Solid Tumor, AdultPhase 1RACINNCT03728179
RACIN in Patients With Advanced TIL-negative Solid Tumors
A Phase 1 study testing Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib in people with Solid Tumor, Adult, run by Centre Hospitalier Universitaire Vaudois at 1 site in Switzerland.
Trial summary
Subjects with locally advanced or metastatic incurable Tumor Infiltrating Lymphocytes (TIL)-negative solid tumors who are not eligible for, declined or failed standard therapy will be treated with a combination nivolumab, low-dose ionizing radiation (RT) (0.5-2 Gy), aspirin (ASA)(cohorts 1 and 2)/celecoxib (cohorts 3… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Solid Tumor, Adult
- What is being tested?
- Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 40 participants
- Where
- 1 siteSwitzerland
- Study dates
- 16 Jan 2019to 27 Oct 2023
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Signed pre-screening Informed Consent Form
- Patients with recurrent or metastatic solid tumor (any histology), who progress after at least one standard therapy for advanced disease
- Patient willingness and acceptance to participate in the immunology research is mandatory
- At least one lesion accessible to biopsy without putting patient at risk
- Biopsies obtained previously (within a maximum of 12 weeks before pre-screening visit), outside this protocol, for TIL assessment can be also considered for patient selection. Fresh tumor biopsies for subsequent translational studies will be used as baseline and collected at pre-screening (when biopsy will be performed for TIL status) or at screening (when archival biopsy will be used for TIL status). Biopsy from metastatic lymph nodes is accepted.
- Eastern Cooperative Oncology Group (ECOG) clinical performance status: 0-1 for all patients, independently of the number of previous lines of therapy.
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- Life expectancy of ≥ 12 weeks
- Patients with Glycose-6-Phosphate Dehydrogenase (G6PD) deficiency or any other hereditary coagulation disorder are excluded, as well as patients with clinical history of Reye syndrome
- Adequate serology defined by the following laboratory results obtained during pre-screening period (day-28 to day-14).
- Seronegative for HIV infection (anti-HIV-1/-2)
- Seronegative for hepatitis B infection (HBs Ag, total anti-hemoglobin C (HBc), anti-HBs). Patients with past or resolved hepatitis B infection (defined as having a negative hepatitis B surface antigen HBsAg test and a positive anti-HBc antibody test) are eligible, if hepatitis B virus (HBV) DNA test is negative.
- Seronegative for hepatitis C infection (anti-HCV): if a patient has positive anti-HCV antibody, a negative hepatitis C virus (HCV) RNA need to be obtain to register the patient.
- Study registration
- Signed main study Informed Consent Form
- Absence of tumor-infiltrating intraepithelial Cluster of differentiation-8 positive T cells (CD8+ T cells) by immunohistochemistry (IHC) on baseline biopsy defined as <5 CD8+ cells per high power field of tumor
- At least one lesion accessible to biopsy without putting patient at risk
- Number of metastatic lesions viewed on Positron emission tomography-computed tomography (PET/CT) scan: for both Phase Ia and Phase Ib, the patient may have any number of metastatic lesions. A maximum of 10 metastatic lesions visible by PET/CT scan will be irradiated at the investigator's discretion. It is at the discretion of the investigator to exclude a metastatic site from the radiation field that, due to the radiotherapy volume, dose or location too close to a healthy organ, may put the patient at risk of suffering from radiation induced toxicity. If this would be the only metastatic site to be irradiated, the concerned patient will be excluded from the study.
- Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol
- Adequate hematologic and end-organ function, defined by the following laboratory results obtained within 14 days prior to the first study treatment:
- Absolute neutrophil count ≥ 1.5 g/L (without granulocyte colony-stimulating factor support within 2 weeks prior registration)
- White Blood Cell (WBC) counts > 2.5 g/L and < 15 g/L
- Lymphocyte count ≥ 0.5 g/L
- Platelet count ≥ 100 g/L (without transfusion within 1 week prior registration)
- Hemoglobin ≥ 90 g/L (Patients may be transfused to meet this criterion but it should not be done within 1 week prior registration)
- Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase ≤ 2.5 x ULN (with the exception for patients with documented liver metastases: AST, ALT and alkaline phosphatase ≤ 5 x ULN)
- Serum bilirubin ≤ 1.5 x ULN (with the exception for: patients with known or suspicion of Gilbert disease who have serum bilirubin level ≤ 3 x ULN may be enrolled)
- Coagulation: International Normalized Ratio (INR) or Prothrombin Time (PT) ≤ 1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or Partial Thromboplastin Time (PTT) is within therapeutic range of intended use of anticoagulants; Activated Partial Thromboplastin Time (aPTT) ≤1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants.
