Secondary angiosarcomas are aggressive mesenchymal tumors with a poor prognosis and limited therapeutic options. Recent studies conducted in patients with cutaneous squamous-cell carcinoma provide evidence that cemiplimab has the potential to be an effective treatment also for patients with secondary angiosarcomas. The purpose of this study is to evaluate the overall response rate after 24 weeks of cemiplimab treatment in patients with locally advanced or metastatic secondary angiosarcomas. The investigators hypothesis is that cemiplimab could be an effective treatment for patients diagnosed with locally advanced and metastatic secondary angiosarcomas.
Study design: A prospective, interventional, non-randomized, multicenter, phase II clinical trial. Hypothesis: Cemiplimab is registered for the use in patients with cutaneous squamous-cell carcinoma. In these patient groups cemiplimab showed impressive results. There are numerous similarities between cutaneous squamous-cell carcinoma and secondary angiosarcomas. Based on these similarities, including a complex genetic background, PD-L1 expression and MYC expression, the investigators hypothesize that cemiplimab might be an effective treatment for locally advanced and metastatic secondary angiosarcomas. Primary Objective: To evaluate the overall response rate (ORR) after 24 weeks of cemiplimab in secondary angiosarcomas, according to Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 or daylight photography as per WHO Offset Publication No. 48. Secondary Objectives: Secondary objectives include the establishment of the best ORR, median time to response, duration of response and progression free survival. The secondary objectives also comprise safety and toxicity quantification and to investigate the relation between response to cemiplimab and various tumor characteristics. Study Population: Patients eligible for inclusion are at least 18 years of age, with adequate organ function, who have a histologically confirmed diagnosis of progressive unresectable locally advanced or metastatic secondary angiosarcoma. Patients eligible are patients in the first line of treatment if they are unfit for chemotherapy and patients in advanced lines of systemic treatment. Major exclusion criteria include significant ongoing autoimmune disease that requires immunosuppressive treatment, prior treatment with immune checkpoint inhibitors, active uncontrolled infections or recent pneumonitis. All patients will provide Informed Consent prior to inclusion in the study and during the course of the trial, al relevant data will be stored in electronic Case Report Forms (eCRF). Treatment Schedule: After study inclusion, patients will be treated with Cemiplimab 350mg intravenously every three weeks. Patients will receive treatment until disease progression or discontinuation due to unacceptable toxic effects, withdrawal of consent or other reasons. The maximum treatment period will be two years, as is standard of care for patients treated with immunotherapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
After inclusion patients will be treated with Cemiplimab 350mg intravenously every three weeks
RadboudUMC
Nijmegen, Netherlands
Overall Response Rate (ORR) after 24 weeks of cemiplimab
To evaluate the overall response rate (ORR) after 24 weeks of cemiplimab in secondary angiosarcomas, according to Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 or daylight photography as per WHO Offset Publication No. 48.
Time frame: From the date of study inclusion until 24 weeks after inclusion. Interim analysis after 13 patients
Best Overall Response Rate
To establish the best ORR of patients with secondary angiosarcomas receiving cemiplimab
Time frame: From the date of study inclusion to the end of the treatment period. Assessed up to 2 years after inclusion
Time to response and duration of response
To establish the median time to response (TTR) and duration of response (DOR) in patients with secondary angiosarcomas receiving cemiplimab.
Time frame: From the date of study inclusion to the date of response or progression. Assessed up to 2 years after inclusion
Progression free survival (PFS)
To assess the median progression-free survival (PFS) of patients with secondary angiosarcomas receiving cemiplimab
Time frame: Counting from the date of study inclusion to the date of progressive disease or death. Assessed up to 2 years after inclusion.
Overall survival (OS)
To establish the overall survival (OS) of patients with secondary angiosarcomas receiving cemiplimab
Time frame: From the date of study inclusion to the date of death. If study medication is discontinued for any reason, survival follow-up takes place every 12 weeks, also assessed up to 2 years
Relation between tumor characteristics and response to treatment
To investigate possible relations between response to cemiplimab and tumor characteristics (i.e. PD-L1 expression, tumour infiltrating lymphocytes, MYC status and tumour mutational burden)
Time frame: 2-3 years
Differences between UV associated and radiation induced secondary angiosarcomas
To assess differences in response to cemiplimab between UV associated and radiation induced secondary angiosarcomas
Time frame: 2-3 years
Effect on tumor tissue
To assess effects of cemiplimab on tumor tissue by comparing pre- and post-treatment biopsies
Time frame: At specific timepoints tumor biopsies and liquid biopsies will be obtained. Tumor biopsies will be obtained at baseline, after 12 weeks and (voluntary) at end of treatment
Adverse events and toxicity
To quantify toxicity during cemiplimab treatment
Time frame: From the date of inclusion until the end of the study (by progression or at the end of the treatment period, up to 2 years
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