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    Summary
    EudraCT Number:2017-001375-22
    Sponsor's Protocol Code Number:1560-GITCG
    National Competent Authority:Netherlands - Competent Authority
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2018-05-17
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedNetherlands - Competent Authority
    A.2EudraCT number2017-001375-22
    A.3Full title of the trial
    EORTC ILOC study: Phase II of immunotherapy plus local tumor ablation (RFA or stereotactic radiotherapy) in patients with colorectal cancer liver metastases
    EORTC ILOC-onderzoek: Fase II Immunotherapie plus Lokale tumorablatie (RFA of stereotactische radiotherapie) in patiënten met Colorectale kanker met levermetastasen
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    EORTC ILOC study: Phase II of immunotherapy plus local tumor ablation (RFA or stereotactic radiotherapy) in patients with colorectal cancer liver metastases
    EORTC ILOC-onderzoek: Fase II Immunotherapie plus Lokale tumorablatie (RFA of stereotactische radiotherapie) in patiënten met Colorectale kanker met levermetastasen
    A.3.2Name or abbreviated title of the trial where available
    ILOC
    A.4.1Sponsor's protocol code number1560-GITCG
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03101475
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorEuropean Organisation for the Research and Treatment of Cancer (EORTC)
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportEuropean Organization for the Research and Treatment of Cancer (EORTC)
    B.4.2CountryBelgium
    B.4.1Name of organisation providing supportAstra Zeneca
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEuropean Organisation for the Research and Treatment of Cancer (EORTC)
    B.5.2Functional name of contact pointRegulatory Affairs Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenue E. Mounier 83 / 11
    B.5.3.2Town/ cityBrussels
    B.5.3.3Post code1200
    B.5.3.4CountryBelgium
    B.5.4Telephone number+3227741023
    B.5.5Fax number+3227727063
    B.5.6E-mailregulatory@eortc.org
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDurvalumab
    D.3.2Product code MEDI4736
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDurvalumab
    D.3.9.1CAS number 1428935-60-7
    D.3.9.2Current sponsor codeMEDI4736
    D.3.9.3Other descriptive nameDurvalumab
    D.3.9.4EV Substance CodeSUB175688
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameTremelimumab
    D.3.2Product code MEDI1123
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTremelimumab
    D.3.9.1CAS number 745013-59-6
    D.3.9.2Current sponsor codeMEDI1123
    D.3.9.3Other descriptive nameTREMELIMUMAB
    D.3.9.4EV Substance CodeSUB37101
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Metastatic colorectal cancer with Incurable liver metastases
    Colorectale kanker met ongeneeslijke levermetastasen
    E.1.1.1Medical condition in easily understood language
    Metastatic colorectal cancer with Incurable liver metastases
    Colorectale kanker met ongeneeslijke levermetastasen
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10052362
    E.1.2Term Metastatic colorectal cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10052358
    E.1.2Term Colorectal cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level SOC
    E.1.2Classification code 10029104
    E.1.2Term Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of this proof of concept study will be to investigate whether the combined use of local tumor ablation/radiation plus immunomodulating drugs may induce a significant immune response in patient with incurable liver metastases from colorectal cancer (CRC) (+/- limited extrahepatic disease) being stable or in partial response after a course of first - or second line therapy.

    The primary objective of the study is to show an overall response rate of lesions not treated by ablation/radiotherapy including the extrahepatic lesions (according to iRECIST criteria) higher than 10%. With the continuation of first line systemic treatment, no further responses are expected.
    De primaire doelstelling van dit ‘proof of concept’ onderzoek is het onderzoeken of het gecombineerde gebruik van lokale tumorablatie/bestraling plus immunomodulerende geneesmiddelen een significante immuunrespons kan induceren bij patiënten met ongeneeslijke levermetastasen van colorectale kanker (CRC) (+/- beperkte extrahepatische ziekte) waarbij de ziekte stabiel is of in gedeeltelijke remissie is na eerstelijns of tweedelijns behandeling.

