This is an Open-label, single-arm, multicenter Phase II pilot study to assess the efficacy and safety of BMS-936558 with stereotactic ablative radiation therapy after induction chemotherapy in cholangiocarcinoma.
The current standard regimen for advanced biliary tract cancers as per NCCN guidelines (version 2.2019) is gemcitabine plus cisplatin. However, since no single chemotherapy agent or combination regimen has consistently led to durable tumor regression, prevention of recurrent obstruction following palliative intervention, and extension of survival beyond 8 to 15 months, there is a pressing need for new treatment approaches in patients with dismal prognosis. Recent discoveries in tumor immunology, paralleled by technological advances in radiation therapy, have provided promising role for combining ablative radiotherapy with targeted immune modulators (El Chediak et al., 2017). objectives: Primary: To evaluate the progression-free survival (PFS) at 8 months and the disease control rate (DCR) in patients with non-resectable locally-advanced or metastatic or recurrent intrahepatic or extrahepatic cholangiocarcinoma (CCA) following BMS-936558 /stereotactic ablative radiation therapy (SBRT) treatment. Secondary: 1\) To evaluate the overall survival (OS) rate in patients with advanced intrahepatic or extrahepatic CCA following BMS-936558/SBRT treatment. . 3\) To evaluate tumor response rates at the primary and secondary sites using the response evaluation criteria in solid tumors (RECIST1.1) criteria. 4\) To evaluate the duration of response at non-irradiated tumor sites in patients with Stage IV disease. 5\) To evaluate the following biomarkers: CD3+, CD4+, and CD8+ T cell infiltration, and changes in PD-L1 expression at baseline and following first cycle of BMS-936558 and SBRT. 6\) To assess the safety and tolerability of BMS-936558/SBRT according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAEv5). 7\) To assess the quality of life of the patients through completed FACT-Hep questionnaires.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
1
BMS-936558 followed by 30 grays of 3 to 5 fractions of high dose SBRT followed by monthly BMS-936558 until progression
Institut Jule Bordet
Brussels, Belgium
Cliniques universitaires Saint-Luc
Brussels, Belgium
American University of Beirut Medical Center
Beirut, Lebanon
Centre hospitalier de Luxembourg
Luxembourg, Luxembourg
To evaluate the progression-free survival (PFS) at 8 months and the disease control rate (DCR) in patients with non-resectable locally-advanced or metastatic or recurrent intrahepatic or extrahepatic CCA following BMS-936558/SBRT treatment
will be done at 8 months of the initial patient diagnosis and after 8 cycles of treatment
Time frame: 8 months
To evaluate the overall survival (OS) rate in patients with advanced intrahepatic or extrahepatic CCA following BMS-936558/SBRT treatment.
survival status will be evaluated every 3 months after progression
Time frame: up to 2 years
To evaluate tumor response rates at the primary and secondary sites using the response evaluation criteria in solid tumors (RECIST1.1) criteria.
evaluation will be done by CT scan of chest ,abdomen and pelvis every 4 months from the D1 ( after each 4 cycles of treatment until progression )
Time frame: every 4 months from the date of first treatment visit until the date of first documented progression, assessed up to 2 years.
To evaluate the duration of response at non-irradiated tumor sites in patients with Stage IV disease.
evaluation will be done by CT scan of abdomen, pelvis and chest every 4 months (after every 4 cycles of treatment until progression )
Time frame: every 4 months from the date of first treatment visit until the date of first documented progression, assessed up to 2 years.
To evaluate the following biomarkers: CD3+, CD4+, and CD8+ , and changes in PD-L1 expression at baseline and following first cycle of BMS-936558and SBRT.
biomarkers will be assessed from baseline biopsy and after receiving first BMS-936558and SBRT for changes. CD3+, CD4+, and CD8+: Will be quantified in mm2 in the most abundant tumor-infiltrating area in both, the stroma and the tumor, of the baseline biopsy (continuous variable) PD-L1: Will be evaluated on tumor cells and infiltrating immune T cells and be classified as negative or positive or not applicable (categorical variable)
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Time frame: at baseline/inclusion visit and Day20 (after radiotherapy)