Study of Cemiplimab in Adults With Cervical Cancer

NCT03257267CompletedPHASE3INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Regeneron Pharmaceuticals

Enrollment

608

Start Date

2017-09-05

Completion Date

2021-03-15

Study Type

INTERVENTIONAL

Official Title

An Open-Label, Randomized, Phase 3 Clinical Trial of REGN2810 Versus Investigator's Choice of Chemotherapy in Recurrent or Metastatic Cervical Carcinoma

Interventions

CemiplimabInvestigator Choice (IC) Chemotherapy

Conditions

Squamous Cell Carcinoma (SCC)Recurrent or MetastaticPlatinum-refractory Cervical Cancer

Eligibility

Age Range

18 Years+

Sex

FEMALE

The criteria listed below are not intended to contain all considerations relevant to a patient's potential participation in this clinical trial.

Key Inclusion Criteria:

1. Recurrent, persistent, and/or metastatic cervical cancer with squamous cell histology, for which there is not a curative-intent option (surgery or radiation therapy with or without chemotherapy).

   * Acceptable histologies (squamous carcinoma, adenocarcinoma, and adenosquamous carcinoma) as defined in the protocol
2. Tumor progression or recurrence after treatment with platinum therapy (must have been used to treat metastatic, persistent, or recurrent cervical cancer)
3. Patient must have measurable disease as defined by RECIST 1.1.
4. Eastern Cooperative Oncology Group (ECOG) performance status ≤1
5. ≥18 years old
6. Adequate organ or bone marrow function
7. Received prior bevacizumab therapy or had clinically documented reason why not administered
8. Received prior paclitaxel therapy or had clinically documented reason why not administered

Key Exclusion Criteria:

1. Ongoing or recent (within 5 years) evidence of significant autoimmune disease that required treatment with systemic immunosuppressive treatments
2. Prior treatment with an agent that blocks the PD-1/PD-L1 pathway
3. Prior treatment with other systemic immune-modulating agents that was

   1. within fewer than 4 weeks (28 days) of the enrollment date, or
   2. associated with irAEs of any grade within 90 days prior to enrollment, or
   3. associated with toxicity that resulted in discontinuation of the immune modulating agent
4. Active or untreated brain metastases
5. Immunosuppressive corticosteroid doses (\>10 mg prednisone daily or equivalent) within 4 weeks prior to the first dose of study drug cemiplimab or IC chemo)
6. Active infection requiring therapy
7. History of pneumonitis within the last 5 years
8. History of documented allergic reactions or acute hypersensitivity reaction attributed to antibody treatments
9. Concurrent malignancy other than cervical cancer and/or history of malignancy other than cervical cancer within 3 years of date of first planned dose of study drug cemiplimab or IC chemo), except for tumors with negligible risk of metastasis or death, such as adequately treated cutaneous squamous cell carcinoma or basal cell carcinoma of the skin or ductal carcinoma in situ of the breast. Patients with hematologic malignancies (eg, chronic lymphocytic leukemia) are excluded.

Note: Other protocol defined Inclusion/Exclusion apply

Outcome Measures

Primary Outcomes

Overall Survival (OS)

Overall survival was defined as the time from randomization to the date of death due to any cause. A participant who had not died was censored at the last known date of contact.

Time frame: From first dose up to 90 following last dose (~42 months)

Overall Survival (OS) in the SCC Population

Overall survival was defined as the time from randomization to the date of death due to any cause. A participant who had not died was censored at the last known date of contact.

Time frame: From first dose up to 90 following last dose (~42 months)

Secondary Outcomes

Progression-free Survival (PFS) Assessed by Investigator Using Response Evaluation Criteria in Solid Tumors (RECIST 1.1)

PFS was defined as the time from randomization to the date of the first documented tumor progression (radiographic) or death due to any cause. Participants who did not have a documented tumor progression or death were censored on the date of their last evaluable tumor assessment.

Time frame: Time from randomization to the date of the first documented tumor progression or death due to any cause (assessed up to 40 months)

Objective Response Rate (ORR) Assessed by Investigator Using RECIST 1.1

ORR was defined as the number of participants who achieved complete response (CR) or partial response (PR) as per RECIST 1.1. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to less than (\<) 10 millimeters (mm) (\<1 centimeter \[cm\]). PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.

Time frame: From date of randomization up to 40 months

Duration of Response (DOR) Assessed Per RECIST 1.1

DOR was defined as the time from the date of first response (CR or PR) to the date of the first documented progressive disease (per RECIST 1.1) or death due to any cause. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm (\<1 cm). PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. Participants who never progressed while being followed was censored at the last valid tumor measurement. DOR was determined by Kaplan-Meier estimate.

Time frame: Time from the date of first response to the date of the first documented progressive disease or death due to any cause (up to 40 months)

Quality of Life (QoL): Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) of Global Health Status /Quality of Life (GHS/QoL) and Physical Functioning Scales

EORTC QLQ-C30 is a 30-question tool used to assess the overall QoL in cancer participants. It consisted of 15 domains: 1 GHS/QoL scale, 5 functional scales (Physical, role, cognitive, emotional, social), and 9 symptom scales/items (Fatigue, nausea and vomiting, pain, dyspnea, sleep disturbance, appetite loss, constipation, diarrhea, financial impact). Most items are scored 1 ("not at all") to 4 ("very much") except for the items contributing to the GHS/QoL, which are scored 1 ("very poor") to 7 ("excellent"). A linear transformation was applied to the raw scores so that all transformed scores lie between 0 to 100. For the GHS/QoL and 5 functional scales a high score indicates better global health status/functioning and a negative change from baseline indicated less improvement. For the symptom scales, a high score indicates a higher level of symptoms, and a negative change from baseline indicated an improvement in symptoms.

Time frame: From Cycle 1 Day 1 up to 40 months (Each cycle = 42 days)

Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and TEAEs Leading to Death

An adverse event (AE) was defined as any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment. A Treatment-emergent adverse event (TEAE) was defined as those that are not present at baseline or represent the exacerbation of a pre-existing condition during the on-treatment period. A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of the following outcomes: death, life- threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious and non-serious TEAEs. Number of participants with TEAEs, serious TEAEs, and TEAEs leading to death were reported.

Time frame: From first dose up to 90 following last dose (~36 months)

Number of Participants With New or Worsened Laboratory Results by National Cancer Institute Common Terminology Criteria for Adverse Event (NCI-CTCAE) Grade

Laboratory parameters included hematology, electrolytes, chemistry (other), and liver function. Clinically significant abnormalities were determined by the investigator based on NCI-CTCAE Grade where Grade 1 = Mild, Grade 2 = moderate, Grade 3 = severe; Grade 4 = life threatening or disabling; Grade 5 = death. Participants with at least 1 lab abnormality Graded 3/4 in hematology, electrolytes, chemistry (other), or liver function reported.

Time frame: From first dose up to 90 following last dose (~36 months)

