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CheckpOiNt Blockade For Inhibition of Relapsed Mesothelioma (CONFIRM)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03063450
Recruitment Status : Recruiting
First Posted : February 24, 2017
Last Update Posted : August 5, 2019
Bristol-Myers Squibb
Information provided by (Responsible Party):
University of Southampton

Brief Summary:

The UK has the highest incidence of mesothelioma. The incidence has risen by 497% since the late 1970's and is increasing worldwide due to continued mining and use of asbestos. For patients with mesothelioma who have relapsed after taking pemetrexed and cisplatin, there is currently no standard treatment, making this an urgent unmet need. Recent trials in this area have not found an effective treatment that improves overall survival.

Following a debate in the House of Lords, a national survey assessing the research priorities in mesothelioma found that 'exploiting the potential of immunotherapy' was a top priority. This trial was designed in response to that survey. It uses the immunotherapy agent nivolumab which blocks programmed cell death 1 (PD-1) receptor on activated T-cells (a type of white blood cell forming part of the immune system). Early research has found a dependency of mesothelioma on the PD-1 checkpoint. By attaching to PD-1, nivolumab blocks its action (checkpoint inhibition), preventing it from turning off the T-cell, and therefore allowing the immune system to work. PD-1 checkpoint inhibition has revolutionised the treatment of melanoma and it is hoped to be as effective in mesothelioma.

This trial is a randomised, double blind placebo controlled trial of patients with mesothelioma who are third relapse following a platinum based chemotherapy treatment. Patients will be randomised in a 2:1 ratio (nivolumab: placebo).

336 patients will be recruited from 25 UK centres over a four-year period with the last patient having a minimum of 6 months follow up. All patients will be on treatment for 12 months unless they progress or withdrawal prior to this. Clinic visits will occur every 12 weeks, mirroring standard care. Data following progression will be obtained from the NHS Information Centre.

Condition or disease Intervention/treatment Phase
Mesothelioma Drug: Nivolumab Other: Placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 336 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: CheckpOiNt Blockade For Inhibition of Relapsed Mesothelioma (CONFIRM): A Phase III Double-Blind, Placebo Controlled Trial to Evaluate the Efficacy of Nivolumab in Relapsed Mesothelioma
Actual Study Start Date : March 28, 2017
Estimated Primary Completion Date : June 2021
Estimated Study Completion Date : July 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Mesothelioma
Drug Information available for: Nivolumab

Arm Intervention/treatment
Experimental: Nivolumab
Nivolumab 240mg flat dose Q2W over 30 minutes IV until disease progression, to a maximum of 12 months
Drug: Nivolumab
Nivolumab at a dose of 240mg as a 30-minute IV infusion, on Day 1 of every 14 day treatment cycle
Other Name: Opdivo

Placebo Comparator: Placebo
Sterile 0.9% sodium chloride Q2W over 30 minutes IV until disease progression, to a maximum of 12 months
Other: Placebo
Matched placebo consisting of sterile 0.9% sodium chloride as a 30-minute IV infusion, on Day 1 of every 14 day treatment cycle

Primary Outcome Measures :
  1. Overall survival [ Time Frame: Time from randomisation to date of death from any cause through study completion up to a maximum of 5 years ]
  2. modified RECIST or RECIST 1.1 - progression free survival [ Time Frame: Time from randomisation to progression through study completion up to a maximum of 5 years ]
    Length of time patients are free from disease

Secondary Outcome Measures :
  1. modified RECIST or RECIST 1.1 - overall response rate [ Time Frame: Time from randomisation to progression through study completion up to a maximum of 5 years ]
    Response of disease to treatment

  2. EQ-5D-5L [ Time Frame: Up to max. 24 months. At baseline, after cycles 3 and 6 (each cycle is 14 days) and 1, 6 and 12 months post progression/treatment discontinuation. ]
    Quality of life

  3. CTCAE V4.03 [ Time Frame: Up to max. 13 months. At baseline, after each treatment cycle (each cycle is 14 days) and each follow up visit. Up to 30 days post progression/treatment discontinuation. ]

  4. Health resource use questionnaire [ Time Frame: Up to max. 24 months. At baseline, after cycles 3 and 6 (each cycle is 14 days) and 1, 6 and 12 months post progression/treatment discontinuation. ]
    Cost effectiveness

