En undersøgelse, der evaluerer effektiviteten og sikkerheden af neoadjuverende immunterapikombinationer hos patienter med kirurgisk resektabelt hepatocellulært karcinom
Et fase Ib/II, åbent, multicenter, randomiseret platformsstudie, der evaluerer effektiviteten og sikkerheden af neoadjuverende immunterapikombinationer hos patienter med kirurgisk resektabelt hepatocellulært karcinom (MORPHEUS-NEO HCC)
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 2
- Fase 1
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Reference Study ID Number: GO44457 https://forpatients.roche.com/
- Telefonnummer: 888-662-6728 (U.S. and Canada)
- E-mail: global.rochegenentechtrials@roche.com
Studiesteder
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London, Det Forenede Kongerige
- Imperial College London - Imperial Centre for Translational and Experimental Medicine (ICTEM)
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California
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Los Angeles, California, Forenede Stater, 90033
- University of Southern California (USC)
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Santa Monica, California, Forenede Stater, 90404-2023
- University of California Los Angeles (UCLA) - Cancer Care - Santa Monica
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District of Columbia
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Washington D.C., District of Columbia, Forenede Stater, 20007
- Georgetown University Medical Center
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New York
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New York, New York, Forenede Stater, 10032
- Columbia University Medical Center
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Texas
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Dallas, Texas, Forenede Stater, 75390-8813
- UT Southwestern Medical Center
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Dijon, Frankrig, 21079
- Centre Georges Francois Leclerc (CGFL)
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Villejuif, Frankrig, 94800
- Gustave Roussy
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Madrid, Spanien, 28040
- Hospital Universitario Fundacion Jimenez Diaz.
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Cantabria
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Santander, Cantabria, Spanien, 39008
- Hospital Universitario Marqués de Valdecilla
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Essen, Tyskland, 45147
- University Essen
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Frankfurt, Tyskland, 60596
- Universitaets Klinikum Frankfurt - Zentrum der Inneren Medizin
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Klagenfurt, Østrig, 9020
- Klinikum Klagenfurt Am Worthersee
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Vienna, Østrig, 1090
- Department of Internal Medicine III AKH and Medical University of Vienna
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
- Diagnose af HCC bekræftet enten histologisk eller klinisk i henhold til AASLD-kriterier for patienter med cirrhose. For deltagere uden skrumpelever er histologisk bekræftelse obligatorisk.
- HCC, der er modtagelig for R0 kirurgisk resektion med kurativ hensigt efter kirurger og onkologer eller hepatologer, der er involveret i plejen af deltageren. Patienter med resektabel HCC inden for eller uden for Milanos kriterier (uden ekstrahepatisk spredning eller makrovaskulær invasion) er kvalificerede.
- Målbar sygdom (mindst én mållæsion) i henhold til RECIST v1.1 som bestemt af investigator
- Eastern Cooperative Oncology Group (ECOG) præstationsstatus på 0 eller 1 inden for 7 dage før randomisering
- Child-Pugh klasse A inden for 7 dage før randomisering
- Negativ HIV-test ved screening
- Ingen forudgående lokoregional eller systemisk behandling for HCC
- Tilstrækkelig hæmatologisk funktion og endeorganfunktion
- Dokumenteret virologisk status for hepatitis
- For kvinder i den fødedygtige alder: aftale om at forblive afholdende (afstå fra heteroseksuelt samleje) eller bruge prævention
- For mænd: aftale om at forblive afholdende (afstå fra heteroseksuelt samleje) eller bruge prævention og aftale om at afstå fra at donere sæd
Generelle udelukkelseskriterier:
- Tilstedeværelse af ekstrahepatisk sygdom eller makrovaskulær invasion
- Kendt fibrolamellær HCC, sarcomatoid HCC, blandet kolangiocarcinom og HCC eller andre sjældne varianter af HCC
- Anamnese med hepatisk encefalopati, hvis det er klinisk signifikant inden for et år før påbegyndelse af undersøgelsesbehandling
- Moderat eller svær ascites
- Aktiv samtidig infektion med HBV og HCV
- Aktiv samtidig infektion med HBV og hepatitis D virusinfektion
- Tidligere behandling med CD137-agonister eller immuncheckpoint-hæmmere, herunder anti-CTLA-4, anti-PD-1 og anti-PD-L1 terapeutiske antistoffer
- Behandling med forsøgsbehandling inden for 28 dage før påbegyndelse af undersøgelsesbehandling
- Ubehandlede eller ufuldstændigt behandlede esophageale og/eller gastriske varicer med blødning eller som har høj risiko for blødning
- En tidligere blødningshændelse på grund af esophageal og/eller gastriske varicer inden for 6 måneder før påbegyndelse af undersøgelsesbehandling
