Elderly Cancer PatIents, Safety and qualiTy of Life Under immunOtheraPies

Study Overview
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Brief Summary
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The co-primary objectives will be to assess the safety and quality of life under treatment.

Detailed Description
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The co-primary objectives will be to assess the safety and quality of life under treatment. Secondary objectives will be evaluations of geriatric data modifications under treatment, efficacy (progression-free survival and overall survival), correlation between toxicity and efficacy, and comparison of the safety profiles between various immunotherapy regimens. Another secondary objective will be the comparison between patients and clinicians symptom reporting. The investigators will also perform a pharmacokinetics analysis on PD1-monoclonal antibodies to improve the understanding of PD-1 inhibitors pharmacokinetics for the elderly population. Finally, toxicity and efficacy will be compared to immunological parameters such as the description of tumor infiltrating lymphocytes, markers of immunosenescence and inflammation.

Official Title
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Elderly Cancer PatIents Treated for Advanced or Metastatic Melanoma or NSCLC, Safety and qualiTy of Life Under immunOtheraPies: a Phase IV Trial

Conditions
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Advanced or Metastatic Melanoma, Advanced or Metastatic NSCLC

Intervention / Treatment
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* Drug: immune-checkpoint inhibitors therapies


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients eligible to start a treatment including immune checkpoint inhibitors (Nivolumab, Ipilimumab, Pembrolizumab, and so on…) Diagnosis of advanced or metastatic melanoma or NSCLC (All treatment lines will be allowed) Age ≥ 70 years Having personally signed and dated informed consent Patient affiliated to the ''National security'' regimen or beneficiary of this regimen Exclusion Criteria: Immune checkpoint inhibitor therapy initiated before study enrolment Concomitant participation in other investigational clinical trials involving an immune checkpoint inhibitor Immune checkpoint inhibitor treatment in a context of other solid tumours Immune checkpoint inhibitor treatment in a context of haematological malignancies Being unable or unwilling to comply with the requirements of the protocol, as assessed by the investigator Patient in urgency situation, adult under legal protection, or unable to give his consent

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: This is a national prospective phase 4, multi-centre, single arm, open-label cohort study to evaluate the safety and efficacy of immune checkpoint inhibitors-based therapies in elderly patients with advanced or metastatic melanoma or NSCLC.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: treatment including immune checkpoint inhibitors<br>All patients included in this study will receive approved immune-checkpoint inhibitors therapies, such as CTLA-4, PD-1, and PD-L1 inhibitors. | Drug: immune-checkpoint inhibitors therapies<br>* All patients included in this study will receive approved immune-checkpoint inhibitors therapies, such as CTLA-4, PD-1, and PD-L1 inhibitors.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants adverse events as assessed by CTCAE v5.0 | Description of adverse events' type, incidence, severity (CTCAE v.5.0), timing, seriousness, and relatedness. This endpoint will be based on the rate of grade ≥ 3 adverse events 18 weeks after treatment initiation, defined as medical assessment of safety including adverse events' type, incidence, severity (graded by the CTCAE] v. 5.0), timing, seriousness, and relatedness. This will include clinical as well as biological toxicities such as liver and endocrine dysfunctions. All high grade adverse events will be taken into account. | From treatment initiation to 18 weeks after treatment initiation. (up to 24 months) | 
| European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and Elderly Cancer Patients module (QLQ - ELD14), combined to compute a total score (between 44 and 128 points) | Quality of life will be evaluated using the EORTC QLQ-C30 and QLQ-ELD14 questionnaires collected at inclusion and at every treatment cycles during the first 6 weeks, then every 6 weeks until treatment discontinuation. The proportion of patients with a decrease superior or equal to 10% for their global score between baseline and at 24 weeks after treatment initiation will be estimated. | From inclusion until 24 weeks after treatment initiation (up to 24 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| geriatric data modifications under treatment | Geriatric data assessment will be done at inclusion and every 6 weeks until treatment discontinuation. Exhaustive data will be collected at inclusion. The investigators will also assess the G-CODE (Geriatric Core Dataset), a recently described minimum geriatric data set (see SOFOG guidelines). G-CODE assessment will be repeated every 6 weeks during treatment and at treatment discontinuation. These data will be collected either by the geriatrician or trained clinical research nurses during geriatric consultation as part of geriatric follow-up, an integral part of the patient management. | From inclusion until treatment discontinuation (up to 24 months) | 
| compare patients and clinician symptoms reporting | Reminder of CTCAE version 5.0 will be completed by clinicians before every treatment cycle. Patients will also complete a language adapted version of patient-reported outcome PRO-CTCAE questionnaire. For all symptoms, the investigators will measure the proportion of pairs for which clinicians and patients gave an identical grade. The investigators will also measure the proportion of pairs that will disagree for each symptom by one point (e.g., patient grade 2 and clinician grade 1), and the proportion that will disagree by two or more points (e.g., patient grade 2 and clinician grade 4). The investigators will also record the number of symptoms for which each pair agreed. | From treatment initiation to 18 weeks after treatment initiation.(up to 24 months) | 
| Progression-free survival | Evaluation of Progression-free Survival (PFS) will be defined as the time from treatment beginning to radiological (according to the RECIST 1.1 criteria) or clinical progression of the disease as declared by the investigators, or death of any cause. Radiological evaluations will be performed every 6 weeks. | time from treatment beginning to radiological or clinical progression of the disease, or death of any cause. (up to 24 months) | 
| Overall Survival | Overall Survival (OS) will be defined as the time from treatment beginning to death of any cause. | time from treatment beginning to death of any cause (up to 24 months) | 
| correlation between toxicity and efficacy | Correlation between occurrence of auto-immune adverse events (with a landmark time at week 18) and efficacy (PFS). | time from treatment beginning to radiological or clinical progression of the disease, or death of any cause. (up to 24 months) | 
| rate of grade 3 to 5 adverse events 18 weeks after treatment initiation | Safety profiles comparison according to treatment regimen (PD1-inhibitor monotherapy vs PD1- inhibitor/CTLA4-inhibitor combination vs CTLA-inhibitor monotherapy vs PDL1-inhibitor if available at time of trial beginning) will be performed by looking at the rate of grade 3 to 5 adverse events 18 weeks after treatment initiation for each therapy. | From treatment initiation to 18 weeks after treatment initiation.(up to 24 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Elderly cancer patients, Immunotherapies