- Serum albumin > 25 g/L
- Serum creatinine ≤1.5 x ULN or creatinine clearance ≥ 40 ml/min on the basis of Cockcroft-Gault Formula
- No prior radiation therapy in areas of desired radiation
- Patients may have had prior therapy provided a washout period of 4 weeks prior to registration is allowed. Exception: hormone therapy for breast and prostate cancer is allowed to be continued during the study.
- Recovery from any toxic effects of prior therapy before registration to ≤ Grade 1 per the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v4.03) except for toxicities described below, as they do not put at risk the patient's condition and do not require systemic immunosuppressive steroids at any dose, including but not limited to: fatigue, alopecia, skin disorders, stable neuropathy, endocrinopathies requiring replacement treament.
- Note: for other medical conditions, or for any other toxicity with a higher grade but controlled by adequate treatment, prior discussion and agreement with the trial chair is mandatory.
- Note: Patients may have undergone surgical procedures within the past 3 weeks, as long as all toxicities have recovered to grade 1 or less.
- For women of childbearing potential (WOCBP: sexually mature women who have not undergone a hysterectomy, have not been naturally post-menopausal for at least 12 consecutive months or have a serum follicle-stimulating hormone (FSH) < 40 Millions International Units (mIU)/ml):
- Agreement to use 2 acceptable methods of contraception during participation in the trial and for 6 months after last study combined treatment and after 5 months of maintenance treatment
- Women must have a negative urine pregnancy test within 7 days before registration. A positive urine test must be confirmed by a serum pregnancy test, or menopausal as per National Comprehensive Cancer Network (NCCN) guidelines.
- For men: agreement to use 2 acceptable methods of effective contraception during participation in the trial and for 7 months after last study treatment (combined or maintenance treatment). Female partners of men who take part in this trial must also use at least one method of effective contraception during the trial and 7 months after last study treatment (combined or maintenance).
Who cannot join
- Patients with soft tissue sarcoma, glioblastoma, or lymphoma are excluded.
- Pregnant or breast-feeding women.
- Symptomatic brain or leptomeningeal disease; any brain metastases must be stable for at least 6 months
- Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently)
- Uncontrolled hypercalcemia (> 1.5 mmol/L ionized calcium or Ca > 12 mg/dL or corrected serum calcium > ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab
- Patients who are receiving bisphosphonate therapy or denosumab specifically to prevent skeletal events and who do not have a history of clinically significant hypercalcemia are eligible.
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- Life expectancy of < 12 weeks
- Current, recent (within 4 weeks prior to registration), or planned participation in an experimental drug study
- New York Heart Association Class II or greater congestive heart failure
- History of myocardial infarction or unstable angina within 6 months prior registration
- History of stroke or transient ischemic attack within 6 months prior registration
- Significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior registration)
- Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation)
- Patients with active peptic or duodenal ulceration (within 4 weeks prior to registration)
- Current or recent (within 14 days prior registration) treatment use of dipyramidole, ticlopidine, clopidogrel, cilostazol, prasugrel, or ticagrelor
- Current or recent (within 14 days prior registration) use of full-dose oral or parenteral anticoagulants or thrombolytic agents for therapeutic (as opposed to prophylactic) purpose
- Prophylactic anticoagulation for the patency of venous access devices is allowed, provided the activity of the agent results in an International Normalized Ratio (INR) < 1.5 x ULN and aPTT is within normal limits within 2 weeks prior registration.
- Prophylactic use of low molecular-weight heparin (e.g., enoxaparin) is allowed.
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins or allergy to biopharmaceuticals produced in Chinese hamster ovary cells
- Known hypersensitivity to any component of the Investigational Medicinal Products (IMPs)
- History of autoimmune disease, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis. The following exceptions are considered:
- Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone are eligible for this study.
- Patients with controlled Type I diabetes mellitus on a stable insulin regimen are eligible
- History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), druginduced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest Computerized Tomography (CT) scan. Exception: history of radiation pneumonitis in previous radiation field (fibrosis) is permitted provided that this area does not undergo current low dose irradiation as part of this protocol.
- Severe infections within 4 weeks prior registration including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia
- Signs or symptoms of infection within 2 weeks prior registration
- Received therapeutic oral or IV antibiotics within 2 weeks prior registration. Exception: patients receiving routine antibiotic prophylaxis (e.g., to prevent chronic obstructive pulmonary disease exacerbation or for dental extraction) are eligible.
- Prior allogeneic stem cell or solid organ transplant
- Administration of a live, attenuated vaccine within 4 weeks before registration. Exception: influenza vaccination should be given during influenza season only (approximately October to March). Patients must not receive live, attenuated influenza vaccine within 4 weeks prior registration or at any time during the study.
- Any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications
- Patients who have received prior treatment with anti-Programmed Cell Death-1 (PD1), anti-Programmed Cell Death Ligand-1 (PD-L1) or anti-Cytotoxic T-lymphocyte Associated 4 (CTLA-4) may be enrolled, provided at least 5 half-lives (approximately 75 days) have elapsed from the last dose to the registration and there was no history of severe immune-mediated adverse effects from such therapy (NCI CTCAE Grade 3 and 4).
- Treatment with systemic immunostimulatory agents (including but not limited to interferon-alpha (IFN-a), interleukin-2 (IL-2)) for any reason within 6 weeks or five half-lives of the drug, whichever is shorter, prior registration
- Treatment with systemic immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor (anti-TNF) agents) within 2 weeks prior registration
- Patients who have received acute, low-dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea) or physiologic replacement doses (i.e., prednisone 5-7.5 mg/day) for adrenal insufficiency may be enrolled in the study.
- The use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) is allowed.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: RACIN, A Phase I Study of the Combination of Nivolumab Associated With Low-dose Radiation, Aspirin/ Celecoxib, and Either Ipilimumab or Low-dose Cyclophosphamide, Followed by Nivolumab Maintenance, in Patients With Advanced, TIL-negative Solid Tumors
Subjects with locally advanced or metastatic incurable Tumor Infiltrating Lymphocytes (TIL)-negative solid tumors who are not eligible for, declined or failed standard therapy will be treated with a combination nivolumab, low-dose ionizing radiation (RT) (0.5-2 Gy), aspirin (ASA)(cohorts 1 and 2)/celecoxib (cohorts 3, 4 and Phase Ib), and either ipilimumab or low-dose cyclophosphamide. The study comprises 2 phases: The aim of Phase Ia, is to determine safety and tolerability of a given combination therapy, as well as the maximum tolerated dose (MTD) or recommended phase Ib dose (RP1bD) of radiotherapy. Phase Ib aims to further explore safety and tolerability of this treatment in an expansion cohort.
In Phase Ia, 4 distinct cohorts will receive the following combination therapy:
Read more
Cohort1: combination therapy for 5 cycles (C0-C4) which includes: RT 0.5 Gy every 2 weeks (Q2W), Cy (200 mg/m2) Q2W (cycles C0 to C4); ASA (300 mg) daily, with nivolumab 240 mg flat dose Q2W and ipilimumab 1 mg/kg every 6 weeks (Q6W) will be administered (cycles C1 to C4).
Cohort2: combination therapy for 5 cycles (C0-C4) which includes: RT 1 Gy every 2 weeks (Q2W), Cy (200 mg/m2) Q2W (cycles C0 to C4); ASA (300 mg) daily, with nivolumab 240 mg flat dose Q2W and ipilimumab 1 mg/kg (Q6W) will be administered (cycles C1 to C4).
Cohorts 3a and 4a: Patients will receive Cy (200 mg/m2) Q2W, celecoxib (2x200mg daily), nivolumab (240 mg flat dose) Q2W, and low-dose radiation. Cohort 3a will receive 1 Gy of low-radiation dose and cohort 4a will receive 2 Gy.
Cohorts 3b and 4b: Patients will receive nivolumab (240 mg flat dose) Q2W, ipilimumab 1 mg/kg (Q6W), celecoxib (2x200mg daily) and low-dose radiation. Cohort 3b will receive 1 Gy of low-radiation dose and cohort 4b will receive 2 Gy.
In Phase Ia, the safety of combination (nivolumab, celecoxib, low-dose irradiation and cyclophosphamide) or (nivolumab, celecoxib, low-dose irradiation and ipilimumab) will be evaluated , and MTD or RP1bD will be defined. RP1bD will be the MTD or, in the absence of dose limiting toxicities (DLTs), the biologically best RT dose based on pharmacodynamics parameters.
In Phase Ib, patients will be treated with the MTD or RP1bD dose of RT and will follow the selected schema of treatment used in the Phase Ia cohort 3 or 4. At the end of the 5th cycle, patients eligible for nivolumab maintenance, will be treated with nivolumab at 240 mg Q2W until progression or excessive toxicity; celecoxib will be maintained according to tolerability.
