Informations générales (source: ClinicalTrials.gov)
A GCO Trial Exploring the Efficacy and Safety of Nivolumab Monotherapy or Nivolumab Plus Ipilimumab in Pre-treated Patients with Advanced, Refractory Pulmonary or Gastroenteropancreatic Poorly Differentiated Neuroendocrine Tumors (NECs) (NIPINEC)
Interventional
Phase 2
Intergroupe Francophone de Cancerologie Thoracique (Voir sur ClinicalTrials)
janvier 2019
janvier 2025
19 octobre 2024
Neuroendocrine tumors of the lung include the small cell carcinoma (SCLC), and large cell
neuroendocrine carcinoma (LCNEC) and represent 20% of lung cancer. One of the only
studies reported to date is reporting on a progression-free survival (PFS) and overall
survival (OS) of 5.2 months and 7.7 months, respectively.
Poorly differentiated gastroentero-pancreatic neuroendocrine carcinomas (GEP-NEC)
represent a small sub-group of digestive NENs, according to the studies, 7 to 21% of
patients. However, their prognosis is more negative, with the 5-year survival at less
than 20%.
Many Phase III trials showed superiority in terms of efficacy and tolerance of
nivolumab+/-ipilimumab versus standard chemotherapy in second-line treatment in
metastatic solid tumors. Neuroendocrine tumors are considered as rare disease without
therapeutic guidelines in this setting. The French academic oncology groups (IFCT, FFCD
and GERCOR) have the opportunity to recruit a sufficient number of patients, in a
reasonable period of time, to provide a proof-of-concept of the safety and efficacy of
nivolumab+/-ipilimumab in this population.
Etablissements
| Les établissements d'Île-de-France ayant mis à jour leurs données Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| CHI DE CRETEIL | Isabelle MONNET | 29/03/2024 01:28:05 | Contacter | ||
| CLCC INSTITUT CURIE | 04/09/2024 13:49:49 | Contact (sur clinicalTrials) | |||
| CLCC INSTITUT GUSTAVE ROUSSY | Eric BAUDIN | 16/04/2024 07:01:45 | Contacter | ||
| HOPITAL FOCH | MAY MABRO | 21/10/2024 07:07:08 | Contacter | ||
| Les établissements hors Île-de-France dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
| CHU d'Angers - Angers - France | Contact (sur clinicalTrials) | ||||
| Les établissements sans correspondance certaine dans le répertoire FINESS dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
| Auxerre - CH - 89011 - Auxerre - France | Contact (sur clinicalTrials) | ||||
| CHU d'Amiens-Picardie - Amiens - France | Contact (sur clinicalTrials) | ||||
| Lyon - Hôpital Edouard Herriot - Lyon - France | Contact (sur clinicalTrials) | ||||
Critères
Tous
Inclusion Criteria:
1. Age ≥ 18 years.
2. WHO Performance status 0 - 1
3. Life expectancy > 12 weeks
4. Poorly differentiated neuroendocrine carcinoma (NEC): large and small cells for
gastroenteropancreatic NEC (WHO 2010 classification) and only large cells for lung
NEC (WHO 2015 classification), independently from PD-L1 expression status by tumor
cells; mixed tumors with a prominent (>70%) NEC component are eligible
5. Tumor progression after one or two lines of treatment, including at least one line
of platin-based chemotherapy
6. Unresectable locally advanced or metastatic stage
7. Measurable disease according to RECIST 1.1 guidelines for solid tumors
8. Patients must have adequate organ function: creatinine clearance > 50 mL/min
(Cockcroft formula), Neutrophiles count ≥ 1500/mm3; Platelets > 100 000/mm3 ;
Hemoglobin > 9 g/dL; hepatic enzymes < 3 x ULN (upper limit of normal) with total
bilirubin ≤ 2 × ULN except subjects with documented Gilbert's syndrome (≤ 5 × ULN)
or liver metastasis, who must have a baseline total bilirubin ≤ 3.0 mg/dL
9. Patients must have recovered from all toxicities associated with prior treatment, to
acceptable baseline status, or a National Cancer Institute Common Terminology
Criteria for Adverse Events(NCI CTCAE v4.0) Grade of 0 or 1, except for toxicities
not considered a safety risk, such as alopecia or vitiligo
10. Availability of tumor material for central review processes and translational
research projects
11. Absence of any unstable systemic disease and any psychological, familial,
sociological or geographical factors potentially hampering compliance with the study
protocol and follow-up schedule.
12. Before patient inclusion, written informed consent must be given according to
ICH/GCP, and national/local regulations.
13. Females of childbearing potential who are sexually active with a non-sterilized male
partner must use a highly effective method of contraception for 28 days prior to the
first dose of investigational product, and must agree to continue using such
precautions for 6 months after the final dose of investigational product; cessation
of contraception after this point should be discussed with a responsible physician.
Periodic abstinence, the rhythm method, and the withdrawal method are not acceptable
methods of contraception. They must also refrain from egg cell donation for 6 months
after the final dose of investigational product. Men receiving nivolumab and who are
sexually active with women of childbearing potential will be instructed to adhere to
contraception for a period of 31 weeks after the last dose of nivolumab.
