The ADJUNCT is a single-arm, phase II clinical trial to evaluate the safety and efficacy of the combination of zimberelimab, domvanalimab and sacituzumab govitecan as first-line therapy for patients with PD-L1 positive advanced or metastatic triple-negative breast cancer.
This is a single-arm, phase II clinical trial to evaluate the safety and efficacy of the combination of zimberelimab, domvanalimab and sacituzumab govitecan as first-line therapy for patients with PD-L1 positive advanced or metastatic triple-negative breast cancer. Patients ≥18 years with PD-L1 positive (Combined Positive Score \[CPS\] ≥10, assessed using the PD-L1 IHC 22C3 pharmDx assay) advanced TNBC that is not amenable to treatment with curative intent, who have measurable disease and have not received prior systemic treatment in the advance setting. Patients who have received prior (neo)adjuvant therapies are permitted if the disease-free interval (DFI) is at least 6 months. Evidence of measurable disease as per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v.1.1), Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and adequate bone marrow and organ function are mandatory. Patients will receive zimberelimab as an intravenous infusion (IV) at a dose of 360 mg on Day 1; domvanalimab as an IV at a dose of 1200 mg on Day 1 and sacituzumab govitecan as an IV at a dose of 10 mg/kg on Days 1 and 8 of each 21-day cycle until unacceptable toxicity, disease progression, death, discontinuation from the Study treatment for any other reason or End of Study (EoS), whichever occurs first.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Patients will receive zimberelimab as an IV at a dose of 360 mg on D1 of each 21-day cycle until unacceptable toxicity, disease progression, death, discontinuation from the Study treatment for any other reason or End of Study (EoS), whichever occurs first.
Patients will receive domvanalimab as an IV at a dose of 1200 mg on D1 of each 21-day cycle until unacceptable toxicity, disease progression, death, discontinuation from the Study treatment for any other reason or End of Study (EoS), whichever occurs first.
Patients will receive sacituzumab govitecan as an IV at a dose of 10 mg/kg on D1 and D8 of each 21-day cycle until unacceptable toxicity, disease progression, death, discontinuation from the Study treatment for any other reason or End of Study (EoS), whichever occurs first.
Efficacy in terms of objective response rate (ORR) as per RECIST v.1.1.
ORR rate defined as the rate of patients with complete response (CR) or partial response (PR) as determined locally by the investigator in accordance RECIST v.1.1.
Time frame: Approximately 1 year
Efficacy in terms of PFS as per RECIST v.1.1.
PFS: period from treatment initiation until the first occurrence of disease progression as determined locally by the investigator assessment using RECIST v.1.1 or death from any cause, whichever occurs first.
Time frame: Aproximately 1 year
Efficacy in terms of Overall Survival.
OS: period from treatment initiation until death from any cause.
Time frame: Aproximately 1 year
Efficacy in terms of Clinical benefit rate (CBR) as per RECIST v.1.1.
CBR: rate of patients with objective response (CR or PR), or stable disease for at least 24 weeks, as determined locally by the investigator using RECIST v.1.1.
Time frame: Aproximately 1 year
Efficacy in terms of Time to response (TTR) as per RECIST v.1.1.
TTR: period from treatment initiation to the first objective tumor response (tumor shrinkage of ≥ 30%) observed for patients who achieved a CR or PR, as determined locally by the investigator using RECIST v.1.1.
Time frame: Aproximately 1 year
Efficacy in terms of Duration of response (DoR) as per RECIST v.1.1.
DoR: period from the first occurrence of a documented objective response to disease progression or death from any cause, whichever occurs first, as determined locally by the investigator using RECIST v.1.1.
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Time frame: Aproximately 1 year
Efficacy in terms of Best percentage of change as per RECIST v.1.1.
Best percentage of change from baseline in the size of target tumor lesions, defined as the biggest decrease, or smallest increase if no decrease will be observed, as determined locally by the investigator using RECIST v.1.1.
Time frame: Aproximately 1 year
To evaluate changes in health-related quality-of-life (QoL)
Changes from baseline in the European Organization for Research and Treatment of Cancer (QoL) Questionnaire Core 30 (EORTC QLQ-C30) scale. The EORTC-QLQ-C30 is a 30-item questionnaire, composed of five multi-item functional subscales (physical, role, emotional, cognitive, and social functioning), three multi-item symptom scales (fatigue, nausea/vomiting, and pain), a global QoL subscale, and six single-item symptom scales assessing other cancer-related symptoms (dyspnea, sleep disturbance, appetite loss, constipation, diarrhea, and the financial impact of cancer). The questionnaire employs 28 4-point Likert scales with responses from "not at all" to "very much" and two 7-point Likert scales for global health and overall QoL. Responses to all items are then converted to a 0 to 100 scale. For functional and global QoL scales, higher scores represent a better level of functioning/QoL. For symptom-oriented scales, a higher score represents more severe symptoms.
Time frame: Approximately 1 year
To evaluate changes in health-related quality-of-life (QoL)
Changes from baseline in the European Organization for Research and Treatment of Cancer (QoL) Questionnaire BR42 (QLQ-BR42). The EORTC-QLQ-BR42 is a 42-item BC-specific companion module to the EORTCQLQ-C30 and consists of nine multi-item scales that assess body image, sexual functioning, breast satisfaction, systemic therapy side effects, arm symptoms, breast symptoms, endocrine therapy symptoms, skin mucosis symptoms, endocrine sexual symptoms; single items assess sexual enjoyment, future perspective, and feelings about upset by hair loss.
Time frame: Approximately 1 year.
To determine the safety and toxicity profile of zimberelimab, sacituzumab govitecan and domvalimab treatment.
Safety and tolerability as per NCI-CTCAE v.5.0. Safety assessments will consist of monitoring and recording protocol-defined AEs, SAEs and non-serious adverse event of special interests (AESIs); measurement of protocol-specified hematology, clinical chemistry, measurement of protocol-specified vital signs; and other protocol specified tests that are deemed critical to the safety evaluation of the Study drug(s).
Time frame: Approximately 1 year