- Conditions
- Solid Tumor, Adult
- Being tested
- Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/CelecoxibCombination product
Low Dose Radiation (RT): RT will be administered as single fractions every 2 weeks (Q2W) from cycle C0 to cycle C4. RT will be delivered to a number of metastatic deposits visible by PET/CT, at the PI's discretion.
Cyclophosphamide: 200mg/m2 will be administered as intravenous infusion (IV) Q2W from cycle C0 to C4.
Nivolumab: 240 mg will be administered as IV Q2W from cycle C1 to C4.
Ipilimumab: 1mg/kg will be administered as IV every 6 weeks (Q6W) from cycle C1 to C4
Aspirin: 300mg will be administered orally daily from cycle C1 to C4. All subjects will receive mandatory gastric prophylaxis with an oral H2 antagonist.
Celecoxib: 200mg will be administered orally twice a day from cycle C1 to C4.
At the end of cycle C4, patients eligible for maintenance will be treated with nivolumab at 240mg Q2W until progression or excessive toxicity; celecoxib will be maintained if the drug is well tolerated
| Study group | Role | What they receive |
|---|---|---|
| Cohort 1 | Experimental | 0,5 Gy of RT + Cyclophosphamide + Nivolumab + Ipilimumab + Aspirin Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
| Cohort 2 | Experimental | 1 Gy of RT + Cyclophosphamide + Nivolumab + Ipilimumab + Aspirin Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
| Cohort 3a | Experimental | 1 Gy of RT + Cyclophosphamide + Nivolumab + Celecoxib Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
| Cohort 4a | Experimental | 2 Gy of RT + Cyclophosphamide + Nivolumab + Celecoxib Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
| Phase I b | Experimental | Recommended Phase Ib RT dose (RP1bD) + Nivolumab + Ipilimumab or Cyclophosphamide + Celecoxib Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
| Cohort 3b | Experimental | 1 Gy of RT + Ipilimumab + Nivolumab + Celecoxib Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
| Cohort 4b | Experimental | 2 Gy of RT + Ipilimumab + Nivolumab + Celecoxib Receives: Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib |
What is being measured
The primary outcome is the main question the study is designed to answer.
Phases Ia and Ib: Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
Phase Ia and IB: Toxicity and tolerability will be assessed through measure and evaluation of adverse events occuring during the study, using the National Cancer Institute (NCI) CommonTerminology Criteria for Adverse Events (CTCAE v.4.03)
Measured: 3.5 years
Maximum Tolerated dose (MTD) or recommended phase Ib dose of low-dose irradiation for radio-immunotherapy combination (RP1bD).
MTD is defined as the dose level below the dose that causes a dose limiting toxicity (DLT) in more than 17% of participants. The MTD analysis population will consist of all evaluable participants registered in the phase Ia , who completed the DLT/ backbone limiting toxicity (BLT) period (cycle C0 and C1), unless discontinued due to toxicity. RP1bD will be the MTD or, in the absence of DLTs, the biologically best radiotherapy dose based on pharmacodynamics parameters.
Measured: 3.5 years
Secondary outcomes (5)
Objective response rate (ORR)
Best objective response rate (Complete Response or Partial Response) during the period from enrolment to termination of trial treatment, will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1 or PCWG3 criteria for prostate cancer.
Measured: 3.5 years
Disease Control Rate (DCR)
Percentage of patients achieving Complete Response, Partial Response or Stable Disease at the end of four cycles of combination therapy (i.e. at 6 months) as well as at 12 and 24 months, will be measured by RECIST v.1.1 or PCWG3 criteria for prostate cancer.
Measured: 6,12 and 24 months
Progression free survival (PFS) rate
The time from enrolment until objective tumor progression or death, whichever occurs first, will be evaluated at 6,12 and 24 months by RECIST v.1.1 or PCWG3 criteria for prostate cancer.
Measured: 6,12 and 24 months
Time to Progression (TTP):
The time from enrolment until objective tumor progression, will be evaluated by RECIST v.1.1 or PCWG3 criteria for prostate cancer.
