Uno studio che valuta l'efficacia e la sicurezza delle combinazioni di immunoterapia neoadiuvante in pazienti con carcinoma epatocellulare resecabile chirurgicamente
Uno studio di fase Ib/II, in aperto, multicentrico, randomizzato in piattaforma che valuta l'efficacia e la sicurezza delle combinazioni di immunoterapia neoadiuvante in pazienti con carcinoma epatocellulare resecabile chirurgicamente (MORPHEUS-NEO HCC)
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Fase
Fase
- Fase 2
- Fase 1
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Reference Study ID Number: GO44457 https://forpatients.roche.com/
- Numero di telefono: 888-662-6728 (U.S. and Canada)
- Email: global.rochegenentechtrials@roche.com
Luoghi di studio
-
-
-
Klagenfurt, Austria, 9020
- Klinikum Klagenfurt Am Worthersee
-
Vienna, Austria, 1090
- Department of Internal Medicine III AKH and Medical University of Vienna
-
-
-
-
-
Dijon, Francia, 21079
- Centre Georges Francois Leclerc (CGFL)
-
Villejuif, Francia, 94800
- Gustave Roussy
-
-
-
-
-
Essen, Germania, 45147
- University Essen
-
Frankfurt, Germania, 60596
- Universitaets Klinikum Frankfurt - Zentrum der Inneren Medizin
-
-
-
-
-
London, Regno Unito
- Imperial College London - Imperial Centre for Translational and Experimental Medicine (ICTEM)
-
-
-
-
-
Madrid, Spagna, 28040
- Hospital Universitario Fundacion Jimenez Diaz.
-
-
Cantabria
-
Santander, Cantabria, Spagna, 39008
- Hospital Universitario Marqués de Valdecilla
-
-
-
-
California
-
Los Angeles, California, Stati Uniti, 90033
- University of Southern California (USC)
-
Santa Monica, California, Stati Uniti, 90404-2023
- University of California Los Angeles (UCLA) - Cancer Care - Santa Monica
-
-
District of Columbia
-
Washington D.C., District of Columbia, Stati Uniti, 20007
- Georgetown University Medical Center
-
-
New York
-
New York, New York, Stati Uniti, 10032
- Columbia University Medical Center
-
-
Texas
-
Dallas, Texas, Stati Uniti, 75390-8813
- UT Southwestern Medical Center
-
-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Descrizione
Criterio di inclusione:
- Diagnosi di HCC confermata istologicamente o clinicamente secondo i criteri AASLD per i pazienti con cirrosi. Per i partecipanti senza cirrosi, la conferma istologica è obbligatoria.
- HCC suscettibile di resezione chirurgica R0 con intento curativo secondo il parere dei chirurghi e degli oncologi o epatologi coinvolti nella cura del partecipante. Sono ammissibili i pazienti che presentano HCC resecabile entro o oltre i criteri di Milano (senza diffusione extraepatica o invasione macrovascolare).
- Malattia misurabile (almeno una lesione target) secondo RECIST v1.1 come determinato dallo sperimentatore
- Performance Status dell'Eastern Cooperative Oncology Group (ECOG) pari a 0 o 1 entro 7 giorni prima della randomizzazione
- Child-Pugh Classe A entro 7 giorni prima della randomizzazione
- Test HIV negativo allo screening
- Nessun precedente trattamento locoregionale o sistemico per HCC
- Adeguata funzionalità ematologica e degli organi terminali
- Stato virologico documentato dell'epatite
- Per le donne in età fertile: accordo per mantenere l'astinenza (astenersi da rapporti eterosessuali) o usare la contraccezione
- Per gli uomini: accordo a rimanere astinenti (astenersi da rapporti eterosessuali) o usare la contraccezione e accordo ad astenersi dalla donazione di sperma
Criteri generali di esclusione:
- Presenza di malattia extraepatica o invasione macrovascolare
- HCC fibrolamellare noto, HCC sarcomatoide, colangiocarcinoma misto e HCC o altre varianti rare di HCC
- - Storia di encefalopatia epatica se clinicamente significativa entro un anno prima dell'inizio del trattamento in studio
- Ascite moderata o grave
- Co-infezione attiva con HBV e HCV
- Co-infezione attiva con HBV e infezione virale da epatite D
- Precedente trattamento con agonisti CD137 o inibitori del checkpoint immunitario, inclusi anticorpi terapeutici anti-CTLA-4, anti-PD-1 e anti-PD-L1
- Trattamento con terapia sperimentale entro 28 giorni prima dell'inizio del trattamento in studio
- Varici esofagee e/o gastriche non trattate o trattate in modo incompleto con sanguinamento o ad alto rischio di sanguinamento
- Un precedente evento di sanguinamento dovuto a varici esofagee e/o gastriche nei 6 mesi precedenti l'inizio del trattamento in studio
