Study Summary for MC/Country Feasibility

Transcription

1 Study Summary for MC/Country Feasibility A Phase III Randomized, Open-label, Multi-center, Global Study of Durvalumab and Tremelimumab Administered as a Monotherapy or in Combination versus Standard of Care in First-Line Treatment of Patients with Advanced Hepatocellular Carcinoma The key objective for this feasibility exercise is to assess interest and capability for this study by the Marketing Companies Key Study Timelines FSI LSI PFS DBL OS Interim Analysis OS DBL Q Q Q Q Q Page 1 October 02, 2016

2 LIST OF ABBREVIATIONS AND DEFINITION OF TERMS The following abbreviations and special terms are used in this study summary. Abbreviation or special term ALT AST BCLC CR CT CTCAE Explanation Alanine aminotransferase Aspartate aminotransferase Barcelona Clinic Liver Cancer Complete Response Computed tomography Common Terminology Criteria for Adverse Event CTLA-4 Cytotoxic T lymphocyte-associated antigen 4 DBL DCR DNA DoR ECOG FSI HBc HBV HCC HCV HIV IP IV LSI MRI NCI ORR OS PD Database Lock Disease Control Rate Deoxyribonucleic acid Duration of Response Eastern Cooperative Oncology Group First Subject In Hepatitis B Core Antibody Hepatitis B Virus Hepatocellular Carcinoma Hepatitis C Virus Human immunodeficiency virus Investigational Product Intravenous Last Subject In Magnetic resonance imaging National Cancer Institute Objective Response Rate Overall Survival Progressive Disease PD-1 Programmed Cell Death 1 PD-L1 Programmed Death Ligand 1 PFS PFS2 Progression Free Survival Time from randomization to second progression Page 2 October 02, 2016

3 Abbreviation or special term PR PRO QoL Explanation Partial Response Patient-reported outcome Quality of Life RECIST 1.1 Response Evaluation Criteria In Solid Tumours version 1.1 TB ULN Tuberculosis Upper limit of normal Primary Objective Overall Survival (OS) Secondary Objectives PFS, PFS2 DOR DCR ORR Safety PRO/QoL Study Design Stratification factors: 1. Macro-vascular invasion: Yes vs No 2. Geography: Asia (China/Korea/Taiwan) vs. Rest of the countries 3. Etiology: HBV vs HCV vs uninfected Target population Patients with advanced HCC that is refractory or not amenable to loco-regional therapy No prior systemic therapy for advanced HCC BCLC stage B or C Child-Pugh class A ECOG PS 0 and 1 Serum bilirubin 2.0 x ULN ALT and AST 5.0 x ULN Randomized N=912 patients Durvalumab + Tremelimumab N=304 Durvalumab monotherapy N=304 Tremelimumab monotherapy N=152 Sorafenib N=152 Primary endpoint Overall survival (D+T vs. Sorafenib) Key Secondary endpoints D+T vs. Sorafenib: DOR, PFS, ORR, Safety, PRO/QoL D mono and T mono vs. Sorafenib: OS, PFS, ORR D+T combo vs. D/T mono: OS, PFS, ORR Page 3 October 02, 2016