    De primaire doelstelling van het onderzoek is het aantonen van een meer dan 10% respons kans van laesies die niet zijn behandeld door ablatie/bestralingstherapie waaronder de extrahepatische laesies (volgens iRECIST-criteria). Met het voortzetten van eerstelijns systemische behandeling wordt geen verdere respons verwacht.

    E.2.2Secondary objectives of the trial
    Secondary objectives are:
    •To establish the feasibility and safety of the combined treatment modalities;
    •To study the impact of the local technique (RFA/Radiotherapy) on the results;
    •To investigate biomarkers to predict response to the combined treatment.
    De secundaire doelstellingen zijn:
    •Het vaststellen van de uitvoerbaarheid en veiligheid van de gecombineerde behandelingsmodaliteiten;
    •Het bestuderen van het effect van de lokale techniek (RFA/bestralingstherapie) op de resultaten;
    •Het onderzoeken van biomarkers om de respons op de gecombineerde behandeling te voorspellen.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    •Histologically confirmed CRC
    •Patients with CRC liver metastases, with/without extrahepatic disease,in which curative treatment is not possible by resection and or local ablation/radiotherapy
    •≥ 18 years of age at time of study entry
    •WHO performance status 0 to 1
    •Body weight >30kg
    Measurable disease according to RECIST 1.1
    •Stable disease or partial remission by RECIST 1.1 criteria after at least 3 months systemic therapy for CRC. Patients are eligible following first - or - second line treatment.
    Note: if patient receives maintenance treatment after the first line treatment, she/he remains eligible for this study
    •Complete responders or partial responders with a 80% or more decrease in the sum of measures (longest diameter for tumor lesions and short axis measure for nodes) of target lesions following last systemic therapy,taking as reference sum of diameters from baseline scan prior to initiation of systemic therapy are excluded as well as patients with almost complete cystic degeneration of liver metastases.
    Note: the interval between last dose of systemic treatment to the first dose of the study drugs must be of maximum 8 weeks (in case
    bevacizumab was administered as part of the systemic treatment, a min 21days wash out period is required from last administration to planned local ablative treatment initiation)
    •Liver metastases amenable to ablation or stereotactic radiotherapy (SBRT) at completion of systemic therapy
    •For SBRT: allowing a total ablated volume of at least 25 cm3 &a maximum of 40 cm3 with a max of 2lesions treated with SBRT
    •For RFA: allowing a total ablated volume of at least 25 cm3 &a maximum advised volume of 120 cm3
    •At least 2measurable liver metastases, or at least 1measurable liver metastasis and 1 measurable extrahepatic lesion should remain untreated by ablation or SBRT to allow response monitoring according to RECIST 1.1 & iRECIST
    •Limited extra hepatic disease is allowed, including up to 2extra hepatic metastatic sites,either lung, abdominal, pelvis, bone, or localized lymph node metastases. Each is counted separately as 1site. 2abdominal lesions will be counted as 1extra-hepatic site; 1lung & 1abdominal lesion will be counted as 2sites. Individual extrahepatic lesions should be ≤ 5 cm
    •Availability of tumor sample for biomarkers testing (MSI, PDL-1, etc) (archival tissue from primary tumor)
    •Adequate normal organ &marrow function before initial systemic treatment as well as baseline as defined below:
    •Absolute neutrophil count (ANC) ≥ 1.5 x 109/L (> 1500 per mm3)
    •Platelet count ≥ 100 x 109/L (>100,000 per mm3)
    •Serum bilirubin ≤ 1.5 x institutional upper limit of normal (ULN). This will not apply to subjects with confirmed Gilbert’s syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in absence of hemolysis or hepatic pathology), who will be allowed only in consultation with physician
    •AST (SGOT)/ALT (SGPT) ≤ 5 x institutional upper limit of normal
    •Creatinine ≤ 1.5 x institutional ULN or measured or calculated creatinine clearance >40 mL/min by the Cockcroft-Gault formula
    •Hemoglobin ≥ 9.0 g/dL at baseline

    •PLEASE SEE THE PROTOCOL FOR FURTHER INCLUSION CRITERIA
    •Histologisch bevestigde CRC;
    •Patiënten met CRC-levermetastasen, met of zonder extrahepatische ziekte, waarbij curatieve behandeling niet mogelijk is door resectie en/of lokale ablatie/bestralingstherapie;
    •≥ 18 jaar oud op het ogenblik van de inschrijving in het onderzoek;
    •WHO-performancestatus 0 tot 1;
    •Lichaamsgewicht > 30 kg;
    •Meetbare ziekte volgens RECIST v1.1;
    •Stabiele ziekte of gedeeltelijke remissie volgens de criteria van RECIST 1.1 na minimum 3 maanden systemische behandeling Patiënten in eerstelijns of tweedelijns behandeling zijn geschikt.
    - Opm.: Een patiënt die onderhoudstherapie krijgt na de eerstelijns behandeling blijft geschikt voor deelname aan de studie.
    - Opm.: Volledige responders of gedeeltelijke responders met een afname van 80% of meer in de som van afmetingen (langste diameter voor tumorlaesies en meting van de korte as voor nodules) van doellaesies na de laatstse kuur systemischetherapie, waarbij de som van de diameters bij de baseline vóór de start van de systemische therapie als referentie wordt genomen, worden uitgesloten, alsmede patiënten met bijna volledige cystische degeneratie van levermetastasen.
    - Opm: Het interval tussen de laatste dosis van de systemische behandeling en de eerste dosis studiemedicatie is maximaal 8 weken (in geval bevacizumab was toegediend als onderdeel van de systemische behandeling is een “wash out” periode van minimaal 21 dagen nodig na de laatste toediening van Bevacizumab tot de geplande start van de lokale ablatieve behandeling).
    •Levermetastasen die geschikt zijn voor ablatie of stereotactische bestralingstherapie (SBRT) na het voltooien van de systemische behandeling:
    •Voor SBRT: het totaal geablateerd volume dient ten minste 25 cm3 te zijn maar niet meer dan 40 cm3 met een maximum aantal laesies van 2.
    •Voor RFA: het totaal geablateerd volume dient ten minste 25 cm3 te zijn met een maximaal geadviseerd volume van 120 cm3;
    •Ten minste twee meetbare levermetastasen, of ten minste 1 meetbare levermetastase en 1 meetbare extrahepatische laesie dienen onbehandeld te blijven met ablatie of SBRT om responscontrole volgens RECIST 1.1 en iRECIST mogelijk te maken;
    •Beperkte extrahepatische ziekte is toegestaan, met een maximum van 2 hierna beschreven extrahepatisch regios:, long, buik, bekken, bot, of gelokaliseerde lymfeklieren. Elk zal afzonderlijk als één regio worden geteld. Twee abdominale laesies worden dus als 1 extrahepatische regio geteld; één long en één abdominale laesie worden als twee regio’s geteld. Individuele extrahepatische laesies moeten ≤ 5 cm zijn;
    •Beschikbaarheid van tumormonster voor biomarkeronderzoek (MSI, PDL-1, enz.) (gearchiveerd weefsel van primaire tumor);
    •Voldoende normale orgaan- en beenmergfunctie vóór de systemische behandeling alsmede bij de baseline, gedefinieerd als volgt:
    •Absoluut aantal neutrofielen (ANC) ≥ 1.5 × 109/l (1500 mm3).
    •Aantal bloedplaatjes ≥ 100 x 109/l (>100.000 per mm3).
    •Serumbilirubine ≤ 1,5 keer de bovenlimiet van normale waarde (upper limit of normal, ULN) van de instelling. Dit is niet van toepassing op proefpersonen met bevestigd syndroom van Gilbert (persistente of periodieke hyperbilirubinemie die hoofdzakelijk ongeconjugeerd is in afwezigheid van hemolyse of hepatische pathologie), deze patiënten kunnen in overleg met hun arts worden toegelaten.
    •AST (SGOT)/ALT (SGPT) ≤ 5 x de bovenlimiet van normale waarde van de instelling.
    •Creatinine ≤ 1,5 x ULN van de instelling of gemeten of berekende kreatinineklaring >40 ml/min aan de hand van de formule van Cockcroft-Gault
    •Hemoglobine ≥ 9,0 g/dl bij de baseline;
    •Patiënt met de volgende medische condities zijn geschikt:
    •Patiënten met vitiligo of alopecia
    •Patiënten met hypothyreoïdie (bijv. na de ziekte van Hashimoto) die stabiel zijn met hormoonvervanging
    •Een chronische huidaandoening die niet systemisch behandeld hoeft te worden
    •Patiënten zonder actieve ziekte in de afgelopen 5 jaar kunnen worden opgenomen maar alleen na overleg met de onderzoeksarts
    •Patiënten met coeliakie die alleen door dieet onder controle wordt gehouden
    • Vrouwen in de vruchtbare leeftijd (women of child bearing potential,WOCBP) moeten een negatieve zwangerschapstest op serum hebben binnen 72 uur voorafgaand aan de eerste dosis van de onderzoeksbehandeling;
    NB: vruchtbare vrouwen zijn gedefinieerd als premenopauzale vrouwen die zwanger kunnen worden (d.w.z. vrouwen die in de afgelopen 12 maanden enige tekenen hadden van menstruatie, met uitzondering van degenen die eerder een hysterectomie hebben ondergaan). Vrouwen met amenorroe gedurende 12 maanden of meer worden echter nog steeds geacht vruchtbaar te zijn als de amenorroe mogelijk het gevolg is van voorafgaande chemotherapie, anti-oestrogenen, laag lichaamsgewicht, ovariële suppressie of andere redenen.

    • ZIE HET PROTOCOL VOOR VERDERE INCLUSIECRITERIA

    E.4Principal exclusion criteria
    •Patients with known brain metastases or history of leptomeningeal carcinomatosis
    • Hilar liver lesions close to central bile ducts to be treated by RFA
    • Prior treatment:
    •History of radiation therapy of the liver, upper abdomen or lower thorax
    •History of radioembolization of the liver
    •Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of durvalumab and tremelimumab.
    •Any previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab, a CTLA-4 including tremelimumab or other checkpoint inhibitors or other immune therapy during the last 12 months
    •Any unresolved toxicity NCI CTCAE v 4.0 Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, 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.
    •Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab and tremelimumab, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid, or steroids as premedication for hypersensitivity reactions (eg, CT scan premedication)
    •Receipt of live attenuated vaccination within 30 days prior to study entry or within 30 days of receiving durvalumab
    •Active or prior documented autoimmune or inflammatory disorders (including inflammatory pulmonary disorders, interstitial lung disease, 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 polyangitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]).
    •History of allogeneic organ transplant
    •History of hypersensitivity to durvalumab, tremelimumab or any excipient
    •Uncontrolled intercurrent illness including, but not limited to:
    •Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive 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 (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
    •Active peptic ulcer disease or gastritis
    •Liver cirrhosis CHILD B+, C
    •Active bleeding diatheses
    •History of primary immunodeficiency
    • Cardiac disorders:
    • Symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia
    •Mean QT interval corrected for heart rate (QTc) ≥470 ms calculated from 3 electrocardiograms (ECGs) using Frediricia’s Correction
    •Female patients who are pregnant or male or female patients of reproductive potential who are not willing to employ effective birth control from screening to 90 days after the last dose of durvalumab monotherapy or 180 days after the last dose of durvalumab + tremelimumab combination therapy.
    •Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial

    Important note: All eligibility criteria must be adhered to, in case of deviation discussion with Headquarters and study coordinator is mandatory.
    •Patiënten met bekende hersenmetastasen of voorgeschiedenis van leptomeningeale carcinomatose;
    •Hilaire leverlaesies dicht bij de galwegen die met RFA moeten worden behandeld;
    •Voorgaande behandeling:
    •Voorgeschiedenis van bestralingstherapie van de lever, bovenbuik of onderste thorax; voorgeschiedenis van radio-embolisatie van de lever;
    •Zware operatie (zoals gedefinieerd door de onderzoeker) binnen 28 dagen vóór de eerste dosis van durvalumab en tremelimumab;
    •Eerdere behandeling met een PD1- of PD-L1-remmer, waaronder durvalumab, een CTLA-4 waaronder tremelimumab of andere checkpoint-remmers of andere immunotherapie in de voorafgaande 12 maanden;
    •Niet verdwenen toxiciteit van NCI CTCAE v 4.0 Graad ≥2 door eerdere antikankerbehandeling met uitzondering van alopecie, vitiligo en de laboratoriumwaarden die in de inclusiecriteria worden gedefinieerd
    •Patiënten met een neuropathie van graad ≥2 worden per geval beoordeeld na overleg met de onderzoeksarts.
    •Patiënten met irreversibele toxiciteit waarvan redelijkerwijs niet wordt verwacht dat het door de behandeling met durvalumab of tremelimumab zal verergeren kunnen alleen na overleg met de onderzoeksarts worden opgenomen;
    •Huidig of eerder gebruik van immunosuppressiva binnen 14 dagen vóór de eerste dosis van durvalumab en tremelimumab met uitzondering van intranasale en geïnhaleerde corticosteroïden of systemische corticosteroïden waarbij fysiologische doses van 10 mg/dag prednison niet worden overschreden, of een gelijkwaardig dosis corticosteroïde, of steroïden als premedicatie voor overgevoeligheidsreacties (bijv. premedicatie voor een CT-scan);
    •Ontvangst van levende verzwakte vaccinatie binnen 30 dagen vóór aanvang van het onderzoek of binnen 30 dagen van het ontvangen van durvalumab;
    •Actieve of eerder gedocumenteerde immuunziekten of inflammatoire aandoeningen (waaronder inflammatoire longaandoeningen, interstiteel longlijden, inflammatoire darmziekte [bijv. colitis of de ziekte van Crohn], diverticulitis [met uitzondering van diverticulose], systemische lupus erythematose, syndroom van Löfgren, of de ziekte van Wegener [granulomatose met polyangiitis, ziekte van Graves, reumatoïde artritis, hypophysitis, uveitis, enz.]);
    •Voorgeschiedenis van allogene orgaantransplantatie;
    •Voorgeschiedenis van overgevoeligheid tegen durvalumab, tremelimumab of een van de hulpstoffen;
    •Ongecontroleerde bijkomende ziekte waaronder, maar niet beperkt tot:
    •Actieve infectie waaronder tuberculose (klinische evaluatie waaronder klinische voorgeschiedenis, lichamelijk onderzoek en radiografische bevindingen, en TB-test in overeenstemming met lokale praktijk), hepatitis B (bekend positief resultaat voor HBV oppervlakteantigeen (HBsAg)), hepatitis C, of humaan immunodeficiëntievirus (positieve HIV 1/2-antilichamen). Patiënten met een eerdere of verdwenen HBV-infectie (gedefinieerd als de aanwezigheid van het hepatitis B-kernantilichaam [anti-HBc] en afwezigheid van HBsAg) zijn geschikt. Patiënten die positief zijn voor het hepatitis C (HCV) antilichaam zijn alleen geschikt als de polymerasekettingreactie negatief is voor HCV RNA.
    •Actieve maagzweer of gastritis
    •Levercirrose CHILD B+, C
    •Actieve bloedings stoornissen
    •Voorgeschiedenis van primaire immunodeficiëntie;
    •Hartafwijkingen:
    •Symptomatisch, congestief hartfalen, ongecontroleerde hypertensie, onstabiele angina pectoris, hartritmestoornissen
    •Gemiddeld Qt-interval gecorrigeerd voor hartslag (QTc) ≥470 ms berekend uit 3 elektrocardiogrammen (ecg’s) met behulp van de correctie van Fredericia;
    •Vrouwelijke patiënten die zwanger zijn of mannelijke of vrouwelijke patiënten in de vruchtbare leeftijd die niet bereid zijn om effectieve anticonceptie toe te passen vanaf de screening tot 90 dagen na de laatste dosis van monotherapie met durvalumab of 180 dagen na de laatste dosis van de combinatietherapie met durvalumab + tremelimumab;
    •Een psychologische, sociologische, geografische of familieomstandigheid die de naleving van het onderzoeksprotocol en het vervolgschema kan belemmeren; dergelijke omstandigheden moeten met de patiënt worden besproken vóór inschrijving in het onderzoek.
