Atezolizumab in this study is expected to have a positive benefit-risk profile for the treatment of patients with platinum-sensitive relapse of ovarian cancer. Of interest, atezolizumab is being investigated also in combination with platinum-based doublet chemotherapy in second line (2L)/ third line (3L) platinum-sensitive recurrent ovarian cancer patients in ATALANTE (NCT02891824), which also includes bevacizumab in the combination. The study is proceeding as expected after \>100 patients enrolled and under independent Data Monitoring Committee (IDMC) supervision. Platinum-containing therapy is considered the treatment of choice for patients with platinum-sensitive relapse. However the duration of response and the prolongation of the progression free interval with chemotherapy are usually brief, among other because these chemotherapy regimens cannot be continued until progression as they are associated with neurological, renal and hematological toxicity and cannot generally be tolerated for more than about 6 to 9 cycles. Niraparib received FDA approval in March 2017 as maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy. Recently, the European Medicines Agency (EMA) has also approved niraparib as maintenance monotherapy. Despite the progress brought about by niraparib, there is a need for a more effective treatment to extend the progression free interval in this patient population. The combination with immune checkpoint inhibitors such as anti-death protein 1 (anti-PD1) or anti-death protein ligand 1 (anti-PD-L1) has a compelling rationale to this aim, especially under the light of the emerging clinical data of this combination. The use of atezolizumab concurrent to platinum-containing chemotherapy followed by niraparib as maintenance therapy after completion of chemotherapy, as per normal clinical practice, may provide further benefit to patients in terms of prolonging the progression free interval and increasing the interval between lines of chemotherapy, hence delaying further hospitalization and the cumulative toxicities associated with chemotherapy. Additionally, preliminary studies with atezolizumab suggest an acceptable tolerability profile for long term clinical use in recurrent ovarian cancer patients and other indications.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
417
Volume equivalent to 1200 mg of atezolizumab drug product. Intravenous Day 1
Intravenous. Day 1
175 mg/m². Intravenous. Day 1
200 mg or 300 mg. Oral. From day 1 to 21
1000 mg/m². Intravenous. Day 1 and day 8.
30 mg/m². Intravenous. Day 1
1200 mg. Intravenous. Day 1
Grand Hôpital de Charleroi
Charleroi, Belgium
UZ Leuven
Leuven, Belgium
CHU de Liège, site Sart Tilman
Liège, Belgium
CHU Ambroise Paré
Mons, Belgium
CHU UCL Namur site St. Elisabeth
Namur, Belgium
ICO - Paul Paupin - ANGERS
Angers, France
Progression-free survival (PFS)
Period from study entry (day of randomization) until disease progression, death or date of last contact. Progression will be based on tumor assessment made by the investigators according to the RECIST v1.1 criteria.
Time frame: 30 months
Overall survival (OS)
The observed length of life from entry into the study (day of randomization) to death due to any cause, or the date of last contact if patient alive.
Time frame: 60 months
Time to first subsequent therapy or death (TFST)
Time from the date of randomization in the current study to the start date of the first subsequent anticancer therapy.
Time frame: 60 months
Time to second subsequent therapy or death (TSST)
Time from the date of randomization in the current study to the start date of the second subsequent anticancer therapy
Time frame: 60 months
Time to second progression or death (PFS2)
Time from treatment randomization to the earliest date of assessment of progression on the next anticancer therapy following study treatment or death by any cause.
Time frame: 60 months
Incidence of Treatment Adverse Events
Frequency and severity of adverse events as assessed by CTCAE version 5.0 for the regimens administered on this study
Time frame: 60 months
Patient-reported abdominal symptoms
Clinically-meaningful improvement in patient-reported abdominal pain or bloating, defined as a 10-point decrease from the baseline score on either of the two items of the EORTC quality of life questionnaire-ovarian cancer module (QLQ-OV28) abdominal/GI symptom scale (items 31 and 32)
Time frame: 60 months
Patient-reported outcomes (PROs) of function and health related quality of life (HRQoL)
Clinical improvement, remaining stable, or deterioration in patient-reported function and HRQoL, defined as a 10-point increase, changes within 10 points, and a 10-point decrease, respectively, from the baseline score on each of the functional (physical, role, emotional, and social) and global health status/HRQoL scales of EORTC QLQ-C30
Time frame: 60 months
Objective Response Rate (ORR)
Based on investigator assessment by RECIST v1.1 during the chemotherapy phase and during the maintenance phase
Time frame: 60 months
Duration of response (DOR)
Based on investigator assessment by RECIST v1.1 during the chemotherapy phase and during the maintenance phase
Time frame: 60 months
Progression-free survival (PFS) from the beginning of the maintenance phase in all patients, in patients in complete or partial response after completing chemotherapy and in patients with stable disease after completing chemotherapy
Period from start of maintenance treatment until disease progression, death or date of last contact assessed by the investigator according to RECIST v1.1 criteria, in all patients receiving maintenance treatment as well as in the subgroup of patients with complete response/partial response (CR/PR) of stable disease (SD) after completing chemotherapy
Time frame: 60 months
Progression Free Survival (PFS) and BRCA status.
Relationship of PFS with BRCA mutational status
Time frame: 60 months
Overall Survival (OS) and BRCA status.
Relationship of OS with BRCA mutational status
Time frame: 60 months
Time to first subsequent therapy or death (TFST) and BRCA status.
Relationship of TFST with BRCA mutational status
Time frame: 60 months
Objective Response Rate (ORR) and BRCA status.
Relationship of ORR with BRCA mutational status
Time frame: 60 months
Duration of Response (DOR) and BRCA status.
Relationship of DOR with BRCA mutational status
Time frame: 60 months
Progression Free Survival (PFS) and PD-L1 status
Relationship of PFS with PD-L1 expression status
Time frame: 60 months
Overall Survival (OS) and PD-L1 status
Relationship of OS with PD-L1 expression status
Time frame: 60 months
Time to first subsequent therapy or death (TFST) and PD-L1 status
Relationship of TFST with PD-L1 expression status
Time frame: 60 months
Objective Response Rate (ORR) and PD-L1 status
Relationship of ORR with PD-L1 expression status
Time frame: 60 months
Duration of Response (DOR) and PD-L1 status
Relationship of DOR with PD-L1 expression status
Time frame: 60 months
Efficacy of atezolizumab compared to placebo in the PD-L1 negative and PD-L1 positive subgroups
To evaluate the immune response to atezolizumab
Time frame: 60 months
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CHU Besançon
Besançon, France
Institut Bergonié
Bordeaux, France
Centre François Baclesse
Caen, France
Centre Jean Perrin
Clermont-Ferrand, France
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