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Solid Tumor, AdultPhase 1/2TEMPLENCT05276284

Thiopurine Enhanced Mutations for PD-1/Ligand-1 Efficacy

A Phase 1/2 study testing Atezolizumab, 6-mercaptopurine, 6-thioguanine in people with Solid Tumor, Adult and Metastatic Cancer, run by Kristoffer Rohrberg at 1 site in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The TEMPLE study is a single-center prospective phase Ib and II trial to determine the safety, tolerability and efficacy of Atezolizumab given in combination with thiopurine therapy (6-mercaptopurine and 6-thioguanine) in patients with advanced and/or metastatic solid tumors with an intermediate tumor mutational… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Solid Tumor, Adult, Metastatic Cancer
What is being tested?
Atezolizumab, 6-mercaptopurine, 6-thioguanine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
18 participants
Where
1 siteDenmark
Study dates
1 Sep 2022to 1 Sep 2025
Phase
Phase 1/2
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

  • The patient MUST MEET ALL the following criteria to be enrolled in the study:
  • Signed written informed consent.
  • Age ≥ 18 years.
  • Performance status (WHO) of 0-1.
  • Histologically confirmed advanced and/or metastatic solid tumors for which standard curative measures do not exist.
  • Radiologically measurable disease according to RECIST v1.1.
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  • Life expectancy estimated by the Investigator to be ≥12 weeks.
  • Metastatic Lesion(s) or primary tumour accessible for biopsy
  • Intermediate tumor mutational burden of 5-10 mutations/mb
  • Adequate organ function assessed by screening laboratory values:
  • Absolute lymphocyte count ≥ 0.5 x 109/L
  • Neutrophils ≥ 1.5 x 109/L
  • Platelets ≥ 100 x 109/L. For patients with primary hepatocellular carcinoma platelet counts ≥65 x 109/L is allowed.
  • Hemoglobin ≥ 90 g/L (5.6 mmol/L) and at least 4 weeks since blood transfusion
  • Serum creatinine ≤ 1.5 × upper limit of normal (ULN) or calculated by Cockroft-Gault formula or directly measured creatinine clearance ≥ 50 mL/min at screening
  • AST ≤ 3 x ULN without, and ≤ 5 x ULN with hepatic metastasis
  • Bilirubin ≤ 1.5 x ULN (except patients with Gilbert's syndrome, who must have total bilirubin < 3.0 mg/dL)
  • Ability to take oral medications.
  • Woman of childbearing potential must have been tested negative in a serum pregnancy test within 5 days prior to study drug initiation.
  • Male and female patients who have the potential to reproduce must agree to use a highly effective method of birth control (i.e., pregnancy rate of less than 1 % per year) during the study and for 5 months after the discontinuation of study medication. Women must refrain from donating eggs and men must refrain from donating sperm during this same period.

Who cannot join

  • Any of the following :
  • Pregnancy, lactation, or breastfeeding.
  • History or clinical evidence of central nervous system (CNS) primary tumors or metastases including leptomeningeal metastases, unless they have been previously treated, are asymptomatic, and have had no requirement for steroids or anticonvulsants in the last 14 days prior to Screening.
  • Deficiency in thiopurine methyltransferase (TPMT) or NUDT15.
  • Use, or have used, any concomitant anti-cancer medications within the previous 30 days or 5 half-lives of the medication (whichever is shortest) prior to first dose (bisphosphonates, denosumab and androgen deprivation therapies such as LHRH (GnRH) agonists are allowed if patient is on stable treatment for at least 4 weeks prior to first dose). Limited field radiotherapy for palliative purpose is allowed at any time.
  • Participants with immune-related adverse events attributed to prior immunomodulatory therapy must have resolved to Grade ≤ 1 (according to NCI CTCAE v 5.0) or baseline other than adverse events that are clinically non-significant and/or stable on supportive therapy, and are not expected to interfere with treatment in the study such as:
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  • Grade ≤ 2 alopecia, asthenia, dermatologic events.
  • Grade ≤ 2 anemia if hemoglobin ≥ 90 g/L (5.6 mmol/L)
  • Grade 2 (> 1.5-2.0 x ULN) asymptomatic amylase and/or lipase elevation with no abdominal pain and no characteristic CT findings. However, weekly monitoring of amylase and lipase is required in this case.
  • Be an organ transplant recipient.
  • Have a history of prior other malignancy (with the exception of localized prostate cancer, adequately treated basal skin cancer or carcinoma in-situ of the cervix) within 2 years prior to first dose.
  • Have a severe autoimmune disorder requiring treatment during the last 12 months prior to first dose. Diabetes on stable anti-diabetic medication, hypothyroidism and adrenocortical deficiency on stable substitution therapy are allowed.
  • Be on chronic therapy with systemic immunosuppressant medication (inhaled, intra articular and low dose systemic corticosteroids, e.g. 7.5 mg or less prednisolone per day is allowed, provided that treatment has been unchanged for at least 4 weeks prior to first dose of IMP).
  • Known HIV, active hepatitis B or hepatitis C infection.
  • Participants with a history of severe allergic anaphylactic reactions to chimeric or humanized antibodies or known hypersensitivity to Chinese hamster ovary cell products or to any component of the Atezolizumab formulation
  • Any condition that, in the opinion of the Investigator, would place the patient at increased risk or preclude the patient's compliance with the study.

