Soft tissue sarcomas represent a subtype of cancer that is both rare and very heterogeneous. When they are organized, their current treatment is essentially based on tumor resection surgery, +/- associated with treatment by chemotherapy and/or radiotherapy. The aim of this treatment is to reduce the risk of local recurrence (appearance of a tumor in the same region where it was first detected) and/or distant (appearance of a tumor in other regions, organs where it was first detected). Currently, no immunotherapy treatment has been approved for the treatment of patients with sarcoma. This research is based on the hypothesis that soft tissue sarcomas in which "tertiary lymphoid structures" or "TLS" are found, recognizable by a cluster of specific immune cells within the tumor, would be likely to respond better to the immunotherapy. Furthermore, the combination of immunotherapy and certain drugs targeting DNA repair has demonstrated some effectiveness in other types of cancers. Trial population :Adult patients with suspected / diagnosed soft tissue sarcoma of the extremities or trunk (Cohort 1: Undifferentiated pleomorphic sarcoma / Cohort 2: Dedifferentiated liposarcoma) The research will therefore focus on two experimental drugs : * Pembrolizumab (immunotherapy) and * Olaparib (DNA repair inhibitor). This research will make it possible to evaluate the effectiveness and safety of use of the two drugs.
This study will allow: * To evaluate the ability of pembrolizumab (with or without olaparib) before surgery to trigger an immune reaction in order to kill tumor cells. * To evaluate the feasibility of therapy with pembrolizumab for 1 year (with or without radiotherapy) after surgery. The research is divided into two groups of patients, called "cohorts" depending on the type of soft tissue sarcoma you have: * Cohort 1: Undifferentiated pleomorphic sarcoma * Cohort 2: Dedifferentiated liposarcoma Before surgery, a group of patients will receive pembrolizumab combined with olaparib, a second group will receive only pembrolizumab. All patients will receive pembrolizumab after surgery (for up to 1 year).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
cf Arm A
cf Arm B
After surgery (adjuvant phase), all patients (Arm A and B) will receive pembrolizumab 200 mg two intravenous (IV) infusions q3w for one-year
Gustave Roussy
Villejuif, Val De Marne, France
Rate of CD8+ T-cell tumor infiltration density at surgery compare to baseline
50% increase in CD8+ T-cell tumor infiltration density between baseline biopsy and resection surgery specimen as defined by expert pathologist who will be blinded for treatment arm and patient outcome
Time frame: 1 year after the end of inclusions
Proportion of patients with 70% pathological response
Proportion of patients with 70% pathological response on the resection surgery specimen as assessed by expert pathologist after WoO treatment
Time frame: Through study completion, an average of 1 year
Surgery evaluation: Quality of resection as defined by Hemanek and Wittekind (R0 the best / R1 / R2 the worst)
Quality of resection is defined at time of resection surgery as follows, as initially defined by Hemanek and Wittekind according to both clinical and pathological findings: R0 corresponds to resection for cure or complete remission. R1 to microscopic residual tumor, R2 to macroscopic residual tumor.
Time frame: Through study completion, an average of 1 year
Surgery evaluation : amputation rate
Time frame: Through study completion, an average of 1 year
Surgery evaluation : Incidence of acute wound complications up to 120 days after surgery
Time frame: 120 days after surgery
Objective Response Rate (ORR)
Objective Response Rate (ORR) at 4 weeks of WoO treatment defined as the rate of patients with Complete Response (CR) or Partial Response (PR) according to RECIST v1.1
Time frame: At 4 weeks of WoO treatment
Time To Relapse (TTR)
Time frame: From date of randomization until the date of first documented Progression or date of death from any cause, whichever came first, assessed up to 75 months
Local Recurrence Rate (LRR)
Local Recurrence Rate (LRR) at 2-year post-surgery
Time frame: 2-year post-surgery
Disease Free Survival (DFS) at 2-year post-surgery
Disease Free Survival (DFS) at 2-year post-surgery
Time frame: 2-year post-surgery
Overall Survival (OS)
Time frame: Through study completion, an average of 1 year
Disease Control Rate (DCR)
Disease Control Rate (DCR) at 4 weeks of WoO according to RECIST v1.1
Time frame: At 4 weeks of WoO treatment
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