Precision Medicine in Patients With Unresectable CholAngiocarcinoma: RadioEmbolization and Combined Biological Therapy

NCT06375915 | Recruiting Phase 2

• 2 other identifiers: PM-CAREPNRR-MAD-2022-12375905
• Study Type: interventional
• Target: 33
• Locations: 1 country
• Sites: 1

Brief Summary

Underlying disease mechanisms are fundamental for correct treatment selection and patient management in highly invasive and debilitating non-transmissible diseases. Even though overall disease burden of cancer may have decreased due to a higher degree of awareness, the availability of high-quality healthcare and early diagnosis may become challenging in certain neoplasms. Cholangiocarcinoma is usually diagnosed at advanced stages due to non-specific presentation and is frequently refractory to chemotherapy, causing a massive impact on patients and their families. Surgery is currently the only curative treatment but is available to only approximately 30% of patients. The combination of interventional- and immune-oncology to standard of care creates the perfect substrate for synergistic mechanisms to fight tumor growth; in situ cell death following transarterial embolization(TARE) elicits immune mediated response, inflammatory response and biomarkers of oxidative stress and increases antigen presenting T-cells which an anti-anti progam death ligand (PD-L)1 can bind to; standard of care can then add on with its known effects.The rationale of a combined- locoregional and systemic - treatment lies in the synergistic effects of each of the treatments.

Conditions

Intrahepatic Cholangiocarcinoma

Keywords

intrahepatic cholangiocarcinoma; precision medicine; combined treatment; radioembolization (TARE); intrahepatic cholangiocarcinoma (iCC); immunotherapy; immunogenicity

Outcome Measures

Primary Outcomes (2)

• Overall response rate (ORR)

  mRECIST criteria on imaging (modified Response Evaluation Criteria in Solid Tumors criteria)

  6 months post TARE

• Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

  Through study completion, an average of 2 years

Secondary Outcomes (17)

• Median progression free survival

  Through study completion, an average of 12 months

• Overall response rate

  3 months post TARE

• Overall response rate

  3 months post TARE

• Overall response rate

  Approximately 6 months post TARE

• Overall response rate

  Approximately 6 months post TARE

Study Arms (1)

tretament arm

EXPERIMENTAL

Single arm treatment

Radiation: radioembolization with Y-90; Drug: Durvalumab; Drug: Cisplatin; Drug: Gemcitabine

Interventions

radioembolization with Y-90 RADIATION

Radioembolization with Y-90 will be performed in nominal day 0

tretament arm

Durvalumab DRUG

Following radioembolization, for 6 cycles -intravenous infusion on day 1 of each cycle

tretament arm

Cisplatin DRUG

Following radioembolization, for 6 cycles -intravenous infusion on day 1 and 8 of each cycle

tretament arm

Gemcitabine DRUG

Following radioembolization, for 6 cycles -intravenous infusion on day 1 and 8 of each cycle

tretament arm

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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 (European Union \[EU\] Data Privacy Directive) obtained from the patient/legal representative prior to performing any protocol related procedures, including screening evaluations.
• Patients with liver predominant intrahepatic cholangiocarcinoma with intermediate/high rate of early recurrence calculated according to https://k-sahara.shinyapps.io/Veryearlyrecurrence/.
• Patients aged \> 18 to ≤ 80 at time of study entry;
• Body weight \>30kg
• Suspicion or biopsy confirmed diagnosis of iCC, not previously treated with systemic or surgical therapies, including not previously enrolled in another clinical study with an investigational product;
• Preserved liver function as defined as: Child Pugh Class A; Model for End Stage Liver Disease Score (MELD) \<10; Future Liver Remnant (FLR) uptake function ≥2.7%/min/m2 on technetium- 99m mebrofenin hepatobiliary scintigraphy and FLR volume\> 30% of total functional liver volume for a normal liver, or \> 40% of total functional liver volume if the liver has been damaged by chronic liver disease, cholestasis, steatohepatitis or diabetes;
• No technical contraindications to TARE as confirmed by pre-procedural angiographic and scintigraphy;
• DNA tests for hepatitis B virus (HBV) and RNA tests for hepatitis C virus (HCV) negative at Screening;
• Adequate heart and lung function;
• Eastern Cooperative Oncology Group (ECOG) Performance Score 0 or 1;
• Adequate renal and hepatic function as indicated by: serum creatinine \<2x upper limit of normal and estimated glomerular filtration rate (eGFR) ≥30ml/min or 1.73m2; measured creatinine clearance (CL) \>40 mL/min or calculated creatinine CL\>40 mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976\*) or by 24-hour urine collection for determination of creatinine clearance; Alkaline phosphatase (ALP), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 5 times the upper limit of normal (ULN) and total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) (this will not apply to patients with confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of hemolysis or hepatic pathology), who will be allowed only in consultation with their physician);
• Hemoglobin ≥9 g/dL, platelet count ≥75,000/mm3, absolute neutrophil count (ANC) ≥ 1.0 x 109 /L
• Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.
• Must have a life expectancy of at least 12 weeks

You may not qualify if:

• Cancer classified as a combined or mixed type (HCC hepatocelular carcinoma and ICC) at screening -histopathological examination;
• Child-Pugh class B or more or evidence of severe portal hypertension at screening or at any time up to and including baseline;
• History of major gastrointestinal bleeding that required medical intervention within 30 days prior to screening or baseline;
• Known hypersensitivity to tumor specific chemotherapy agents used during the study;
• Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients;
• Previous allogeneic bone marrow transplant, kidney or liver transplant, i.e. - history of allogenic organ transplantation;
• Active viral, bacterial or fungal infection, clinically relevant for the assessment of suitability;
• Current history or evidence of neuropsychiatric diseases, including depression, schizophrenia,bipolar disorder, impaired cognitive function, dementia, or suicidal tendency;
• Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease \[e.g., colitis or Crohn's disease\], 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 (e.g., 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;
• History of severe cardiovascular disease such as a previous stroke, coronary artery disease requiring surgery, or unresolved arrhythmias within the past 6 months;
• Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) ≥470 ms calculated from 3 ECGs (within 15 minutes at 5 minutes apart);
• Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring adverse events (AEs) or compromise the ability of the patient to give written informed consent
• 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 IP 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
• History of leptomeningeal carcinomatosis;
• Evidence of any hematological malignancy;

Sponsors & Collaborators

• Francesco De Cobelli: lead
• Cardarelli Hospital: collaborator
• A.O. Ospedale Papa Giovanni XXIII: collaborator
• AOU Pisana, Pisa, Italy: collaborator

Study Sites (1)

Department of Radiology, IRCCS Ospedale San Raffaele

Milan, 20132, Italy

RECRUITING

MeSH Terms

Conditions

Cholangiocarcinoma

Interventions

Yttrium-90; durvalumab; Cisplatin; Gemcitabine

Condition Hierarchy (Ancestors)

Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms

Intervention Hierarchy (Ancestors)

Chlorine Compounds; Inorganic Chemicals; Nitrogen Compounds; Platinum Compounds; Heterocyclic Compounds; Deoxycytidine; Cytidine; Pyrimidine Nucleosides; Pyrimidines; Heterocyclic Compounds, 1-Ring

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: MD, Professor, PI

Study Record Dates

• First Submitted: March 4, 2024
• First Posted: April 19, 2024
• Study Start: May 1, 2024
• Primary Completion: January 1, 2026
• Study Completion: January 1, 2026
• Last Updated: May 24, 2024

Record last verified: 2024-05

Data Sharing

• IPD Sharing: Will not share

Locations

IT (1)