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • University Hospital of Copenhagen, Rigshospitalet

    Copenhagen, 2100

Other trials in Denmark

About this study

Official title: TEMPLE - Thiopurine Enhanced Mutations for PD-1/Ligand-1 Efficacy

The TEMPLE study is a single-center prospective phase Ib and II trial to determine the safety, tolerability and efficacy of Atezolizumab given in combination with thiopurine therapy (6-mercaptopurine and 6-thioguanine) in patients with advanced and/or metastatic solid tumors with an intermediate tumor mutational burden.

Maximum tolerated dose (MTD) and/or recommended phase II dose (RP2D) will be determined in a single armed, open label phase Ib trial with a fixed dose of Atezolizumab in combination with thiopurine therapy with a dose-limiting toxicity (DLT) period of 4 weeks. A total of 27-39 patients will be enrolled in the TEMPLE study. Phase Ib will enroll 3-18 patients depending on the number of DLTs and need for dose de-escalation. Data from patients treated in the phase Ib study at RP2D will be included when assessing endpoints in the phase II part of the study. Phase II will enroll a total of 27 patients (including 3-6 patients treated at RP2D in the phase I part of the trial) in a Simon's 2 stage design (13 in stage 1 and 14 in stage 2).

Read the detailed description

INTRODUCTION:

Immune checkpoint inhibitors (ICI) have revolutionized treatment of several cancer types. However, many patients fail to respond. A prerequisite for response is the presence of neoepitopes on cancer cells that trigger the immune system, and the likelihood hereof increases with the number of mutations in the cancer. The thiopurines 6-mercaptopurine (6MP) and 6-thioguanine (6TG) are prodrugs that are converted into cytotoxic metabolites that are incorporated into DNA (DNA-TG) and cause DNA-damage through futile DNA mismatch repair attempts. 6MP and 6TG have been used for more than 50 years for long-term treatment of hematological cancers. In leukemia, high levels of DNA-TG are associated with higher cure rates. A recent pilot study has shown that combination therapy with 6MP and 6TG significantly increases DNA-TG levels and that the drug combination is safe and tolerable. The higher DNA-TG levels most likely increase the mutational burden and thus presence of neoepitopes that activate cytotoxic T-cell responses.

The TEMPLE project will apply the innovative thiopurine combination strategy to increase the mutational burden, presence of neoepitopes and thus proportion of patients with incurable solid cancers that respond to treatment with ICIs.

STUDY DESIGN:

The TEMPLE study is a single-center prospective phase Ib and II trial to determine the safety, tolerability and efficacy of Atezolizumab given in combination with thiopurine therapy in patients with advanced and/or metastatic solid tumors with an intermediate tumor mutational burden. Maximum tolerated dose (MTD) and/or recommended phase II dose (RP2D) will be determined in a single armed, open label phase Ib trial with a fixed dose of Atezolizumab in combination with thiopurine therapy. In the phase Ib part of the study, patients will start treatment with investigational medicinal products:

  1. 6-mercaptopurine (6MP) 50 mg/m2 orally taken once a day,
  2. 6-thioguanine (6TG) 12.5 mg/m2 orally taken once a day, and
  3. Atezolizumab 1200 mg every 3 weeks

The combination of thiopurines and Atezolizumab will be administered in 21-day cycles. The DLT evaluation period will be four weeks. Patients will be included in a modified 3+3 design. 3-18 patients are expected to be enrolled in the phase Ib study, depending on observed DLTs. Phase II be an open label, single arm phase II trial enrolling additional patients up to a total of 27 patients treated at RP2D in a Simon's 2 stage design (13 in stage 1 and 14 in stage 2).

