Vulvar Squamous Cell Carcinoma
Conditions
Keywords
vulvar squamous cell carcinoma, nivolumab, imiquimod
Brief summary
COLOMBE is a multicenter, single arm, phase 1/2 trial designed to evaluate the safety and efficacy of imiquimod cream with IV low dose nivolumab in primary resectable vulvar squamous cell carcinoma patients prior to surgery, leveraging the preoperative "window of opportunity" period, an unavoidable interval due to surgical scheduling.
Interventions
At the starting dose (DL1) : 5 consecutive days per week for 4 weeks At DL-1: 3 consecutive days per week for 4 weeks
DRUGNivolumab
At DL1 and DL-1: Administration IV at a dose of 40 mg, every two weeks for 6 weeks (3 doses)
Sponsors
Centre Leon Berard
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
I1. Female patient ≥ 18 years of age on day of signing informed consent. I2. Histologically confirmed primary VSCC, with all of the following characteristics: * At least 1 lesion that can be measured in at least 1 dimension with ≥ 10 mm in largest diameter * Clinically stage FIGO I-III (2021 FIGO staging) * Eligible for primary tumour surgery * Surgical complexity due to either bulky tumors \> 4 cm OR multifocal tumor (defined as the presence of two or more foci of cancer on the vulva), the largest lesion must be ≥ 10 mm and all lesions ≥ 10 mm are designated as "target" lesion(s) for all subsequent tumor evaluations OR any tumor for which a surgical excision would have anatomical or functional consequences deemed significant by the treating surgeon I3. Availability of a representative formalin-fixed paraffin-embedded (FFPE) sample of the primary tumor tissue (biopsy) with an associated pathology report. This tumor sample must meet the following quality/quantity control criteria: ≥30 % of tumor cells and a tumor surface area ≥ 5mm2 I4. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) ≤ 2 I5. Patients with adequate organ function: * Absolute Neutrophil Count (ANC) ≥ 1 10\^9/L * Platelets ≥ 100 10\^9/L (without transfusion for platelets within 7 days) * Hemoglobin ≥ 9 g/dL * Creatinine clearance according to CKD-EPI ≥ 30 mL/min * Serum total bilirubin ≤ 1.5 x ULN (except for patients with Gilbert disease for whom a total serum bilirubin ≤ 3 x ULN is acceptable) * AST and ALT ≤ 3 x ULN I6. Women of child-bearing potential (WOCBP) must have a negative serum pregnancy test within 7 days prior to C1D1 and must agree to use effective forms of contraception from the time of the negative pregnancy test up to 5 months after the last dose of nivolumab. I7. Patient should understand, sign, and date the written voluntary informed consent form at the screening visit prior to any protocol-specific procedures performed. Patient should be able and willing to comply with study visits and procedures as per protocol. I8. Patients must be covered by a medical insurance.
Exclusion criteria
E1. Patients participating in another clinical trial with therapeutic intent. E2. Patients previously treated with any anti-cancer treatment including anti-PD-1, anti-PDL1, or anti PD L2 agent or with an agent directed to another stimulatory or co-inhibitory T cell receptor (e.g., CTLA-4, OX 40, CD37). E3. Patients not respecting the minimal washout period or receiving or anticipation of need during the study of the following medications/procedure: * Major surgery: 2 weeks * Live vaccines: 4 weeks * Systemic corticosteroids (in dosing exceeding 10 mg daily of prednisone or equivalent) or any other form of immunosuppressive therapy: 1 week E4. Patients with known additional malignancy that is progressing or has required active treatment within the past 3 years. Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin on a location other than the vulva, or carcinoma in situ (e.g. of the breast, cervix or bladder) that have undergone potentially curative therapy are not excluded. E5. Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients. E6. Patients with evidence of significant uncontrolled infection or concomitant disease, or psychiatric illness/social situations that could affect compliance with the protocol or interpretation of results. E7. Patients with prior organ or bone marrow transplant. E8. Patients with known active hepatitis B, C, or HIV infection or any active infection requiring systemic therapy. E9. Patients with known or suspected active autoimmune disease. Note: Patients with skin disorders (such as vitiligo, psoriasis or alopecia), type I diabetes mellitus, hypothyroidism only requiring hormone replacement or conditions not expected to recur in the absence of an external trigger are eligible. E10. Pregnant or breastfeeding women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase I Safety run-in: Dose-limiting toxicity (DLT) related to imiquimod and/or nivolumab, occurring during the induction period (first 6 weeks of