Combination of relatlimab and nivolumab for advanced cervical cancer
A MULTICENTER, SEEKING SIGNAL, RANDOMISED, OPEN-LABEL PHASE II OF RELATLIMAB AND NIVOLUMAB VS NIVOLUMAB ALONE IN LOCALLY ADVANCED CERVICAL CANCERS
This study is testing a new combination of two medications, relatlimab and nivolumab, to see if they can help women with advanced cervical cancer before they start standard treatment.
Quick facts
| Phase | Phase 2 |
|---|---|
| Study type | Interventional |
| Enrollment | 77 (estimated) |
| Ages | 18 Years to 99 Years |
| Sex | Female |
| Sponsor | Arcagy/ Gineco Group Academic / other |
| Drugs / interventions | relatlimab, nivolumab, radiation, methotrexate, cyclophosphamide, prednisone |
| Locations | 26 sites (Angers and 25 other locations) |
| Trial ID | NCT06715241 on ClinicalTrials.gov |
What this trial studies
This Phase II clinical trial evaluates the effectiveness of a combination treatment using relatlimab and nivolumab in women with locally advanced cervical cancer before standard chemoradiotherapy (CCRT). The study aims to assess the clinical activity and safety of this combination, as well as to identify potential biomarkers that may predict treatment response. Participants will undergo a new cervix biopsy and will be monitored for their response to the treatment through various assessments.
Who should consider this trial
Good fit: Ideal candidates are female patients aged 18 and older with histologically confirmed locally advanced cervical cancer who have not received prior anti-cancer treatment.
Not a fit: Patients with metastatic cervical cancer or those who have previously undergone anti-cancer treatment may not benefit from this study.
Why it matters
Potential benefit: If successful, this treatment could provide a new effective option for women with locally advanced cervical cancer.
How similar studies have performed: While this approach is exploring a novel combination, similar immunotherapy strategies have shown promise in other cancer types, suggesting potential for success.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria:
* Female patients aged ≥18 years at time of inform consent signature.
* Patients must have histologically confirmed diagnosis of cervical squamous or adenosquamous carcinoma stage IIB to IVA according to FIGO 2018 (Appendix 1) and no evidence of metastatic disease (M0). Note: Nodal staging may be either surgical or by imaging (MRI/PET-CT) with pathological lymph node size defined by a short-axis diameter of ≥10mm (axial plane) or FDG uptake greater than that of the surrounding tissue and corresponding to the LN structure on CT when CT was performed for PETCT analysis.
* Patients must be naïve from prior anti-cancer treatment (all type) and eligible to standard CCRT as per standard practice and investigator' judgement.
* Known HPV status as per local assessment.
* Patient accepting to undergo a new cervix biopsy and with at least one lesion with a diameter ≥10 mm, visible by medical imaging and accessible to percutaneous sampling (needle biopsies 16 gauge or larger) that permit core needle biopsy (ideally 4 cores) without unacceptable risk of a major procedural complication.
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (Appendix 2).
* Adequate organ and marrow function with following lab values within 7 days before C1D1:
* Absolute neutrophil count (ANC) ≥1500/μL
* White blood cell (WBC) \>3000/μL
* Platelets ≥100 000/μL
* Hemoglobin (Hb) ≥9 g/dL
* Total bilirubin ≤1.5× upper limit of normal (ULN) unless due to Gilbert's syndrome
* ASAT /ALAT ≤3 ULN
* Creatinine ≤1.5 within normal limit, or
* Creatinine clearance ≥ 40 mL/min according to CKD-EPI formula (Appendix 3)
* Troponin T or I \< 2 x ULN
* Adequate cardiovascular function documented by:
* QTc interval \<450 msec.
* Left ventricular Ejection fraction \> 50% based on screening echocardiogram (ECHO) or multigated acquisition scan (MUGA).
* Controlled blood pressure (BP, \<150/90mmHg), with or without current antihypertensive treatment.
* No congestive heart failure New York Heart Association class 3 or 4, unstable angina pectoris, serious cardiac arrhythmias (eg, ventricular flutter, ventricular fibrillation, Torsades de pointes).
* No stroke (including transient ischemic attack \[TIA\]), myocardial infarction, or other clinically significant ischemic event within 12 months before first dose.
* No prior history of myocarditis.
* Women of childbearing potential
* must have a negative serum pregnancy test within 7 days prior C1D1 and use adequate contraceptive methods (for example, intrauterine device \[IUD\], birth control pills unless clinically contraindicated, or barrier device - see Appendix 4) beginning 2 weeks before the first dose of study drugs and for up to 6 months after the final dose of study drugs (i.e., 30 days \[duration of ovulatory cycle\] plus the time required for relatlimab and nivolumab to undergo approximately five halflives).
* A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries, fallopian tubes, and/or uterus).
* Ability to understand and sign informed consent and willingness to comply with the study procedures before study entry.
* Covered by a medical insurance.
Exclusion Criteria:
* Evidence or treatment for another malignancy within 3 years prior to study entry. Curatively treated non-melanoma skin cancer, in situ carcinoma, or cervical intraepithelial neoplasia is allowed.
* History of severe allergic or other hypersensitivity reactions to:
* chimeric or humanized antibodies or fusion proteins,
* biopharmaceuticals produced in Chinese hamster ovary cells, or
* any component of the study treatments formulation.
