- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05836571
Testing Ipilimumab and Nivolumab Combination With or Without Cabozantinib in People >= 18 Years Old With Advanced Soft Tissue Sarcoma
Randomized Phase 2 Study of Cabozantinib, Ipilimumab, and Nivolumab in Patients With Soft Tissue Sarcoma
Study Overview
Status
Conditions
- Locally Advanced Leiomyosarcoma
- Unresectable Leiomyosarcoma
- Metastatic Undifferentiated Pleomorphic Sarcoma
- Metastatic Soft Tissue Sarcoma
- Locally Advanced Liposarcoma
- Locally Advanced Undifferentiated Pleomorphic Sarcoma
- Unresectable Liposarcoma
- Unresectable Undifferentiated Pleomorphic Sarcoma
- Locally Advanced Extraskeletal Myxoid Chondrosarcoma
- Locally Advanced Unresectable Soft Tissue Sarcoma
Detailed Description
PRIMARY OBJECTIVE:
I. Assess progression free survival (PFS) of ipilimumab + nivolumab versus (vs.) the cabozantinib + nivolumab + ipilimumab combination in patients with metastatic, or locally advanced, surgically unresectable soft tissue sarcoma (STS) using Response Evaluation Criteria in Solid Tumors (RECIST) version (v) 1.1.
SECONDARY OBJECTIVES:
I. Evaluate the response rate (complete response [CR]+partial response [PR]) of ipilimumab + nivolumab vs. the cabozantinib + nivolumab + ipilimumab combination.
II. Evaluate the response rate (CR+PR) of cabozantinib + ipilimumab + nivolumab in (crossover) patients whose disease has progressed on ipilimumab + nivolumab therapy.
III. Assess the number of tumor-infiltrating CD8+ T cells in tumor biopsies before and after treatment.
EXPLORATORY OBJECTIVES:
I. Measure tumor-infiltrating CD3+ T cells and CD68+ macrophages in biopsy specimens.
II. Evaluate genomic alterations in circulating tumor DNA (ctDNA) and their potential association with therapy response or resistance.
III. Investigate whether response is associated with genetic aberrations and/or tumor mutational burden.
IV. Analyze total MET and activated MET (p1235-MET) in biopsy specimens before and after study treatment and evaluate molecular target engagement by cabozantinib (as shown by a lower phosphorylated [p]MET/MET ratio).
V. Evaluate the objective response rate in patients treated with ipilimumab + nivolumab or the cabozantinib + nivolumab + ipilimumab combination using immune-modified Response Evaluation Criteria in Solid Tumors (iRECIST).
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM A: Patients receive nivolumab intravenously (IV) over 30-60 minutes and ipilimumab IV over 60-90 minutes on day 1 of each cycle. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity for 4 cycles. Patients then receive nivolumab IV over 30 minutes on day 1 of subsequent cycles. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT) or magnetic resonance imaging (MRI) scans, tumor biopsies, and collection of urine samples throughout the trial. Patients may also optionally undergo collection of blood samples at baseline. Patients can crossover from Arm A to Arm B at the time of disease progression.
ARM B: Patients receive cabozantinib orally (PO) once daily (QD) or every other day (QOD), nivolumab IV over 30-60 minutes on day 1, and ipilimumab IV over 60-90 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity for 4 cycles. Patients then receive nivolumab IV over 30 minutes on day 1 and cabozantinib PO QD or QOD of subsequent cycles. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients crossing over after ≥ 4 ipilimumab + nivolumab (Arm A) cycles will receive cabozantinib and nivolumab only on Arm B; patients that cross over after < 4 ipilimumab + nivolumab (Arm A) cycles will receive the remaining cycles of ipilimumab (totaling 4 doses) plus nivolumab in combination with cabozantinib. Patients who crossover will start with the every 3 weeks cycle 1 treatment even if they will not be receiving ipilimumab. Patients also undergo CT or MRI scans, tumor biopsies, and collection of urine samples throughout the trial. Patients may also optionally undergo collection of blood samples at baseline.
