Clinical trial NCT03706625: Integrated Discovery of New Immuno-Molecular Actionable Biomarkers for Tumors With Immune-suppressed Environment
Official title: Integrated Discovery of New Immuno-Molecular Actionable Biomarkers for Tumors With Immune-suppressed Environment
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Non Hodgkin Lymphoma
Non Small Cell Lung Cancer
Glioma
Keywords: Non Hodgkin Lymphoma
glioma
lung cancer
HIV
transplantation
brain
Lead sponsor: Assistance Publique - Hôpitaux de Paris
Sponsor class: OTHER
First posted: 2018-10-16
Enrollment: 201
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients followed-up at Pitié-Salpêtrière hospital, Tenon hospital, Henri Mondor hospital, Saint-Louis hospital or intercommunal hospital center of Créteil with histological diagnosis of HIV-related non-small cell lung cancer, immunocompetent non-small cell lung cancer, HIV-related Non-Hodgkin-Lymphomas (NHL), immunocompetent NHL, post-transplant NHL, primary lymphoma of the central nervous system, glioma.

Brief summary: The explosion of novel therapies targeting tumor mutations or immune molecules requests to define or better characterize the mutational profiles of tumors that are none or insufficiently explored so far. This is particularly the case for tumors arising in immune-suppressed individuals or environments which have been poorly, if any, analyzed so far with modern molecular methods. The goal of the translational research program, Ideation, is to define novel biomarkers such as the tumor mutational profiling and immunomutanome in such contexts and to compare the results obtained to those observed in immune competent individuals. In addition, this approach will allow to characterize novel key non-invasive diagnostic and prognostic biomarkers such as circulating tumoral DNA and cells. Altogether results will provide novel biomarkers to better adapt therapeutic strategies in these cancers, to monitor response to treatment as well as to define new molecular targets of potential therapeutic strategies.

Detailed description: The main objective is to discover novel invasive and non-invasive immuno-molecular actionable biomarkers in rare but severe tumors arising in immune-suppressed compared for some tumors in immune-competent patients. Indeed, this tumors present a deficient immune environment, either due to the host acquired immune deficiency, i.e. transplantations or HIV infection, or because the diseased tissue belongs in an immune sanctuary as the brain. The primary hypothesis, in this context, is that these tumor mutational profiles and their changes during drug therapy must be influenced by the immune environment and response. This must lead to differences from similar tumors observed in immune-competent environments (immunocompetent individuals or tissues expressing immunity), responsible for: modification in the molecular targets for appropriate drugs ; alteration of tumor immunogenicity and of future immune-based therapies ; specific biomarkers for monitoring the response to drug therapy. The objectives of this program are to carry on invasive and non-invasive investigations in order to define the mutational profile of these free types of severe tumors, non-Hodgkin lymphoma (NHL), lung cancers and gliomas arising in hosts or tissues with altered immunity. These investigations will lead to : identify novel invasive and non-invasive biomarkers for predicting and evaluating efficacy of future personalized and immune-based therapies; compare tumors from immune-suppressed and immune-competent hosts; discover hot spots of tumoral mutations as mechanisms of tumors resistance, new molecular targets for future molecular and immune-bases therapeutic strategies; define the tumor immunomutanome as a score of neo-epitopes predicting: tumor immunogenicity, disease outcome and efficacy of immunotherapies; detect non-invasive tumoral biomarkers from liquid biopsies based on Circulating tumoral DNA and Circulating tumoral Cells to facilitate future diagnosis and monitoring of such tumors; identify biomarkers of tumor escape or resistance to treatments.

Eligibility criteria: Inclusion Criteria:

* Age ≥ 18 years.
* Followed at Pitié-Salpêtrière hospital, Tenon hospital, Henri Mondor hospital, Saint-Louis hospital or intercommunal hospital center of Créteil
* Histological diagnosis confirmed of:

  * Non-small cell lung cancer (adenocarcinoma, squamous cell, large cells) related to HIV, or
  * Immunocompetent non-small cell lung cancer (adenocarcinoma, squamous cell, large cells), or
  * Non-Hodgkin's lymphoma (NHL): HIV-related NHL, post-transplant lymphoproliferation (LPT) according to WHO (World Health Organization) 2016 classification, primary CNS (central nervous system) lymphoma (LPS), or
  * Primary CNS lymphoma
  * Immunocompetent NHL: diffuse large B cell lymphoma (ABC or GC)
  * Glioma
* Naïve cancer treatment (except for the specific case of gliomas with certain or possible activation of MAPK (Mitogen-activated protein kinases) and MMR (Mismatch Repair) inactivation).
* Cancer undergoing surgery for excision or a large biopsy (pleural biopsy under video-thoracoscopy, mediastinoscopy, biopsy lymph node excision or cutaneous or cerebral metastasis).
* For patients with NSCLC: hemoglobin level\> 9 g / dL; for patients with NHL or glioma: hemoglobin \> 7 g / dL.
* Weight ≥ 48 kg.
* Informed consent to participation signed before carrying out any specific procedure of the study.
* Affiliation to the French social security system.

Exclusion Criteria:

* Other cancer than those in the study:

  * For NHL after transplantation: marginal zone NHL, follicular NHL, mantle cell NHL, lymphoplasmocytic NHL (non-WHO lymphoma as LPT)
  * For HIV-related LPTs and NHLs: LPS
  * For LPT: tumor EBV status unknown
  * For immunocompetent NHL: other NHL than diffuse large B cell lymphoma
  * For lung cancers: small cell lung cancer
* Absence of tumor material, blood or saliva samples taken before the start of chemotherapy (except for the specific case of gliomas with certain or possible activation of MAPK and MMR inactivation)
* Major under guardianship or curatorship

Primary outcomes:
measure: Prognostic value of the tumor invasive biomarkers
timeFrame: at Day 0
Secondary outcomes:
measure: Determination of tumoral biomarkers
timeFrame: at Day 0
measure: Prognostic value of the tumor non invasive biomarkers
timeFrame: at Day 0, Month 3 and Month 6
measure: Prognostic value of the tumor non-invasive biomarkers
timeFrame: at Day 0, Month 3 and Month 6
Other outcomes:
Locations:
city: Paris
country: France
facility: Groupe Hospitalier Pitié-Salpêtrière
Study officials:
affiliation: Pitié-Salpêtrière hospital (APHP)
name: Jean-Philippe SPANO, MD, PhD
role: STUDY_CHAIR
References: