- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02499367
Nivolumab After Induction Treatment in Triple-negative Breast Cancer (TNBC) Patients (TONIC)
March 21, 2022 updated by: The Netherlands Cancer Institute
Adaptive Phase II Randomized Non-comparative Trial of Nivolumab After Induction Treatment in Triple-negative Breast Cancer (TNBC) Patients: TONIC-trial
This is a single center non-blinded randomized non-comparative phase II trial. The first stage of the trial consists of five arms ( with induction treatment followed by nivolumab, 1 with no induction treatment before nivolumab).
For the second stage, the number of arms will be reduced based on the results obtained in the first stage.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Detailed Description
Triple negative breast cancer (TNBC) patients have a relatively high relapse rate and upon relapse the median overall survival is less than a year.
No targeted therapies are currently available for this subgroup.
Compared to other breast cancer subtypes, the percentage of tumor-infiltrating lymphocytes (TILs) is significantly higher in TNBC.
Given the durable responses induced by the immune checkpoint inhibitor nivolumab in other advanced solid cancers, immunotherapeutic approaches, such as blockade of PD-1 by nivolumab may be the key to treat TNBC.
Moreover, since classical anticancer agents can stimulate immune effector cells, the investigators hypothesize that short-term induction treatment with radiation, doxorubicin, cyclophosphamide or cisplatin induces an anticancer immune response resulting in synergistic activity with nivolumab.
Study Type
Interventional
Enrollment (Anticipated)
84
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Amsterdam, Netherlands, 1066 CX
- Antoni van Leeuwenhoek
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Metastatic triple negative breast cancer with confirmation of Estrogen Receptor (ER) and HER2 negativity on a histological biopsy of a metastatic lesion
- 18 years or older
- Metastatic lesion accessible for histological biopsy (Mandatory biopsies: pre-induction treatment, post-induction treatment, 6-weeks. Optional biopsies: 12-weeks, at progression, of irradiated site). The pre-induction treatment biopsy has to contain sufficient tumor content (≥100 tumor cells); subjects with samples that have insufficient tumor content will require re-biopsy prior to induction treatment. Interval between last treatment and pre-induction biopsy has to be at least 14 days
- One, two or three line(s) of chemotherapy for metastatic disease and with progression of disease on last treatment regimen
- Evaluable disease according to RECIST 1.1
- Metastatic lesion accessible for radiation with 1x20 Gray or 3x8 Gray
- Subjects with brain metastases are eligible if these are not symptomatic. Subjects who received prior treatment for brain metastases should be free of progression on magnetic resonance imaging (MRI) for at least 4 weeks after treatment is completed and prior to first dose of study drug administration. There must also be no requirement for immunosuppressive doses of systemic corticosteroids (> 10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration.
- WHO performance status of 0 or 1
- Adequate bone marrow function
- Adequate hepatic function
- Adequate renal function
- Signed written informed consent
Exclusion Criteria:
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris.
- known history of leptomeningeal disease localization
- history of having received other anticancer therapies within 2 weeks of start of the study drug
- history of immunodeficiency, autoimmune disease, conditions requiring immunosuppression (>10 mgl daily prednisone equivalents) or chronic infections.
- prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, or anti-CTLA-4 antibody
- live vaccine within 30 days of planned start of study therapy.
- active other cancer
- positive test for hepatitis B surface virus surface antigen (HBsAg) or hepatitis
- history of uncontrolled serious medical or psychiatric illness
- any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
- current pregnancy or breastfeeding.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Radiation therapy
Radiotherapy on metastatic lesion
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nivolumab 3 mg/kg, every 2 weeks after induction treatment
20 Gy to metastatic lesion
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Active Comparator: Low dose doxorubicin
15mg flat dose, once weekly for 2 weeks
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nivolumab 3 mg/kg, every 2 weeks after induction treatment
15 mg flat dose, once weekly for 2 weeks
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Active Comparator: Cyclophosphamide
metronomic schedule, 50mg daily orally for 2 weeks
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nivolumab 3 mg/kg, every 2 weeks after induction treatment
metronomic schedule, 50 mg daily orally for 2 weeks
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Active Comparator: Cisplatin
40mg/m2, weekly for 2 weeks
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nivolumab 3 mg/kg, every 2 weeks after induction treatment
40 mg/m2, weekly for 2 weeks
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Active Comparator: No induction treatment
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nivolumab 3 mg/kg, every 2 weeks after induction treatment
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression free survival
Time Frame: assessed monthly until progression; median 12 months
|
Time from randomization todate of first tumor progression
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assessed monthly until progression; median 12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall response rate
Time Frame: At 12 weeks and 6 months
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complete response or partial response at 12 weeks and 6 months
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At 12 weeks and 6 months
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Clinical benefit rate
Time Frame: At 6 months
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Beneficial response (complete response, partial response or stable disease) at 6 months
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At 6 months
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Toxicity of all study regimens
Time Frame: assessed until 100 days after of treatment end
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adverse events will be graded according to NCI Common Toxicity Criteria v 4.0
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assessed until 100 days after of treatment end
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Marleen Kok, MD, Antoni van Leeuwenhoek
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
August 1, 2015
Primary Completion (Anticipated)
December 1, 2023
Study Completion (Anticipated)
August 1, 2025
Study Registration Dates
First Submitted
July 6, 2015
First Submitted That Met QC Criteria
July 13, 2015
First Posted (Estimate)
July 16, 2015
Study Record Updates
Last Update Posted (Actual)
March 22, 2022
Last Update Submitted That Met QC Criteria
March 21, 2022
Last Verified
March 1, 2022
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Skin Diseases
- Neoplasms
- Neoplasms by Site
- Breast Diseases
- Breast Neoplasms
- Triple Negative Breast Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Topoisomerase II Inhibitors
- Topoisomerase Inhibitors
- Antineoplastic Agents, Immunological
- Antibiotics, Antineoplastic
- Immune Checkpoint Inhibitors
- Cyclophosphamide
- Cisplatin
- Nivolumab
- Doxorubicin
Other Study ID Numbers
- N15TON
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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