All three study drugs are already approved for within hospital use in Denmark and the Summary of Product Characteristics (SmPCs) will be used in assessment of possible undesirable effects during the study. Patients will be monitored closely for adverse events using the NCI CTCAE v 5.0. If patients develop toxicity, the dose may be modified or discontinued. All dosing interruptions and modifications should be based on the worst preceding toxicity. Patients will be monitored continuously, and dose modifications or interruptions will occur based on the observed toxicity. For Atezolizumab, no dose reduction is permitted, but infusions may be omitted. Dose modifications may be implemented to manage toxicities for 6MP and 6TG.

Patients will continue treatment until progression disease, death, development of unacceptable toxicity or withdrawal of consent. Patients can be treated for a maximum of 2 years with option to re-challenge upon progression or relapse for those responding.

Being tested
Atezolizumab, 6-mercaptopurine, 6-thioguanine
Medical subject headings
Neoplasm Metastasis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Atezolizumab, 6-mercaptopurine, 6-thioguanineCombination product

    Combination therapy with Atezolizumab, 6-mercaptopurine and 6-thioguanine

Study groups in NCT05276284
Study groupRoleWhat they receive
TEMPLEExperimentalStudy drugs: Atezolizumab, 6-mercaptopurine and 6-thioguanine
Receives: Combination Product: Atezolizumab, 6-mercaptopurine, 6-thioguanine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Adverse events

    Type and number of adverse events

    Measured: 3-6 months

  2. Dose limiting toxicities

    Dose limiting toxicities (DLTs) and the MTD for determination of RP2D of Atezolizumab, 6TG and 6MP

    Measured: 28 days

  3. Best overall response

    Complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), unconfirmed (iUPD) and confirmed PD (iCPD), assessed according to Response Evaluation Criteria in Solid Tumours (RECIST) 1.1

    Measured: One year

Secondary outcomes (3)
  1. Progression Free Survival

    Survival time without progression

    Measured: Two years

  2. Overall Survival

    Survival time of participants

    Measured: Two years

  3. Duration of response

    Time from initial time of response according to RECIST 1.1 until progression, censoring or death.

    Measured: Two years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Mar 2022
  2. Study start1 Sep 2022
  3. Primary completion31 Dec 2024
  4. Study completion1 Sep 2025

Resources

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 1/2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
The TEMPLE study is a single-center prospective phase Ib and II trial to determine the safety, tolerability and efficacy of Atezolizumab given in combination with thiopurine therapy in patients with advanced and/or metastatic solid tumors with an intermediate tumor mutational burden.
Masking
None (open label)
Enrolment
18 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05276284
Sponsor's protocol ID
TEMPLE01
Acronym
TEMPLE
Status last verified
Jan 2026
First submitted
4 Feb 2022
Last updated
14 Jan 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Nazerai L, Willis SC, Yankilevich P, Di Leo L, Bosisio FM, Frias A, Bertolotto C, Nersting J, Thastrup M, Buus S, Thomsen AR, Nielsen M, Rohrberg KS, Schmiegelow K, De Zio D. Thiopurine 6TG treatment increases tumor immunogenicity and response to immune checkpoint blockade. Oncoimmunology. 2022 Dec 17;12(1):2158610. doi: 10.1080/2162402X.2022.2158610. eCollection 2023.

    PubMed 36545256

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Atezolizumab, 6-mercaptopurine, 6-thioguanine in people with Solid Tumor, Adult and Metastatic Cancer, run by Kristoffer Rohrberg at 1 site in Denmark.

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 20 inclusion and 16 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 14 Jan 2026. 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 Denmark. 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 combined 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.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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?

Adverse events (time frame: 3-6 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05276284, which also lists 1 linked publication.

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 14 Jan 2026.

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