- Utilstrækkeligt kontrolleret hypertension
- Anamnese med hypertensiv krise eller hypertensiv encefalopati
- Betydelig vaskulær sygdom inden for 6 måneder før påbegyndelse af undersøgelsesbehandling
- Anamnese med hæmoptyse inden for 1 måned før påbegyndelse af undersøgelsesbehandling
- Tegn på blødende diatese eller signifikant koagulopati
- Aktuel eller nylig (<= 10 dage før påbegyndelse af undersøgelsesbehandling) brug af fulddosis orale eller parenterale antikoagulantia eller trombolytiske midler til terapeutiske formål
- Anamnese med abdominal eller trakeøsofageal fistel, GI-perforation eller intraabdominale bylder inden for 6 måneder før påbegyndelse af undersøgelsesbehandling
- Anamnese med intestinal obstruktion og/eller kliniske tegn eller symptomer på GI obstruktion
- Alvorligt, ikke-helende eller afskrævende sår, aktivt sår eller ubehandlet knoglebrud
- Grad >= proteinuri
- Større kirurgisk indgreb, åben biopsi eller betydelig traumatisk skade, eller abdominal kirurgi, indgreb eller traumatiske skader, eller forventning om behov for større kirurgisk indgreb, bortset fra potentielt helbredende leverresektion
- Kronisk daglig behandling med et ikke-steroidt antiinflammatorisk lægemiddel (NSAID)
- Alvorlig infektion, der kræver oral eller IV antibiotika og/eller hospitalsindlæggelse
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Eksperimentel: Atezo + Bev
Deltagere i atezolizumab plus bevacizumab (Atezo + Bev)-armen vil modtage op til tre behandlingscyklusser indtil operation eller uacceptabel toksicitet, alt efter hvad der indtræffer først.
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Atezolizumab vil blive indgivet i en dosis på 1200 mg ved IV-infusion på dag 1.
Andre navne:
Bevacizumab vil blive indgivet i en dosis på 15 mg/kg ved IV-infusion på dag 1.
Andre navne:
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Eksperimentel: Atezo + Bev + Tira
Deltagere i atezolizumab plus bevacizumab plus tiragolumab (Atezo + Bev +Tira)-armen vil modtage op til tre behandlingscyklusser indtil operation eller uacceptabel toksicitet, alt efter hvad der indtræffer først.
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Atezolizumab vil blive indgivet i en dosis på 1200 mg ved IV-infusion på dag 1.
Andre navne:
Bevacizumab vil blive indgivet i en dosis på 15 mg/kg ved IV-infusion på dag 1.
Andre navne:
Tiragolumab vil blive indgivet i en dosis på 600 mg ved IV-infusion på dag 1.
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Eksperimentel: Tobe + Bev
Deltagere i Tobemstomig + Bev -armen modtager op til tre behandlingscykler indtil operation eller uacceptabel toksicitet, alt efter hvad der forekommer først. Tilmelding er lukket. |
Bevacizumab vil blive indgivet i en dosis på 15 mg/kg ved IV-infusion på dag 1.
Andre navne:
Tobemstomig vil blive indgivet i en dosis på 600 mg ved IV-infusion på dag 1
Andre navne:
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Major Pathologic Response (MPR) Rate
Tidsramme: At the time of surgery (up to 15 weeks)
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MPR rate was defined as the percentage of participants who had achieved MPR and was estimated for each treatment cohort in the efficacy-evaluable population.
MPR was defined as ≤ 10% residual viable tumor in the tumor bed at the time of surgical resection in the primary tumor, as assessed by the central pathology laboratory.
Participants who did not proceed to surgery were considered as non-responders for MPR.
Percentages have been rounded off.
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At the time of surgery (up to 15 weeks)
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Pathologic Complete Response (pCR) Rate
Tidsramme: At the time of surgery (up to 15 weeks)
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pCR rate was defined as the percentage of participants who had achieved pCR.
pCR was defined as the absence of any viable tumor cells in both the primary tumor and all sampled lymph nodes at the time of surgical resection, as assessed by central pathological review.
Percentages have been rounded off.
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At the time of surgery (up to 15 weeks)
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Relapse-free Survival (RFS), as Assessed by the Investigator According to European Association for the Study of the Liver (EASL) and/or Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v1.1)
Tidsramme: From surgery to the first documented recurrence of disease (up to 20.5 months)
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RFS was defined as the time from surgery to the first documented recurrence of disease (intrahepatic or extrahepatic), as assessed by the investigator according to EASL and/or RECIST v1.1, or death from any cause.
Intrahepatic recurrence was defined by the appearance of one or more intrahepatic lesions with a longest diameter of > 1 cm and a typical vascular pattern of HCC on dynamic imaging (i.e., hypervascularization in the arterial phase with washout in the portal venous or late venous phase).