After completion of study treatment, patients are followed for 30 days.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
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Ontario
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Toronto, Ontario, Canada, M5G 2M9
- University Health Network-Princess Margaret Hospital
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-
-
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California
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Duarte, California, United States, 91010
- City of Hope Comprehensive Cancer Center
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Irvine, California, United States, 92612
- UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
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Los Angeles, California, United States, 90033
- USC / Norris Comprehensive Cancer Center
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Los Angeles, California, United States, 90020
- Keck Medicine of USC Koreatown
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Los Angeles, California, United States, 90033
- Los Angeles General Medical Center
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Newport Beach, California, United States, 92663
- USC Norris Oncology/Hematology-Newport Beach
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Orange, California, United States, 92868
- UC Irvine Health/Chao Family Comprehensive Cancer Center
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Connecticut
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Hartford, Connecticut, United States, 06105
- Smilow Cancer Hospital Care Center at Saint Francis
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New Haven, Connecticut, United States, 06520
- Yale University
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Trumbull, Connecticut, United States, 06611
- Smilow Cancer Hospital Care Center-Trumbull
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District of Columbia
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Washington D.C., District of Columbia, United States, 20007
- MedStar Georgetown University Hospital
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Florida
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Gainesville, Florida, United States, 32610
- UF Health Cancer Institute - Gainesville
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Maryland
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Bethesda, Maryland, United States, 20892
- National Institutes of Health Clinical Center
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Bethesda, Maryland, United States, 20892
- National Cancer Institute Developmental Therapeutics Clinic
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Missouri
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St Louis, Missouri, United States, 63110
- Washington University School of Medicine
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St Louis, Missouri, United States, 63129
- Siteman Cancer Center-South County
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New York
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New York, New York, United States, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
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North Carolina
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Chapel Hill, North Carolina, United States, 27599
- UNC Lineberger Comprehensive Cancer Center
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Ohio
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Columbus, Ohio, United States, 43210
- Ohio State University Comprehensive Cancer Center
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Oklahoma
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Oklahoma City, Oklahoma, United States, 73104
- University of Oklahoma Health Sciences Center
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Pennsylvania
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Pittsburgh, Pennsylvania, United States, 15232
- University of Pittsburgh Cancer Institute (UPCI)
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Tennessee
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Nashville, Tennessee, United States, 37232
- Vanderbilt University/Ingram Cancer Center
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Texas
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Houston, Texas, United States, 77030
- M D Anderson Cancer Center
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Utah
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Salt Lake City, Utah, United States, 84112
- Huntsman Cancer Institute/University of Utah
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Virginia
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Charlottesville, Virginia, United States, 22908
- University of Virginia Cancer Center
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Richmond, Virginia, United States, 23298
- VCU Massey Comprehensive Cancer Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients must have histologically or cytologically confirmed metastatic STS, specifically undifferentiated pleomorphic sarcoma (UPS), extraskeletal myxoid chondrosarcoma (EMC), liposarcoma (LPS) or non-uterine leiomyosarcoma (LMS) that are locally advanced and surgically unresectable
- Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >= 20 mm (>= 2 cm) by chest x-ray or as >= 10 mm (>= 1 cm) with CT scan, MRI, or calipers by clinical exam. Disease will be measured by RECISTv1.1
- Patients with prior treatment with MET or VEGFR inhibitors are allowed. However, prior cabozantinib-treated patients will not be allowed. Prior ipilimumab in combination with nivolumab-treated patients will not be allowed
- Age >= 18 years
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
- Absolute neutrophil count >= 1,000/mcL
- Platelets >= 75,000/mcL
- Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 3 x institutional ULN
- Creatinine =< 1.5 x institutional ULN OR glomerular filtration rate (GFR) >= 50 mL/min/1.73 m^2
- Serum albumin >= 2.8g/dL
- Lipase < 2.0 x ULN and no radiologic or clinical evidence of pancreatitis
- Urine protein/creatinine ratio (UPCR) =< 1 mg/mg
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy if indicated
