A MULTICENTER, SEEKING SIGNAL, RANDOMISED, OPEN-LABEL PHASE II OF RELATLIMAB AND NIVOLUMAB VS NIVOLUMAB ALONE IN LOCALLY ADVANCED CERVICAL CANCERS
Multicenter, open-label, randomized, seeking signal (non-comparative), Phase II aiming to assess the clinical activity of the combination relatlimab + nivolumab in locally advanced cervical cancer eligible to standard CCRT
• Female patients aged ≥18 years at time of inform consent signature.
• Patients must have histologically confirmed diagnosis of cervical squamous or adenosquamous carcinoma stage IIB to IVA according to FIGO 2018 (Appendix 1) and no evidence of metastatic disease (M0). Note: Nodal staging may be either surgical or by imaging (MRI/PET-CT) with pathological lymph node size defined by a short-axis diameter of ≥10mm (axial plane) or FDG uptake greater than that of the surrounding tissue and corresponding to the LN structure on CT when CT was performed for PETCT analysis.
• Patients must be naïve from prior anti-cancer treatment (all type) and eligible to standard CCRT as per standard practice and investigator' judgement.
• Known HPV status as per local assessment.
• Patient accepting to undergo a new cervix biopsy and with at least one lesion with a diameter ≥10 mm, visible by medical imaging and accessible to percutaneous sampling (needle biopsies 16 gauge or larger) that permit core needle biopsy (ideally 4 cores) without unacceptable risk of a major procedural complication.
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (Appendix 2).
• Adequate organ and marrow function with following lab values within 7 days before C1D1:
‣ Absolute neutrophil count (ANC) ≥1500/μL
⁃ White blood cell (WBC) \>3000/μL
⁃ Platelets ≥100 000/μL
⁃ Hemoglobin (Hb) ≥9 g/dL
⁃ Total bilirubin ≤1.5× upper limit of normal (ULN) unless due to Gilbert's syndrome
⁃ ASAT /ALAT ≤3 ULN
⁃ Creatinine ≤1.5 within normal limit, or
⁃ Creatinine clearance ≥ 40 mL/min according to CKD-EPI formula (Appendix 3)
⁃ Troponin T or I \< 2 x ULN
• Adequate cardiovascular function documented by:
‣ QTc interval \<450 msec.
⁃ Left ventricular Ejection fraction \> 50% based on screening echocardiogram (ECHO) or multigated acquisition scan (MUGA).
⁃ Controlled blood pressure (BP, \<150/90mmHg), with or without current antihypertensive treatment.
⁃ No congestive heart failure New York Heart Association class 3 or 4, unstable angina pectoris, serious cardiac arrhythmias (eg, ventricular flutter, ventricular fibrillation, Torsades de pointes).
⁃ No stroke (including transient ischemic attack \[TIA\]), myocardial infarction, or other clinically significant ischemic event within 12 months before first dose.
⁃ No prior history of myocarditis.
• Women of childbearing potential
‣ must have a negative serum pregnancy test within 7 days prior C1D1 and use adequate contraceptive methods (for example, intrauterine device \[IUD\], birth control pills unless clinically contraindicated, or barrier device - see Appendix 4) beginning 2 weeks before the first dose of study drugs and for up to 6 months after the final dose of study drugs (i.e., 30 days \[duration of ovulatory cycle\] plus the time required for relatlimab and nivolumab to undergo approximately five halflives).
⁃ A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries, fallopian tubes, and/or uterus).
• Ability to understand and sign informed consent and willingness to comply with the study procedures before study entry.
• Covered by a medical insurance.