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CHEckpoint Inhibition in Combination With an Immunoboost of External Beam Radiotherapy in Solid Tumors (CHEERS)

Primary Purpose

Urothelial Carcinoma, Melanoma, Renal Cell Carcinoma

Status
Active
Phase
Phase 2
Locations
Belgium
Study Type
Interventional
Intervention
Nivolumab or Pembrolizumab or Atezolizumab
SBRT
Sponsored by
University Hospital, Ghent
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Urothelial Carcinoma focused on measuring radiotherapy, checkpoint inhibitors

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Before patient registration, written informed consent must be given according to ICH/GCP and national/local regulations.
  • Histologically confirmed diagnosis of a solid tumour.
  • At least one extracranial tumour lesion available for radiotherapy administration.
  • Patient will receive a checkpoint inhibitor per standard of care in one of the following settings (locally advanced or metastatic): melanoma (1st - 3rd line nivolumab or pembrolizumab); renal cell carcinoma (2nd line nivolumab); non-small cell lung carcinoma (2nd or 3rd line nivolumab, pembrolizumab or atezolizumab); urothelial cell carcinoma ( 1st-3rd line nivolumab, pembrolizumab or atezolizumab); head-& neck squamous cell carcinoma (1st-2nd line pembrolizumab, 2nd line nivolumab).
  • Karnofsky Performance status > 60.
  • Age 18 years or older.

Exclusion Criteria:

  • Prior radiotherapy preventing treatment with SBRT.
  • Prior treatment with an anti-PD-(L)1 antibody.
  • Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer or prostate cancer that has undergone potentially curative therapy and with normalized PSA.
  • Uncontrolled central nervous system (CNS) metastases at baseline (controlled = previously-treated CNS metastases (surgery ± radiotherapy, radiosurgery, or gamma knife) and who meet both of the following criteria: a) are asymptomatic and b) have no requirement for steroids or enzyme-inducing anticonvulsants), and/or carcinomatous meningitis.
  • Any condition requiring systemic treatment with corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medication within 14 days prior to the first dose of study drug. Inhaled steroids and adrenal replacement steroid doses > 10 mg daily prednisone equivalent are permitted in the absence of active autoimmune disease.
  • Has a diagnosis of immunodeficiency or history of human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C infection.
  • Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study.
  • Patient not likely to comply with the protocol; I.e. uncooperative attitude, inability to return for follow-up visits and unlikely to complete the study.
  • Contraindication for radiotherapy.
  • Female subjects of childbearing potential must be willing to use an adequate method of contraception for the course of the study through 120 days after the last dose of study medication.

Sites / Locations

  • AZ Sint-Lucas
  • AZ Sint-Lucas
  • GasthuisZusters Antwerpen
  • Jules Bordet Institute
  • University Hospital Ghent

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Experimental arm

Control arm

Arm Description

Stereotactic body radiotherapy concurrent with checkpoint inhibitor treatment: Nivolumab or Pembrolizumab or Atezolizumab + SBRT

Checkpoint inhibitor treatment only: Nivolumab or Pembrolizumab or Atezolizumab monotherapy

Outcomes

Primary Outcome Measures

Progression-free survival
Progression-free survival will be defined as the time from randomization to disease progression (as per iRECIST) or death from any cause.

Secondary Outcome Measures

Overall survival
Overall survival will be defined as the time from randomization to death from any cause.
Tumor response as per RECIST
Response of non-irradiated lesions will be evaluated as per RECIST v1.1.
Tumor response as per iRECIST
Response of non-irradiated lesions will be evaluated as per iRECIST
Incidence of Treatment-Related Adverse Events [safety and tolerability]
Adverse events will be monitored as per Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Patient-reported quality of life
Quality of life will be assessed as per EORTC-QLQ C30 questionnaire
Systemic immune response
Exploratory translational analyses will be performed using blood and fecal samples

Full Information

First Posted
April 17, 2018
Last Updated
February 20, 2023
Sponsor
University Hospital, Ghent
Collaborators
GZA Ziekenhuizen Campus Sint-Augustinus, AZ Sint-Lucas Brugge, Jules Bordet Institute, AZ Sint-Lucas Gent
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1. Study Identification

Unique Protocol Identification Number
NCT03511391
Brief Title
CHEckpoint Inhibition in Combination With an Immunoboost of External Beam Radiotherapy in Solid Tumors
Acronym
CHEERS
Official Title
CHEckpoint Inhibition in Combination With an Immunoboost of External Beam Radiotherapy in Solid Tumors: CHEERS-trial
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 9, 2018 (Actual)
Primary Completion Date
February 1, 2022 (Actual)
Study Completion Date
January 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Ghent
Collaborators
GZA Ziekenhuizen Campus Sint-Augustinus, AZ Sint-Lucas Brugge, Jules Bordet Institute, AZ Sint-Lucas Gent

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This randomized controlled phase II trial will investigate whether the addition of stereotactic body radiotherapy to checkpoint inhibitor treatment in patients with non-small-cell lung carcinoma, urothelial carcinoma, renal cell carcinoma, melanoma or head-and-neck carcinoma can improve progression-free survival as compared to checkpoint inhibitor monotherapy. The primary outcome is progression-free survival; secondary outcomes include overall survival, response according to iRecist and Recist v1.1 and toxicity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Urothelial Carcinoma, Melanoma, Renal Cell Carcinoma, Non-small Cell Lung Cancer, Head and Neck Cancer
Keywords
radiotherapy, checkpoint inhibitors

