Single arm multicenter phase II trial evaluating the role of Pembrolizumab in combination to Carboplatin-Paclitaxel chemotherapy in locally advanced cervical cancer patients.
Patients with stage IB2-IIB cervical cancer will be treated with 3 cycles of neoadjuvant Carboplatin-Paclitaxel chemotherapy (Carboplatin AUC 5 d1 q 21+ Paclitaxel 175 mg/mq d1 q 21)+ Pembrolizumab (200 mg flat dose every 3 weeks). After 3 cycles of neo-adjuvant platinum-based chemotherapy patients non progressing will undergo radical surgery. After surgery, patients presenting with high risk factors (positive lymphnodes, positive parametria, positive surgical margins or at least 2 of the following risk factor between tumor diameter \>3 cm, LVSI, stromal infiltration \>1/3) will receive 3 cycles of adjuvant Carboplatin-Paclitaxel chemotherapy + Pembrolizumab in combination and maintenance with Pembrolizumab 200 mg every 3 weeks until progression or unacceptable toxicity or patient consent withdrawal for up to 35 cycles.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Humanized antibody used in cancer immunotherapy. It targets the programmed cell death protein 1 (PD-1) receptor of lymphocytes.
Chemotherapy medication
Chemotherapy medication
Fondazione Policlinico Universitario A. Gemelli IRCCS
Rome, Italy
RECRUITING2-years Progression-free survival
The combination of Pembrolizumab-chemotherapy is expected to increase 2-years progression free survival with respect to historical controls.
Time frame: 42 months
Overall survival
The combination of pembrolizumab- chemotherapy is expected to increase overall survival with respect to historical controls
Time frame: 42 months
Clinical Response rate
The combination of pembrolizumab-chemotherapy is expected to increase clinical response rate with respect to historical controls
Time frame: 42 months
Pathologic optimal response
The combination of pembrolizumab-chemotherapy is expected to increase pathologic response rate with respect to historical controls
Time frame: 42 months
Adverse events
The combination of pembrolizumab-chemotherapy is expected to have an acceptable toxicity profile
Time frame: 42 months
Quality of life
At baseline, every 3 cycles during the chemotherapy treatment phase, at chemotherapy completion, 6 months after chemotherapy completion, 1 and 2 years after chemotherapy completion and at progression, will be assessed the quality of life of patients according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and CX24. The questionnaires record in a scale from 1 (better outcome) to 4 (worse outcome) the physical, role, emotional, cognitive and social function of patients.
Time frame: 42 months
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Immune-related gene signatures associated with response or resistance to immune checkpoint blockade
1)Messenger RNA (mRNA) transcript profiling will be performed.
Time frame: 42 months
Immune-related gene signatures associated with response or resistance to immune checkpoint blockade
blood sample will be collected before cycle 1, before cycle 6 and at progression. CD3 cells will be isolated and CD4/CD8 ratio will be evaluated by FACS analyses.
Time frame: 42 months
Immune-related gene signatures associated with response or resistance to immune checkpoint blockade
serum levels of IL -2, IL-10; TGF- Beta and IL-6 will be assessed.
Time frame: 42 months
Immune-related gene signatures associated with response or resistance to immune checkpoint blockade
tumor biopsies at progression will be collected in order to determine the PD-1R infiltrating lymphocyte population before and after treatment.
Time frame: 42 months
Immune-related gene signatures associated with response or resistance to immune checkpoint blockade
single and dual staining IHC analysis of: OX40-OX40L; ICOS; PD1, PD-L1, PD2, PDL2 and CTLA-4; FOXP3 and CD4; CD95 and CD95L
Time frame: 42 months