NIPISAFE is open-label, phase II study to identify a combination scheme of nivolumab and ipilimumab with a high level of clinical activity, but with a lower toxicity in MSI/dMMR metastatic colorectal cancer patients.
This is a randomized non-comparative two-stage phase II study with a co-primary endpoint (toxicity and progression-free survival) to evaluate two different schemes of the nivolumab and ipilimumab combination in terms of the toxicity and efficacy in MSI/dMMR metastatic colorectal cancer patients in order to identify a combination scheme with a higher level of clinical activity and a lower toxicity. Patients will be randomized in a 2:1 ratio to receive one of the following treatments: Experimental ARM A: Nivolumab 480 mg every 4 weeks and ipilimumab 1 mg/kg every 6 weeks for a total of 24 months of treatment Control ARM B: Nivolumab 240 mg and ipilimumab 1 mg/kg every 3 weeks for 4 dosing cycles. Maintenance of 96 weeks: Nivolumab 480 mg every 4 weeks for 24 dosing cycles for a total of 24 months of treatment (or less in case of RECIST PD or limiting toxicity, whichever occurs first).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
96
Nivolumab 480 mg q4w + Ipilimumab 1 mg/kg q6w
induction phase : Nivolumab 240 mg q3w + Ipilimumab 1 mg/kg q3w and then maintenance : Nivolumab 480 mg q4w
Institut Sainte Catherine
Avignon, France
CHU Jean Minjoz
Besançon, France
CHU Morvan
Brest, France
Number of adverse events grade 3 or 4 at week 24 for two combination schemes.
According to NCI Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0
Time frame: At week 24
Progression-free survival (PFS) at week 24 for two combination schemes.
PFS is defined as time from inclusion to the first documented PD determined by the Investigator assessment in accordance to RECIST v1.1 or death due to any cause, whichever occurs first. Alive patients without progression will be censored at the last tumor assessment, either during study treatment period or during follow-up period.
Time frame: At week 24 for two combination schemes
Number of participants with treatment-related adverse events
All grade and severe toxicities, according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
Time frame: Assessed up to 80 months
Overall response rate (ORR)
To assess ORR of two combination schemes (RECIST v1.1),
Time frame: At weeks 24 and 48, and at 2 years
PFS of two combination schemes according to RECIST v1.1
PFS is defined as time from inclusion to the first documented PD determined by the Investigator assessment in accordance to RECIST v1.1 or death due to any cause, whichever occurs first. Alive patients without progression will be censored at the last tumor assessment, either during study treatment period or during follow-up period.
Time frame: At week 48 and at 2 years
PFS of two combination schemes according to Immune Response Evaluation Criteria In Solid Tumors (iRECIST)
PFS is defined as time from inclusion to the first documented PD determined by the Investigator assessment in accordance to RECIST v1.1 or death due to any cause, whichever occurs first. Alive patients without progression will be censored at the last tumor assessment, either during study treatment period or during follow-up period.
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Hôpital Henri Mondor
Créteil, France
Centre Georges François Leclerc
Dijon, France
Clinique Victor Hugo-Centre jean Bernard
Le Mans, France
Hopital Franco-Britannique - Fondation Cognacq-Jay
Levallois-Perret, France
CHRU Lille
Lille, France
Centre Léon Bérard
Lyon, France
Hôpital Privé Jean Mermoz
Lyon, France
...and 9 more locations
Time frame: At weeks 24 and 48, and at 2 years
Overall survival (OS) of two combination schemes (RECIST v1.1),
OS is defined as the time between inclusion and death.
Time frame: At week 48 and at 2 years
Percentage of patients who received immune modulating concomitant medication
To evaluate the percentage of patients who received immune modulating concomitant medication (e.g., corticosteroids, infliximab, mycophenolate mofetil).
Time frame: Until the study treatment end - 48 months
Percentage of patients who received hormonal replacement therapy for immune-related endocrine toxicities
To evaluate the percentage of patients who received hormonal replacement therapy for immune-related endocrine toxicities.
Time frame: Until the study treatment end - 48 months
Median time to onset, median time to resolution (grade 3-4) of serious adverse event (SAEs) and Treatment-related adverse events (TRAEs),
To assess median time to onset and median time to resolution of serious AEs (SAEs) and TRAEs (grade 3-4).
Time frame: Up to 80 months
Time to Health-related quality of life (HRQoL) score definitive deterioration (TUDD)
TUDD is defined as the time interval between randomization and the first occurrence of a decrease in quality of life questionnaire (QLQ)-C30 score ⩾5 points without any further improvement in Quality of life (QoL) score ⩾5 points or any further available QoL data. TUDD will be estimated using the Kaplan-Meier method and the long-rank test. Cox regression analyses will be used to identify HRQoL items influencing TUDD. All analyses will be done on the HRQoL population.
Time frame: assessed up 48 months