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
99 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Experimental arm
Arm Type
Experimental
Arm Description
Stereotactic body radiotherapy concurrent with checkpoint inhibitor treatment: Nivolumab or Pembrolizumab or Atezolizumab + SBRT
Arm Title
Control arm
Arm Type
Active Comparator
Arm Description
Checkpoint inhibitor treatment only: Nivolumab or Pembrolizumab or Atezolizumab monotherapy
Intervention Type
Drug
Intervention Name(s)
Nivolumab or Pembrolizumab or Atezolizumab
Other Intervention Name(s)
Immune checkpoint inhibitor
Intervention Description
per national standard of care
Intervention Type
Radiation
Intervention Name(s)
SBRT
Other Intervention Name(s)
Stereotactic body radiotherapy, SABR, Stereotactic ablative radiotherapy
Intervention Description
Stereotactic body radiotherapy is administered to maximally 3 lesions in 3 fractions of 8Gy prior to the second/third cycle of checkpoint inhibitors.
Primary Outcome Measure Information:
Title
Progression-free survival
Description
Progression-free survival will be defined as the time from randomization to disease progression (as per iRECIST) or death from any cause.
Time Frame
15 months
Secondary Outcome Measure Information:
Title
Overall survival
Description
Overall survival will be defined as the time from randomization to death from any cause.
Time Frame
2 years after start trial treatment
Title
Tumor response as per RECIST
Description
Response of non-irradiated lesions will be evaluated as per RECIST v1.1.
Time Frame
12 weeks
Title
Tumor response as per iRECIST
Description
Response of non-irradiated lesions will be evaluated as per iRECIST
Time Frame
12 weeks
Title
Incidence of Treatment-Related Adverse Events [safety and tolerability]
Description
Adverse events will be monitored as per Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Time Frame
12 weeks
Title
Patient-reported quality of life
Description
Quality of life will be assessed as per EORTC-QLQ C30 questionnaire
Time Frame
12 weeks
Title
Systemic immune response
Description
Exploratory translational analyses will be performed using blood and fecal samples
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Before patient registration, written informed consent must be given according to ICH/GCP and national/local regulations. Histologically confirmed diagnosis of a solid tumour. At least one extracranial tumour lesion available for radiotherapy administration. Patient will receive a checkpoint inhibitor per standard of care in one of the following settings (locally advanced or metastatic): melanoma (1st - 3rd line nivolumab or pembrolizumab); renal cell carcinoma (2nd line nivolumab); non-small cell lung carcinoma (2nd or 3rd line nivolumab, pembrolizumab or atezolizumab); urothelial cell carcinoma ( 1st-3rd line nivolumab, pembrolizumab or atezolizumab); head-& neck squamous cell carcinoma (1st-2nd line pembrolizumab, 2nd line nivolumab). Karnofsky Performance status > 60. Age 18 years or older. Exclusion Criteria: Prior radiotherapy preventing treatment with SBRT. Prior treatment with an anti-PD-(L)1 antibody. Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer or prostate cancer that has undergone potentially curative therapy and with normalized PSA. Uncontrolled central nervous system (CNS) metastases at baseline (controlled = previously-treated CNS metastases (surgery ± radiotherapy, radiosurgery, or gamma knife) and who meet both of the following criteria: a) are asymptomatic and b) have no requirement for steroids or enzyme-inducing anticonvulsants), and/or carcinomatous meningitis. Any condition requiring systemic treatment with corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medication within 14 days prior to the first dose of study drug. Inhaled steroids and adrenal replacement steroid doses > 10 mg daily prednisone equivalent are permitted in the absence of active autoimmune disease. Has a diagnosis of immunodeficiency or history of human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C infection. Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study. Patient not likely to comply with the protocol; I.e. uncooperative attitude, inability to return for follow-up visits and unlikely to complete the study. Contraindication for radiotherapy. Female subjects of childbearing potential must be willing to use an adequate method of contraception for the course of the study through 120 days after the last dose of study medication.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Piet Ost, PhD
Organizational Affiliation
University Ghent
Official's Role
Principal Investigator
Facility Information:
Facility Name
AZ Sint-Lucas
City
Ghent
State/Province
Oost-Vlaanderen
ZIP/Postal Code
9000
Country
Belgium
Facility Name
AZ Sint-Lucas
City
Brugge
State/Province
West-Vlaanderen
ZIP/Postal Code
8000
Country
Belgium
Facility Name
GasthuisZusters Antwerpen
City
Antwerp
ZIP/Postal Code
2000
Country
Belgium
Facility Name
Jules Bordet Institute
City
Brussels
ZIP/Postal Code
1000
Country
Belgium
Facility Name
University Hospital Ghent
City
Ghent
ZIP/Postal Code
9000
Country
Belgium

12. IPD Sharing Statement

Citations:
PubMed Identifier
33962592
Citation
Spaas M, Sundahl N, Hulstaert E, Kruse V, Rottey S, De Maeseneer D, Surmont V, Meireson A, Brochez L, Reynders D, Goetghebeur E, Van den Begin R, Van Gestel D, Renard V, Dirix P, Mestdagh P, Ost P. Checkpoint inhibition in combination with an immunoboost of external beam radiotherapy in solid tumors (CHEERS): study protocol for a phase 2, open-label, randomized controlled trial. BMC Cancer. 2021 May 7;21(1):514. doi: 10.1186/s12885-021-08088-w.
Results Reference
derived

Learn more about this trial

CHEckpoint Inhibition in Combination With an Immunoboost of External Beam Radiotherapy in Solid Tumors

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