Clinical trial NCT04261855: Targeted Therapy and Avelumab in Merkel Cell Carcinoma
Official title: A Phase Ib/II Study of Combination Avelumab With Peptide Receptor Radionuclide Therapy or Conventional Fractionated Radiotherapy in Patients With Metastatic Merkel Cell Carcinoma
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
PHASE2
Conditions: Metastatic Merkel Cell Carcinoma
Keywords: radiotherapy
peptide receptor radionuclide therapy
neuroendocrine tumour
rare cancer
merkel cell
carcinoma
immunotherapy
merkel cell carcinoma
Lead sponsor: Melanoma and Skin Cancer Trials Limited
Sponsor class: OTHER
First posted: 2020-02-10
Enrollment: 19
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The LuTate treatment arm is now closed to recruitment
Primary purpose: TREATMENT

Brief summary: 10.17 GoTHAM is intended as a signal-seeking, biomarker, phase Ib/II study that will evaluate the safety and anti-tumour activities of the novel combination of avelumab with 177-Lu-DOTATATE (a type of peptide receptor radionuclide therapy; PRRT) or external beam radiation therapy (EBRT) in patients with metastatic Merkel cell carcinoma (mMCC).

Detailed description: Despite recent advances with immune checkpoint inhibitors, such as avelumab which has changed the treatment landscape for metastatic Merkel Cell Carcinoma (mMCC), many mMCC patients who attained an initial response exhibit acquired resistance within 1 year. Therefore, novel treatment combinations are needed to improve patient outcome. MCC is an exquisitely radiosensitive tumour and there is emerging data supporting the role of radiation in inducing immunogenic cell death and therefore potentially improving the anti-tumour efficacy when combined with immune checkpoint inhibitors. Peptide receptor radionuclide therapy (PRRT) is used in first-line treatment for neuroendocrine tumours (NETs), by delivering radiation to somatostatin receptor (SSTR) expressing tumour cells. Most NETs, including MCC, express SSTR. Therefore, MCC tumours are ideal candidates for PRRT, and immune checkpoint inhibitor combination approaches with PRRT are highly attractive.

The GoTHAM trial is intended as a signal-seeking and biomarker study. It is designed as a prospective, open-labelled, multi-institutional, two-arm, phase Ib/II trial that will evaluate the safety and anti-tumour activity of 177Lu-DOTA-octreotate (LuTate) or external beam radiation therapy (EBRT) in combination with avelumab in patients with mMCC. The primary objective is to evaluate the anti-tumour activity as reflected by PFS rate at 12 months.

The LuTate arm of this study is now closed to recruitment.

Eligibility criteria: Inclusion Criteria:

* Patient is 18 years of age or older and who has provided written informed consent.
* Patient has histologically confirmed metastatic MCC.
* Eastern Cooperative Oncology Group (ECOG) performance status of ≤2 .
* Willing and able to comply with all study protocol requirements for the duration of the study.
* Patient must have measurable disease by CT or MRI per RECIST version 1.1 criteria.
* Patient is treatment naïve (no prior systemic therapy for unresectable or metastatic MCC). Note that prior chemotherapy is permitted in the adjuvant setting for loco-regional disease. Prior radiation is permitted for treatment of the primary or loco-regional disease.
* At least 2 weeks since the completion of prior therapy, including surgery or radiotherapy.
* Screening laboratory values, obtained within 14 days prior to registration/randomisation must meet the criteria specified in the protocol.
* Women of childbearing potential (WOCBP) must use appropriate method(s) of contraception
* WOCBP must have a negative serum or urine pregnancy test within within 7 days prior to the start of avelumab treatment and should be performed every 4 weeks in line with other safety bloods or clinical reviews.
* Male patients who are sexually active with a WOCBP must use any contraceptive method with a failure rate of less than 1% per year.
* Patient must be agreeable to have archival tumour material collected

Exclusion Criteria:

* Patient is excluded if they have ever had any brain or leptomeningeal metastases.
* Prior exposure to immune checkpoint inhibitors (e.g. anti-CTLA-4, anti-PD-1/PD-L1/PD-L2, etc.) or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways.
* Prior exposure to 177Lu-DOTATATE.
* Prior malignancy within the previous 2 years, except for locally curable cancers that have been apparently cured (e.g. basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the cervix, colon, bladder or breast).
* Life expectancy of 6 months or less.
* An active, known or suspected autoimmune disease that might lead to clinically significant deterioration as per the investigator when receiving an immunostimulatory agent. Patients are permitted to enrol if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger. They are permitted to enrol if they have clinically quiescent auto-immune conditions not requiring immunomodulation beyond low dose steroids (ie \<10mg per day of prednisolone or equivalent) or topical therapies (including mesalazine or steroid enemas).
* Current use of immunosuppressive medication, with exceptions detailed in the protocol
* Prior organ transplantation, including allogeneic stem-cell transplantation.
* Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS).
* Positive test for hepatitis B virus (HBV) surface antigen and/or confirmatory hepatitis C virus (HCV) RNA (if anti-HCV antibody tested positive at Screening).
* Pregnant or breastfeeding.
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
* Patients should be excluded if they have a condition requiring systemic treatment with either corticosteroids (\> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration.
* Persisting toxicity related to prior therapy (NCI CTCAE v5.0 Grade \> 1); however, alopecia, sensory neuropathy Grade ≤ 2, or other Grade ≤ 2 not constituting a safety risk based on Investigator's judgement are acceptable.
* Known prior severe hypersensitivity to investigational product or any component in its formulations, including known hypersensitivity reactions to monoclonal antibodies (NCI CTCAE v5.0 Grade 3).
* Patients with symptomatic or impending cord compression unless appropriately treated beforehand and clinically stable.
* Use of any live vaccines against infectious diseases (e.g., influenza, varicella, etc.) within 30 days of registration.

Primary outcomes:
measure: Progression Free Survival (PFS) at 12 months
timeFrame: 3 years
Secondary outcomes:
measure: Progression Free Survival (PFS) at 24 months
timeFrame: 4 years
measure: Overall Survival (OS) at 12 and 24 months
timeFrame: 4 years
measure: Best Objective Response Rate (ORR) according to RECIST v1.1
timeFrame: 4 years
measure: The safety and tolerability of 177Lu-DOTATATE or EBRT in combination with avelumab.
timeFrame: 4 years
measure: Rate of treatment discontinuation due to toxicity
timeFrame: 4 years
Other outcomes:
Locations:
city: Coffs Harbour
country: Australia
facility: Mid North Coast Cancer Institute - Coffs Harbour Health Campus
state: New South Wales
city: Gateshead
country: Australia
facility: Lake Macquarie Private Hospital
state: New South Wales
city: Gosford
country: Australia
facility: Gosford Hospital
state: New South Wales
city: Hamlyn Terrace
country: Australia
facility: Wyong Hospital
state: New South Wales
city: Sydney
country: Australia
facility: Royal North Shore Hospital
state: New South Wales
city: Brisbane
country: Australia
facility: Royal Brisbane and Women's Hospital
state: Queensland
city: Brisbane
country: Australia
facility: Princess Alexandra Hospital
state: Queensland
city: Adelaide
country: Australia
facility: Royal Adelaide Hospital
state: South Australia
city: Melbourne
country: Australia
facility: Peter MacCallum Cancer Centre
state: Victoria
city: Perth
country: Australia
facility: Sir Charles Gaidner Hospital
state: Western Australia
Study officials:
affiliation: Peter MacCallum Cancer Centre, Australia
name: Prof Shahneen Sandhu, MBBS, FRACP
role: STUDY_CHAIR
References: