The study is a two-stage trial: 1. First stage (closed - 16 patients recruited in France): Phase I feasibility trial to evaluate the safety of the combination of Nivolumab + metronomic chemotherapy considering three possible metronomic chemotherapy regimens 2. Second stage (opened - 86 patients expected in France and Belgium): Phase II randomized controlled balanced 1:1 open-label trial comparing the efficacy of the metronomic chemotherapy regimen selected at the end of the previous stage (arm C: cyclophosphamide, capecitabine, vinblastine), with or without nivolumab. 3. "Trans-MetroPD1" ancillary sub-study is partially implemented since April 2022, and proposed to patients participating to second stage
1. First stage (closed): * Arm A: Nivolumab + Cyclophosphamide-Vinblastine * Arm B: Nivolumab + Capecitabin * Arm C: Nivolumab + Cyclophosphamide-Vinblastine + Capecitabin Arm A and Arm B have been allocated sequentially (A/B/A/B/A/B). Arm C has been opened, since arm A and Arm B were deemed safe. In each arm, the second patient was not recruited before the first patient has been observed for a 28-day duration. 2. Second stage (opened): Following the analysis of safety data from first stage, and according to IDMC's recommendations on December 2020, the metronomic chemotherapy selected for second stage was arm C: cyclophosphamide, capecitabine, vinblastine Randomization will be balanced 1:1, controlling for: * histological type: embryonal brain tumor, ependymoma, low-grade glioma, rhabdomyosarcoma, neuroblastoma, Ewing sarcoma, and other solid tumors after approval from coordinators, * and treating center, using a dynamic allocation of treatment (minimization program) with a random factor set at 0.8. 3. Trans-MetroPD1 is divided into 3 axes: * to evaluate the health-related quality of life * to measure the kinectis of progastrin/hPG80, a biomarker over-expressed in a wide range of cancers * to determine the distribution of immune cells within blood tissue
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
63
* Experimentals Arm A or C (First stage): 2 mg/m2/day IV, weekly per cycle, 28 days cycle * Experimental Arms Metronomic or Metronomic+Nivolumab (second stage): see C
* Arm A (First stage): 30 mg/m2/day PO, D1-4// D8-11// D15-18// D22-25 per cycle, 28 days cycle * Arm C (First stage): 30 mg/m2/day PO, D1-D4// D15-D18 per cycle, 28 days cycle * Metronomic or Metronomic+Nivolumab Arm (second stage): see C
* Arm B (First stage): 400 to 600 mg/m2/day PO, all days per cycle, 28 days cycle * Arm C (First stage): 400 to 600 mg/m2/day PO, D8-D11// D22-D25 per cycle, 28 days cycle * Metronomic or Metronomic+Nivolumab Arm (second stage): see C
* Arm A, B or C (First stage): 3 mg/kg IV, D1 \& D15 per cycle, 28 days cycle * Metronomic+Nivolumab Arm (second stage): 3 mg/kg IV, D1 \& D15 per cycle, 28 days cycle
Cliniques Universitaires Saint-Luc (CUSL)
Brussels, Belgium
University Hospital Ghent
Ghent, Belgium
University Hospital Leuven
Leuven, Belgium
Centre Oscar Lambret
Lille, France
Centre Léon Bérard (IHOPe)
Lyon, France
Hôpital La Timone, AP-HM
Marseille, France
Hôpital d'Enfants - CHRU Nancy
Nancy, France
Hôpital Mère-Enfant, CHU Nantes
Nantes, France
Institut Curie
Paris, France
Hôpital de Hautepierre, CHRU Strasbourg
Strasbourg, France
...and 1 more locations
Dose Limiting Toxicities according to the NCI-CTCAE V5
First Stage Primary Outcome 3 metronomic CT are : A:Cyclophosphamide + Vinblastine B:Capecitabin C:Cyclophosphamide + Vinblastine + Capecitabin
Time frame: Over the first chemotherapy cycle (28 days)
Progression-free survival according appropriate criteria (RANO, RAPNO, WHO, INRC, RECIST v1.1).
Second Stage Primary Outcome Metronomic chemotherapy is the same as regimen selected at the end of the first stage
Time frame: up to 2 years
Adverse events according to the NCI-CTCAE V5.
First Stage Secondary Outcome 1 \& Second Stage Secondary Outcome 1
Time frame: up to 2 years
Tumor response in terms of complete/partial response or stable/progressive disease (using RANO, RAPNO, WHO, INRC, or RECIST v1.1) and overall survival
Second Stage Secondary Outcome 2
Time frame: up to 2 years
Dose-intensity for each drug (ratio between the computed dose-intensity, and the protocol dose-intensity)
First Stage Secondary Outcome 2 \& Second Stage Secondary Outcome 3
Time frame: up to 2 years
Description of molecular profile (number of genetic alterations) on individual tumor ; the data will be collected from large-scale analysis programs performed in Europe (Mappyacts, France Genomic 2025) in agreement with the Sponsors
Second Stage Secondary Outcome 4
Time frame: At study entrance
Health Related Quality of Life using the age-appropriate KINDL-R questionnaire (self- and proxy-assessment)
Second Stage Ancillary Outcome 1
Time frame: from date of randomization until the date of first documented progression or date corresponding to the end of treatment, assessed up to 24 months
Dosage of circulating progastrine (hPG80) on blood-derived samples.
Second Stage Ancillary Outcome 2
Time frame: from date of randomization until the date of first documented progression or date corresponding to the end of treatment, up to 24 months
Counting of immune cells (number of: B cells, T cells, NK cells, dendritic cells subsets, and monocytes populations at each timepoint) on blood and blood-derived samples with flow cytometry analysis
Second Stage Ancillary Outcome 3
Time frame: At day-0, Day-8, Day-15, Day-28, Day-42, and until the date of first documented progression (assessed up to 24 months)
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