- Ipertensione non adeguatamente controllata
- Storia di crisi ipertensive o encefalopatia ipertensiva
- - Malattia vascolare significativa entro 6 mesi prima dell'inizio del trattamento in studio
- Storia di emottisi entro 1 mese prima dell'inizio del trattamento in studio
- Evidenza di diatesi emorragica o significativa coagulopatia
- Uso attuale o recente (<= 10 giorni prima dell'inizio del trattamento in studio) di anticoagulanti orali o parenterali a dose piena o di agenti trombolitici a scopo terapeutico
- Storia di fistola addominale o tracheoesofagea, perforazione gastrointestinale o ascessi intra-addominali nei 6 mesi precedenti l'inizio del trattamento in studio
- Storia di ostruzione intestinale e/o segni o sintomi clinici di ostruzione gastrointestinale
- Ferita grave, non cicatrizzante o deiscente, ulcera attiva o frattura ossea non trattata
- Grado >= proteinuria
- Procedura chirurgica maggiore, biopsia aperta o lesione traumatica significativa o chirurgia addominale, interventi o lesioni traumatiche o anticipazione della necessità di una procedura chirurgica maggiore diversa dalla resezione epatica potenzialmente curativa
- Trattamento giornaliero cronico con un farmaco antinfiammatorio non steroideo (FANS)
- Infezione grave che richiede antibiotici per via orale o EV e/o ospedalizzazione
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
|
Sperimentale: Atezo + Bev
I partecipanti al braccio atezolizumab più bevacizumab (Atezo + Bev) riceveranno fino a tre cicli di trattamento fino all'intervento chirurgico o alla tossicità inaccettabile, a seconda di quale evento si verifichi per primo.
|
Atezolizumab verrà somministrato alla dose di 1200 mg per infusione endovenosa il giorno 1.
Altri nomi:
Bevacizumab verrà somministrato alla dose di 15 mg/kg per infusione endovenosa il giorno 1.
Altri nomi:
|
|
Sperimentale: Atezo + Bev + Tira
I partecipanti al braccio atezolizumab più bevacizumab più tiragolumab (Atezo + Bev + Tira) riceveranno fino a tre cicli di trattamento fino all'intervento chirurgico o alla tossicità inaccettabile, a seconda di quale evento si verifichi per primo.
|
Atezolizumab verrà somministrato alla dose di 1200 mg per infusione endovenosa il giorno 1.
Altri nomi:
Bevacizumab verrà somministrato alla dose di 15 mg/kg per infusione endovenosa il giorno 1.
Altri nomi:
Il tiragolumab verrà somministrato alla dose di 600 mg per infusione endovenosa il giorno 1.
|
|
Sperimentale: Tobe + Bev
I partecipanti al braccio di Tobemstomig + Bev riceveranno fino a tre cicli di trattamento fino a un intervento chirurgico o di una tossicità inaccettabile, a seconda di quale si verifichi prima. L'iscrizione è chiusa. |
Bevacizumab verrà somministrato alla dose di 15 mg/kg per infusione endovenosa il giorno 1.
Altri nomi:
Tobemstomig verrà somministrato alla dose di 600 mg mediante infusione endovenosa il giorno 1
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Major Pathologic Response (MPR) Rate
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
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.
|
At the time of surgery (up to 15 weeks)
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Pathologic Complete Response (pCR) Rate
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
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.
|
At the time of surgery (up to 15 weeks)
|
|
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)
Lasso di tempo: From surgery to the first documented recurrence of disease (up to 20.5 months)
|
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.
|
From surgery to the first documented recurrence of disease (up to 20.5 months)
|
|
Event-free Survival (EFS), as Assessed by the Investigator According to EASL and RECIST v1.1
Lasso di tempo: From randomization to PD that precluded surgery or disease recurrence or death from any cause, whichever occurred first (up to 20.5 months)
|
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.
|
From randomization to PD that precluded surgery or disease recurrence or death from any cause, whichever occurred first (up to 20.5 months)
|
|
Overall Survival (OS)
Lasso di tempo: From randomization to death from any cause (up to 20.5 months)
|
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.