Extrahepatic recurrence was assessed by RECIST v1.1 as the appearance of new, measurable malignant lesions outside the liver.
Data for participants who did not have documented recurrence of disease or death were censored at the day of the last tumor assessment for participants.
Kaplan-Meier (K-M) method was used to estimate median RFS.
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From surgery to the first documented recurrence of disease (up to 20.5 months)
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Event-free Survival (EFS), as Assessed by the Investigator According to EASL and RECIST v1.1
Tidsramme: From randomization to PD that precluded surgery or disease recurrence or death from any cause, whichever occurred first (up to 20.5 months)
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EFS was defined as the time from randomization to any of the following events, whichever occurred first: PD that precluded surgery, as assessed by the investigator according to RECIST v1.1.
PD was defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum of diameters at prior timepoints (including baseline); local, regional, or distant disease recurrence as measured by EASL and/or RECIST v1.1; or death from any cause.
Data for participants who had not experienced EFS events were censored at the time of their last post-surgical tumor assessment.
K-M method was used to estimate median RFS.
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From randomization to PD that precluded surgery or disease recurrence or death from any cause, whichever occurred first (up to 20.5 months)
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Overall Survival (OS)
Tidsramme: From randomization to death from any cause (up to 20.5 months)
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OS was defined as the time from randomization to death from any cause.
Data for participants who had not died were censored at the last date they were known to be alive.
K-M method was used to estimate median OS.
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From randomization to death from any cause (up to 20.5 months)
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OS Rate at 6 Months, 12 Months, and 18 Months
Tidsramme: At Months 6, 12, and 18
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OS rate at 6, 12, and 18 months was defined as the percentage of participants who had not experienced death from any cause at 6 months, 12 months, and 18 months after randomization, respectively.
OS was defined as the time from randomization to death from any cause.
K-M method was used to estimate OS rate.
Percentages have been rounded off.
Due to the low number of events the results need to be interpreted with caution.
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At Months 6, 12, and 18
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Objective Response Rate (ORR), as Assessed by the Investigator According to RECIST v1.1
Tidsramme: Prior to surgery (at approximately Week 11)
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ORR was defined as the percentage of participants with a radiographic objective response (OR), characterized by a complete response (CR) or a partial response (PR) prior to surgery, as determined by the investigator according to RECIST v1.1.
CR was defined as the disappearance of all target and non-target lesions.
Additionally, any pathological lymph nodes (whether target or non-target) must have a reduction in short axis to <10 millimeters (mm).
PR was defined as at least a 30% decrease in the sum of diameters (SOD) of all target lesions, taking as reference the baseline SOD, in the absence of CR.
Percentages have been rounded off.
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Prior to surgery (at approximately Week 11)
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ORR, as Assessed by the Investigator According to Hepatocellular Carcinoma-Specific Modified Response Evaluation Criteria in Solid Tumors (HCC mRECIST)
Tidsramme: Prior to surgery (at approximately Week 11)
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ORR was defined as the percentage of participants with a radiographic OR, characterized by a CR or a PR prior to surgery, as determined by the investigator according to HCC mRECIST.
CR was defined as the disappearance of any intratumoral arterial enhancement in all target and non-target lesions.
PR was defined as an increase of at least 30% in the sum of the longest diameters of viable (contrast enhancement in the arterial phase) target lesions, taking as reference the baseline SOD of target lesions.
Percentages have been rounded off.
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Prior to surgery (at approximately Week 11)
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Percentage of Participants Downstaged to Within Milan Criteria (for Participants Beyond Criteria at Randomization)
Tidsramme: At the time of surgery (up to 15 weeks)
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Percentage of participants downstaged to within Milan Criteria was defined as the number of participants who were beyond Milan criteria at enrollment and staged as within Milan criteria (single tumor ≤ 5 or 2 to 3 nodules all ≤ 3 centimeters [cm]) during the study.
Milan criteria=single tumor > 5 cm or 2 to 3 nodules > 3 cm, or ≥ 4 nodules.
Percentages have been rounded off.
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At the time of surgery (up to 15 weeks)
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Negative Surgical Margins (R0) Resection Rate
Tidsramme: At the time of surgery (up to 15 weeks)
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R0 resection rate was defined as the percentage of resected participants who achieved complete resection (R0 resection), confirmed by pathology.
R0 resection was defined as a microscopically margin-negative resection, in which no tumor (gross or microscopic) remains in the primary tumor bed.
Percentages have been rounded off.
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At the time of surgery (up to 15 weeks)
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Number of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs) and Immune-related AEs
Tidsramme: From initiation of study treatment up to 135 days (Serious AEs and AESI) or 30 days (all other AEs) after the final dose of study treatment or until initiation of new systemic anti-cancer therapy (up to 7.7 moths)
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An AE was defined as any untoward medical occurrence in a clinical investigation subject administered a pharmaceutical product, regardless of causal attribution.
