Immunotherapies have revolutionized medical oncology following the remarkable and, in some cases, unprecedented outcomes observed in certain groups of patients with cancer. However results in adults and mainly in pediatric cancer are still disappointing. Modulators of angiogenesis, such as VEGF, have a broad range of diverse effects on the immune system and the tumor micro-environment that are mainly immunosuppressive. In patients with early-stage disease, anti-VEGF therapy can lead to antitumor effects by modulating immune mechanisms - provided that therapy is maintained for an adequate length and tumors are sufficiently immunogenic. Nevertheless, blocking angiogenic molecules using a strategy based on a single therapeutic approach is likely insufficient to generate a complete or robust immune response against cancer, especially in patients with advanced-stage disease. Based on the results of previous studies which evaluated the safety profile of spartalizumab, of pazopanib and the combination of antiangiogenic agents with checkpoint inhibitors, a study combining spartalizumab and low-dose pazopanib in refractory or relapsed solid tumors of pediatric and adults is proposed. This study will include 2 separate cohorts: * the pediatric cohort will consist of a phase I study (dose-finding and expansion phases) combining pazopanib at a fixed dose of 225 mg/m2 and spartalizumab with four potential candidate doses (2, 3, 4 and 6 mg/kg). * the adult cohort will consist of a phase II study combining pazopanib at a fixed dose of 400 mg and spartalizumab at the RP2D of 400 mg every 4 weeks.
Immunotherapies have revolutionized medical oncology following the remarkable and, in some cases, unprecedented outcomes observed in certain groups of patients with cancer. However results in adults and mainly in pediatric cancer are still disappointing. One hypothesis is that the tumor micro-environment (TME) - characterized by hypoxia, a low pH, and a high interstitial fluid pressure - can reduce the effectiveness of virtually all types of anticancer therapies, including immunotherapy. In adults, combination with other therapeutic modalities, including anti-angiogenic agents, is one of the many strategies currently under investigation to improve the response rates and duration of immunotherapies. Modulators of angiogenesis, such as VEGF, have a broad range of diverse effects on the immune system and the tumor micro-environment that are mainly immunosuppressive. In patients with early-stage disease, anti-VEGF therapy can lead to antitumor effects by modulating immune mechanisms - provided that therapy is maintained for an adequate length and tumors are sufficiently immunogenic. Nevertheless, blocking angiogenic molecules using a strategy based on a single therapeutic approach is likely insufficient to generate a complete or robust immune response against cancer, especially in patients with advanced-stage disease. Therefore, such anti-angiogenic agents will likely need to be used in combination with various immunotherapeutic strategies that boost adaptive immune responses, such as those described in the next sections. For these reasons, the investigators proposed to combine immunotherapy and low dose of pazopanib to enhance the efficacy of immunotherapy in some selected pediatric patients and adults. PDR001 (also referred to as spartalizumab) is a humanized monoclonal antibody (mAb) directed against human programmed death-1 (PD-1) that blocks the interaction between PD-1 and its ligands (PD-L1 and PD-L2). Pazopanib is a potent, selective, oral, ATP competitive multitargeted receptor tyrosine kinase inhibitor of vascular endothelial growth factor receptors (VEGFR) -1, -2, and -3, c-kit, and platelet-derived growth factor receptors. It is approved by the US Food and Drug Administration for the treatment of advanced renal cell carcinoma and soft tissue sarcoma (STS) in adults. Based on the results of previous studies which evaluated the safety profile of spartalizumab, of pazopanib and the combination of antiangiogenic agents with checkpoint inhibitors, a study combining spartalizumab and low-dose pazopanib in refractory or relapsed solid tumors of pediatric and adults is proposed. This study will include 2 separate cohorts: * the pediatric cohort will consist of a phase I study (dose-finding and expansion phases) combining pazopanib at a fixed dose of 225 mg/m2 and spartalizumab with four potential candidate doses (2, 3, 4 and 6 mg/kg). * the adult cohort will consist of a phase II study combining pazopanib at a fixed dose of 400 mg and spartalizumab at the RP2D of 400 mg every 4 weeks.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
Infusion of spartalizumab at four dose escalation levels: 2, 3, 4 and 6 mg/kg in successive cohorts of 3 patients, depending on the number of patients with dose-limiting toxicity (DLT) to maximum tolerated dose (MTD).
Oral pazopanib treatment at a fixed dose of 225mg/m²/day
Infusion of 400 mg of spartalizumab on Day1 of each cycle.