14. Patient must be affiliated to or a beneficiary of social security insurance.
1. Age ≥ 18 years.
2. WHO Performance status 0 - 1
3. Life expectancy > 12 weeks
4. Poorly differentiated neuroendocrine carcinoma (NEC): large and small cells for
gastroenteropancreatic NEC (WHO 2010 classification) and only large cells for lung
NEC (WHO 2015 classification), independently from PD-L1 expression status by tumor
cells; mixed tumors with a prominent (>70%) NEC component are eligible
5. Tumor progression after one or two lines of treatment, including at least one line
of platin-based chemotherapy
6. Unresectable locally advanced or metastatic stage
7. Measurable disease according to RECIST 1.1 guidelines for solid tumors
8. Patients must have adequate organ function: creatinine clearance > 50 mL/min
(Cockcroft formula), Neutrophiles count ≥ 1500/mm3; Platelets > 100 000/mm3 ;
Hemoglobin > 9 g/dL; hepatic enzymes < 3 x ULN (upper limit of normal) with total
bilirubin ≤ 2 × ULN except subjects with documented Gilbert's syndrome (≤ 5 × ULN)
or liver metastasis, who must have a baseline total bilirubin ≤ 3.0 mg/dL
9. Patients must have recovered from all toxicities associated with prior treatment, to
acceptable baseline status, or a National Cancer Institute Common Terminology
Criteria for Adverse Events(NCI CTCAE v4.0) Grade of 0 or 1, except for toxicities
not considered a safety risk, such as alopecia or vitiligo
10. Availability of tumor material for central review processes and translational
research projects
11. Absence of any unstable systemic disease and any psychological, familial,
sociological or geographical factors potentially hampering compliance with the study
protocol and follow-up schedule.
12. Before patient inclusion, written informed consent must be given according to
ICH/GCP, and national/local regulations.
13. Females of childbearing potential who are sexually active with a non-sterilized male
partner must use a highly effective method of contraception for 28 days prior to the
first dose of investigational product, and must agree to continue using such
precautions for 6 months after the final dose of investigational product; cessation
of contraception after this point should be discussed with a responsible physician.
Periodic abstinence, the rhythm method, and the withdrawal method are not acceptable
methods of contraception. They must also refrain from egg cell donation for 6 months
after the final dose of investigational product. Men receiving nivolumab and who are
sexually active with women of childbearing potential will be instructed to adhere to
contraception for a period of 31 weeks after the last dose of nivolumab.
14. Patient must be affiliated to or a beneficiary of social security insurance.
1. Patients <18 years old
2. Well-differentiated neuroendocrine tumor (NET G1 and G2 according to digestive WHO
2010 classification or typical/atypical carcinoid tumor according to lung WHO 2015
classification)
3. Small cell lung NEC (except as a minor <30% component in mixed tumors)
4. Known EGFR activating mutation or ALK or ROS1 rearrangement for lung NEC
5. Brain metastasis, except if surgically resected or treated with stereotaxic
radiotherapy with no evolution within the 3 months before inclusion, and
asymptomatic patient
6. Patients with a recent history of other malignancies except adequately treated
non-melanoma skin cancer, and curatively treated in-situ cancer. Patients with
history of solid tumors, including adenocarcinoma, treated in a curative way with or
without chemotherapy and without any evidence of disease >2 years before
randomisation can be included as well.
7. History of primary immunodeficiency, history of organ transplant that requires
therapeutic immunosuppression and the use of immunosuppressive agents within 28 days
of randomization or a prior history of severe (grade 3 or 4) immune mediated
toxicity from other immune therapy.
8. Subjects with a condition requiring systemic treatment with either corticosteroids
(> 10 mg daily prednisone equivalent) or other immunosuppressive medications within
14 days of randomization. Intranasal/inhaled or topical steroids, and adrenal
replacement steroid doses ≤ 10 mg daily prednisone equivalent, are permitted in the
absence of active autoimmune disease.
9. Live attenuated vaccination administered within 30 days prior to randomization.
10. Known history of interstitial lung disease or CT-scan signs of interstitial lung
disease.
11. Subjects with an active, known or suspected autoimmune disease, including systemic
lupus erythematosis or Wegener's granulomatosis.
Note : Subjects with type I diabetes mellitis, or hypothyroidism are eligible if
only requiring hormone replacement therapy.
Subjects with skin disorders (such as vitiligo, psoriasis, or alopecia) not
requiring systemic treatment, are permitted to enroll.
12. Active or history of inflammatory or irritable bowel disease (eg, diverticulitis,
colitis, Crohn's), irritable bowel disease, celiac disease or other serious
gastrointestinal chronic conditions associated with diarrhea. Note that
diverticulosis is permitted.
13. Patients with active or uncontrolled infections or with serious illnesses or medical
conditions which would not permit the patient to be managed according to the
protocol. This includes but is not limited to:
- known prior history of active tuberculosis-disease;
- known acute or chronic B or C hepatitis by serological evaluation. Patients
with serological sequelae of hepatitis (antibodies test serologically positive
for virus) without hepatitis could be included.
- known Human immunodeficiency virus infection.
14. Concurrent administration of any anti-cancer therapies (e.g., chemotherapy, other
targeted therapy, experimental drug, etc.) other than those administered in this
study
15. Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or
any other antibody or drug specifically targeting T-cell co-stimulation or
checkpoint pathways
16. The last dose of prior chemotherapy or radiation therapy (with the exception of
palliative radiotherapy) was received less than 3 weeks prior to randomization;
17. Patients with a psychiatric history that hinders the comprehension of the
information leaflet
18. Individual deprived of liberty or placed under the authority of a tutor.
19. Unwillingness to practice effective birth control. Pregnant or lactating women.
20. Patients with other concurrent severe and/or uncontrolled medical disease which
could compromise participation in the study