A Study of Tiragolumab Plus Atezolizumab and Atezolizumab Monotherapy in Participants With Metastatic and/or Recurrent PD-L1-Positive Cervical Cancer

NCT04300647CompletedPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Hoffmann-La Roche

Enrollment

172

Start Date

2020-06-30

Completion Date

2021-12-08

Study Type

INTERVENTIONAL

Official Title

A Phase II, Safety, and Efficacy Study of Tiragolumab Plus Atezolizumab and Atezolizumab Monotherapy in Patients With Metastatic and/or Recurrent PD-L1-Positive Cervical Cancer

Interventions

TiragolumabAtezolizumab

Conditions

Cervical Cancer

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria:

* Histologically confirmed recurrent or persistent squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix after progression on or after 1-2 lines of prior systemic chemotherapy in the metastatic/recurrent setting that is not amenable to curative treatment with systemic chemotherapy, surgery, and/or radiotherapy
* Radiologically-measurable disease
* Eastern Cooperative Oncology Group (ECOG) performance Status of 0 or 1
* Cervical cancer tissue for study analysis (archival or fresh biopsy specimen)
* Life expectancy of at least 12 weeks
* Adequate hematologic and organ function
* Female of childbearing potential must be willing to comply with adequate contraception

Exclusion Criteria:

* Treatment with investigational therapy with therapeutic intent within 28 days prior to randomization
* Active or untreated central nervous system (CNS) or brain metastases
* Active or history of autoimmune disease or immune deficiency
* Active tuberculosis
* Known, clinically significant liver disease
* Severe infection per investigator judgement at the time of randomization or any active infection that, in the opinion of the investigator, could impact patient safety
* Prior treatment with CD137 agonists or immune checkpoint blockade therapies, anti-CTLA-4, anti-TIGIT, anti-PD-1, and anti-PD-L1 therapeutic antibodies
* Treatment with systemic immunostimulatory agents within 4 weeks or 5 drug-elimination half-lives (whichever is longer) prior to randomization
* Treatment with systemic immunosuppressive medications within 1 week prior to randomization or anticipation of need for systemic immunosuppressive medication during study
* Pregnant or breastfeeding woman
* Known hypersensitivity to any component of the tiragolumab or atezolizumab formulations

Outcome Measures

Primary Outcomes

Pre-crossover Period: Independent Review Committee (IRC)-Assessed Objective Response Rate (ORR)

ORR was defined as the percentage of participants with a complete response (CR) or a partial response (PR) on two consecutive occasions ≥4 weeks apart, as determined by the IRC according to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1). CR=Disappearance of all target \& non-target lesions or any pathological lymph nodes (whether target or non-target) have reduction in short axis to \<10 millimeters (mm). PR=At least a 30% decrease in the sum of diameters (SOD) of all target lesions, taking as reference the baseline SOD, in the absence of CR. The study enrolled participants with measurable disease as determined by the investigator. Participants found to have non-measurable disease at baseline according to RECIST v1.1 (through IRC assessment or Protocol Deviations) were only considered responders if they achieved a CR. Percentages have been rounded off.

Time frame: From randomization up to approximately 17 months

Secondary Outcomes

Pre- and Post-crossover Periods: Number of Participants With Adverse Events (AEs)

An AE was any untoward medical occurrence in a clinical investigation participant administered a pharmaceutical product, regardless of causal attribution. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.

Time frame: Up to approximately 50.3 months

Pre-crossover Period: IRC-assessed Duration of Response (DOR)

DOR was defined for participants who had objective response (OR) as time from first occurrence of a documented OR (CR/PR) to date of PD or death from any cause (whichever occurred first), determined by IRC per RECIST v1.1. CR=Disappearance of all target \& non-target lesions or any pathological lymph nodes (whether target/non-target) have reduction in short axis to \<10 mm. PR=≥30% decrease in SOD of all target lesions, taking as reference baseline SOD, in absence of CR. PD = ≥ 20% increase in SOD of target lesions, taking as reference smallest SOD at prior timepoints (including baseline); in addition to relative increase of 20%, SOD must also demonstrate an absolute increase of ≥5 mm or unequivocal progression in non-target lesion(s). Study enrolled participants with measurable disease as per investigator. Participants who had non-measurable disease at baseline according to RECIST v1.1 (IRC assessment or Protocol Deviations) were only considered responders if they achieved CR.