Measured: 3.5 years
Overall survival (OS)
OS will be assessed at 12 and 24 months
Measured: 12 and 24 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Nov 2018
- Study start16 Jan 2019
- Primary completion27 Oct 2023
- Study completion27 Oct 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Solid Tumor, AdultStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Enrolment
- 40 participants (actual)
Sponsor and investigators
- Lead sponsor
- Centre Hospitalier Universitaire Vaudois
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Dr Fernanda Herrera, Centre Hospitalier Universitaire Vaudois
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03728179
- Sponsor's protocol ID
- CHUV-DO-0003-RACIN_2017
- Acronym
- RACIN
- Status last verified
- Feb 2024
- First submitted
- 15 Oct 2018
- Last updated
- 20 Feb 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 20 Feb 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- RACIN, A Phase I Study of the Combination of Nivolumab Associated With Low-dose Radiation, Aspirin/ Celecoxib, and Either Ipilimumab or Low-dose Cyclophosphamide, Followed by Nivolumab Maintenance, in Patients With Advanced, TIL-negative Solid Tumors
- ClinicalTrials.gov ID
- NCT03728179
- Acronym / sponsor ID
- RACIN / CHUV-DO-0003-RACIN_2017
- Conditions
- Solid Tumor, Adult
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 40 participants (actual)
- Lead sponsor
- Centre Hospitalier Universitaire VaudoisUniversity, hospital or other
- Study start
- 16 Jan 2019 (actual)
- Primary completion
- 27 Oct 2023 (actual)
- Study completion
- 27 Oct 2023 (actual)
- First posted
- 1 Nov 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Subjects with locally advanced or metastatic incurable Tumor Infiltrating Lymphocytes (TIL)-negative solid tumors who are not eligible for, declined or failed standard therapy will be treated with a combination nivolumab, low-dose ionizing radiation (RT) (0.5-2 Gy), aspirin (ASA)(cohorts 1 and 2)/celecoxib (cohorts 3, 4 and Phase Ib), and either ipilimumab or low-dose cyclophosphamide. The study comprises 2 phases: The aim of Phase Ia, is to determine safety and tolerability of a given combination therapy, as well as the maximum tolerated dose (MTD) or recommended phase Ib dose (RP1bD) of radiotherapy. Phase Ib aims to further explore safety and tolerability of this treatment in an expansion cohort.
In Phase Ia, 4 distinct cohorts will receive the following combination therapy:
Cohort1: combination therapy for 5 cycles (C0-C4) which includes: RT 0.5 Gy every 2 weeks (Q2W), Cy (200 mg/m2) Q2W (cycles C0 to C4); ASA (300 mg) daily, with nivolumab 240 mg flat dose Q2W and ipilimumab 1 mg/kg every 6 weeks (Q6W) will be administered (cycles C1 to C4).
Cohort2: combination therapy for 5 cycles (C0-C4) which includes: RT 1 Gy every 2 weeks (Q2W), Cy (200 mg/m2) Q2W (cycles C0 to C4); ASA (300 mg) daily, with nivolumab 240 mg flat dose Q2W and ipilimumab 1 mg/kg (Q6W) will be administered (cycles C1 to C4).
Cohorts 3a and 4a: Patients will receive Cy (200 mg/m2) Q2W, celecoxib (2x200mg daily), nivolumab (240 mg flat dose) Q2W, and low-dose radiation. Cohort 3a will receive 1 Gy of low-radiation dose and cohort 4a will receive 2 Gy.
Cohorts 3b and 4b: Patients will receive nivolumab (240 mg flat dose) Q2W, ipilimumab 1 mg/kg (Q6W), celecoxib (2x200mg daily) and low-dose radiation. Cohort 3b will receive 1 Gy of low-radiation dose and cohort 4b will receive 2 Gy.
In Phase Ia, the safety of combination (nivolumab, celecoxib, low-dose irradiation and cyclophosphamide) or (nivolumab, celecoxib, low-dose irradiation and ipilimumab) will be evaluated , and MTD or RP1bD will be defined. RP1bD will be the MTD or, in the absence of dose limiting toxicities (DLTs), the biologically best RT dose based on pharmacodynamics parameters.
