| Eligibility |
Inclusion Criteria:
1. Patient information sheet and written informed consent form signed.
2. Histologically confirmed diagnosis of a pathology corresponding to one of the
following selected cancer types:
- Rare sarcoma: Alveolar soft part sarcoma, Chordoma, Dedifferentiated
chondrosarcoma, epithelioid sarcoma, sarcoma with loss of INI1, malignant
rhabdoid tumours, myxoid liposarcoma, angiosarcoma of the scalp, radiation
induced sarcomas.From the 51st patient included in this cohort, only the
following histological types will be selected: Alveolar soft part sarcoma,
Chordoma, SMARCA4-malignant rhabdoid tumours and Desmoplastic small-round-cell
tumor.
- Rare ovarian cancer: recurrent or relapsed; sex cord tumour, germ cell tumour
(immature teratoma, non seminomatous germ cell & dysgerminoma), low-grade serous
carcinoma, mucinous carcinoma, clear cell adenocarcinoma, small cell carcinoma,
and carcinosarcoma - with histological confirmation following review by members
of the Tumeurs Malignes Rares Gynécologiques (TMRG) network (French rare
gynaecological tumour group).From the 51st patient included in this cohort, only
the following histological types will be selected: teratoma, low-grade serous
carcinoma and ovarian small cell carcinoma hypercalcemic type (SCOOHT).
- Primary central nervous system lymphoma (PCNSL): refractory primary intraocular
and CNS lymphoma.From the 51st patient included in this cohort, only CNS lymphoma
will be selected.
- Rare thyroid cancer: differentiated thyroid carcinoma (Papillary, follicular,
Hurthle cell (oncocytic), poorly differentiated thyroid carcinoma), medullary
thyroid carcinoma, anaplastic thyroid carcinoma.
- Rare malignant neuroendocrine tumour: poorly differentiated tumours refractory
after 2 lines of chemotherapy, well differentiated tumours refractory after 4
lines of treatment, carcinoid tumours after 2 lines of treatment.
- Germ-cell cancer progressing after standard therapy.
- Natural killer T-cell lymphoma: extranodal NK/T-cell lymphoma regardless of
localization that is resistant or refractory to prior L-asparaginase therapy.
3. Metastatic disease or unresectable locally advanced malignancy that is resistant or
refractory to standard therapy or for which standard therapy does not exist or is not
considered appropriate by the Investigator.
4. Aged =18 years old for cohort 2 to 7 and aged =15 years old for patients included in
cohort 1 (rare sarcoma).
5. Measurable disease according to RECIST v1.1 guidelines for solid tumours; or
International primary central nervous system lymphoma cooperative group (IPCG)
response criteria for patients in the PCNSL cohort. For patients with germ-cell cancer
measurable disease is defined as measurable according to RECIST v1.1 and / or abnormal
levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and lactate
dehydrogenase (LDH). For patients with NK/T-cell lymphoma measurable disease is
defined as focal uptake in at least one nodal or extra-nodal site with a Lugano 5-PS
score of 4 or 5.
6. Able to provide a Formalin-fixed/paraffin-embedded (FFPE) biopsy sample of a
metastatic site or primitive tumour tissue.
Note: Patients for whom suitable archived biopsy material is not available must be
willing to undergo a biopsy of a tumour lesion prior to study entry, unless this is
medically contraindicated (e.g. site inaccessible or patient safety concerns).
7. Patients must have a mandatory treatment-free interval of at least 21 days following
previous systemic anti-cancer treatments.
8. Patients who have received previous systemic anticancer treatment and/or radiotherapy
should have recovered from any treatment related toxicity, to a level of = grade 1
(according to NCI-CTCAE criteria, v 4.0) with the exception of Grade 2 alopecia.
9. Adequate hematologic function (absolute neutrophil count (ANC) =1.0 x10?/L, platelets
=100 x10?/L, haemoglobin =9 g/L) measured within 14 days of treatment initiation.
