Advanced Solid Malignancies
Conditions
Keywords
Programmed death ligand 1 (PD-L1), Cytotoxic T-lymphocyte antigen-4 (CTLA-4), Durvalumab in combination with tremelimumab
Brief summary
To evaluate the safety, tolerability, and anti-tumor activity of the combination of durvalumab + tremelimumab or durvalumab alone in different solid tumors.
Detailed description
This is an open-label, multi-center, study to determine the short and long term safety of fixed doses of durvalumab 1500 mg + tremelimumab 75 mg combination therapy or durvalumab 1500 mg monotherapy in patients with advanced solid malignancies. This study is modular in design, one or more of the modules will be opened in a given country / region based on local patient population prevalence, and results of feasibility studies. The total number of patients to be enrolled overall and in each module will depend on the types and number of tumor modules added to the main study and country-specific ancillary studies. The number of patients and sites to be involved in individual countries will be dependent on each module or ancillary study. This study consisted of a screening period, a treatment period, a 90 day safety follow-up period and a survival follow-up period. Patients will receive the investigation product (IP) via intravenous (IV) infusion once every 4 weeks (Q4W) in combination therapy or monotherapy as mentioned below - Combination therapy: Durvalumab 1,500 mg + tremelimumab 75 mg on Week 0, for up to a maximum of 4 doses (or cycles) followed by durvalumab 1,500 mg starting 4 weeks after the last infusion of the combination or discontinuation of tremelimumab. Monotherapy: Durvalumab 1,500 mg on week 0. Patients will attend a safety follow-up visit 90 days after study treatment discontinuation. Thereafter, patients will be contacted by phone or electronic communication every 3 months for survival status up to 5 years following date of first patient treatment initiation. All patients will be followed for a minimum of 6 months following enrolment of last patient. It is anticipated that the total enrolment period for the overall study will be approximately 2 to 3 years, with an overall duration of approximately 5 years
Interventions
BIOLOGICALMEDI4736 (Durvalumab)
A human monoclonal antibody (mAb) of the immunoglobulin G (IgG) 1 kappa subclass that blocks the interaction of PD-L1 (but not programmed cell death ligand-2) with PD-1 on T cells and CD80 (B7.1) on immune cells (IC).
BIOLOGICALMEDI4736 (Durvalumab) + Tremelimumab
Durvalumab: A human mAb of IgG 1 kappa subclass that blocks the interaction of PD-L1 (but not programmed cell death ligand-2) with PD-1 on T cells and CD80 (B7.1) on IC. Tremelimumab: A human Ig G2 mAb that completely blocks the interaction of human CTLA-4 (cluster of differentiation \[CD\]152) with CD80 and CD86 and increase release of cytokines (interleukin \[IL\]-2 and interferon \[IFN\]-γ) from human T cells, peripheral blood mononuclear cells and whole blood.
Sponsors
AstraZeneca
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 130 Years
Healthy volunteers
No
Inclusion criteria
1. Must have a life expectancy of at least 12 weeks. 2. Age ≥18 years at the time of screening. For patients aged \<20 years and enrolled in Japan, a written informed consent should be obtained from the patient and his or her legally acceptable representative 3. Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. Written informed consent and any locally required authorization (eg, Health Insurance Portability and Accountability Act in the US, European Union \[EU\] Data Privacy Directive in the EU) obtained from the patient/legal representative prior to performing any protocol-related procedures, including screening evaluations. For patients aged \<20 years and enrolling in Japan, a written informed consent should be obtained from the patient and his or her legally acceptable representative. 4. Disease not amenable to curative surgery 5. Eastern Cooperative Oncology Group (ECOG) performance status as defined in the specific module. 6. Body weight \>30 kg. 7. No prior exposure to anti-PD-1 or anti-PD-L1, including on another AstraZeneca study. Exposure to other investigational agents may be permitted after discussion with the Sponsor. 8. Adequate organ and marrow function as defined below * Hemoglobin ≥9.0 g/dL * Absolute neutrophil count ≥1.0 × 109 /L * Platelet count ≥75 × 109/L * Serum bilirubin ≤1.5 × the upper limit of normal (ULN). This will not apply to patients with confirmed Gilbert's syndrome, who will be allowed in consultation with their physician. * ALT and AST ≤2.5 × ULN; for patients with hepatic metastases, ALT and AST ≤5 × ULN * Measured creatinine clearance (CL) \>40 mL/min or calculated creatinine clearance (CL) \>40 mL/min as determined by Cockcroft-Gault (using actual body weight) Males: Creatinine CL = Weight (kg) × (140 - Age) (mL/min) 72 × serum creatinine (mg/dL) Females: Creatinine CL = Weight (kg) × (140 - Age) x 0.85 (mL/min) 72 × serum creatinine (mg/dL) 9. Female patients of childbearing potential (ie, not surgically sterile or post menopausal) who are sexually active with a non sterilized male partner must use at least one highly effective method of contraception from the time of screening and must agree to continue using such precautions for 180 days after the last dose of durvalumab + tremelimumab combination therapy or 90 days after the last dose of durvalumab monotherapy (see Section 3.8 and specifically Table 1). 