In Phase Ib, patients will be treated with the MTD or RP1bD dose of RT and will follow the selected schema of treatment used in the Phase Ia cohort 3 or 4. At the end of the 5th cycle, patients eligible for nivolumab maintenance, will be treated with nivolumab at 240 mg Q2W until progression or excessive toxicity; celecoxib will be maintained according to tolerability.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 7
| Arm | Type | Receives |
|---|---|---|
| Cohort 1 | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib0,5 Gy of RT + Cyclophosphamide + Nivolumab + Ipilimumab + Aspirin |
| Cohort 2 | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib1 Gy of RT + Cyclophosphamide + Nivolumab + Ipilimumab + Aspirin |
| Cohort 3a | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib1 Gy of RT + Cyclophosphamide + Nivolumab + Celecoxib |
| Cohort 4a | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib2 Gy of RT + Cyclophosphamide + Nivolumab + Celecoxib |
| Phase I b | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/CelecoxibRecommended Phase Ib RT dose (RP1bD) + Nivolumab + Ipilimumab or Cyclophosphamide + Celecoxib |
| Cohort 3b | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib1 Gy of RT + Ipilimumab + Nivolumab + Celecoxib |
| Cohort 4b | Experimental | Combination Product: Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib2 Gy of RT + Ipilimumab + Nivolumab + Celecoxib |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (38 listed)
- Signed pre-screening Informed Consent Form
- Patients with recurrent or metastatic solid tumor (any histology), who progress after at least one standard therapy for advanced disease
- Patient willingness and acceptance to participate in the immunology research is mandatory
- At least one lesion accessible to biopsy without putting patient at risk
- Biopsies obtained previously (within a maximum of 12 weeks before pre-screening visit), outside this protocol, for TIL assessment can be also considered for patient selection. Fresh tumor biopsies for subsequent translational studies will be used as baseline and collected at pre-screening (when biopsy will be performed for TIL status) or at screening (when archival biopsy will be used for TIL status). Biopsy from metastatic lymph nodes is accepted.
Key exclusion criteria (35 listed)
- Patients with soft tissue sarcoma, glioblastoma, or lymphoma are excluded.
- Pregnant or breast-feeding women.
- Symptomatic brain or leptomeningeal disease; any brain metastases must be stable for at least 6 months
- Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently)
- Uncontrolled hypercalcemia (> 1.5 mmol/L ionized calcium or Ca > 12 mg/dL or corrected serum calcium > ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/CelecoxibLow Dose Radiation (RT): RT will be administered as single fractions every 2 weeks (Q2W) from cycle C0 to cycle C4. RT will be delivered to a number of metastatic deposits visible by PET/CT, at the PI's discretion. Cyclophosphamide: 200mg/m2 will be administered as intravenous infusion (IV) Q2W from cycle C0 to C4. Nivolumab: 240 mg will be administered as IV Q2W from cycle C1 to C4. Ipilimumab: 1mg/kg will be administered as IV every 6 weeks (Q6W) from cycle C1 to C4 Aspirin: 300mg will be administered orally daily from cycle C1 to C4. All subjects will receive mandatory gastric prophylaxis with an oral H2 antagonist. Celecoxib: 200mg will be administered orally twice a day from cycle C1 to C4. At the end of cycle C4, patients eligible for maintenance will be treated with nivolumab at 240mg Q2W until progression or excessive toxicity; celecoxib will be maintained if the drug is well tolerated | Combination product | Cohort 1, Cohort 2, Cohort 3a, Cohort 3b, Cohort 4a, Cohort 4b, Phase I b |
Primary outcome
Phases Ia and Ib: Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
Time frame: 3.5 years
Phase Ia and IB: Toxicity and tolerability will be assessed through measure and evaluation of adverse events occuring during the study, using the National Cancer Institute (NCI) CommonTerminology Criteria for Adverse Events (CTCAE v.4.03)
Maximum Tolerated dose (MTD) or recommended phase Ib dose of low-dose irradiation for radio-immunotherapy combination (RP1bD).
Time frame: 3.5 years
MTD is defined as the dose level below the dose that causes a dose limiting toxicity (DLT) in more than 17% of participants. The MTD analysis population will consist of all evaluable participants registered in the phase Ia , who completed the DLT/ backbone limiting toxicity (BLT) period (cycle C0 and C1), unless discontinued due to toxicity. RP1bD will be the MTD or, in the absence of DLTs, the biologically best radiotherapy dose based on pharmacodynamics parameters.
5 secondary outcomes
Objective response rate (ORR)
Time frame: 3.5 years
Disease Control Rate (DCR)
Time frame: 6,12 and 24 months
Progression free survival (PFS) rate
Time frame: 6,12 and 24 months
Time to Progression (TTP):
Time frame: 3.5 years
Overall survival (OS)
Time frame: 12 and 24 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Feb 2024.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Low dose irradiation + Nivolumab + Ipilimumab or Cyclophosphamide + Aspirin/Celecoxib in people with Solid Tumor, Adult, run by Centre Hospitalier Universitaire Vaudois at 1 site in Switzerland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 38 inclusion and 35 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 20 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Phases Ia and Ib: Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] (time frame: 3.5 years). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Feb 2024.