This is an interventional, prospective multicenter, open-label, phase II study in patients after curative surgery for BTC in a classic adjuvant situation, consisting of a two arm feasibility pilot part with a randomized pick-the-winner design and an option to proceed into a randomized phase 2/3 trial in order to compare the winner with the current SOC (capecitabine).
The primary objective is to assess the anti-tumor activity of the combination of durvalumab and tremelimumab with or without capecitabine by the recurrence-free survival rate after 12 months (RFS@12). Secondary objectives are to assess the efficacy by recurrence-free surviaval (RFS) and overall survival (OS); to assess safety of the combination treatments (AEs, impact on liver function, use of subsequent therapies); to assess quality of life (QoL). Exploratory objective is to perform correlation analysis between selected molecular parameters and clinical data to identify molecular biomarkers predictive for RFS and OS. Patients will be stratified according to the tumor site (ICC vs. ECC vs. gallbladder) and resection status (R0 vs. R1). In this pilot trial phase, a pick the winner design is applied to determine wether treatment with durvalumab and tremelimumab in combination with or without capecitabine is more promising. In the initial pilot phase, 40 patients with histologically proven and curatively resected biliary tract cancer (intrahepatic, hilar or distal CCA as well gallbladder carcinoma) without metastatic disease, will be enrolled in a 1:1 randomized design (i.e. 20 patients per Arm). Patients will be recruited from up to 15 sites and patients withdrawn from the trial will not be replaced.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Durvalumab at a fixed dose of 1500 mg as an IV infusion over 1 hour, on day 1 together with the Tremelimumab infusion. Durvalumab only infusion to be repeated every 4 weeks for a maximum of 12 months on day 1 of each cycle.
Tremelimumab at a fixed dose of 300 mg as an IV infusion over 1 hour on day 1 of cycle 1.
Capecitabine at 1250 mg/m² p.o. twice a day on days 1 to 14 of a 3-weekly cycle (eight cycles).
Krankenhaus Nordwest
Frankfurt am Main, Germany
Recurrence free survival at 12 months (RFS@12).
Recurrence free survival at 12 months (RFS@12) will be defined as the proportion of allocated subjects without any recurrence/progression and alive at 12 months after the date of treatment allocation.
Time frame: 12 months
Recurrence free survival (RFS)
Recurrence-free survival (RFS) will be determined as time from the date of treatment allocation to the date of (1) any recurrence/progression (local or regional \[including invasive ipsilateral tumor and invasive locoregional tumor\], or distant) or (2) death due to any cause.
Time frame: 30 months
Overall survival (OS)
Overall survival (OS) will be determined as time from the date of treatment allocation to the date of death due to any cause. A subject who has not died will be censored at last known date alive.
Time frame: 30 months
Safety: (serious) adverse events
Safety assessments will include adverse events. All observed toxicities and side effects will be graded according to NCI CTCAE v5.0 for all patients and the degree of association of each with the study treatment assessed and summarized. Treatment related serious adverse events rate (SAE) will be determined.
Time frame: 30 months
QoL QLQ-C30
QoL will be assessed by the EORTC QLQ-C30 questionnaire in itsmost current version. The QoL analyses will include QoL mean values, QoL response and time to symptom deterioration (TTSD) defined as the time interval between randomization and the first decrease by ≥ 10-points. All randomly assigned patients with a baseline and at least one post-baseline assessment will be included in TTSD analyses. Patients without observed deterioration will be censored at the time of their last QoL assessment. EORTC QLQ C30 (30 questions) regarding body fitness, daily routines, restrictions at work and hobby, appetite, fatigue, cough, breathlessness, pain, tiredness, body conditions, state of health and Quality of life.
Time frame: 30 months
QoL BIL21
QoL will be assessed by the EORTC QLQ-BIL21 questionnaire in its most current version. The QoL analyses will include QoL mean values, QoL response and time to symptom deterioration (TTSD) defined as the time interval between randomization and the first decrease by ≥ 10-points. All randomly assigned patients with a baseline and at least one post-baseline assessment will be included in TTSD analyses. Patients without observed deterioration will be censored at the time of their last QoL assessment. EORTC QLQ BIL21 (21 questions) regarding eating habits, body fitness, fatigue, pain, tiredness and mental health.
Time frame: 30 months
QoL EQ-5D-5L
QoL will be assessed by the QoL EQ-5D-5L questionnaire in its most current version. The QoL analyses will include QoL mean values, QoL response and time to symptom deterioration (TTSD) defined as the time interval between randomization and the first decrease by ≥ 10-points. All randomly assigned patients with a baseline and at least one post-baseline assessment will be included in TTSD analyses. Patients without observed deterioration will be censored at the time of their last QoL assessment. EQ 5D-5L (6 questions) about mobility, sorrows, daily routine, pain, anxiety and health perception.
Time frame: 30 months
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