This is an open-label, multicentric, international, phase II trial testing aromatase inhibitors in combination with durvalumab in patients with CD8+ T cell infiltration (\>10% CD8+ T cells in the tumor). The trial includes two sequences: The first part of the treatment will consist in 4-6 weeks treatment with immune-attractants; in the second part, CD8+ patients will receive 6 months of durvalumab combined with exemestane.
The study is conducted in 2 parts: Part 1: lymphocyte attraction. After the screening phase, the patient will receive immune-attractant combined with exemestane for six weeks. As immune-attractants are added over the course of the study, they will appear as subsequent appendices in the full protocol. Up to 4 cohorts may be tested sequentially in this design until up to 240 evaluable patients have been treated. The first cohort of patients will receive tremelimumab (3 mg/kg, single infusion) combined with exemestane (25 mg daily). In each cohort, an interim analysis will be performed after 30 patients in order to potentially stop the cohort (if less than 25% of patients present \>10% CD8+ cells in the tumor after 3 weeks). If all 4 cohorts are closed and the target number of 56 patients for part 2 has not been reached, additional patients will be recruited and treated with the best performing immune-attractant treatment based on the part I results. From the moment 56 patients are included in part 2, no more patients will be entered in part 1. After three weeks (+/- 3 days), a tumor biopsy will be done. Patients who present \>10% CD8+ cells in the tumor after 3 weeks and remain eligible will be included in the second part of the trial (patients who do not present CD8+ T cells on the 3-week biopsy will be treated at the investigator's choice). Part 2: lymphocyte activation (anti-PD1 treatment) Four to six weeks after immune-attractant start, patients having \>10% CD8+ cells in the tumor will receive durvalumab 1500 mg Q4W (equivalent to 20 mg/kg Q4W) IV, combined with exemestane (25 mg daily), for six months. Part 2 will include two steps. In the first step, we will include 23 patients. If 2 or more pathological complete responses are observed in these 23 patients, the part 2 will move to step 2. 33 additional patients will be included in the step 2.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
61
The first cohort patients will receive tremelimumab (3 mg/kg, single infusion) as immune-attractants combined with exemestane (25 mg daily).
Durvalumab (lymphocyte activation) will be administrated at a dose of 1500 mg Q4W (equivalent to 20 mg/kg Q4W) IV, combined with exemestane (25 mg daily), for six months
After three weeks (+/- 3 days) of immune-attractants, a tumor biopsy will be done. Patients who present \>10% CD8+ cells in the tumor after 3 weeks will receive the Durvalumab
Centre Hospitalier cote Basque
Bayonne, France
Institut Bergonié
Bordeaux, France
Centre François Baclesse
Caen, France
Centre Hospitalier de Cahors
Cahors, France
Centre Hôspitalier de Cholet
Cholet, France
Centre George François Leclerc
Dijon, France
Institut Daniel Hollard Groupe Hôspitalier
Grenoble, France
Centre Oscar Lambret
Lille, France
CHU Limoges
Limoges, France
Centre Hospitalier Bretagne Sud
Lorient, France
...and 19 more locations
pathological Complete Response
Response at surgery
Time frame: at time of surgery
Number of CD8+ T cell
exam at biopsy and comparison between biopsy and Baseline biopsy rates
Time frame: at biopsy (3 weeks)
Clinical response
Clinical exam
Time frame: after 6 months of Durvalumab
Assessment of Ki67
measure of Ki67
Time frame: at surgery
Toxicities
Common terminology criteria for adverse events (CTC-AE) v4.03
Time frame: 1 year and 8 months
Predictive value of Mutational load for efficacy of Durvalumab
exome sequencing on baseline samples
Time frame: on baseline biopsy and blood samples
Predictive value of PDL1 expression for the efficacy of Durvalumab
correlate Immune infiltrate intensity with the proportion of tumor cells expressing PD-L1 by Ventana SP263 assay
Time frame: on baseline biopsy and biopsy at 3 weeks
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