    Belangrijke opmerking: Alle geschiktheidscriteria moeten worden nageleefd; in geval van een afwijking is een bespreking met het Headquaters EORTC en met de onderzoekscoördinator verplicht.
    E.5 End points
    E.5.1Primary end point(s)
    •1 year (maximum) after the start of study treatment of the last enrolled patient
    •1 jaar (maximaal) na aanvang van de onderzoeksbehandeling van de laatst ingeschreven patiënt
    E.5.1.1Timepoint(s) of evaluation of this end point
    •1 year (maximum) after the start of study treatment of the last enrolled patient
    • 1 jaar (maximaal) na aanvang van de onderzoeksbehandeling van de laatst geregistreerde patiënt
    E.5.2Secondary end point(s)
    •Best overall immune response (best overall immune response, iBOR) rate of liver lesions not treated with local therapy according to iRECIST (with response confirmation)
    •Best overall response rate of lesions not treated by ablation/radiotherapy including or not the extrahepatic lesions according to RECIST v1.1 (with response confirmation)
    •Response duration according to iRECIST and to RECIST v1.1
    •Stable disease duration according to iRECIST and to RECIST v1.1
    (At the same time as primary endpoint)
    •Progression free survival according to iRECIST and RECIST v1.1
    •Overall survival
    •Long-term endpoints to be reported 30 months after the last patient has been enrolled (individual follow-up of 30 months minimum for each patient)
    •Beste overall immuunrespons (iBOR) van leverlaesies die niet zijn behandeld met lokale therapie volgens iRECIST (met bevestiging van respons);
    •Beste overall respons van laesies die niet zijn behandeld door ablatie/bestralingstherapie, waaronder wel of geen extrahepatische laesies volgens RECIST v1.1 (met bevestiging van respons)
    •Duur van respons volgens iRECIST en RECIST v1.1
    •Duur van stabiele ziekte volgens iRECIST en RECIST v1.1
    •Progressievrije overleving volgens iRECIST en RECIST v1.1
    •Totale overleving
    •Eindpunten op de lange termijn moeten worden gerapporteerd 30 maanden nadat de laatste patiënt is geregistreerd (individuele opvolging van minimaal 30 maanden voor elke patiënt)
    E.5.2.1Timepoint(s) of evaluation of this end point
    •180 days after all patients have stopped protocol treatment
    •Adverse events (Common Toxicity Criteria CTCAE v4.0)
    • 180 dagen nadat alle patiënten zijn gestopt met de protocolbehandeling
    • Bijwerkingen (Common Toxicity Criteria CTCAE v4.0)
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    G8 screening assessment for patient ≥ 70 years within 21 days prior to registration
    G8-screening evaluatie voor patiënt ≥ 70 jaar binnen 21 dagen voorafgaand aan registratie
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA10
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Austria
    France
    Germany
    Netherlands
    Sweden
    Switzerland
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    End of study occurs when all of the following criteria have been satisfied:
    1. 90 days after all patients have stopped protocol treatment
    2. The trial is mature for the analysis of the primary endpoint as defined in the protocol, if the study reaches its primary endpoint
    3. The database has been fully cleaned and frozen for this analysis
    Einde van de studie vindt plaats wanneer aan alle volgende criteria is voldaan:
    1. 90 dagen nadat alle patiënten zijn gestopt met protocolbehandeling
    2. De proef is klaar voor de analyse van het primaire eindpunt zoals gedefinieerd in het protocol, als het onderzoek zijn primaire eindpunt bereikt
    3. De database is volledig schoongemaakt en bevroren voor deze analyse
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months6
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 42
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 28
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Information not present in EudraCT
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state13
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 61
    F.4.2.2In the whole clinical trial 70
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    According to the discretion of the treating physician
    Volgens het oordeel van behandelend arts
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-05-17
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-01-11
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2022-02-22
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