- Patients with a history of hepatitis C virus (HCV) infection must have been treated and have undetectable HCV viral load 12 or more weeks after treatment completion. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
- Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression >= 1 month after treatment of the brain metastases. Patients with new or progressive brain metastases (active brain metastases) or leptomeningeal disease are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first 2 cycles of therapy
- Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better
- Patients must be willing to provide blood specimens and undergo biopsies for research purposes
- Patients with baseline blood pressure (BP) lower than 140 mmHg (systolic) and 90 mmHg (diastolic). Patients on > 2 anti-hypertensive agents will be excluded
- Human immunodeficiency virus (HIV)-infected patients on effective combination antiretroviral therapy are eligible as long as HIV is well-controlled and there is undetectable viral load within 6 months. For these patients, an HIV viral load test must be completed within 28 days prior to enrollment
- The effects of nivolumab, ipilimumab, and cabozantinib on the developing human fetus are unknown. For this reason and because other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential (WOCBP) and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. WOCBP (defined as any female who has experienced menarche and who has not undergone surgical sterilization [hysterectomy or bilateral oophorectomy] or who is not postmenopausal) should use an adequate method to avoid pregnancy for 5 months after the last dose of investigational drug. Women of childbearing potential must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) at the time of enrollment and within 8 days prior to each cycle. Women must not be breastfeeding
- Men who are sexually active with women of child-bearing potential (WOCBP) must use any contraceptive method with a failure rate of less than 1% per year. Men receiving cabozantinib and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 5 months after the last dose of investigational product. Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile) as well as azoospermic men do not require contraception
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
- Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1) with the exception of alopecia, stable hyperthyroidism on replacement therapy, type-1 diabetes, well-controlled on insulin, and non-clinically significant toxicities at the discretion of the study Principal Investigator
- Patients who are receiving any other investigational agents
- Eligibility of subjects receiving any medications or substances known to affect or with the potential to affect the activity of cabozantinib will be determined following review of their cases by the Principal Investigator. Patients who are taking enzyme-inducing anticonvulsant agents are not eligible
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to cabozantinib, nivolumab, or ipilimumab
- Patients receiving any medications or substances that are strong inhibitors or inducers of CYP3A4 are ineligible. Strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital, and St. John's Wort) are not allowed for this study. Because the lists of these agents are constantly changing, frequently updated lists available at http://medicine.iupui.edu/clinpharm/ddis/table.asp or other reliable resources will be consulted. Patients who need to come off CYP3A4 inhibitors/inducers should adhere to a washout period of at least 5 times the half-life of the CYP3A4 inhibitors and 14 days of CYP3A4 inducers
- Patients with any other significant condition(s) that would make this protocol unreasonably hazardous are ineligible. Patients with uncontrolled intercurrent illness or clinical evidence of an active infection at the time of enrollment are ineligible
- Pregnant women are excluded from this study because cabozantinib is a receptor kinase inhibitor agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with cabozantinib in combination with nivolumab and ipilimumab, breastfeeding should be discontinued if the mother is treated with cabozantinib. These potential risks may also apply to other immunotherapeutic agents (ipilimumab and nivolumab) used in this study
- Patients with any of the following within 12 weeks prior to the first dose of cabozantinib: gastrointestinal bleeding, hemoptysis or pulmonary hemorrhage, radiographic evidence of cavitating pulmonary lesion(s), evidence of tumor invasion of the gastrointestinal (GI) tract (esophagus, stomach, small or large bowel, rectum, or anus), or any evidence of endotracheal or endobronchial tumor or encasement of any major blood vessels are ineligible
- The patient is unable to swallow tablets
- The patient has a corrected QT interval calculated by the Fridericia formula (QTcF) >= 470 ms within 28 days before enrollment
- Patients with a requirement for steroid or immunosuppressive treatment should be excluded if they have a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
Study Plan
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: Arm A (nivolumab, ipilimumab)
Patients receive nivolumab IV over 30-60 minutes and ipilimumab IV over 60-90 minutes on day 1 of each cycle.
Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity for 4 cycles.
Patients then receive nivolumab IV over 30 minutes on day 1 of subsequent cycles.
Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Patients also undergo CT or MRI scans, tumor biopsies, and collection of urine samples throughout the trial.
Patients may also optionally undergo collection of blood samples at baseline.
Patients can crossover from Arm A to Arm B at the time of disease progression.
|
Given IV
Other Names:
Undergo MRI
Other Names:
Given IV
Other Names:
Undergo CT
Other Names:
Undergo biopsy
Other Names:
Undergo collection of urine and/or blood sample
Other Names:
|
|
Experimental: Arm B (cabozantinib, nivolumab, ipilimumab)
See Detailed Description.
|
Given IV
Other Names:
Undergo MRI
Other Names:
Given IV
Other Names:
Undergo CT
Other Names:
Given PO
Undergo biopsy
Other Names:
Undergo collection of urine and/or blood sample
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Progression-free survival (PFS)
Time Frame: Up to 30 days after completion of study treatment
|
Will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1.