An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.
An SAE is any AE that meets any of the following criteria: Is fatal; Is life threatening; Requires or prolongs inpatient hospitalization; Results in persistent or significant disability/incapacity; Is a congenital anomaly/birth defect in a neonate/infant born to a mother exposed to study treatment; Is a significant medical event in the investigator's judgment.
Participants with immune-mediated Hepatitis (Diagnosis and Lab Abnormalities) have been reported as immune-related AEs.
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From initiation of study treatment up to 135 days (Serious AEs and AESI) or 30 days (all other AEs) after the final dose of study treatment or until initiation of new systemic anti-cancer therapy (up to 7.7 moths)
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Percentage of Participants With Delayed or Cancelled Surgery Due to Treatment-related Adverse Events (TRAEs)
Tidsramme: Assessed at pre-surgery (scheduled at Week 11)
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Delayed Surgery was defined as delay in surgery by > 28 days from the surgical restaging or pre-surgery visit.
Percentages have been rounded off.
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Assessed at pre-surgery (scheduled at Week 11)
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Length of Surgical Delays
Tidsramme: Assessed at pre-surgery (scheduled at Week 11) up to 20 weeks
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Delayed Surgery was defined as a delay in surgery by > 28 days from the surgical restaging or pre-surgery visit.
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Assessed at pre-surgery (scheduled at Week 11) up to 20 weeks
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Duration of Surgery
Tidsramme: At the time of surgery (up to 15 weeks)
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At the time of surgery (up to 15 weeks)
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Duration of Hospital Stay Post-surgery
Tidsramme: From time of surgery (15 weeks) up to 6 weeks (± 2 weeks) post-surgery (up to 23 weeks)
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From time of surgery (15 weeks) up to 6 weeks (± 2 weeks) post-surgery (up to 23 weeks)
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Number of Participants With Specific Surgical Approach
Tidsramme: At the time of surgery (up to 15 weeks)
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The surgical approach was categorized as: Hemihepatectomy; Sectionectomy; Segmentectomy; Other.
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At the time of surgery (up to 15 weeks)
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Intraoperative Blood Loss
Tidsramme: At the time of surgery (up to 15 weeks)
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At the time of surgery (up to 15 weeks)
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Number of Participants Needing Intraoperative Blood Transfusion
Tidsramme: At the time of surgery (up to 15 weeks)
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At the time of surgery (up to 15 weeks)
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Post-operative Surgical Complication Rates Assessed According to the Clavien-dindo Surgical Classification
Tidsramme: From time of surgery (15 weeks) up to neo-adjuvant treatment completion/discontinuation (6 weeks [± 2 weeks]) (up to 23 weeks)
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Clavien-dindo Surgical Classification graded surgical complications as: Grade I- Any complication that does not need pharmacological treatment or surgical, endoscopic, & radiological interventions; Grade II- Complications requiring pharmacological treatment with drugs other than such allowed for Grade I complications or complications requiring blood transfusions & total parenteral nutrition; Grade III- Complications requiring surgical, endoscopic, or radiological intervention with (Grade IIIb) or without (Grade IIIa) general anesthesia; Grade IV- Life-threatening complications requiring intensive care unit (ICU) management, which may be single organ (Grade IVa) or multiorgan (Grade IVb) dysfunction; Grade V- Complications causing death.
The percentage of participants with any post-surgical complications specifically related to the HCC resection was reported.
Percentages have been rounded off.
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From time of surgery (15 weeks) up to neo-adjuvant treatment completion/discontinuation (6 weeks [± 2 weeks]) (up to 23 weeks)
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Number of Participants With Post-operative Mortality
Tidsramme: From surgery (15 weeks) up to 90 days post-surgery (up to 27.8 weeks)
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From surgery (15 weeks) up to 90 days post-surgery (up to 27.8 weeks)
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studieleder: Clinical Trials, Hoffmann-La Roche
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Neoplasmer efter sted
- Neoplasmer
- Neoplasmer efter histologisk type
- Neoplasmer i fordøjelsessystemet
- Sygdomme i fordøjelsessystemet
- Leversygdomme
- Neoplasmer, kirtel og epitel
- Adenocarcinom
- Neoplasmer i leveren
- Karcinom
- Carcinom, hepatocellulært
- Aminosyrer, peptider og proteiner
- Proteiner
- Antistoffer, monoklonal, humaniseret
- Antistoffer, monoklonal
- Antistoffer
- Immunoglobuliner
- Immunoproteiner
- Blodproteiner
- Serum globuliner
- Globuliner
- Bevacizumab
- atezolizumab
- Tiragolumab
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- GO44457
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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