Chemotherapy is controversial for soft tissue sarcoma that has not yet metastasized. Surgery and radiation are effective for local control, but there are no highly effective interventions to prevent metastatic spread of soft tissue sarcoma. Immunotherapy has shown promise in other types of cancer. Combining two types of immunotherapy agents with preoperative radiation may help the immune system recognize the sarcoma and stimulate an anti-tumor immune response.
The main purposes of this study are to evaluate the safety, tolerability, and efficacy of Durvalumab and Tremelimumab in combination with radiation prior to surgical resection of high-risk soft tissue sarcoma in the pelvis and extremities. Patients will receive the same radiation therapy and surgical care they would receive normally and with no change in timing or duration of each treatment. They will also receive two immunotherapy agents, Durvalumab and Tremelimumab, during radiation prior to surgery, and a single agent, Durvalumab, after surgery.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Three doses of Durvalumab (1500 mg) and Tremelimumab (75 mg) given intravenously once every four weeks during radiotherapy prior to surgery. Radiation therapy delivered with a minimum dose of 50 Gy and 1.8-2 Gy per fraction. Bulky sarcomas, defined as \>10 cms in greatest dimension, receive a single 15 Gy fraction of high-dose spatially fractionated (GRID) radiation therapy within 1-3 days prior to radiation therapy Surgical resection is performed at least 5-8 weeks after cessation of radiotherapy and 4 weeks after completion of neoadjuvant immunotherapy. Patients with no evidence of disease following surgical resection receive four additional doses and patients with evidence of disease receive nine additional doses of Durvalumab (1500 mg IV) once every four weeks unless there is clear progression of disease.
University of Arizona
Tucson, Arizona, United States
University of Maryland Medical Center, Greenebaum Comprehensive Cancer Center
Baltimore, Maryland, United States
Allegheny General Hospital
Pittsburgh, Pennsylvania, United States
Toxicity: Number of subjects experiencing high-grade toxicity
Number of subjects experiencing high-grade toxicity
Time frame: 90 days after receipt of final dose of Durvalumab monotherapy or 180 days after receipt of final dose of combination Durvalumab/Tremelimumab, whichever is longer
Histopathologic Response
Number of subjects with an excellent response on histopathologic examination of the surgically removed tumor
Time frame: At time of surgery
Overall Survival Rate
Percentage of patients still alive
Time frame: Two years after start of treatment
Overall Survival Rate
Percentage of patients still alive
Time frame: Five years after start of treatment
Disease-Specific Survival Rate
Percentage of patients who have not died from soft tissue sarcoma
Time frame: Two years after start of treatment
Disease-Specific Survival Rate
Percentage of patients who have not died from soft tissue sarcoma
Time frame: Five years after start of treatment
Relapse-Free Survival Rate
Percentage of patients who have not had a documented relapse of local or distant disease
Time frame: Two years after start of treatment
Relapse-Free Survival Rate
Percentage of patients who have not had a documented relapse of local or distant disease
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Time frame: Five years after start of treatment
Radiologic Response To Treatment
Best overall response to Neoadjuvant Radiation and Immunotherapy using Response Evaluation Criteria in Solid Tumors (RECIST)
Time frame: At time of surgery
Radiologic Response To Treatment
Best overall response to Neoadjuvant Radiation and Immunotherapy using immune-related response criteria (irRC)
Time frame: At time of surgery