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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03603184
Other study ID # IRFMN-EN-7556
Secondary ID
Status Active, not recruiting
Phase Phase 3
First received
Last updated
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
Health authority
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

Study Design


Related Conditions & MeSH terms


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
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