10. Adequate renal function (creatinine clearance =50 mL/min using the Modification of
Diet in Renal Disease (MDRD) or CKI EPI method) measured within 14 days of treatment
initiation.
11. Adequate hepatic function (serum bilirubin =1.5 x the reference upper limit of normal
(ULN) unless due to Gilbert's syndrome; aspartate aminotransferase(ASAT) and alanine
aminotransferase (ALAT) =2.5 x ULN) measured within 14 days of treatment initiation.
For patients with documented liver metastasis ASAT/ALAT = 5 x ULN is acceptable.
12. Strictly normal blood levels of calcium and magnesium, measured within 14 days of
treatment initiation.
13. Eastern Cooperative Oncology Group (ECOG) Performance Status of =1.
14. Estimated life expectancy =90 days.
15. Patients who are sexually active must agree to use a medically accepted method of
contraception (e.g. implants, injectables, combined oral contraceptives, some
intrauterine devices or vasectomized partner, for participating women; condoms for
participating men) or practice complete abstinence, beginning 14 days before the first
administration of the investigational product (IP), while on treatment and for at
least 5 months after the last administration of IP for female patients, and 7 months
after the last administration of IP for male patients.
16. Women of childbearing potential must have a negative urine or serum pregnancy test
within 72 hours prior to the first administration of IP. If urine test results are
positive or cannot be confirmed as negative, a serum pregnancy test will be required.
17. Women who are breastfeeding should discontinue nursing prior to the first
administration of IP and for at least 120 days after the last administration of IP.
18. Patients must be affiliated to a Social Security System or equivalent.
Exclusion Criteria:
1. Prior treatment with an anti-PD1 or anti-PD-L1 antibody
2. Eligible, and willing, to participate in a clinical trial of an alternative anticancer
therapy targeting their disease which is open to accrual in France.
3. Concurrent steroid medication at a dose greater than prednisone 10 mg/day or
equivalent. For patients with PCNSL or germ-cell cancer, concurrent steroid medication
at a dose greater than prednisone 20 mg/day or equivalent.
4. Has active autoimmune disease that has required systemic treatment in the past 2 years
(i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid
replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
form of systemic treatment.
5. History of (non-infectious) pneumonitis that required steroids, or current
pneumonitis.
6. History of severe hypersensitivity reaction to any monoclonal antibody therapy
7. Radiotherapy (except for brain and extremities) within 21 days prior to the first
administration of IP.
8. Treatment with other investigational drugs or participation in another clinical trial
within 21 days prior to the first administration of IP or concomitantly with the
trial.
9. Has known symptomatic central nervous system (CNS) metastases. Patients with
previously treated brain metastases may participate provided they are stable (without
evidence of progression by imaging for at least four weeks prior to the first dose of
trial treatment and any neurologic symptoms have returned to baseline), have no
evidence of new or enlarging brain metastases, and are not using steroids for at least
7 days prior to trial treatment.
10. Has known carcinomatous meningitis or a history of leptomeningeal disease, except for
patients with primary CNS lymphoma.
11. Serum creatinine >1.5 x ULN or glomerular filtration rate (GFR) <50 ml/min.
12. Other malignancies within the past 5 years other than basal cell skin cancer or in
situ carcinoma of the cervix.
13. Active serious infections in particular if requiring systemic antibiotic or
antimicrobial therapy.
14. Active or chronic hepatitis B, hepatitis C and/or human immunodeficiency virus (HIV)
infection (HIV 1/2 antibodies), or a known history of active Tuberculosis bacillus.
15. Has received a live vaccine within 30 days of planned start of study treatment. Note:
Seasonal influenza vaccines for injection are generally inactivated vaccines and are
allowed.
16. Active alcohol or drug abuse.
17. Psychological, familial, sociological or geographical factors potentially hampering
compliance with the study protocol and follow-up schedule.
18. Any condition which in the Investigator's opinion makes it undesirable for the subject
to participate in the trial or which would jeopardize compliance with the protocol.
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