The combination of chemotherapy with PD-1 immune checkpoint blockade agents demonstrated promising results especially in the neo-adjuvant and early metastatic setting in TNBC. However, a substantial proportion of patients do not derive benefit from this approach. CD73 is an adenosine-generating enzyme overexpressed in several cancers and associated with poor prognosis and reduced anti-tumor immunity in TNBC. Monoclonal antibodies directed against CD73 could help to reprogram the tumor microenvironement by decreasing the adenosine mediated immunosuppression, particularly as a synergistic immunotherapeutic combination with immune checkpoint blockade. The SYNERGY trial investigates the role of an anti-CD73 (MEDI9447) in a randomized phase II trial evaluating the efficacy and safety of the combination of chemotherapy (paclitaxel + carboplatin) with immunotherapy (durvalumab \[anti-PD-L1\] +/- MEDI9447 \[anti-CD73\]) in previously untreated locally recurrent inoperable or metastatic TNBC. A large translational research program is planned including baseline and dynamic biomarkers
The trial consists of two parts: PHASE I Part 1 is a phase I trial examining the combination of paclitaxel, carboplatin, durvalumab and oleclumab in order to define the recommended phase II dose (RP2D) of oleclumab in this treatment combination. The period for DLT evaluation is defined as the time from receiving the first dose of oleclumab until the planned administration of the third dose; this corresponds to 28 days after receiving the first dose of oleclumab in case no treatment interruption occured. Patients who develop a DLT will stop study treatment permanently. PHASE II Part 2 is a multicenter, randomized, open-label trial investigating the role of an anti-CD73 monoclonal antibody (oleclumab) in combination with an anti-PD-L1 antibody (durvalumab) plus chemotherapy (paclitaxel + carboplatin) as first-line treatment for locally recurrent inoperable or metastatic TNBC. Patients will be randomized between chemotherapy (paclitaxel and carboplatin) with immunotherapy including durvalumab with or without oleclumab (1:1 ratio). PHASE I and PHASE II Paclitaxel and carboplatin will be given weekly for a total of 12 injections. Immunotherapy (durvalumab with or without oleclumab) will be given as long as the patient benefits. Premature discontinuation of paclitaxel/carboplatin or discontinuation of durvalumab/oleclumab is indicated in case of: * Progressive disease (PD) using RECIST v1.1 criteria or iRECIST assessed locally * Unacceptable toxicity * Intercurrent illness that necessitates discontinuation of study treatment * Investigator's decision to withdraw the subject * Pregnancy * Subject noncompliance with the study treatment or procedure requirements * Withdrawal of consent to treatment * Death * Administrative reasons requiring cessation of study treatment. Initial disease status will be evaluated by imaging studies (contrast-enhanced CT scan of the chest, the abdomen and the pelvis or MRI of the chest, the abdomen and the pelvis) during the screening phase. Disease status will be followed by imaging studies at weeks 8 (± 3 days), 16 (± 3 days) and 24 (± 3 days) post start of treatment (allowing efficacy data to be captured as close to 24 weeks post start of study treatment as possible for a more accurate evaluation of DCR). Thereafter imaging will continue every 12 weeks (± 3 days; contrast-enhanced CT scan or MRI) independent of any treatment delays. Patients who stopped all study treatments for reasons other than PD will continue post-treatment imaging studies for disease status follow-up as described in the schedule of assessment until verified PD, start of a new anti-cancer treatment, withdrawal of consent to study participation, death, or end of the study whichever comes first. Note: Pseudo-progression related to immunotherapy: Patients experiencing PD as defined by RECIST v1.1 can continue the study treatment in case of good clinical condition assessed by a stable or even improved ECOG performance status. If the next assessment of tumour burden (8 weeks later) confirms PD (as defined by iRECIST) study treatment must be discontinued. Unconfirmed PD as defined by iRECIST (iUPD) can only be assigned for the first 2 imaging assessments (week 8 and week 16) and several times as long as confirmed progression (iCPD) is not confirmed at the next assessment. If PD is not confirmed, reassessments continue as originally planned.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
129
Patients will be randomized between chemotherapy (paclitaxel and carboplatin) with immunotherapy including durvalumab with or without oleclumab (1:1 ratio).