Locations

Arizona Oncology Associates, Phoenix, United States

Arizona Oncology Associates, Tucson, United States

University of California Irvine, Orange, United States

Ochsner Clinic Foundation, New Orleans, United States

Cancer Research for the Ozarks, Springfield, United States

New York Presbyterian Queens, Flushing, United States

Northwell Health, Lake Success, United States

Laura and Issac Perlmutter Cancer Center at NYU Langone, New York, United States

First Health of the Carolinas Outpatient Cancer Center, Pinehurst, United States

Thomas Jefferson University Hospital, Philadelphia, United States

Texas Oncology, P.A., Austin, United States

St. George Hospital, Kogarah, Australia

Northern NSW Health District, The Tweed Hospital, Tweed Heads, Australia

Royal Brisbane & Women's Hospital, Herston, Australia

Peter MacCallum Cancer Centre, Melbourne, Australia

Sir Charles Gairdner Hospital, Nedlands, Australia

St. John of God Subiaco Hospital, Subiaco, Australia

OLV ziekenhuis Aalst, Medische oncologie- Radiotherapie, Aalst, Belgium

Institut Bordet, Brussels, Belgium

Cliniques universitaires Saint-Luc, Brussels, Belgium

UZLeuven Gynaelologic Oncology, Leuven, Belgium

CHC Saint Joseph, Liège, Belgium

CHU Liège, Liège, Belgium

CHU UCL Namur site Sainte Elisabeth, Namur, Belgium

Liga Norte Riograndense Contra o Câncer, Natal, Brazil

Hosptial Sao Lucas da PUC de Porto Alegre, Porto Alegre, Brazil

Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

Centro de Novos Tratamentos Itajai, Itajaí, Brazil

Fundação Pio XII - Hospital de Câncer de Barretos, Barretos, Brazil

Instituto de Pesquisas Clinicas para Estudos Multicentricos - IPCEM, Caxias do Sul, Brazil

Instituto Nacional de Cancer - INCA, Rio de Janeiro, Brazil

Instituto COI de Pesquisa, Rio de Janeiro, Brazil

Tom Baker Cancer Center, Calgary, Canada

British Columbia Cancer Agency, Vancouver, Canada

London Health Sciences Centre, London, Canada

Princess Margaret Cancer Centre, Toronto, Canada

Hospital Maisonneuve-Rosemont, Montreal, Canada

Hopital Notre-Dame du Centre Hospitalier de l'Universite de Montreal, Montreal, Canada

Jewish General Hospital, Montreal, Canada

General Hospital of Athens Alexandra, Athens, Greece

University Hospital of Ioannina, Ioannina, Greece

General Hospital of Patras, Pátrai, Greece

Euromedica General Clinic, B'Oncology Clinic, Thessaloniki, Greece

Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy

U.O Oncologia Medica P.O Vito Fazzi, Lecce, Italy

Asst Lecco, Lecco, Italy

Irst Irccs, Meldola, Italy

Istituto Europeo di Oncologia, Milan, Italy

AUSL, IRCCS di Reggio Emilia, Reggio Emilia, Italy

Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Roma, Italy

Regina Elena National Cancer Institute, Rome, Italy

Shikoku Cancer Center, Matsuyama, Japan

Ehime University Hospital, Tōon, Japan

Fukui University Hospital, Yoshida-gun, Japan

Kurume University Hospital, Kurume, Japan

Hokkaido University Hospital, Sapporo, Japan

St. Marianna University School of Medicine Hospital, Kawasaki, Japan

University of the Ryukyus Hospital, Nakagami-gun, Japan

Saitama Medical University, Saitama, Japan

National Cancer Center Hospital, Chuo-ku, Japan

The Cancer Institute Hospital of JFCR, Koto-Ku, Japan

Kyorin University Hospital, Mitaka, Japan

Saitama Cancer Center, Saitama, Japan

National Kyushu Cancer Center, Fukuoka, Japan

Kagoshima City Hospital, Kagoshima, Japan

Bialostockie Centrum Onkologii, Bialystok, Poland

Szpitale Pomorskie, Gdynia, Poland

Center and Institute of Oncology Gliwice, Gliwice, Poland

Centrum Onkologii Ziemi Lubelskiej im sw. Jana z Dukli, Lublin, Poland

Greater Poland Cancer Center, Poznan, Poland

Regional Budgetary Institution of Healthcare Ivanovo Regional Oncology Dispensary, Ivanovo, Russia

State Budgetary Healthcare Institution "Oncology Dispensary" of Ministry of Healthcare of the Kabardino-Balkarian Republic, Nal'chik, Russia

A. Tsyb Medical Radiological Research Center, Obninsk, Russia

State Budgetary Institution of Healthcare, Clinical Oncology Dispensary #1 of Ministry of Health of Krasnodar Region, Krasnodar, Russia

State Budgetary Healthcare Institution Leningrad Regional Oncological Dispensary (SBHI "LROD"), Vsevolozhsk, Russia

State Autonomous Healthcare Institution ,Republican Clinical Oncological Dispensary of the Ministry of Healthcare of the Tatarstan Republic, Kazan', Russia

Budgetary Institution of Healthcare of Omsk region Clinical Oncology Dispensary, Omsk, Russia