* Patients with:
* Active hepatitis B (chronic or acute; defined as having a positive hepatitis B surface antigen \[HBsAg\] test at screening) unless their HBV is stably controlled on nucleoside analogs (eg entecavir or tenofovir) which will be continued for the duration of the study. Note: Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as the presence of hepatitis B core antibody \[anti-HBc\] and absence of HBsAg) are eligible. HBV DNA test must be performed in these patients prior to C1D1.
* Active hepatitis C. Patients positive for hepatitis C virus (HCV) antibody are eligible only if PCR is negative for HCV RNA, or
* HIV infection. Patients with prior organ or bone marrow transplant.
* Patients with active, suspected or 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, Sjogren's syndrome, Guillain-Barre syndrome, multiple sclerosis, vasculitis, or glomerulonephritis (see Appendix 5 for a more comprehensive list of pre-existing autoimmune diseases and immune deficiencies) with the following exceptions:
* patients with a history of autoimmune-related hypothyroidism who are on thyroid replacement hormone,
* patients with controlled Type 1 diabetes mellitus,
* patients with eczema, psoriasis, lichen simplex chronicus, or vitiligo with dermatologic manifestations only (e.g., patients with psoriatic arthritis would be excluded) are permitted provided that they meet the following conditions:
* rash must cover less than 10% of body surface area (BSA).
* disease is well controlled at baseline and only requiring low potency topical steroids.
* no acute exacerbations of underlying condition within the previous 12 months requiring PUVA \[psoralen plus ultraviolet A radiation\], methotrexate, retinoids, biologic agents, oral calcineurin inhibitors, high potency or oral steroids.
* Patients not respecting the minimal washout period or anticipation of need during the study of the following medications:
1. For "Systemic immunosuppressive medication (e.g.corticosteroids, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-TNF-alpha agents)", a minimal wash out period before C1D1 ≥ 2 weeks is requested.
But use during the study is not allowed with the exceptions of intranasal, inhaled, or topical corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10mg/day of prednisone, or an equivalent corticosteroid.
2. For "Systemic immunostimulatory (e.g., interferons and IL-2), a minimal wash out period ≥ 4 weeks or 5 \* t(1/2) of medication whichever is longer.
But use during the study is not allowed.
* Patients with any serious or uncontrolled medical disorder that, in the opinion of the investigator, may have increased the risk associated with trial participation or trial treatment administration, impaired the ability of the patients to receive protocol therapy, or interfered with the interpretation of trial results.
* Patients have received a live/attenuated vaccine within 30 days of C1D1 (inactivated vaccines were permitted).
* Pregnant or lactating women.
* Patients deprived of liberty, under guardianship, or under curatorship.
Where this trial is running
Angers and 25 other locations
- ICO Paul Papin — Angers, France (Not_yet_recruiting)
- Sainte-Catherine Institut du Cancer Avignon-Provence — Avignon, France (Not_yet_recruiting)
- CHRU Besançon - Hôpital Jean Minjoz — Besancon, France (Not_yet_recruiting)
- Institut Bergonié — Bordeaux, France (Not_yet_recruiting)
- CHU de BREST - Hôpital Cavale Blanche — Brest, France (Not_yet_recruiting)
- Centre François Baclesse — Caen, France (Not_yet_recruiting)
- CHU de Dijon — Dijon, France (Not_yet_recruiting)
- CHRU Lille - Hôpital Jeanne de Flandre — Lille, France (Not_yet_recruiting)
- CHU de Limoges - Hôpital Dupuytren — Limoges, France (Not_yet_recruiting)
- Centre Léon Bérard — Lyon, France (Recruiting)
- Institut Paoli Calmettes — Marseille, France (Not_yet_recruiting)
- ICM Val d'Aurelle — Montpellier, France (Not_yet_recruiting)
- Centre Antoine Lacassagne — Nice, France (Not_yet_recruiting)
- Institut Curie — Paris, France (Not_yet_recruiting)
- Groupe Hospitalier Diaconesses - Croix Saint-Simon — Paris, France (Not_yet_recruiting)
- Centre CARIO - HPCA — Plerin, France (Not_yet_recruiting)
- CHU de Poitiers - Hôpital de la Milétrie — Poitiers, France (Not_yet_recruiting)
- Centre Eugène Marquis — Rennes, France (Not_yet_recruiting)
- CHU Saint-Etienne - Pôle de Cancérologie — Saint-etienne, France (Not_yet_recruiting)
- ICO - Centre René Gauducheau — Saint-herblain, France (Not_yet_recruiting)
- ICANS - Institut de cancérologie Strasbourg Europe — Strasbourg, France (Not_yet_recruiting)
- Oncopole Claudius Regaud — Toulouse, France (Not_yet_recruiting)
- CHRU de Tours - Hôpital Bretonneau - Centre Henry Kaplan — Tours, France (Withdrawn)
- Centre d'Oncologie et de Radiothérapie 37 (ROC37) — Tours, France (Not_yet_recruiting)
- ICL - Centre Alexis Vautrin — Vandoeuvre-les-nancy, France (Not_yet_recruiting)
- Gustave Roussy — Villejuif, France (Not_yet_recruiting)
Study contacts
- Study coordinator: Latifa BOUDALI
- Email: lboudali@arcagy.org
- Phone: +33184852042
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.