Time frame: First occurrence of a documented objective response to the date of PD or death from any cause, whichever occurred first (up to approximately 17 months)

Pre-crossover Period: IRC-assessed Disease Control Rate (DCR)

DCR was defined as the percentage of participants with a CR, PR, or stable disease (SD), as determined by the IRC according to RECIST v1.1. CR and PR were defined the same as in the description of primary outcome measure (OM), ORR. SD=Neither sufficient shrinkage to qualify for CR/PR nor sufficient increase to qualify for PD. Participants were classified as SD only if SD was observed on two consecutive assessments ≥6 weeks apart. PD = ≥ 20% increase in SOD of target lesions, taking as reference smallest SOD at prior timepoints (including baseline); in addition to relative increase of 20%, SOD must also demonstrate an absolute increase of ≥5 mm or unequivocal progression in non-target lesion(s). Study enrolled participants with measurable disease as per the investigator. Participants who had non-measurable disease at baseline per RECIST v1.1 (IRC assessment or Protocol Deviations) were only considered responders if they achieved CR.

Time frame: From randomization up to approximately 17 months

Pre-crossover Period: Investigator-assessed Best Clinical Response (BCR) Rate

BCR was defined as the percentage of participants with a CR, PR, or SD, as determined by the investigator according to RECIST v1.1. CR=Disappearance of all target \& non-target lesions or any pathological lymph nodes (whether target/non-target) have reduction in short axis to \<10 mm. PR=At least a 30% decrease in SOD of all target lesions, taking as reference the baseline SOD, in the absence of CR. SD=Neither sufficient shrinkage to qualify for CR/PR nor sufficient increase to qualify for PD. Participants were classified as SD only if SD was observed on two consecutive assessments ≥6 weeks apart. PD=At least 20% increase in SOD of target lesions, taking as reference the smallest SOD at prior timepoints (including baseline); in addition to the relative increase of 20%, the SOD must also demonstrate an absolute increase of ≥5 mm or unequivocal progression in non-target lesion(s). Percentages have been rounded off.

Time frame: From randomization up to approximately 17 months

Pre-crossover Period: Investigator-assessed Duration of BCR

Duration of BCR was defined for BCR responders as the time from first occurrence of a documented response (CR, PR, or SD) to date of PD or death from any cause (whichever occurred first), as clinically determined by the investigator according to RECIST v1.1. CR=Disappearance of all target \& non-target lesions or any pathological lymph nodes (whether target/non-target) have reduction in short axis to \<10 mm. PR = ≥30% decrease in SOD of all target lesions, taking as reference the baseline SOD, in the absence of CR. SD=Neither sufficient shrinkage to qualify for CR/PR nor sufficient increase to qualify for PD. Participants were classified as SD only if SD was observed on two consecutive assessments ≥6 weeks apart. PD = ≥20% increase in SOD of target lesions, taking as reference smallest SOD at prior timepoints (including baseline); in addition to relative increase of 20%, the SOD must also demonstrate an absolute increase of ≥5 mm or unequivocal progression in non-target lesion(s).

Time frame: First occurrence of a documented clinical response to the date of PD or death from any cause, whichever occurred first (up to approximately 17 months)

Pre-crossover Period: IRC-assessed Progression-free Survival (PFS)

PFS was defined as the time from randomization to the first occurrence of PD or death from any cause (whichever occurred first), as determined by the IRC according to RECIST v1.1. PD was defined as at least 20% increase in SOD of target lesions, taking as reference the smallest SOD at prior timepoints (including baseline); in addition to the relative increase of 20%, the SOD must also demonstrate an absolute increase of ≥5 mm or unequivocal progression in non-target lesion(s).

