naïve to first line systemic anti-cancer treatment. Recurrent endometrial cancer patients if not yet treated for recurrent disease.

I-2. Eastern Cooperative Oncology Group (ECOG) performance status 0-2 I-3. Age = 18 years I-4. Only one prior line of systemic platinum-based regimen is permitted if the platinum-free interval = 6 months. Such prior line is the up-front/adjuvant treatment which can be concurrent chemoradiation or concurrent chemoradiation followed by chemotherapy or only chemotherapy.

I-5. Patients with history of primary breast cancer may be eligible provided they completed their definitive anticancer treatment more than 3 years ago and they remain breast cancer disease free prior to start of study treatment.

I-6. Previous pelvic and outside pelvis radiation is allowed if completed more than 6 weeks ago.

I-7. Signed informed consent and ability to comply with treatment and follow-up.

I-8. Representative FFPE tumor sample or, only if unfeasible, at least 20 unstained slides from initial surgery or from diagnostic biopsy, in case surgery was not performed, available and sent to central laboratory for Micro Satellite (MS) determination prior to randomization.

I-9. Patients must have normal organ and bone marrow function :

1. Haemoglobin = 10.0 g/dL.

2. Absolute neutrophil count (ANC) = 1.5 x 109/L.

3. Platelet count = 100 x 109/L.

4. Total bilirubin = 1.5 x institutional upper limit of normal (ULN).

5. Aspartate aminotransferase /Serum Glutamic Oxaloacetic Transaminase (ASAT/SGOT)) and Alanine aminotransferase /Serum Glutamic Pyruvate Transaminase (ALAT/SGPT)) = 2.5 x ULN, unless liver metastases are present in which case they must be = 5 x ULN.

6. Serum creatinine = 1.5 x institutional ULN

Exclusion Criteria:

E-1. Other malignancy within the last 5 years except: adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS) of the breast. Patients with a history of localized malignancy diagnosed over 5 years ago may be eligible provided they completed their adjuvant systemic therapy prior to randomization and that the patient remains free of recurrent or metastatic disease.

E-2. Patients with uterine leiomyosarcoma . E-3. Major surgery within 4 weeks of starting study treatment or patients who have not completely recovered from the effects of any major surgery.

E-4. Previous allogeneic bone marrow transplant or previous solid organ transplantation.

E-5. Administration of other simultaneous chemotherapy drugs, any other anticancer therapy or anti-neoplastic hormonal therapy, or simultaneous radiotherapy during the trial treatment period (hormonal replacement therapy is permitted).

E-6. Prior treatment with CD137 agonists or immune checkpoint blockade therapies, anti-PD1, or anti-PDL1 therapeutic antibodies or anti-CTLA4 .

E-7. Treatment with systemic immunostimulatory agents (including but not limited to interferon-alpha (IFN-a) and interleukin-2 (IL-2) within 4 weeks or five half-lives of the drug (whichever is shorter) prior to Cycle 1, Day 1.

E-8. Treatment with systemic corticosteroids or other systemic immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [TNF] agents) within 2 weeks prior to Cycle 1, Day 1, or anticipated requirement for systemic immunosuppressive medications during the trial. However, please note that the use of inhaled corticosteroids for chronic obstructive pulmonary disease or for asthma is allowed, as well as the use of mineralocorticoids (e.g., fludrocortisones) and low-dose supplemental corticosteroids for adrenocortical insufficiency and for patients with orthostatic hypotension. The use of corticosteroids as premedication for paclitaxel-based regimen is allowed).

E-9. History of autoimmune disease, including but not limited to myasthenia gravis, myositis,autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with anti-phospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis [please note: patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone are eligible; patients with controlled Type 1 diabetes mellitus on a stable insulin regimen are eligible; history of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing pneumonia) is permitted].

E-10. Immunocompromised patients, e.g., patients who are known to be serologically positive for human immunodeficiency virus (HIV).

E-11. Patients with active hepatitis B (defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) or hepatitis C .

1. Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as having a negative HBsAg test and a positive total hepatitis B core antibody [HBcAb]) are eligible only if hepatitis B virus (HBV) DNA is negative. The HBV DNA test will be performed only for patients who have a positive total HBcAb test.

2. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction (PCR) is negative for HCV RNA. The HCV RNA test will be performed only for patients who have a positive HCV antibody test.

E-12. Active tuberculosis (all patients will have tuberculin [PPD] skin test or Interferon-Gamma Releasing Assay [IGRA] done locally prior to inclusion to study) E-13. Signs or symptoms of infection within 2 weeks prior to Cycle 1, Day 1 E-14. Administration of a live, attenuated vaccine within 4 weeks prior to Cycle 1, Day 1 or anticipation that such a live attenuated vaccine will be required during the study. Influenza vaccination should be given during influenza season only (example approximately October to March in the Northern Hemisphere). Patients must not receive live, attenuated influenza vaccine.

E-15. Clinically significant (e.g. active) cardiovascular disease, including:

1. Myocardial infarction or unstable angina within = 6 months of randomization,

2. New York Heart Association (NYHA) = grade 2 congestive heart failure (CHF),

3. Poorly controlled cardiac arrhythmia despite medication (patients with rate controlled atrial fibrillation are eligible),

4. Peripheral vascular disease grade = 3 (e.g. symptomatic and interfering with activities of daily living [ADL] requiring repair or revision) E-16. Resting ECG with QTc > 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome.

E-17. History or clinical suspicion of brain metastases or spinal cord compression. CT/MRI of the brain is mandatory (within 4 weeks prior to randomization) in case of suspected brain metastases. Spinal MRI is mandatory (within 4 weeks prior to randomization) in any case of suspected central nervous system (CNS) involvement .

E-18. History or evidence upon neurological examination of central nervous system (CNS) disease, unless asymptomatic and adequately treated with standard medical therapy.

E-19. Evidence of any other disease, metabolic dysfunction, physical examination finding or laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or puts the patient at high risk for treatment related complications.

E-20. Women of childbearing potential (<2 years after last menstruation) not willing to use highly-effective means of contraception.

E-21. Pregnant or lactating women. E-22. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins.

E-23. Known hypersensitivity or allergy to biopharmaceuticals produced in Chinese hamster ovary cells or to any component of the atezolizumab formulation.

E-24. Known hypersensitivity reaction or allergy to drugs chemically related to carboplatin, paclitaxel, or their excipients that contraindicates the subject's participation

Related Conditions & MeSH terms

• Endometrial Cancer
• Endometrial Neoplasms

Intervention

Drug:
• Atezolizumab
Atezolizumab will be administered as I.V. infusion at a fixed dose of 1200 mg, every 21 days until objective radiological disease progression as assessed by the investigator if they do not meet any other discontinuation criteria (patient refusal, toxicity).
• Placebos
Placebo will be administered as I.V. infusion every 21 days until objective radiological disease progression as assessed by the investigator if they do not meet any other discontinuation criteria (patient refusal, toxicity).
• Paclitaxel
Paclitaxel 175 mg/m2 will be administered every 21 days for 6-8 cycles or until progression of disease.
• Carboplatin
Carboplatin AUC 5 or AUC 6 will be administered every 21 days for 6-8 cycles or until progression of disease.

