A Value-Driven Study on Reducing Immune Checkpoint Inhibitor Dosing Frequency in Advanced Cancers: Phase 2 Randomized Trial (VALUE-CHECK)
This study is a prospective, open label, multi-centre phase 2 trial which assesses the efficacy and safety of standard dosing compared to extended dosing interval of nivolumab, atezolizumab or pembrolizumab in advanced/unresectable gastric/gastroesophageal junction/oesphageal adenocarcinomas with PDL1 CPS ≥5%, hepatocellular carcinoma andnon-small cell lung cancer with PDL1 TPS≥50% with no prior treatment. The investigators hypothesize that nivolumab, pembrolizumab and atezolizumab can be used efficiently at extended dosing intervals, compared to their approved labels with comparable clinical outcome.
• Provision of informed consent prior to any study-specific procedure
• Patients with one of the following:
‣ Cohort A: Previously untreated locally advanced/metastatic HER2 -ve gastric/gastroesophageal junction/esophageal (PDL1 CPS ≥5% adenocarcinomas not amenable to curative surgery or radiotherapy who are above to begin platinum double and nivolumab.
⁃ Cohort B: Previously untreated locally advanced/metastatic Child's A hepatocellular carcinoma not amenable to curative surgery or radiotherapy who are above to begin atezolizumab and bevacizumab.
⁃ Cohort C: Previously untreated locally advanced/metastatic lung adenocarcinoma (PDL1 TPS≥50%, EGFR/ALK wildtype) not amenable to curative surgery or radiotherapy who are above to begin pembrolizumab monotherapy
• Measurable disease per RECIST 1.1 criteria
• ECOG Performance status is 0-2
• Normal organ and bone marrow function measured within 28 days before the study as defined below:
‣ Haemoglobin ≥ 8.0 g/dL and no blood transfusions in the 28 days prior to entry
⁃ Absolute neutrophil count (ANC) ≥ 1.5 x 10\^9/L
⁃ No features suggestive of MDS/AML on peripheral blood smear
⁃ White blood cells (WBC) \> 3x10\^9/L
⁃ Platelet count ≥ 100 x 10\^9/L
⁃ Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN)
⁃ AST (SGOT)/ALT (SGPT) ≤ 2.5 x institutional upper limit of normal unless liver metastases are present in which case it must be ≤ 5x ULN
⁃ Serum creatinine ≤ 1.5 x institutional upper limit of normal (ULN)
• A life expectancy ≥ 12 weeks in all patients.
• Females in childbearing age should be using adequate contraceptive measures, should not be breastfeeding and their pregnancy test prior to the start of treatment must be negative. Evidence of non-child-bearing potential is fulfilled by one of the following criteria at screening:
• The post-menopausal period defined as age ≥50 years and amenorrheic for at least 12 months following cessation of all exogenous hormonal treatments
• Women \<50 years old they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and with LH and FSH levels in the post-menopausal range.
⁃ Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not a tubal ligatio
⁃ Male patients should be willing to use barrier contraception
⁃ The patient is willing to comply with the protocol during the study including undergoing treatment and scheduled visits and examinations including follow up.
⁃ At least one lesion, not previously irradiated, that can be accurately measured at baseline as ≥ 10 mm in the longest diameter (except lymph nodes which must have short axis ≥ 15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI) and is considered suitable for accurate repeated measurements