10. Evidence of post-menopausal status or negative urinary or serum pregnancy test (per Section 4) for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply: 11. Women \<50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle- stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy). Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses \>1 year ago, had chemotherapy-induced menopause with last menses \>1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy). Non sterilized male patients who are sexually active with a female partner of childbearing potential must use a male condom plus spermicide from screening through 180 days after receipt of the final dose of durvalumab + tremelimumab combination therapy or 90 days after receipt of the final dose of durvalumab monotherapy.
Exclusion criteria
1. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site). 2. Previous IP assignment in the present study. 3. Concurrent enrollment in another clinical study, or another sub-study of this protocol, unless it is an observational (non-interventional) clinical study or during the follow up period of an interventional study. 4. Participation in another clinical study with an investigational product during the last 28 days or 5 half-lives, whichever is longer, prior to the first dose of study treatment. 5. Any concurrent chemotherapy, investigational agent, biologic, or hormonal therapy for cancer treatment. Concurrent use of hormonal therapy for non-cancer-related conditions (eg, hormone replacement therapy) is acceptable. 6. Local treatment of isolated lesions for palliative intent is acceptable (eg, local surgery or radiotherapy). 7. Receipt of any investigational anticancer therapy within 28 days or 5 half-lives, whichever is longer, prior to the first dose of study treatment. 8. Radiotherapy treatment to more than 30% of the bone marrow or with a wide field of radiation within 4 weeks of the first dose of study drug. Note: Local treatment of isolated lesions, excluding target lesions, for palliative intent is acceptable. 9. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of IP. Note: Local surgery of isolated lesions for palliative intent is acceptable. 10. History of allogenic organ transplantation. 11. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, ILD, serious chronic GI conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent 12. History of another primary malignancy except for * Malignancy treated with curative intent and with no known active disease ≥5 years before the first dose of investigational product (durvalumab + tremelimumab) and of low potential risk for recurrence * Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease * Adequately treated carcinoma in situ without evidence of disease 13. History of leptomeningeal carcinomatosis 14. Has untreated central nervous system (CNS) metastases and/or carcinomatous meningitis identified either on baseline brain imaging (please refer to RECIST for details on the imaging modality) obtained during the screening period or identified prior to signing the ICF. Patients whose brain metastases have been treated may participate provided they show radiographic stability (defined as 2 brain images, both of which are obtained after treatment to the brain metastases. These imaging scans should both be obtained at least 4 weeks apart and show no evidence of intracranial progression). In addition, any neurologic symptoms that developed either as a result of the brain metastases or their treatment must have resolved or be stable either, without the use of steroids, or are stable on a steroid dose of ≤10 mg/day of prednisone or its equivalent and anti-convulsants for at least 14 days prior to the start of treatment. Brain metastases will not be recorded as RECIST Target Lesions at baseline. 15. History of active primary immunodeficiency. 16. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis testing in line with local practice), hepatitis B (known positive hepatitis B virus \[HBV\] surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody \[anti-HBc\] and absence of HBsAg) are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA. 17. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab or tremelimumab. The following are exceptions to this criterion: * Intranasal, inhaled, topical steroids, or local steroid injections (eg, intra articular injection) * Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent 18. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease \[eg, colitis or Crohn's disease\], diverticulitis \[with the exception of diverticulosis\], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc.\]). The following are exceptions to this criterion: * Patients with vitiligo or alopecia * Patients with hypothyroidism (eg, following Hashimoto syndrome) stable on hormone replacement * Any chronic skin condition that does not require systemic therapy * Patients without active disease in the last 5 years may be included but only after consultation with the study physician * Patients with celiac disease controlled by diet alone 19. Receipt of live attenuated vaccine within 30 days prior to the first dose of IP. Note: Patients, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP. 20. Known allergy or hypersensitivity to study drug(s) or compounds of similar biologic composition to the study drug(s), or any of the study drug excipients. 21. Any unresolved NCI CTCAE Grade ≥2 toxicities from prior anti cancer therapy with the exception of vitiligo, alopecia, and the laboratory values defined in the inclusion criteria. * Patients with Grade ≥2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician. * Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab or tremelimumab may be included only after consultation with the Study Physician 22. For women only, currently pregnant (confirmed with positive pregnancy test) or breast feeding. 23. Female patients who are pregnant or breastfeeding or male or female patients of reproductive potential who are not willing to employ effective birth control from screening to 180 days after the last dose of durvalumab + tremelimumab combination therapy or 90 days after the last dose of durvalumab monotherapy. 24. Prior randomization or treatment in a previous durvalumab and/or tremelimumab clinical study regardless of treatment arm assignment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Adverse Events of Special Interest (AESIs) | From screening to safety follow up visit (90 days after last dose), up to approximately 3 years. | Incidence, severity, nature, seriousness, intervention/treatment, outcome, and causality of AESIs were assessed. AESIs included events with a potential inflammatory or immune-mediated mechanism that required interventions such as steroids, immunosuppressants, and/or hormone replacement therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From screening to final data cutoff (maximum up to 4 years) following date of first patient treatment initiation. | Overall survival was defined as the time from the first date of treatment until death due to any cause. |
| Number of Participants With Adverse Events | From screening to safety follow up visit (90 days after last dose), maximum up to 4 years. | Incidence, severity, nature, seriousness, intervention/treatment, outcome, and causality of treatment-emergent AEs (including SAEs) will be assessed |
Countries
Canada, France, Germany, Italy, Netherlands, South Korea, United Kingdom, United States
Participant flow
Recruitment details
Participants who met all the inclusion and none of the exclusion criteria were randomized at 77 study centers across 8 countries (Canada, France, Germany, Italy, Republic of Korea, Netherlands, United Kingdom and United States of America).
Pre-assignment details
During the screening period (4 weeks), eligible participants signed the informed consent. All the study assessments were performed as per the schedule of assessment.
Participants by arm
| Arm | Count |
|---|---|
| Durvalumab All participants received fixed-dose of durvalumab 1500 mg every 4 weeks until disease progression or unacceptable toxicity. | 867 |
| Total | 867 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 73 |
| Overall Study | Condition under investigation worsened | 84 |
| Overall Study | Development of study specific discontinuation criteria | 2 |
| Overall Study | Disease relapse | 181 |
| Overall Study | Lack of therapeutic response | 2 |
| Overall Study | Other (as recorded) | 33 |
| Overall Study | Patients who were still on study treatment at Data Cutoff | 120 |
| Overall Study | Protocol Violation | 1 |
| Overall Study | Subjective disease progression | 359 |
| Overall Study | Withdrawal by Subject | 12 |
Baseline characteristics
| Characteristic | Durvalumab |
|---|---|
| Age, Continuous | 67.5 years STANDARD_DEVIATION 9.36 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 65 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 28 Participants |
| Race (NIH/OMB) White | 508 Participants |
| Sex: Female, Male Female | 173 Participants |
| Sex: Female, Male Male | 694 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 600 / 867 |
| other Total, other adverse events | 669 / 867 |
| serious Total, serious adverse events | 254 / 867 |
Outcome results
Primary
Number of Participants With Adverse Events of Special Interest (AESIs)
Incidence, severity, nature, seriousness, intervention/treatment, outcome, and causality of AESIs were assessed. AESIs included events with a potential inflammatory or immune-mediated mechanism that required interventions such as steroids, immunosuppressants, and/or hormone replacement therapy.
