Personalised Immunotherapy Platform

Official title

Personalised Immunotherapy Platform (PIP) - Implementation of a Predictive Model of Response to Immunotherapies in Melanoma

Overview

This is a non-interventional study to prospectively test a suite of predictive biomarker models of immunotherapy resistance in patients with melanoma, non-melanoma skin cancers and other solid tumours. The study will evaluate the documentation, processes, accuracy and utility of the predictive biomarker model in clinical practice.

Detailed description

The Personalised Immunotherapy Program (PIP) is a multicenter biomarker discovery and validation program of multi-omic biomarker based predictive models which aim to identify patients with immunotherapy resistant disease. PIP developed predictive models in retrospective setting, with validation within a prospective clinical observational study.

Immune checkpoint inhibitors targeting the cytotoxic T-cell lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) receptors have revolutionised the treatment of advanced melanoma, resulting in long-term durable responses and a 5-year overall survival of 52% with combination immunotherapy. However, clinical benefit is not universal, and half of these patients do not respond. Therefore, there is an urgent need for clinically validated biomarkers which can identify patients who are at high risk of not responding to standard-of-care immunotherapies and determine which emerging clinical trial agent is most appropriate for a particular patient's disease.

Researchers performed mutation, gene expression and tumour immune profiling on tumour biopsies from melanoma patients treated with anti-PD-1 monotherapy or combined anti-PD-1 and anti-CTLA-4 therapy. From this dataset PIP has developed predictive models to identify patients with immunotherapy resistant disease.

The subsequent PIP-PREDICT is a prospective clinical study that enrols advanced cancer patients who are eligible to receive approved immunotherapies. PIP testing and biomarker reporting is used to screen potential patients. Each patient enrolled in the study receives an individual PIP Biomarker Report, which is presented as part of the established Biomarker Multidisciplinary Team (MDT) meeting of clinical oncologists, pathologists, molecular biologists, trials nursing, PIP, and biospecimen staff on a fortnightly basis.

PIP-PREDICT has a primary goal of determining the accuracy of biomarker predictions from PIP prospectively within oncology clinics. Secondary goals include assessing the feasibility of biomarker assay workflows within diagnostic providers, conducting a cost-benefit ratio analysis, evaluating the effect of biomarker reports on treatment selection within multidisciplinary teams (MDTs), and performing a post-implementation analysis of personalised immunotherapy biomarker reports in treatment decision making.

Interventions

• Other Predictive model
  Patient who have not had immunotherapy will have tumour tested using the predictive model. This determines whether patients are likely to respond, or not to respond to immunotherapy. Results of the predictive model will be compared with the actual response to immunotherapy when this has been completed.

Primary outcome measures

• Assessment of the accuracy of predictive test results in melanoma [Time frame: 6 months]

Secondary outcome measures (12)

• Assessment of the inaccuracy of predictive test results [Time frame: 6 months]
• Evaluation of a test request form - completion rate [Time frame: 2 years]
• Analysis of potential barriers to complete a test request form [Time frame: 2 years]
• Evaluation of accessible data in medical records for completion of a test request form [Time frame: 2 years]
• Evaluation of a test request form from clinician feedback via qualitative surveys [Time frame: 2 years]
• Conduct qualitative surveys to evaluate a test result report from consumers' viewpoint [Time frame: 1 year]
• Qualiaitive evaluation of a test result report from consumers' viewpoint [Time frame: 1 year]
• Conduct qualitative surveys to evaluation of a test result report from the clinicians' viewpoint [Time frame: 2 years]
• Qualiaitive evaluation of a test result report from clinicians' viewpoint [Time frame: 2 years]
• Evaluation of the predictive model workflow on result completion [Time frame: 2 years]
• Evaluation of the predictive model workflow on result delivery [Time frame: 2 years]
• Evaluation of the predictive model workflow turnaround timeframes [Time frame: 2 years]

Eligibility criteria

MELANOMA:

Inclusion criteria

• Written informed consent to participation for the use of tumour tissue, blood and stool and collection of standard clinical data.
• Histologically confirmed resected stage II (at high risk of recurrence of disease), III or stage IV melanoma (including cutaneous, mucosal, acral, subungual, uveal or unknown primary melanoma) and unresectable Stage III or IV melanoma
• Eligible to receive immunotherapy
• Availability of a melanoma tissue sample which was obtained at surgery and where no systemic treatments (e.g. adjuvant treatment) were administered between sample procurement and proposed PIP testing
• Patients who have received adjuvant or neoadjuvant systemic therapy in the past are eligible if they have had recurrence after neoadjuvant or adjuvant therapy has been completed and the biopsy represents this relapsed disease
• RECIST version 1.1 measurable disease.
• Tissue sample must be representative of the whole tumour and therefore excision biopsies are preferred over core biopsies.
• A life expectancy over 6 months.
• Prior treatment with BRAF (B-Raf proto-oncogene) / MEK (mitogen-activated protein kinase) inhibitors are acceptable, providing the other eligibility criteria are met.
• If a patient has had prior radiotherapy for melanoma, the biopsy to be used for the biomarker test must be from an area that was not within the radiotherapy field.