Locations

Country	Name	City	State
Australia	Royal Adelaide hospital	Adelaide
Australia	Border Medical Oncology Research Unit	Albury
Australia	Icon Cancer Centre	Auchenflower
Australia	Pindara Private Hospital	Benowa
Australia	Box Hill Hospital	Box Hill
Australia	Frankston Hospital	Frankston
Australia	Gosford Hospital	Gosford
Australia	Royal Brisbane and Women's Hospital	Herston
Australia	Royal Hobart Hospital	Hobart
Australia	Liverpool Hospital	Liverpool
Australia	Northern Cancer Institute	Saint Leonards
Australia	Darling Downs Hospital and Health Service - Toowoomba Hospital	Toowoomba
Australia	Calvary Mater Newcastle	Waratah
Australia	Wollongong Hospital	Wollongong
Austria	Medizinische Universitaet Graz - Universitätsklinik für Frauenheilkunde und Geburtshilfe	Graz
Austria	Medical University of Innsbruck	Innsbruck
Germany	Charité Universitätsmedizin Berlin	Berlin
Germany	Kliniken Essen Mitte	Essen
Germany	UniversitätsKlinikum Heidelberg	Mannheim
Germany	Klinikum der Ludwig-Maximilians-Universität München (LMU)	Muenchen
Italy	AO SS Antonio e Biagio e Cesare Arrigo	Alessandria
Italy	Policlinico S. Orsola Malpighi	Bologna
Italy	Azienda Sanitaria dell'Alto Adige	Bolzano
Italy	ASST degli Spedali Civili di Brescia	Brescia
Italy	Fondazione Poliambulanza	Brescia
Italy	AOU Cagliari, Policlinico Universitario	Cagliari
Italy	AOU Careggi	Firenze
Italy	ASST di Lecco	Lecco
Italy	Ospedale San Luca	Lucca
Italy	Istituto Europeo di Oncologia	Milan
Italy	Ospedale San Gerardo	Monza
Italy	Istituto Oncologico Veneto (IOV)	Padova
Italy	AOU di Parma	Parma
Italy	AOU Pisana	Pisa
Italy	AO Arcispedale Santa Maria Nuova	Reggio Emilia
Italy	Ausl Romagna	Rimini
Italy	Policlinico Umberto I, Università di Roma "La Sapienza"	Roma
Italy	Ospedale di Sondrio ASST Valtellina e Alto Lario	Sondrio
Italy	Ospedale SS Trinità	Sora
Italy	AO Ordine Mauriziano	Torino
Italy	AOU Città della Salute e della Scienza di Torino - Ospedale Sant'Anna	Torino
Italy	P.O Sant'Andrea Vercelli	Vercelli
Japan	Hirosaki University Hospital	Aomori
Japan	National Cancer Center Hospital East	Chiba
Japan	Shikoku Cancer Center	Ehime
Japan	Kurume University Hospital	Fukuoka
Japan	Hokkaido University Hospital	Hokkaido
Japan	Tohoku University Hospital	Miyagi
Japan	Niigata University Medical&Dental Hospital	Niigata
Japan	Osaka University Hospital	Osaka
Japan	Shizuoka Cancer Center	Shizuoka
Japan	Keio University Hospital	Tokyo
Korea, Republic of	Keimyung University Dongsan Medical Center	Daegu
Korea, Republic of	Ilsan Cha Medical Center	Gyeonggi-do
Korea, Republic of	Seoul National University Bundang Hospital	Gyeonggi-do
Korea, Republic of	Gachon University Gil Medical Center	Incheon
Korea, Republic of	Asan Medical Center	Seoul
Korea, Republic of	Gangnam Severance Hospital	Seoul
Korea, Republic of	Konkuk University Medical Center	Seoul
Korea, Republic of	Samsung Medical Center	Seoul
Korea, Republic of	Seoul St. Mary's Hospital	Seoul
Korea, Republic of	Severance Hospital	Seoul
New Zealand	Auckland city Hospital	Auckland
Spain	Hospital De Sant Pau I La Santa Creu	Barcelona
Spain	Hospital Universitario Vall d´Hebron Institute of Oncology (VHIO)	Barcelona
Spain	Institut Català d'Oncologia (ICO) Girona	Girona
Spain	Institut Català d'Oncologia (ICO), L'Hospitalet- Hospital Duran I Reynals	Hospitalet de Llobregat
Spain	Hospital 12 de Octubre	Madrid
Spain	Hospital Universitario La Paz	Madrid
Spain	MD Anderson Cancer Center	Madrid
Spain	Hospital Universitario Central de Asturias	Oviedo
Spain	Hospital Clínico Universitario Santiago de Compostela	Santiago De Compostela
Spain	Hospital Universitario Miguel Servet Zaragoza	Zaragoza
Switzerland	Kantonsspital	Baden
Switzerland	Universitätsspital	Basel
Switzerland	IOSI	Bellinzona
Switzerland	Inselspital	Bern
Switzerland	Kantonsspital	Luzern
Switzerland	Frauenfeld	Münsterlingen
Switzerland	Kantonsspital	Winterthur
Switzerland	Universitätsspital	Zürich
Taiwan	Chang Gung Memorial Hospital-Kaohsiung	Kaohsiung City
Taiwan	Chang Gung Memorial Hospital-Linkou	Taoyuan City
United Kingdom	Royal Derby Hospital	Derby
United Kingdom	Royal Devon & Exeter Hospital	Exeter
United Kingdom	Beatson West of Scotland Cancer Centre, Gartnavel General Hospital	Glasgow
United Kingdom	Velindre Cancer Centre	Glasgow
United Kingdom	Imperial College Healthcare NHS Trust	London
United Kingdom	Royal Marsden Hospital	London
United Kingdom	St Bartholomew's Hospital	London
United Kingdom	The Christie NHS Foundation Trust	Manchester
United Kingdom	NUHT - Nottingham University Hospital NHS Trust	Nottingham
United Kingdom	Derriford Hospital	Plymouth