Time frame: From screening to safety follow up visit (90 days after last dose), up to approximately 3 years.
Population: Safety analysis set: all enrolled participants who received at least one dose of durvalumab.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE with outcome = death, causally related to treatment | 1 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE, causally related to treatment | 191 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Event outcome resolved | 140 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any SAE, causally related to treatment | 14 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE of common terminology criteria Grade 3 or 4, causally related to treatment | 15 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any adverse event (AE) | 265 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any serious adverse event (SAE) (including events with outcome = death) | 19 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE of common terminology criteria for AEs Grade 3 or 4 | 21 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE leading to discontinuation of study treatment | 12 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE with outcome = death | 1 participants |
| AESI | Number of Participants With Adverse Events of Special Interest (AESIs) | Event outcome not resolved | 124 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE of common terminology criteria Grade 3 or 4, causally related to treatment | 20 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any adverse event (AE) | 300 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE of common terminology criteria for AEs Grade 3 or 4 | 49 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any serious adverse event (SAE) (including events with outcome = death) | 13 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE with outcome = death | 0 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE, causally related to treatment | 145 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any SAE, causally related to treatment | 3 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE with outcome = death, causally related to treatment | 0 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE leading to discontinuation of study treatment | 7 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Event outcome resolved | 119 participants |
| AEPI | Number of Participants With Adverse Events of Special Interest (AESIs) | Event outcome not resolved | 181 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Event outcome resolved | 32 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE with outcome = death, causally related to treatment | 0 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any serious adverse event (SAE) (including events with outcome = death) | 11 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any adverse event (AE) | 97 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE leading to discontinuation of study treatment | 10 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE of common terminology criteria for AEs Grade 3 or 4 | 17 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE of common terminology criteria Grade 3 or 4, causally related to treatment | 16 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE, causally related to treatment | 87 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Event outcome not resolved | 65 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any SAE, causally related to treatment | 10 participants |
| imAE | Number of Participants With Adverse Events of Special Interest (AESIs) | Any AE with outcome = death | 0 participants |
Secondary
Number of Participants With Adverse Events
Incidence, severity, nature, seriousness, intervention/treatment, outcome, and causality of treatment-emergent AEs (including SAEs) will be assessed
Time frame: From screening to safety follow up visit (90 days after last dose), maximum up to 4 years.
Population: Safety analysis set: all enrolled participants who received at least one dose of durvalumab.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| AESI | Number of Participants With Adverse Events | Any AE | 787 participants |
| AESI | Number of Participants With Adverse Events | Any AE causally related to any study treatment | 407 participants |
| AESI | Number of Participants With Adverse Events | Any AE of common terminology criteria grade 3 or higher | 365 participants |
| AESI | Number of Participants With Adverse Events | Any AE of common terminology criteria grade 3 or higher, causally related to study treatment | 78 participants |
| AESI | Number of Participants With Adverse Events | Any AE with outcome = death | 42 participants |
| AESI | Number of Participants With Adverse Events | Any AE with outcome = death causally related to study treatment | 9 participants |
| AESI | Number of Participants With Adverse Events | Any SAE (including events with outcome = death) | 254 participants |
| AESI | Number of Participants With Adverse Events | Any SAE (including events with outcome = death) causally related to study treatment | 41 participants |
| AESI | Number of Participants With Adverse Events | Any AE leading to discontinuation of study treatment | 77 participants |
| AESI | Number of Participants With Adverse Events | Any AE leading to discontinuation of study treatment causally related to study treatment | 33 participants |
Secondary
Overall Survival
Overall survival was defined as the time from the first date of treatment until death due to any cause.
Time frame: From screening to final data cutoff (maximum up to 4 years) following date of first patient treatment initiation.
Population: Safety analysis set: all enrolled participants who received at least 1 dose of durvalumab.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| AESI | Overall Survival | 7.0 months |