Time frame: From randomization to the first occurrence of PD or death from any cause, whichever occurred first (up to approximately 17 months)

Pre-crossover Period: IRC-assessed PFS Rate at 6 Months

PFS rate was defined as the percentage of participants who were event-free at 6 months post-randomization, as determined by the IRC according to RECIST v1.1. PFS was defined as the time from randomization to the first occurrence of PD or death from any cause (whichever occurred first), as determined by the IRC according to RECIST v1.1. PD was defined as at least 20% increase in SOD of target lesions, taking as reference the smallest SOD at prior timepoints (including baseline); in addition to the relative increase of 20%, the SOD must also demonstrate an absolute increase of ≥5 mm or unequivocal progression in non-target lesion(s)..

Time frame: At Month 6

Pre-crossover Period: Overall Survival (OS)

OS was defined as the time of randomization to death from any cause.

Time frame: From randomization to death from any cause (up to approximately 17 months)

Pre-crossover Period: OS Rate at 6 Months and 12 Months

OS rate was defined as the percentage of participants who were still alive at 6 months and 12 months. OS was defined as the time of randomization to death from any cause.

Time frame: At Months 6 and 12

Pre-crossover Period: Minimum Serum Concentration (Cmin) of Tiragolumab

Time frame: Predose on Day 1 of Cycles 2, 3, 4, 8, 12 and 16 (1 cycle = 21 days)

Pre-crossover Period: Maximum Serum Concentration (Cmax) of Tiragolumab

Time frame: At 30 minutes post-dose on Cycle 1 Day 1 (1 Cycle = 21 days)

Pre-crossover Period: Cmin of Atezolizumab

Time frame: Predose on Day 1 of Cycles 2, 3, 4, 8, 12 and 16 (1 cycle = 21 days)

Pre-crossover Period: Cmax of Atezolizumab

Time frame: At 30 minutes post-dose on Day 1 of Cycle 1 (1 cycle = 21 days)

Pre-crossover Period: Percentage of Participants With Anti-Drug Antibodies (ADAs) to Tiragolumab

Participants were considered treatment-emergent ADA-positive if they were ADA negative at baseline or missing data but developed an ADA response following study drug administration (treatment-induced ADA response) or if they were ADA-positive at baseline and the titre of one or more post-baseline samples was at least 4-fold greater (i.e., ≥ 0.60 titre units\[t.u\]) than the titre of the baseline sample (treatment-enhanced ADA response).

Time frame: Up to approximately 17 months

Pre-crossover Period: Percentage of Participants With ADAs to Atezolizumab

Participants were considered treatment-emergent ADA-positive if they were ADA negative at baseline or missing data but developed an ADA response following study drug administration (treatment-induced ADA response) or if they were ADA-positive at baseline and the titre of one or more post-baseline samples was at least 4-fold greater (i.e., ≥ 0.60 t.u) than the titre of the baseline sample (treatment-enhanced ADA response). Percentages have been rounded off.

Time frame: Up to approximately 17 months

Locations

Arizona Oncology Associates, Phoenix, United States

Kaiser Permanente - Irvine, Irvine, United States

Augusta University, Augusta, United States

Oncology Associates of Oregon, P.C, Eugene, United States

Mater Misericordiae Limited, South Brisbane, Australia

Hospital Sao Rafael - HSR, Salvador, Brazil

Hospital Araujo Jorge, Goiânia, Brazil

Hospital de Caridade de Ijui, Ijuí, Brazil

Hospital Sao Lucas - PUCRS, Porto Alegre, Brazil

Hospital Nossa Senhora da Conceicao, Porto Alegre, Brazil

Clinica de Pesquisa e Centro de Estudos em Oncologia Ginecologica e Mamaria Ltda, São Paulo, Brazil

Royal Victoria Regional Health Centre, Barrie, Canada

London Regional Cancer Centre, London, Canada

Princess Margaret Cancer Center, Toronto, Canada

Jewish General Hospital, Montreal, Canada

McGill University Health Centre - Glen Site, Montreal, Canada

Clinica CIMCA, San José, Costa Rica

ICIMED Instituto de Investigación en Ciencias Médicas, San José, Costa Rica

Centre Leon Berard, Lyon, France

Institut Paoli Calmettes, Marseille, France

Centre Régional de Lutte Contre Le Cancer Val D'aurelle Paul Lamarque, Montpellier, France

