Combining Retifanlimab with chemotherapy for advanced soft tissue sarcoma

A Multi-cohort Study of Retifanlimab With or Without Gemcitabine and Docetaxel in Patients With Advanced Sarcoma

This study is testing if adding Retifanlimab to chemotherapy can help people with advanced soft tissue sarcoma fight their cancer better than the usual treatments.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 98 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Memorial Sloan Kettering Cancer Center (Academic / other)
• Drugs / interventions: Radiation, prednisone, Retifanlimab, chemotherapy
• Locations: 1 site (New York, New York)
• Trial ID: NCT04577014 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the safety and effectiveness of Retifanlimab, an anti-PD-1 monoclonal antibody, when used in combination with the chemotherapy drugs gemcitabine and docetaxel for patients with advanced soft tissue sarcoma. The goal is to enhance the immune response against cancer cells and improve treatment outcomes for patients whose tumors are locally advanced or have metastasized and cannot be surgically removed. Participants will undergo mandatory tumor biopsies to assess the treatment's impact and monitor disease progression. The study aims to determine if this combination therapy can provide better results than standard treatments alone.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with unresectable high-grade soft tissue sarcoma that is either locally advanced or metastatic.

Not a fit: Patients with prior systemic therapy for their sarcoma or those with low ECOG performance status may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could offer a new effective option for patients with advanced soft tissue sarcoma.

How similar studies have performed: Other studies have shown promising results with similar immunotherapy approaches in treating various cancers, suggesting potential for success in this novel combination.

Eligibility criteria

Inclusion Criteria:

* Diagnosis of metastatic or locally advanced and unresectable high-grade soft tissue sarcoma. Unresectable is defined as:

  1. primary tumor cannot be safely removed surgically, or
  2. primary tumor would benefit from systemic therapy prior to a surgical approach
* Be willing and able to provide written informed consent
* Must consent to mandatory tumor biopsy (if deemed safe and feasible) for research studies at screening, if archival tissue is not available, and at C1D15, C3D15.
* Age ≥ 18 years
* ECOG performance status ≤ 1
* Presence of measurable disease per RECIST v1.1

  * Target lesions must not be chosen from a previously irradiated field unless there has been radiographically and/or pathologically documented tumor progression in that lesion prior to enrollment.
* No prior systemic therapy (see exclusion criteria, below)
* Negative serum pregnancy test in women of childbearing potential
* Patients with chronic HBV (HBsAg-positive with undetectable or low HBV DNA and normal ALT, or HBsAg-negative with anti-HBc-positive serology) and HCV (completed curative antiviral treatment with HCV viral load below the limit of quantification) may be eligible

  * Patients with HBV should be treated with suppressive antiviral therapy prior to enrollment
  * Patients with HCV must have completed curative therapy and have negative HCV viral load
* Adequate organ function, as defined in Table 2:

Table 2: Laboratory Parameters Required for Study Inclusion

Hematological Absolute neutrophil count (ANC): ≥ 1,500 /mcL Platelets: ≥ 75,000 / mcL Hemoglobin: ≥ 9g/dL or ≥ 5.6 mmol/L

Renal Serum creatinine: ≤ 1.5 X upper limit of normal (ULN) OR Measured or calculated creatinine clearance: ≥ 60 mL/min for patient with creatinine levels \> 1.5 X institutional ULN (GFR can also be used in place of creatinine orCrCl)

Hepatic Serum total bilirubin: ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for patients with total bilirubin levels \> 1.5 ULN except patients with Gilbert's disease (≤ 3x ULN) AST (SGOT) and ALT (SGPT): ≤ 2.5 X ULN OR ≤ 5 X ULN for patients with liver metastases

Exclusion Criteria:

* Received any systemic therapy in the advanced or metastatic setting

  * Adjuvant or neoadjuvant therapies received ≥ 1 year prior to enrollment are permitted
* Unstable or deteriorating cardiovascular disease within the previous 6 months, including:

  * Unstable angina or myocardial infarction
  * CVA/stroke
  * New York Heart Association \[NYHA\] Class III or IV congestive heart failure
  * Uncontrolled clinically significant arrhythmias
* Current use of immunosuppressive medication, EXCEPT for the following:

  * Intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection)
  * Systemic corticosteroids at physiologic doses ≤ 10 mg/day of prednisone or equivalent
  * Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication)
* Evidence of clinically significant immunosuppression such as the following:

  * Primary immunodeficiency state such as Severe Combined Immunodeficiency Disease
  * Concurrent opportunistic infection
  * Receiving systemic immunosuppressive therapy (\> 2 weeks) including oral steroid doses \> 10 mg/day of prednisone or equivalent within 2 months prior to enrollment
* History or evidence of symptomatic autoimmune disease in past 2 years prior to enrollment.

  * Replacement therapy (e.g., thyroxine for hypothyroidism, insulin for diabetes or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment for autoimmune disease
* Uncontrolled HIV infection, as defined by one or more of the following:

  * Patients with CD4+ T-cell (CD4+) counts \< 350 cells/uL
  * Patients with a history of an opportunistic infection secondary to AIDS
  * Patients on anti-microbials with drug-drug interactions with the study drugs on this protocol, who cannot be switched to alternative anti-microbials
  * Patients on antiretroviral therapy \< 4 weeks
  * Patients with HIV viral load \> 400 copies/mL
* Active Hepatitis B or Hepatitis C
* Patients who have received a live vaccine within 30 days of the start date of the planned study therapy (with the exception of COVID-19 vaccines)
* History of active TB (Bacillus Tuberculosis)
* Radiation therapy within 2 weeks prior to study day 1
* If patient received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy
* Women who are pregnant or breast feeding
* Patients expecting to conceive or father children within the projected duration of the trial, starting with the visit through 180 days after the last dose of study treatment(s)
* Prior organ transplantation including allogenic stem-cell transplantation
* Active infection requiring systemic therapy
* Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (NCI CTCAE v5.0 Grade ≥ 3)
* Patients with prior history of interstitial lung disease and clinically significant pulmonary compromise, including those who have a requirement for supplemental oxygen use to maintain adequate oxygenation

Where this trial is running

New York, New York

• Memorial Sloan Kettering Cancer Center — New York, New York, United States (Recruiting)

Study contacts

• Principal investigator: Sandra D'Angelo, MD — Memorial Sloan Kettering Cancer Center
• Study coordinator: Sandra D'Angelo, MD

Conditions Soft Tissue Sarcoma; Sarcoma,Soft Tissue; Sarcoma; Soft Tissue Sarcoma Adult; soft tissue sarcoma; locally advanced soft tissue sarcoma; unresectable soft tissue sarcoma; metastasized soft tissue sarcoma