Sponsors (2)

Lead Sponsor	Collaborator
Mario Negri Institute for Pharmacological Research	Hoffmann-La Roche

Countries where clinical trial is conducted

Australia,  Austria,  Germany,  Italy,  Japan,  Korea, Republic of,  New Zealand,  Spain,  Switzerland,  Taiwan,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	PFS in the MSI	PFS is defined as the time from randomization to the date of first progression or death	Up to 18 months after the last patient enrolled
Primary	PFS	PFS is defined as the time from randomization to the date of first progression or death from any cause, whichever comes first.; Progression will be established as the radiological disease progression according to RECIST 1.1 or death from any cause, whichever occurs first.	Up to 18 months after the last patient enrolled
Primary	OS	OS is defined as the time from randomization until the date of death from any cause.	Up to two years after the last patient enrolled
Secondary	Objective response rate	Objective Response Rate (ORR), defined as the percentage of patients with an objective response as determined by RECIST 1.1	Up to three years after the last patient enrolled
Secondary	Duration of response	Duration of response, defined as the time from the date of first documentation of response (complete response (CR) or partial response (PR), whichever occurs first) to the date of documented PD or death	Up to two years after the last patient enrolled
Secondary	Safety: Maximum toxicity grade	Maximum toxicity grade experienced by each patient, for each toxicity, according to NCI-CTCAE v. 4.03	Up to 30 days after the end of treatment
Secondary	Safety: Number of patients experiencing grade 3-4 toxicity for each toxicity	Number of patients experiencing grade 3-4 toxicity for each toxicity according to NCI-CTCAE v. 4.03	Up to 30 days after the end of treatment
Secondary	Safety: Type, frequency and nature of SAEs	Type, frequency and nature of SAEs, according to NCI-CTCAE v. 4.03	Up to 30 days after the end of treatment
Secondary	Safety: Number of patients with at least a SAE	Number of patients with at least a SAE according to NCI-CTCAE v. 4.03	Up to 30 days after the end of treatment
Secondary	Safety: Number of patients with at least a SADR	Number of patients with at least a SADR, according to NCI-CTCAE v. 4.03	Up to two years after the last patient enrolled
Secondary	Safety: Number of patients with at least a SUSAR	Number of patients with at least a SUSAR, according to NCI-CTCAE v. 4.03	Up to two years after the last patient enrolled
Secondary	Quality of life: EORTC QLQ-C30 questionnaire	Mean changes from the baseline scores in quality of life by cycle and between treatment arms.	Up to two years after the last patient enrolled
Secondary	Quality of life: QLQ-EN24 questionnaire	Mean changes from the baseline score in quality of life by cycle and between treatment arms.	Up to two years after the last patient enrolled
Secondary	Quality of life: GP5 item	Proportion of patients reporting each response option at each assessment timepoint by treatment arm for item GP5 from the FACT G instrument.	Up to two years after the last patient enrolled
Secondary	Compliance: Number of administered cycles	Number of administered cycles	Up to two year after the last patient enrolled
Secondary	Compliance: Reasons for discontinuation and treatment modification	Number of patients for each reasons	Up to two year after the last patient enrolled
Secondary	Compliance: Dose intensity	Entire dose administered during treatment	Up to two year after the last patient enrolled