About this trial
The object of this trial is to evaluate whether the introduction of a targeted therapy after 4 cycles of the current standard-of-care treatment for advanced biliary cancer is superior to continuing with the standard treatment.
The trial is composed of two phases: (i) An initial screening phase to identify a suitable patient population, during which a molecular profile of the patient's tumour will be obtained, and (ii) a randomised comparative trial in which patients with disease control after 4 cycles of standard treatment, and whose tumour harbours a targetable molecular alteration, will be randomised (2:1) to receive either a matched targeted therapy or to continue with the standard treatment.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Signed a written informed consent form prior to any trial specific procedures (Consent #1)
Histologically-proven intrahepatic, perihilar or distal cholangiocarcinoma, or gallbladder carcinoma (ampullary carcinoma excluded)
De novo or recurrent, locally advanced (non-resectable) or metastatic disease
Availability of a suitable archived sample of primary or metastatic tumour tissue (frozen, or FFPE) or able to undergo a biopsy to obtain a suitable malignant tissue sample
Disqualifiers
Contraindication to 1L-SoC
Patients who are candidates for locoregional therapy
Contraindication to tumour biopsy in the absence of suitable archived sample of tumour tissue
Prior anticancer therapy in the palliative setting. Adjuvant capecitabine allowed if completed ≥ 183 days prior to study entry
Trial design
Parallel
Treatments tested in this trial
Futibatinib
DrugDose 20 mg once a day (QD)
Ivosidenib
DrugDose 500 mg QD
Zanidatamab
DrugDose: Patients \< 70 kg: 1800 mg every 3 weeks (Q3W), Patients ≥ 70 kg: 2400 mg Q3W
Trastuzumab
DrugLoading dose 8 mg/kg, then 6 mg/kg Q3W (Combination with neratinib)
Neratinib
DrugDose: 240 mg QD (combination with trastuzumab)
Encorafenib
DrugDose: 450 mg QD (Combination with binimetinib)
Binimetinib
DrugDose: 45 mg twice a day (BID) (Combination with encorafenib)
Niraparib
DrugDose: 200 mg QD or 300 mg QD
Cisplatin
DrugDose: 25 mg/m2 IV on days 1 and 8 Q3W (CISGEM)
Gemcitabine
DrugDose: 1000 mg/m2 IV on days 1 and 8 Q3W (CISGEM)
Treatment groups
Trial outcomes
Primary outcomes
Progression-free survival (PFS)
Time from randomisation to the first documented progression of disease (PD) as assessed by the investigator according to RECIST v1.1, or death from any cause, whichever occurs first.
Secondary outcomes
Overall Survival (OS)
The overall survival is the length of time from randomization that patients enrolled in the study are still alive.
Objective response rate
Objective response rate is defined as the proportion of patients achieving complete response (CR) or partial response (PR) (according to RECIST v1.1). Objective response rate will be presented as the best response achieved compared to the disease assessment performed at randomisation.
Time to treatment failure
Time from patient starting their allocated treatment to the date at which a patient first experiences a treatment failure event. The following will be considered as treatment failure events: early treatment discontinuation (regardless of reason), disease progression, death, starting a new treatment after completing scheduled treatment, withdrawal from the study due to any reason or loss to follow-up.
Progression-free survival after next line of treatment (PFS2)
Time from randomisation to the date of second disease progression or death, whichever occurs first.
Other outcomes
Feasibility of molecular screening
The proportion of patients with an available MTB proposition at the time of the 3-month standard of care treatment evaluation.
Quality of life questionnaire - Core 30 (QLQ-C30)
Developed by the EORTC, this self-reported questionnaire assesses the health-related quality of life of cancer patients in clinical trials. The questionnaire includes five functional scales (physical, everyday activity, cognitive, emotional, and social), three symptom scales (fatigue, pain, nausea and vomiting), a health/quality of life overall scale, and a number of additional elements assessing common symptoms (including dyspnea, loss of appetite, insomnia, constipation, and diarrhea), as well as, the perceived financial impact of the disease. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.
Quality of life Questionnaire - Biliary tract cancer module (QLQ-BIL21)
This EORTC cholangiocarcinoma and gallbladder cancer specific questionnaire is intended to supplement the QLQ-C30. The QLQ-BIL21 contains 21 items to assess symptoms. All items are rated on a four-point Likert-type scale (1 = "not at all", 2 = "a little", 3 = "quite a bit", and 4 = "very much"), and are linearly transformed to a 0-100 scale.
EuroQOL EQ-5D-5L questionnaire
Developed by the EuroQol group, the self-reported questionnaire assesses the health-related quality of life of cancer patients in clinical trials consists of a descriptive system and a visual analogue scale (VAS). The EQ-5D-5L descriptive system comprises five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each dimension has 5 levels (1 = "no problems", 2 = "slight problems", 3 = "moderate problems", 4 = "severe problems", and 5 = "extreme problems"). This questionnaire provide a 5-digit score which generate a health state profile. The VAS records the patient's self-rated health on a vertical visual analogue scale where the score range from 0 (The best health you can imagine) to 100 (The worst health you can imagine). The VAS is used as a quantitative measure of health outcome that reflects the patient's own judgement.
Sponsors and contacts
Click on the lead sponsor to view all of their trials.
UNICANCER
Lead sponsor
Cancer Research UK & UCL Cancer Trials Centre
Collaborator
Belgian Group of Digestive Oncology
Collaborator
National Cancer Institute, France
Collaborator
Cancer Research UK
Collaborator
Taiho Oncology, Inc.
Collaborator
Servier
Collaborator
Zymeworks BC Inc.
Collaborator
Accord Healthcare, Inc.
Collaborator
Pierre Fabre Medicament
Collaborator