The purpose of this research is to evaluate whether adding histotripsy to maintenance durvalumab increases immune response and to assess the safety of this combination for participants with advanced intrahepatic cholangiocarcinoma (iCCA). Histotripsy is a non-invasive, non-thermal treatment that uses focused ultrasound energy to destroy tumor tissue. 12 people will be enrolled in this study.
The primary objective of this pilot phase II study is to evaluate preliminary efficacy of increased immune system activation and safety of combined histotripsy and maintenance durvalumab therapy. The secondary objectives are to evaluate additional efficacy signal and safety of the addition of histotripsy along with continued maintenance durvalumab therapy. Exploratory objectives include evaluation for off-target effects on iCCA tumors not targeted for histotripsy treatment and evaluation of peripheral blood samples for assessment of circulating immune biomarkers and circulating tumor DNA (ctDNA).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
Histotripsy will be performed using the Edison® System (HistoSonics, Inc.), which is FDA cleared for destruction of liver tissue using non thermal focused ultrasound. Performed on Cycle 1 Day 8 (C1D8) to treat the Target Tumor.
Durvalumab is an immunotherapy drug and will be administered on day 1 of each 28-day cycle as per local standards. Dosing of maintenance durvalumab is 1500mg IV per FDA labeling with administration performed over 60 minutes as per standard clinical practice.
Two research biopsies are planned for cycle 1 day 3 and cycle 1 day 22, before and after histotripsy.
University of Wisconsin
Madison, Wisconsin, United States
Number of Participants with Increase in Adaptive Immune System Response following histotripsy
Increased adaptive immune system response following histotripsy in addition to ongoing maintenance durvalumab therapy will be interpreted as T cell infiltration, downregulation of myelosuppressive cell types, and upregulation of IFN-γ. This will be completed on the biopsy tissue (pre histotripsy in comparison to post histotripsy).
Time frame: data collected cycle 1 day 3 (C1D3) and cycle 1 day 22 (C1D22) (up to about 30 days with allowable procedural windows)
Percent of Participants Experiencing Immune-mediated Adverse Events within 30 days of histotrispy
Time frame: data collected up to day 38 (30 days post-histotripsy)
Progression Free Survival (PFS)
Time frame: up to 5 years
Overall Survival (OS)
Time frame: up to 5 years
Treatment Efficacy
Treatment Efficacy: defined as the lack of a nodular or mass-like area of enhancement within or along the edge of completed treated tumors assessed via MR or CT imaging at 30-days post procedure
Time frame: data collected up to day 38 (30 days post-histotripsy)
Hepatic toxicity profile of immunotherapy checkpoint with histotripsy reported as Incidence of Dose Limiting Toxicities per Protocol
Hepatic toxicity profile of immunotherapy checkpoint with histotripsy will be assessed using CTCAE version 5 grading and summarized here by number of events.
Time frame: data collected up to day 38 (30 days post-histotripsy)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.