State Budgetary Institution of Healthcare "Orenburg Regional Clinical Oncology Dispensary", Orenburg, Russia

Saint- Petersburg State Budgetary institution of Healthcare "City Clinical Oncological Dispensary", Saint Petersburg, Russia

National Cancer Center, Goyang-si, South Korea

Keimyung University Dongsan Medical Center, Daegu, South Korea

Seoul National University Hospital, Seoul, South Korea

Asan Medical Center, Seoul, South Korea

Gangnam Severance Hospital, Seoul, South Korea

Korea University Guro Hospital, Seoul, South Korea

Hospital Universitario Son Espases, Palma de Mallorca, Spain

Vall d´Hebron University Hospital, Barcelona, Spain

Hospital Reina Sofia, Córdoba, Spain

Instituto Catalan de Oncologia de Gerona, Girona, Spain

Hospital Ramon y Cajal, Madrid, Spain

Hospital Universitario HM Sanchinarro CIOCC, Madrid, Spain

Hospital Virgen de la Victoria, Málaga, Spain

Fundacion Instituto Valenciano de Oncologia, Valencia, Spain

Hospital Universitario La Fe, Valencia, Spain

Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain

Taichung Veterans General Hospital, Taichung, Taiwan

MacKay Memorial Hospital, Taipei, Taiwan

Koo-Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

Taipei Veterans General Hospital, Taipei, Taiwan

Velindre Cancer Centre, Cardiff, United Kingdom

NHS Greater Glasgow and Clyde Beatson, West of Scotland Cancer care, Glasgow, United Kingdom

University College Hospital, London, United Kingdom

Royal Marsden NHS Foundation Trust, Chelsea, London, United Kingdom

Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

Royal Marsden NHS Foundation Trust, Sutton, Sutton, United Kingdom

Linked Papers

Survival with Cemiplimab in Recurrent Cervical Cancer

Patients with recurrent cervical cancer have a poor prognosis. Cemiplimab, the fully human programmed cell death 1 (PD-1)-blocking antibody approved to treat lung and skin cancers, has been shown to have preliminary clinical activity in this population. In this phase 3 trial, we enrolled patients who had disease progression after first-line platinum-containing chemotherapy, regardless of their programmed cell death ligand 1 (PD-L1) status. Women were randomly assigned (1:1) to receive cemiplimab (350 mg every 3 weeks) or the investigator's choice of single-agent chemotherapy. The primary end point was overall survival. Progression-free survival and safety were also assessed. A total of 608 women were enrolled (304 in each group). In the overall trial population, median overall survival was longer in the cemiplimab group than in the chemotherapy group (12.0 months vs. 8.5 months; hazard ratio for death, 0.69; 95% confidence interval [CI], 0.56 to 0.84; two-sided P<0.001). The overall survival benefit was consistent in both histologic subgroups (squamous-cell carcinoma and adenocarcinoma [including adenosquamous carcinoma]). Progression-free survival was also longer in the cemiplimab group than in the chemotherapy group in the overall population (hazard ratio for disease progression or death, 0.75; 95% CI, 0.63 to 0.89; two-sided P<0.001). In the overall population, an objective response occurred in 16.4% (95% CI, 12.5 to 21.1) of the patients in the cemiplimab group, as compared with 6.3% (95% CI, 3.8 to 9.6) in the chemotherapy group. An objective response occurred in 18% (95% CI, 11 to 28) of the cemiplimab-treated patients with PD-L1 expression greater than or equal to 1% and in 11% (95% CI, 4 to 25) of those with PD-L1 expression of less than 1%. Overall, grade 3 or higher adverse events occurred in 45.0% of the patients who received cemiplimab and in 53.4% of those who received chemotherapy. Survival was significantly longer with cemiplimab than with single-agent chemotherapy among patients with recurrent cervical cancer after first-line platinum-containing chemotherapy. (Funded by Regeneron Pharmaceuticals and Sanofi; EMPOWER-Cervical 1/GOG-3016/ENGOT-cx9 ClinicalTrials.gov number, NCT03257267.).

Linked Investigators

Study of Cemiplimab in Adults With Cervical Cancer