ICO - Site René Gauducheau, Saint-Herblain, France

Gustave Roussy, Villejuif, France

Istituto Tumori Napoli, Naples, Italy

Policlinico Universitario Agostino Gemelli, Rome, Italy

Istituto Europeo Di Oncologia, Milan, Italy

Christus Muguerza Clinica Vidriera, Monterrey, Mexico

Centro Oncológico de Panamá, Panama City, Panama

The Panama Clinic, Panama City, Panama

Clinica Ricardo Palma, San Isidro, Peru

Bialostockie Centrum Onkologi, Bialystok, Poland

Szpital Morski im.PCK, Gdynia, Poland

Narodowy Inst.Onkol.im.Sklodowskiej-Curie Panstw.Inst.Bad Gliwice, Gliwice, Poland

Wielkopolskie Centrum Onkologii im. M. Sklodowskiej-Curie, Poznan, Poland

Narodowy Instytut Onkologii im. M.Sklodowskiej-Curie, Warsaw, Poland

MEDSI Clinical Hospital on Pyatnitsky Highway, Moscow, Russia

Chelyabisnk regional clinical center for oncology and nuclear medicine, Chelyabinsk, Russia

Republican Clinical Oncology Dispensary of Ministry of Healthcare of Tatarstan Republic, Kazan', Russia

Tomsk scientific research institute of oncology SO RAMN, PAD, Tomsk, Russia

Volgograd Regional Clinical Oncology Dispensary, Volgograd, Russia

Keimyung University Dongsan Hospital, Daegu, South Korea

Korea Cancer Center Hospital of Korea Institute of Radiological and Medical Sciences, Seoul, South Korea

Seoul National University Hospital, Seoul, South Korea

Severance Hospital, Yonsei University Health System, Seoul, South Korea

Asan Medical Center, Seoul, South Korea

Gangnam Severance Hospital, Seoul, South Korea

Samsung Medical Center, Seoul, South Korea

Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain

Hospital Universitario 12 de Octubre, Madrid, Spain

Hospital Universitario La Paz, Madrid, Spain

Taichung Veterans General Hospital, Taichung, Taiwan

National Taiwan University Hospital, Taipei, Taiwan

Taipei Veterans General Hospital, Taipei, Taiwan

Mackay Memorial Hospital, Taipei, Taiwan

Chang Gung Medical Foundation, Linkou Branch, Taoyuan, Taiwan

Maharaj Nakorn Chiang Mai Hospital, Muang, Thailand

University College London Hospital, London, United Kingdom

Sarah Cannon Research Institute, London, United Kingdom

Linked Papers

2024-08-05

A non-comparative, randomized, phase II trial of atezolizumab or atezolizumab plus tiragolumab for programmed death-ligand 1-positive recurrent cervical cancer (SKYSCRAPER-04)

To evaluate tiragolumab (anti-TIGIT) and atezolizumab (anti-PD-L1) as second- or third-line therapy for PD-L1-positive persistent/recurrent cervical cancer. In the open-label, non-comparative, randomized phase II SKYSCRAPER-04 trial (NCT04300647), patients with PD-L1-positive (SP263 tumor area positivity ≥5%) recurrent/persistent cervical cancer after 1-2 chemotherapy lines (≥1 platinum-based) were randomized 3:1 to atezolizumab 1200 mg with/without tiragolumab 600 mg every 3 weeks until disease progression or unacceptable toxicity. Stratification factors were performance status, prior (chemo)radiotherapy, and disease status. The primary endpoint was independent review committee-assessed confirmed objective response rate per RECIST v1.1 in patients receiving tiragolumab plus atezolizumab. An objective response rate ≥21% (one-sample z-test p≤0.0245) was required for statistical significance versus a historical reference. Protocol-defined independent review committee-assessed objective response rates were 19.0% (95% CI 12.6 to 27.0) in 126 patients receiving tiragolumab plus atezolizumab (p=0.0787 vs historical reference) and 15.6% (95% CI 6.5 to 29.5) in 45 atezolizumab-treated patients. Response rates were higher in PD-L1 The objective response rate with the tiragolumab-plus-atezolizumab combination was numerically higher than the historical reference but did not reach statistical significance.