4 This is a randomized, open-label, multi-center, global, Phase III study to determine the efficacy and safety of durvalumab + tremelimumab combination therapy, durvalumab monotherapy and tremelimumab monotherapy versus Sorafenib in the treatment of patients with no prior systemic therapy for advanced HCC. The patients should not be amenable to locoregional therapy or should have disease progression after surgical or locoregional therapy for advanced HCC. Summary of Visit Schedule At a high level we plan to have screening assessments within 28 days of randomization. Whilst on treatment there will be monthly visits for intravenous administration (if applicable), study drug dispensing and safety assessments including labs and RECIST scans every 8 weeks for the first 48 weeks and 12 weeks thereafter (until progression even if therapy stopped pre progression). Target subject population The study population includes patients aged 18 years or older, had a diagnosis of HCC and Barcelona Clinic Liver Cancer stage C or stage B that was refractory or not amenable to locoregional therapy, and had Child-Pugh A liver disease. Diagnosis of HCC was based on histopathological findings from tumour tissue, or in the absence of histological confirmation, patients had clinical findings consistent with a diagnosis of liver cirrhosis and a liver mass measuring at least 2 cm with characteristic vascularisation (intense inhomogeneous enhancement seen in the hepatic arterial-dominant phase and contrast washout in the late portal venous phase) seen on either triphasic CT scan or MRI with gadolinium. Duration of treatment Unless specific treatment discontinuation criteria are met, patients in all arms will continue therapy until disease progression. Progression during treatment Patients in the immunotherapy arms (durvalumab and/or tremelimumab arms) may continue receiving therapy in the setting of unconfirmed progressive disease (PD), at the Investigator s discretion, until PD is confirmed. According to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) modified for confirmation of progression, a confirmatory scan is required following an overall time point assessment of progression (PD), preferably at the next scheduled visit and no earlier than 4 weeks after the previous assessment of PD. Patients in immunotherapy arms with PD by RECIST 1.1(unconfirmed and confirmed) who, in the Investigator s opinion, continue to receive benefit from their assigned treatment and who meet the criteria for treatment in the setting of PD may continue to receive their assigned treatment for as long as they are gaining clinical benefit. However, patients in the immunotherapy arm(s) will not be permitted to continue immunotherapy if progression occurs after confirmed response (CR or PR as defined by RECIST 1.1) to immunotherapy treatment in the target lesions (regardless of the appearance of new lesions) i.e the response and progression events both occurred in the target lesions while receiving immunotherapy during the same treatment period. Patients in the durvalumab + tremelimumab group may restart treatment with the combination if they complete the 4 dosing cycles with durvalumab + tremelimumab (with clinical benefit per Investigator judgement) but subsequently have PD during treatment with durvalumab alone and provided they meet eligibility criteria for re-treatment. Page 4 October 02, 2016

5 SUBJECT SELECTION Each patient should meet all of the inclusion criteria and none of the exclusion criteria for this study. Under no circumstances can there be exceptions to this rule. Inclusion criteria 1. Age 18 years at the time of screening. For subjects aged <20 years and enrolled in Japan, a written informed consent should be obtained from the subject and his or her legally acceptable representative. 2. Written informed consent and any locally required authorization (eg, Health Insurance Portability and Accountability Act in the US, European Union [EU] Data Privacy Directive in the EU) obtained from the patient/legal representative prior to performing any protocolrelated procedures, including screening evaluations. For patients aged <20 years and enrolling in Japan, a written informed consent should be obtained from the patient and his or her legally acceptable representative. 3. Advanced or metastatic HCC (Stage IV) with diagnosis confirmed pathologically or with noninvasive methods (as described below) with and without concomitant HBV or HCV infection. a. Patients must not have received any systemic therapy for advanced or metastatic disease. For patients who progressed after locoregional therapy for HCC, locoregional therapy must have been completed 28 days prior to the baseline scan for the current study. b. Noninvasive methods: focal lesion > 1 cm with arterial hypervascularity and venous or delayed phase washout on a 4 phase multi-detector computed tomography (CT) or dynamic contrast enhanced magnetic resonance imaging (MRI; Bruix and Sherman, 2011). c. Subjects with concomitant HBV infection must have a confirmed diagnosis of HBV characterized by the presence of anti-hbc, and be sufficiently suppressed with active antiviral treatment such that HBV DNA < 2000 IU/mL. d. Subjects with concomitant HCV infection must have confirmed diagnosis of HCV characterized by the presence of detectable HCV RNA or anti-hcv antibody upon enrollment. 4. Child-Pugh Score class A. 5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 at enrollment 6. Subjects in this study with confirmed concomitant HBV infection that are eligible for inclusion must be treated with antiviral therapy (per local institutional practice) prior to enrollment to ensure adequate viral suppression (HBV DNA < 2000 IU/mL), must remain on antiviral therapy for the study duration, and continue therapy for 6 months after the last dose of investigational product(s). 7. At least 1 lesion, not previously irradiated, that can be accurately measured at baseline as 10 mm in the longest diameter (except lymph nodes which must have a short axis 15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI) and that is suitable for accurate repeated measurements as per RECIST 1.1 guidelines Page 5 October 02, 2016

