CompletedPhase 2

Avelumab in Chemo-resistant Gestational Trophoblastic Neoplasias

France24 participantsStarted 2017-02-21

Plain-language summary

Gestational trophoblastic neoplasias (GTN) are characterized by the persistence of elevated hCG titers after complete uterine evacuation of a partial hydatidiform mole (PHM) or a complete hydatidiform mole. GTN patients are commonly treated with single agent treatment (methotrexate or actinomycine-D) or polychemotherapy (first line treatment EMA-CO) according to the predicted risk of resistance to single agent treatment by FIGO score. GTN patients with resistance to these treatments are treated with another single agent drug or polychemotherapy regimens. Chemotherapy standard regimens are old and toxic for these young lady patients, with potential long term effects detrimental for further maternity and quality of life. There is a need for modern targeted agents with better benefit/toxicity profiles. There is a strong rational for investigating the anti-PDL1 monoclonal antibody avelumab in chemoresistant GTN patients. Several elements suggest that the normal pregnancy immune tolerance is "hijacked" by GTN cell for proliferating : * Spontaneous regressions of metastasic GTN are regularly observed, thereby the role of immune system for rejecting GTN cells. * Strong and constant overexpression of PDL1 and NK cells has been found in all subtypes and settings of GTN tumors from French reference gestational trophoblastic center. * The case of complete and durable response to pembrolizumab was reported in a patient with multi chemo-resistant GTN.

Who can participate

Age range18 Years

SexFEMALE

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Inclusion criteria for all patients : * Woman older than 18 years - Patients with Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 * Patients with adequate bone marrow function : * Absolute neutrophil granulocyte count ≥ 1.5 x 10 9 /L * Platelet count ≥ 100 x 10 9 /L * Haemoglobin ≥ 9.0 g/dL (may have been blood transfused). * Patients with adequate renal function : * Calculated creatinine clearance \>= 30 ml/min according to the Cockcroft-Gault formula (or local institutional standard method) * Patients with adequate hepatic function * Serum bilirubin ≤ 1.5 x UNL and AST/ALT ≤ 2.5 X UNL (≤ 5 X UNL for patients with liver metastases) * Patients must have a life expectancy ≥ 16 weeks * Confirmation of non-childbearing status for women of childbearing potential. An evolutive pregnancy can be ruled out in the following cases: * in case of a previous hysterectomy * if serum hCG level ≥ 2 000 IU/L and no intra or extra-uterine gestational sac is detected on pelvic ultrasound * if serum hCG level \< 2 000 IU/L on a first measurement and serum hCG increases \<100% on a second measurement performed 3 days later * Highly effective contraception if the risk of conception exists. (Note: The effects of the trial drug on the developing human fetus are unknown; thus, women of childbearing potential must agree to use 2 highly effective contraceptions, defined as methods with a failure rate of less than 1 % per year. Highly effective contraception is requ…

What they're measuring

The rate of patients with successful normalization of hCG assays

Timeframe: up to 6 months

Trial details

NCT IDNCT03135769

SponsorHospices Civils de Lyon

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2020-12-02