Personalized Medicine for Advanced Biliary Cancer Patients

Trial statusRecruiting
Trial phasePhase 3
Trial typeInterventional
Biological sexAll
Age18+
SponsorUNICANCER

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 volunteers

Qualifiers

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

Design model

Parallel

Treatments tested in this trial

  • Futibatinib

    Drug

    Dose 20 mg once a day (QD)

  • Ivosidenib

    Drug

    Dose 500 mg QD

  • Zanidatamab

    Drug

    Dose: Patients \< 70 kg: 1800 mg every 3 weeks (Q3W), Patients ≥ 70 kg: 2400 mg Q3W

  • Trastuzumab

    Drug

    Loading dose 8 mg/kg, then 6 mg/kg Q3W (Combination with neratinib)

  • Neratinib

    Drug

    Dose: 240 mg QD (combination with trastuzumab)

  • Encorafenib

    Drug

    Dose: 450 mg QD (Combination with binimetinib)

  • Binimetinib

    Drug

    Dose: 45 mg twice a day (BID) (Combination with encorafenib)

  • Niraparib

    Drug

    Dose: 200 mg QD or 300 mg QD

  • Cisplatin

    Drug

    Dose: 25 mg/m2 IV on days 1 and 8 Q3W (CISGEM)

  • Gemcitabine

    Drug

    Dose: 1000 mg/m2 IV on days 1 and 8 Q3W (CISGEM)

Treatment groups

800 Participants
are divided into 2 treatment groups
Group A: ExperimentalExperimental treatment 8 interventions
Group B: ControlActive comparator 2 interventions

Trial outcomes

Primary outcomes

1

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.

Time frame
From randomisation to disease progression or death, up to 5 years.

Secondary outcomes

1

Overall Survival (OS)

The overall survival is the length of time from randomization that patients enrolled in the study are still alive.

Time frame
From randomisation to death, up to 5 years.
2

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 frame
From randomisation, up to 5 years.
3

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.

Time frame
From randomisation to treatment failure event, up to 5 years.
4

Progression-free survival after next line of treatment (PFS2)

Time from randomisation to the date of second disease progression or death, whichever occurs first.

Time frame
From randomisation to second disease progression or death, up to 5 years.

Other outcomes

1

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.

Time frame
Up to 3 months from start of treatment
2

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.

Time frame
From baseline, every 3 cycles (every 9 weeks) until end of treatment, an average of 1 year
3

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.

Time frame
From baseline, every 3 cycles (every 9 weeks) until end of treatment, an average of 1 year
4

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.

Time frame
From baseline, every 3 cycles (every 9 weeks) until end of treatment, an average of 1 year

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