treatment) | From Cycle 1 Day 1 to week 6 | Dose-limiting toxicity (DLT) defined as any adverse event (AE) related to imiquimod and/or nivolumab, occurring during the induction period (first 6 weeks of treatment, i.e., DLT period) and graded according to the NCI-CTCAE V6.0 classification: * Grade 4 non-laboratory AE including skin toxicity; * Grade 3 non-laboratory AE lasting \>14 days despite optimal supportive care with the following exceptions: Influenza-like symptoms and application site reaction related to imiquimod * Any grade 3 or grade 4 laboratory value with clinical symptoms requiring medical intervention or hospitalization, and persisting for more than 14 days; * Any imiquimod site application AE or nivolumab related AE postponing the surgery of at least 14 days * Any other AE evaluated as clinically significant by investigator and sponsor, for instance delaying the nivolumab administration for more than 14 days * Any toxic death, grade 5 AE |
| Phase II: To evaluate the clinical efficacy of imiquimod and nivolumab combination in adult patients with resectable primary VSCC | From Cycle 1 Day 1 to surgery (up to 3 cycles - each cycle is 14 days) | Clinical ORR (objective response rate) as per RECIST 1.1 category documented by calipers using standardized digital photography with reference ruler at the time of surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of the Pathological Response | At time of surgery | The pathological tumor response (pTR) is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor): pTR-0 (\<10%), pTR-1 (10%-49%), pTR-2 (≥50%), pTR-3 (100%, complete response). The pTR will be quantified in increments of 10%. |
| Rate of positive margin | At time of surgery | Rate of patients with positive margin defined as \<8mm |
| Rate of positive Sentinel Lymph Node | Through study completion, up to 3 years | Rate of patients with positive Sentinel Lymph Node (SLN) |
| Rate of patients undergoing RT | Through study completion, up to 3 years | Rate of patients undergoing radiotherapy |
| Evaluation of Overall Survival (OS) | From Cycle 1 Day 1 to the date of death from any cause (assessed up to 3 years) | Overall survival defined as the time between treatment initiation (C1D1) and death from any cause. Patients still alive at the time of analysis will be censored at the date of last news they are known to be alive. |
| Recurrence Free Survival (RFS) | From Cycle 1 Day 1 to the date of first documented disease recurrence or death (assessed up to 3 years) | Recurrence Free Survival (RFS): defined as the time from C1D1 to the first documented disease recurrence or death from any cause, whichever occurs first. Patients who are alive and without evidence of recurrence at the time of analysis will be censored at the date of their last disease assessment. |
| Evaluation of surgical complications | From surgery to short term safety visit (occuring 30 days after surgery) | The frequency of surgical complications: * The percentage of wound breakdown (dehiscence) in the vulva defined as larger than one third of the length of excision. * The percentage of wound breakdown (dehiscence) in the groins defined as larger than one third of the length of excision. * The percentage of wound infection in the vulva defined as a clinical infection (e.g. the presence of a purulent exudate and/or a positive culture with the presence of erythema, oedema, and localized pain involving skin and subcutaneous tissue) which requires antibiotic therapy * The percentage of wound infection in the groins defined as a clinical infection (e.g. the presence of a purulent exudate and/or a positive culture with the presence of erythema, oedema, and localized pain involving skin and subcutaneous tissue) which requires antibiotic therapy. * The percentage of patients with lymphocyst formation defined by greater than 4 cm in diameter and confirmed by puncture or ultrasound |
| To assess the impact of the proposed induction treatment on patient QoL | From enrollment to Short Term Safety Visit (STSV) (assesed up to 30 days following surgery) | To assess the impact of the proposed induction treatment on patient QoL with Quality of Life questionnaires: * EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30): scores range from 0 to 100, with higher scores indicating better functioning/global health status but worse symptoms * EORTC QLQ-VU34 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Vulva Cancer module with 34 questions): scores range from 0 to 100, with higher scores indicating better functioning/global health status but worse symptoms |
| To define the tolerability of the proposed therapeutic strategy | Through study completion, up to 3 years | Incidence and severity of AE according to NCI CTCAE V6.0 |
Countries
France
Contacts
CONTACTOlivia LE SAUX, MD, PhD
Outcome results
None listed