Patients will be randomized between chemotherapy (paclitaxel and carboplatin) with immunotherapy including durvalumab with or without oleclumab (1:1 ratio).
Patients will be randomized between chemotherapy (paclitaxel and carboplatin) with immunotherapy including durvalumab with or without oleclumab (1:1 ratio).
Patients will be randomized between chemotherapy (paclitaxel and carboplatin) with immunotherapy including durvalumab with or without oleclumab (1:1 ratio).
Institut Jules Bordet
Brussels, Belgium
Cliniques universitaires Saint Luc
Brussels, Belgium
Grand Hôpital de Charleroi
Charleroi, Belgium
UZ Leuven Gasthuisberg
Leuven, Belgium
CHU UCL Namur Sainte-Elisabeth
Namur, Belgium
Clinique St Pierre
Ottignies, Belgium
Sint-Augustinus, GZA Ziekenhuizen
Wilrijk, Belgium
CHU Besançon
Besançon, France
Institut Bergonié
Bordeaux, France
Centre Georges François Leclerc
Dijon, France
...and 6 more locations
Phase I:The adverse events (AEs)
Safety and tolerability will be assessed by monitoring frequency, duration and severity of adverse events (AEs).
Time frame: Through the Phase I, approximately 7 months
Phase II: Clinical Benefit of oleclumab in combination with chemotherapy and durvalumab by the comparing the CB rate at 24 weeks from the 1st dose of study drug administration between patients treated with or without the anti-CD73 antibody oleclumab
CB is defined as a patient who achieved CR or PR or demonstrated SD at 24 weeks from the 1st dose of study drug administration based on RECIST v1.1.
Time frame: At 24 weeks from the 1st study drug administration
Phase I: Recommended phase II dose (RP2D) of oleclumab in combination with chemotherapy and durvalumab
Safety and tolerability will be assessed by monitoring frequency, duration and severity of adverse events (AEs) including Dose limiting toxicities (DLTs) as defined per protocol.
Time frame: through study completion, approximately 50 months
Phase II: Efficacy of oleclumab in combination with chemotherapy and durvalumab by comparing the OR rate (ORR; CR + PR) and the duration of response (DOR) between patients treated with or without the anti-CD73 antibody oleclumab.
OR is defined as a patient (in the intent-to treat population) who achieved a CR or PR as best overall response (BOR) based on RECIST v1.1.
Time frame: through study completion, approximately 50 months
Phase II: Efficacy of oleclumab in combination with chemotherapy and durvalumab by comparing the OR rate (ORR; CR + PR) and the duration of response (DOR) between patients treated with or without the anti-CD73 antibody oleclumab.
DOR is defined as the time from documentation of first tumour response to disease progression based on RECIST v1.1.
Time frame: through study completion, approximately 50 months
Phase II: the progression-free survival (PFS)
PFS is defined as the time from 1st study drug administration to the first documented disease progression based on RECIST v1.1 or death due to any cause, whichever occurs first. (Subjects who are alive and progression free at the time of analysis will be censored at the time-point of their last tumour assessment by imaging.)
Time frame: through study completion, approximately 50 months
Phase II: overall survival (OS)
OS is defined as the time from 1st study drug administration to death due to any cause. (Subject without documented death at the time of the analysis will be censored at the date of the last follow-up.)
Time frame: through study completion, approximately 50 months
Phase II: AEs assessment based on CTCAE 5.0.
Frequency, duration and severity of AEs assessment based on CTCAE 5.0.
Time frame: through study completion, approximately 50 months
Phase II: Efficacy, clinical and survival benefits of oleclumab in combination with chemotherapy and durvalumab according to PD-L1 and CD73 expression.
PD-L1 and CD73 expression will be assessed using immunohistochemistry (IHC) on the screening FFPE tumour tissue lesion biopsy by a central laboratory prior to randomization for stratification purposes
Time frame: through study completion, approximately 50 months
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