Exclusion criteria

1\. Patients will be excluded if they have had a positive test result for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV antibody), indicating acute or chronic infection. If receiving treatment and from HCV for at least one year, patients are allowed to participate. No new testing is required for the sole purpose of this pilot phase. Patients will be excluded if they have known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). No new testing is required

NON-MELANOMA:

Inclusion criteria

• Written informed consent to participation for the use of tumour tissue and collection of standard clinical data
• Histologically confirmed cancer and eligibility to receive immunotherapy treatment.
• Availability of a tissue sample where no systemic treatments were administered between sample procurement and proposed PIP testing
• If treatment has been administered since the last tissue sample was obtained, a new biopsy should be planned for routine testing or clinical trial screening, where a portion of the sample can be used for the predictive assay. No new biopsies are required for the sole purpose of this study.
• Patients who have received adjuvant or neoadjuvant systemic therapy in the past are eligible if they have had recurrence after neoadjuvant or adjuvant therapy has been completed and the biopsy represents this relapsed disease.
• Have clinically detectable disease defined as one of more of the following:

• RECIST measurable. Lesions situated in a previously irradiated area are considered measurable if RECIST-defined disease progression since radiotherapy has been demonstrated in such lesions, OR,
• Positron Emission Tomography (PET) avid, OR,
• Clinically evident disease: photographically, detectable on CT or palpable, OR
• Clinical status measured by observable and diagnosable signs or symptoms.
• The tissue sample must be representative of the whole tumour and therefore excision biopsies are preferred over core biopsies.
• A life expectancy over 6 months.
• Prior treatment with targeted therapies are acceptable, providing the other eligibility criteria are met.
• If a patient has had prior radiotherapy for melanoma, the biopsy to be used for the biomarker test must be from an area that was not within the radiotherapy field

Exclusion criteria

1\. Patients will be excluded if they have had a positive test result for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV antibody), indicating acute or chronic infection. If receiving treatment and from HCV for at least one year, patients are allowed to participate. No new testing is required for the sole purpose of this pilot phase. Patients will be excluded if they have known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). No new testing is required

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Australia · 3 centers

• Chris O'Brien Lifehouse — Sydney
• Melanoma Institute Australia — Sydney
• Westmead Hospital — Sydney

Publications

• Gide TN, Paver EC, Yaseen Z, Maher N, Adegoke N, Menzies AM, Pires da Silva I, Wilmott JS, Long GV, Scolyer RA. Lag-3 expression and clinical outcomes in metastatic melanoma patients treated with combination anti-lag-3 + anti-PD-1-based immunotherapies. Oncoimmunology. 2023 Oct 4;12(1):2261248. doi: 10.1080/2162402X.2023.2261248. eCollection 2023. PMID 37808404
• Mao Y, Gide TN, Adegoke NA, Quek C, Maher N, Potter A, Patrick E, Saw RPM, Thompson JF, Spillane AJ, Shannon KF, Carlino MS, Lo SN, Menzies AM, da Silva IP, Long GV, Scolyer RA, Wilmott JS. Cross-platform comparison of immune signatures in immunotherapy-treated patients with advanced melanoma using a rank-based scoring approach. J Transl Med. 2023 Apr 13;21(1):257. doi: 10.1186/s12967-023-04092-9. PMID 37055772
• Adegoke NA, Gide TN, Mao Y, Quek C, Patrick E, Carlino MS, Lo SN, Menzies AM, Pires da Silva I, Vergara IA, Long G, Scolyer RA, Wilmott JS. Classification of the tumor immune microenvironment and associations with outcomes in patients with metastatic melanoma treated with immunotherapies. J Immunother Cancer. 2023 Oct;11(10):e007144. doi: 10.1136/jitc-2023-007144. PMID 37865395

Identifiers

NCT: NCT06536257 · MIA2020/283

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