Avelumab and Methotrexate in in Low-risk Gestational Trophoblastic Neoplasias as First Line Treatment

STATUS

Recruiting
End date

Jul 12, 2026
participants needed

26
sponsor

Hospices Civils de Lyon

Updated on 19 February 2024

See if I qualify

Summary

Show definitions

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.

Low-risk GTN patients (FIGO score 6) are commonly treated with single agent treatment (methotrexate or actinomycin-D) The cure rate, assessed by hCG normalization, is obtained in 65 to 75% of patients with these agents GTN patients with resistance to these treatments are treated with another single agent drug or polychemotherapy regimens, such as EMA-CO or BEP regimen.

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 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 metastastic 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.
Complete and durable responses to pembrolizumab were reported in 3 patients with multi-chemoresistant GTN in United Kingdom.
Three cases of hCG normalization with avelumab in 6 patients with chemo-resistant GTN enrolled in TROPHIMMUN cohort A (resistant to a mono-chemotherapy).
Cytotoxicity of avelumab is mediated through antibody dependent cell cytotoxicity (ADCC) by NK cells.

Details

Condition	Gestational Trophoblastic Neoplasias (GTN)
Age	18years - 100years
Treatment	Avelumab Injection, Methotrexate 1 GM Injection
Clinical Study Identifier	NCT04396223
Sponsor	Hospices Civils de Lyon
Last Modified on	19 February 2024

How understandable was the trial content above?

Hard to understand

Easy to understand

Eligibility		Yes	No	Not Sure
Inclusion Criteria
	\- Woman older than 18 years
	Low-risk gestational trophoblastic neoplasia according to FIGO score (FIGO score 6) with indication of methotrexate as first line treatment
	Patients with Eastern Cooperative Oncology Group (ECOG) performance status 2
	Patients with adequate bone marrow function measured within 28 days prior to administration of study treatment as defined below
	Absolute 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 required at least 28 days prior, throughout and for at least 12 months after avelumab treatment
	Patients who gave its written informed consent to participate to the study
	Patients affiliated to a social insurance regime
	Patient is willing and able to comply with the protocol for the duration of the treatment
Exclusion Criteria
	Prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti- CTLA 4 antibody (including ipilimumab, tremelimumab or any other antibody or drug specifically targeting T-cell costimulation or immune checkpoint pathways)
	Illness, incompatible with avelumab, such as congestive heart failure; respiratory distress; liver failure; uncontrolled epilepsy; allergy
	Patients with a known allergic hypersensitivity to methotrexate or any of the other ingredients (sodium chloride, sodium hydroxide, and hydrochloric acid if excipient)
	Patients with second primary cancer, except: adequately treated non-melanoma skin cancer, curatively treated in-situ cancer of the cervix, or other solid tumours curatively treated with no evidence of disease for 5 years
	All subjects with brain metastases, except those meeting the following criteria
	Brain metastases that have been treated locally and are clinically stable for at least 2 weeks prior to enrolment, No ongoing neurological symptoms that are related to the brain localization of the disease (sequelae that are a consequence of the treatment of the brain metastases are acceptable)
	Subjects with brain metastases must be either off steroids except a stable or decreasing dose of <10mg daily prednisone (or equivalent)
	Patients receiving any systemic chemotherapy, radiotherapy (except for palliative reasons), within 2 weeks from the last dose prior to study treatment (or a longer period depending on the defined characteristics of the agents used). The patient can receive a stable dose of bisphosphonates for bone metastases, before and during the study as long as these were started at least 4 weeks prior to treatment with study drug
	Persistent toxicities (>=CTCAE grade 2) with the exception of alopecia and sensory neuropathy, caused by previous cancer therapy
	Treatment with other investigational agents
	Bowel occlusive syndrome, inflammatory bowel disease, immune colitis, or other gastro-intestinal disorder that does not allow oral medication such as malabsorption
	Stomatitis, ulcers of the oral cavity and known active gastrointestinal ulcer disease
	Clinically significant (i.e., active) and severe cardiovascular disease according to investigator opinion such as myocardial infarction (< 6 months prior to enrollment)
	Patients with immune pneumonitis, pulmonary fibrosis
	Known severe hypersensitivity reactions to monoclonal antibodies, any history of anaphylaxis, or uncontrolled asthma (ie, 3 or more features of partially controlled asthma Global Initiative for Asthma 2011)
	Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) related illness
	Active infection requiring systemic therapy
	Positive test for HBV surface antigen and / or confirmatory HCV RNA (if anti-HCV antibody tested positive)
	Administration of a live vaccine within 30 days prior to study entry
	Current or prior use of immunosuppressive medication within 7 days prior to start of study treatment
	The following are exceptions to this exclusion 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 equivalent
	Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication)
	Active autoimmune disease that might deteriorate when receiving an immunostimulatory agents
	Patients with diabetes type I, vitiligo, psoriasis, hypo- or hyperthyroid
	disease not requiring immunosuppressive treatment are eligible
	Female patients who are pregnant or lactating, or are of childbearing potential and not practicing a medically acceptable method of birth control
	Treatment with oral anticoagulant such Coumadin
	Alcoholism (patient interview, investigator judgment)
	Resting ECG with QTc > 470msec on 2 or more time points within a 24 hour period or family history of long QT syndrome. Torsades de Pointes, arrhythmias (including sustained ventricular tachyarrhythmia and ventricular fibrillation, bradycardia defined as <50 bpm), right bundle branch block and left anterior hemiblock (bifascicular block), unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure (CHF New York Heart Association Class III or IV), cerebrovascular accident, transient ischemic attack or symptomatic pulmonary embolism
	Prior organ transplantation, including allogeneic stem cell transplantation (excluding autologous bone marrow transplant)
	Patients under guardianship

How to participate?

Step 1 Connect with a study center

Send a message

Enter your contact details to connect with study team

First name*

Last name*

Email*

Phone number*

Other language

I am at least 18 years old.

By sending a message, I agree to share my information with the study team for the selected site and consent to receive emails and text messages for trial updates, notifications, and related communication. TrialX values your privacy; your information will be handled in accordance with our Privacy Policy

Step 2 Get screened

Additional screening procedures may be conducted by the study team before you can be confirmed eligible to participate.

Learn more

Step 3 Enroll in the clinical study

If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

Learn more

Step 4 Get your study results

Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

Learn more

Similar trials to consider

Not finding what you're looking for?

Every year hundreds of thousands of volunteers step forward to participate in research. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.

Avelumab and Methotrexate in in Low-risk Gestational Trophoblastic Neoplasias as First Line Treatment

Summary

Details

How to participate?

Similar trials to consider

Not finding what you're looking for?

Study AnnotationsStudy Notes

Add a private note

Study Definition

Add a private note

Avelumab and Methotrexate in in Low-risk Gestational Trophoblastic Neoplasias as First Line Treatment

Summary

Details

How to participate?

Similar trials to consider

Not finding what you're looking for?

Sign up as a volunteer to stay informed

Study AnnotationsStudy Notes

Add a private note

Study Definition

Add a private note