6 8. No prior exposure to immune-mediated therapy including, but not limited to, anti CTLA-4, anti-pd-1, anti-pd-l1, and anti-programmed cell death ligand 2 (anti-pd-l2) antibodies, excluding therapeutic anticancer vaccines. 9. Adequate organ and marrow function as defined below: Hemoglobin 9.0 g/dl Absolute neutrophil count /L Platelet count /L Serum bilirubin 2.0 the upper limit of normal (ULN). ALT and AST 5 ULN Calculated creatinine clearance (CL) >40 ml/min as determined by Cockcroft-Gault (using actual body weight) Males Creatinine CL = (ml/min) Weight (kg) (140 - Age) 72 serum creatinine (mg/dl) Females: Creatinine CL = Weight (kg) (140 - Age) 0.85 (ml/min) 72 serum creatinine (mg/dl) 10. Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply: Women <50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy). Women 50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy). Exclusion criteria 1. Patients with known fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC. Page 6 October 02, 2016

7 2. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site). 3. Previous IP assignment in the present study. 4. Concurrent enrolment in another clinical study, unless it is an observational (noninterventional) clinical study or during the follow-up period of an interventional study. 5. Participation in another clinical study with an investigational product during the last 28 days prior to the first dose of study treatment. 6. Any unresolved toxicity NCI CTCAE Grade 2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria Patients with Grade 2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician. Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab or tremelimumab may be included only after consultation with the Study Physician. 7. Any concurrent chemotherapy, IP, biologic, or hormonal therapy for cancer treatment. Concurrent use of hormonal therapy for non-cancer-related conditions (eg, hormone replacement therapy) is acceptable. 8. Radiotherapy treatment to more than 30% of the bone marrow or with a wide field of radiation within 28 days of the first dose of study drug. 9. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of IP. Note: Local surgery of isolated lesions for palliative intent is acceptable. 10. History of allogenic organ transplantation. 11. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [eg, colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion: Patients with vitiligo or alopecia Patients with hypothyroidism (eg, following Hashimoto syndrome) stable on hormone replacement Any chronic skin condition that does not require systemic therapy Patients without active disease in the last 5 years may be included but only after consultation with the study physician Patients with celiac disease controlled by diet alone Page 7 October 02, 2016

8 12. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent. 13. History of another primary malignancy except for Malignancy treated with curative intent and with no known active disease 5 years before the first dose of IP and of low potential risk for recurrence Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease Adequately treated carcinoma in situ without evidence of disease 14. History of leptomeningeal carcinomatosis. 15. Brain metastases or spinal cord compression. Patients with suspected brain metastases at screening should have an MRI (preferred) or CT each preferably with IV contrast of the brain prior to study entry. 16. History of active primary immunodeficiency 17. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), or human immunodeficiency virus (positive HIV 1/2 antibodies). 18. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab or tremelimumab. The following are exceptions to this criterion: Intranasal, inhaled, topical steroids, or local steroid injections (eg, intra articular injection) Systemic corticosteroids at physiologic doses not to exceed <<10 mg/day>> of prednisone or its equivalent Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication) 19. Receipt of live attenuated vaccine within 30 days prior to the first dose of IP. Note: Patients, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP. 20. Female patients who are pregnant or breastfeeding or male or female patients of reproductive potential who are not willing to employ effective birth control from screening to 90 days after the last dose of durvalumab monotherapy or180 days after the last dose of durvalumab + tremelimumab combination therapy 21. Known allergy or hypersensitivity to IP or any IP excipient Page 8 October 02, 2016

9 22. Prior randomisation or treatment in a previous durvalumab and/or tremelimumab clinical study regardless of treatment arm assignment. Page 9 October 02, 2016