Oral pazopanib treatment with a fixed dose of 400 mg/day
CHU d'Angers - Unité d'Hématologie et d'Oncologie pédiatrique
Angers, France
CHU de Bordeaux - Unité d'Hématologie et d'Oncologie pédiatrique
Bordeaux, France
Institut Bergonié - Oncologie Médicale
Bordeaux, France
Centre Oscar Lambret - Oncologie pédiatrie
Lille, France
Oscar Lambret Center
Lille, France
Centre Léon Bérard - Oncologie Médicale
Lyon, France
Institut d'Hématologie et d'Oncologie Pédiatrique (IHOP) - Oncologie pédiatrique
Lyon, France
APHM Hôpital des Enfants La Timone - Hématologie Oncologie Pédiatrique
Marseille, France
Nantes University Hospital
Nantes, France
Institut Curie - Centre D'Oncologie SIREDO
Paris, France
...and 3 more locations
The maximum tolerated dose (MTD) in the pediatric cohort
The maximum tolerated dose (MTD) in the pediatric cohort will be defined as the dose closest to the target toxicity level of 25% of DLTs (Dose Limiting Toxicity) up to cycle 2 (8 weeks of treatment). All patients will be evaluable for toxicity from the time of their first dose of study drug. All patients will be evaluable for DLT if they receive \>75% of the planned dose after 2 cycles or if they have treatment-related toxicity at any time during the two cycles.
Time frame: 2 months after inclusion ( treatment initiation)
6-month disease control rate in the adult cohort
The 6-month disease control rate is defined as the proportion of participants in complete response (CR), partial response (PR) or stable disease (SD) 6 months after treatment initiation. All evaluable patients will be included in the response rate calculation. The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 6 months after inclusion ( treatment initiation)
Dose-limiting toxicity (DLT) in the pediatric cohort
A dose-limiting toxicity (DLT) is defined as a drug-related AE occurring in the first 8 weeks of study treatment. DLT will be defined as follows: * nausea, vomiting, alopecia, fever ≥ grade 3 lasting more than 72 hours * fatigue ≥ grade 3 lasting more than one week * other non-hematological toxicity ≥ grade 3 * laboratory abnormality ≥ grade 3 lasting \> 10 days (except for hyperglycaemia and changes in serum electrolytes/enzymes without clinical impact) * laboratory abnormality ≥ grade 4 (except for hyperglycaemia and changes in serum electrolytes/enzymes without clinical impact) * febrile neutropenia (ANC\<1000/mm3 with a single temperature of \>38.3 degrees C (101 degrees F) or a sustained temperature of \>= 38degrees C (100.4 degrees F) for more than one hour) * grade 4 neutropenia lasting ≥ 10 days * grade 4 thrombocytopenia or grade 3 with bleeding requiring a platelet transfusion. * amylase or lipase elevation grade 3 with symptom or sign on imagery of pancreatitis
Time frame: 2 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 1 month after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 2 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 3 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 4 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 5 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 6 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 7 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 8 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 9 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 10 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 11 months after inclusion ( treatment initiation)
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]in pediatric and adult cohorts
Incidence of adverse events and serious adverse events, defined according to the NCI CTCAE v5.
Time frame: 12 months after inclusion ( treatment initiation)
Overall Response Rate in pediatric and adult cohorts
The best overall response is the best response (CR or PR) recorded from the start of the treatment until patients get off-study or the cut-off date, whichever comes first.
Time frame: 12 months after inclusion ( treatment initiation)
Progression-free survival in pediatric and adult cohorts
duration from start of the treatment to disease progression (clinically or radiologically) or death (regardless of cause of death), whichever comes first. Patients alive and free of progression at the cut-off date will be censored at the last assessment date.
Time frame: 12 months after inclusion ( treatment initiation)
Overall survival in pediatric and adult cohorts
duration from start of the treatment to death (regardless of cause of death). Patients alive at the cut-off date will be censored at the last assessment date
Time frame: 12 months after inclusion ( treatment initiation)
Response duration in pediatric and adult cohorts
Response duration will be measured from the time measurement criteria for CR/PR are first met until the first date that recurrent or progressive disease is objectively documented or death, whichever occurs earlier. Duration of response for patients free of progression at the cut-off date will be censored at the last imaging response-scan date.
Time frame: 12 months after inclusion ( treatment initiation)
Response rate in pediatric and adult cohorts
The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 2 months after inclusion ( treatment initiation)
Response rate in pediatric and adult cohorts
The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 4 months after inclusion ( treatment initiation)
Response rate in pediatric and adult cohorts
The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 8 months after inclusion ( treatment initiation)
Response rate in pediatric and adult cohorts
The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 10 months after inclusion ( treatment initiation)
Response rate in pediatric and adult cohorts
The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 12 months after inclusion ( treatment initiation)
Response rate in pediatric cohort
The subjects that will be assigned a response category are all patients who have received at least one treatment dose and have had their disease reevaluated. Objective tumor response will be measured according to RECIST 1.1 (Eisenhauer 2009) for solid tumor.
Time frame: 6 months after inclusion ( treatment initiation)
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