The primary analysis will be a logrank test and will be performed once 52 PFS events have been observed or once all patients have gone off trial, whichever comes first.
For Arm A (ipilimumab + nivolumab), a within-arm interim futility analysis will be performed; if at least one partial response, complete response, or stable disease (SD) (SD with duration of at least 6 months) is observed among the first 14 patients enrolled to this arm.
In addition, a single interim futility analysis (Wieand rule) will be performed at 50% information (26 PFS events).
|
Up to 30 days after completion of study treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Objective response rate
Time Frame: Up to 30 days after completion of study treatment
|
Defined as complete response or partial response by RECIST v1.1.
Response rates within the two study arms will be (separately) reported and will be directly compared using a two-sample test of proportions.
In addition, will report the rate of objective response to cabozantinib + ipilimumab + nivolumab triplet therapy in patients who have crossed over after their disease progressed on ipilimumab + nivolumab doublet.
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Up to 30 days after completion of study treatment
|
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Number of tumor-infiltrating CD8+ T cells
Time Frame: Baseline and pre-cycle 3
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Will be evaluated in tumor biopsies before and after treatment.
Changes between paired samples will be interpreted as being likely treatment-induced if they exceed the sampling, biological, and technical variabilities determined for the assay.
Unpaired baseline and post-treatment measurements may also be assessed for correlation with response, which will shed light on possible CD8+ T cell density or infiltration requirements that could inform future trial designs.
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Baseline and pre-cycle 3
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Genetic aberrations and/or tumor mutational burden
Time Frame: Up to 30 days after completion of study treatment
|
Will investigate whether response is associated with genetic aberrations and/or tumor mutational burden.
Non-parametric analyses will be used.
|
Up to 30 days after completion of study treatment
|
|
T cell receptor signaling in tumor-infiltrating T cells
Time Frame: Baseline and C2D22
|
Will be evaluated in tumor biopsies.
Non-parametric analyses will be used.
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Baseline and C2D22
|
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Overall response
Time Frame: Up to 30 days after completion of study treatment
|
Will be assessed using Immune-Modified RECIST as an exploratory endpoint, for comparison to RECIST v1.1.
Non-parametric analyses will be used.
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Up to 30 days after completion of study treatment
|
|
Tumor-infiltrating CD3+ T cells and CD68+ macrophages
Time Frame: Baseline and Cycle[C] 2 Day[D] 22
|
Will be evaluated in tumor biopsies.
Non-parametric analyses will be used.
|
Baseline and Cycle[C] 2 Day[D] 22
|
|
Total MET and activated MET
Time Frame: Baseline and C2D22
|
Will be evaluated in biopsy specimens before and after study treatment.
Will evaluate molecular target engagement by cabozantinib (as shown by a lower phosphorylated MET/MET ratio).
Non-parametric analyses will be used.
|
Baseline and C2D22
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: A P Chen, National Cancer Institute LAO
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms
- Neoplasms by Histologic Type
- Neoplasms, Connective and Soft Tissue
- Neoplasms, Connective Tissue
- Neoplasms, Fibrous Tissue
- Histiocytoma
- Sarcoma
- Histiocytoma, Malignant Fibrous
- Amino Acids, Peptides, and Proteins
- Proteins
- Investigative Techniques
- Clinical Laboratory Techniques
- Diagnostic Techniques and Procedures
- Diagnosis
- Surgical Procedures, Operative
- Cytological Techniques
- Cytodiagnosis
- Biological Factors
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal
- Antibodies
- Immunoglobulins
- Immunoproteins
- Blood Proteins
- Serum Globulins
- Globulins
- Diagnostic Techniques, Surgical
- Chemistry Techniques, Analytical
- Spectrum Analysis
- Receptors, Cell Surface
- Membrane Proteins
- Antigens
- Antigens, Surface
- Biomarkers
- Receptors, Immunologic
- Antigens, Differentiation, T-Lymphocyte
- Antigens, Differentiation
- Immune Checkpoint Proteins
- Costimulatory and Inhibitory T-Cell Receptors
- Nivolumab
- Ipilimumab
- Biopsy
- Specimen Handling
- Magnetic Resonance Spectroscopy
- cabozantinib
- CTLA-4 Antigen
Other Study ID Numbers
- NCI-2023-03149 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- 10556 (Other Identifier: CTEP)
- 001704
Plan for Individual participant data (IPD)
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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