|
From randomization to death from any cause (up to 20.5 months)
|
|
OS Rate at 6 Months, 12 Months, and 18 Months
Lasso di tempo: At Months 6, 12, and 18
|
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.
|
At Months 6, 12, and 18
|
|
Objective Response Rate (ORR), as Assessed by the Investigator According to RECIST v1.1
Lasso di tempo: Prior to surgery (at approximately Week 11)
|
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.
|
Prior to surgery (at approximately Week 11)
|
|
ORR, as Assessed by the Investigator According to Hepatocellular Carcinoma-Specific Modified Response Evaluation Criteria in Solid Tumors (HCC mRECIST)
Lasso di tempo: Prior to surgery (at approximately Week 11)
|
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.
|
Prior to surgery (at approximately Week 11)
|
|
Percentage of Participants Downstaged to Within Milan Criteria (for Participants Beyond Criteria at Randomization)
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
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.
|
At the time of surgery (up to 15 weeks)
|
|
Negative Surgical Margins (R0) Resection Rate
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
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.
|
At the time of surgery (up to 15 weeks)
|
|
Number of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs) and Immune-related AEs
Lasso di tempo: 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)
|
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.
|
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)
|
|
Percentage of Participants With Delayed or Cancelled Surgery Due to Treatment-related Adverse Events (TRAEs)
Lasso di tempo: Assessed at pre-surgery (scheduled at Week 11)
|
Delayed Surgery was defined as delay in surgery by > 28 days from the surgical restaging or pre-surgery visit.
Percentages have been rounded off.
|
Assessed at pre-surgery (scheduled at Week 11)
|
|
Length of Surgical Delays
Lasso di tempo: Assessed at pre-surgery (scheduled at Week 11) up to 20 weeks
|
Delayed Surgery was defined as a delay in surgery by > 28 days from the surgical restaging or pre-surgery visit.
|
Assessed at pre-surgery (scheduled at Week 11) up to 20 weeks
|
|
Duration of Surgery
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
At the time of surgery (up to 15 weeks)
|
|
|
Duration of Hospital Stay Post-surgery
Lasso di tempo: From time of surgery (15 weeks) up to 6 weeks (± 2 weeks) post-surgery (up to 23 weeks)
|
From time of surgery (15 weeks) up to 6 weeks (± 2 weeks) post-surgery (up to 23 weeks)
|
|
|
Number of Participants With Specific Surgical Approach
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
The surgical approach was categorized as: Hemihepatectomy; Sectionectomy; Segmentectomy; Other.
|
At the time of surgery (up to 15 weeks)
|
|
Intraoperative Blood Loss
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
At the time of surgery (up to 15 weeks)
|
|
|
Number of Participants Needing Intraoperative Blood Transfusion
Lasso di tempo: At the time of surgery (up to 15 weeks)
|
At the time of surgery (up to 15 weeks)
|
|
|
Post-operative Surgical Complication Rates Assessed According to the Clavien-dindo Surgical Classification
Lasso di tempo: From time of surgery (15 weeks) up to neo-adjuvant treatment completion/discontinuation (6 weeks [± 2 weeks]) (up to 23 weeks)
|
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.
|
From time of surgery (15 weeks) up to neo-adjuvant treatment completion/discontinuation (6 weeks [± 2 weeks]) (up to 23 weeks)
|
|
Number of Participants With Post-operative Mortality
Lasso di tempo: From surgery (15 weeks) up to 90 days post-surgery (up to 27.8 weeks)
|
From surgery (15 weeks) up to 90 days post-surgery (up to 27.8 weeks)
|
Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Direttore dello studio: Clinical Trials, Hoffmann-La Roche
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Effettivo)
Completamento primario
Completamento dello studio (Effettivo)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Neoplasie per sede
- Neoplasie
- Neoplasie per tipo istologico
- Neoplasie dell'apparato digerente
- Malattie dell'apparato digerente
- Malattie del fegato
- Neoplasie, ghiandolari ed epiteliali
- Adenocarcinoma
- Neoplasie del fegato
- Carcinoma
- Carcinoma, epatocellulare
- Aminoacidi, peptidi e proteine
- Proteine
- Anticorpi, monoclonali, umanizzati
- Anticorpi, monoclonali
- Anticorpi
- Immunoglobuline
- Immunoproteine
- Proteine del sangue
- Globuline sieriche
- Globuline
- Bevacizumab
- atezolizumab
- Tiragolumab
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- GO44457
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Descrizione del piano IPD
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .