The goal of this investigator-initiated, single-center, and randomized phase II trial is to investigate the potential synergistic effect of combining stereotactic body radiotherapy of a single soft tissue- or bone metastasis with ipilimumab and nivolumab in patients with mCRPC and perform translational analyses on tissue and blood, searching for predictive biomarkers of efficacy and toxicity. Participants will be randomized to receive ipilimumab and nivolumab with or without stereotactic body radiotherapy (SBRT).
The participants receive treatment for 52 weeks, including four cycles of ipilimumab and nivolumab with or without concomitant SBRT (24 Gray in three fractions) to a single soft tissue or bone metastasis, followed by 10 cycles of nivolumab. Participants are followed until progression, death, or for 12 months after the end of treatment. Biopsies from metastatic sites are collected at baseline, before the third treatment, and at the end of treatment. Blood sampling for immune monitoring and circulating tumor DNA is performed consecutively at baseline and every radiographic assessment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
90
8 Gray x 3
1 mg/kg IV Q3W for four doses,
Nivolumab 3mg/kg IV Q3W for four doses, then then Nivolumab 480mg IV Q4W
From soft tissue metastases.
Department of Oncology, Copenhagen University Hospital Herlev and Gentofte Hospital
Herlev, Capital Region, Denmark
Co-primary endpoint 1
Objective response rate (ORR) according to modified Response Evaluation Criteria in Solid Tumours (RECIST1.1) per Prostate Cancer Clinical Trials Working Group (PCWG3) criteria for patients with measurable disease
Time frame: From baseline until progression (up to 24 months)
Co-primary endpoint 2
Prostate-specific antigen (PSA) response rate of ≥ 50% decline from baseline at any time from treatment start (confirmed after ≥ 4 weeks, all patients with measurable and non-measurable disease)
Time frame: Any time after treatment start (confirmed ≥ 3 weeks later, up to 24 months)
Adverse events (Safety)
Common Terminology Criteria for Adverse Events (CTCAE) v. 5
Time frame: From inclusion to 100 days after the last dose of ipilimumab or nivolumab or until the last study visit (up to 24 months)
Radiographic progression-free survival
Per PCWG3 with 2+2 rule and clinical progression (all patients)
Time frame: From baseline until progression (up to 24 months)
Clinical benefit rate
Per RECIST 1.1 and Immune Response Evaluation Criteria in Solid Tumours (iRECIST)
Time frame: From baseline until progression (up to 24 months)
Objective response rate (ORR)
Per iRECIST
Time frame: From baseline until progression (up to 24 months)
PSA progression-free survival
Per PCWG3
Time frame: beyond 12 weeks (up to 24 months)
Survival
Overall survival
Time frame: From randomization until death by any cause or last follow-up (up to 24 months)
European Organization for Research and Treatment of Cancer Quality of life of cancer patients (EORTC QLQ-C30)
Questionaire The EORTC QLQ-C30 is a validated questionnaire to assess the quality of life of cancer patients. It includes 30 questions, divided into three major dimensions of global health status, functional-, and symptoms scale. The scales are calculated into a score ranging from 0-100. A high score on global health status and functional scales represents a better quality of life, but a high score on the symptoms scale represents a high burden of symptoms/low quality of life.
Time frame: Baseline and then every 8 weeks (up to three times) until end-of-treatment (up to 24 months)
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