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Signed and dated a REC-approved written informed consent form in accordance with regulatory and institutional guidelines. Must be obtained before the performance of any protocol-related procedures that are not part of normal patient care.
  • Consent to provide tissue and blood samples for research
  • Must be willing and able to comply with scheduled visits, treatment schedule, laboratory tests, and other requirements of the study
  • Histological confirmation of mesothelioma (any subtype, pleural or peritoneal).
  • Must have received treatment with at least one prior line of treatment. Prior maintenance therapy (e.g. avastin) is allowed and will not count as a line of therapy.
  • Patients enrolled into the CRUK VIM trial as second line therapy who are randomised to best supportive care, will be eligible to enrol into CONFIRM upon disease progression.
  • Prior lines of antineoplastic therapy, including chemotherapy, surgical resection of lesions, radiation therapy, must be completed within 14 days of receiving nivolumab
  • ECOG PS 0-1
  • Age≥18 years
  • Expected survival of at least 12 weeks
  • Radiologically assessable disease by modified RECIST (pleural mesothelioma) or RECIST 1.1 (non-pleural mesothelioma or where measurements for mRECIST cannot be obtained).
  • Evidence of disease progression by CT scan
  • Prior palliative radiotherapy must have been completed at least 14 days prior to study drug administration
  • Screening laboratory values must meet the following criteria within 48 hours prior to commencement of treatment:

    i) White blood cells ≥ 2 x 109/L ii) Neutrophils ≥1.5 x 109/L iii) Platelets ≥ 100 X109/L iv) Haemoglobin ≥ 90 g/L v) Serum creatinine of ≤ 1.5 X ULN or creatinine clearance (CrCl) > 50 mL/minute (using Cockcroft/Gault formula) vi) AST ≤ 3 X ULN vii) ALT ≤ 3 X ULN viii) Total bilirubin ≤ 1.5 X ULN (except patients with Gilbert Syndrome, who must have total bilirubin < 51.3 μmol/L) 2 x 109/L

  • Reproductive status

    1. Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) at enrolment and within 24 hours prior to the start of study drug.
    2. Women must not be breastfeeding.
    3. WOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment with nivolumab plus 5 half-lives of nivolumab (5 x half-life=125 days) plus 30 days (duration of ovulatory cycle) for a total of 5 months post- treatment completion.
    4. Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 7 months after the last dose of investigational product. Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile as well as azoospermic men do not require contraception.

Exclusion Criteria:

  • Target Disease Exceptions

    1. Patients with untreated, symptomatic CNS metastases are excluded. Participants are eligible if CNS metastases are adequately treated and participants are neurologically returned to baseline (except for residual signs or symptoms related to the CNS treatment) for at least 2 weeks prior to treatment assignment. In addition, participants must be either off corticosteroids, or on a stable or decreasing dose of

      • 10 mg daily prednisone (or equivalent) for at least 2 weeks prior to treatment.
    2. Patients with carcinomatous meningitis are excluded.
  • Physical and Laboratory Test Findings

    1. Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS).
    2. Any positive test for hepatitis B virus or hepatitis C virus indicating acute or chronic infection.
  • Allergies and Adverse Drug Reactions

    a) History of severe hypersensitivity reactions to other monoclonal antibodies

  • Medical History and Concurrent Diseases

    1. Patients with active, known or suspected autoimmune disease.
    2. Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of the first dose of study drug administration. Inhaled or topical steroids and adrenal replacement steroid doses > 10 mg daily prednisone or equivalent are permitted in the absence of active autoimmune disease.
    3. Other active malignancy requiring concurrent intervention.
    4. Patients with previous malignancies (except non-melanoma skin cancers, and the following in situ cancers: bladder, gastric, colon, endometrial, cervical/dysplasia, melanoma or breast) are excluded unless a complete remission was achieved at least 2 years prior to study entry AND no additional therapy is required during the study period.
    5. Any serious or uncontrolled medical disorder or active infection that, in the opinion of the investigator, may increase the risk associated with study participation, study drug administration, or would impair the ability of the patient to receive protocol therapy.
    6. All toxicities attributed to prior anti-cancer therapy other than alopecia and fatigue not resolved to Grade 1 (NCI CTCAE version 4.03) or baseline before administration of study drug.
    7. Patients who have not recovered from the effects of major surgery or significant traumatic injury at least 14 days before the first dose of study treatment.
    8. Known alcohol or drug abuse.
    9. Patients who have received prior therapy with anti-PD-1, anti-PD-L1, anti-PD-L2, anti- CD137, or anti-CTLA-4 antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways) or who have previously taken part in a randomised Bristol Myers Squibb (BMS) clinical trial for nivolumab or ipilimumab including study CA209-743 (CheckMate 172).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03063450

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Contact: Calley Middleton 023 8120 4307
Contact: Ellice Marwood 023 8120 5608

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United Kingdom
Ulster Hospital Recruiting
Dundonald, Belfast, United Kingdom, BT16 1RH
Principal Investigator: Lois Mulholland         
East Kent Hospitals University Foundation Trust Recruiting
Canterbury, Kent, United Kingdom, CT1 3NG
Principal Investigator: Mathilda Cominos         
Northumbria Healthcare NHS Foundation Trust Recruiting
Newcastle Upon Tyne, Northumberland, United Kingdom, NE12 8EW
Principal Investigator: Jill Gardiner         
Aberdeen Royal Infirmary Recruiting
Aberdeen, United Kingdom
Contact: Gillian Price         
Belfast City Hospital Recruiting
Belfast, United Kingdom
Contact: Gerry Hanna         
Royal Bournemouth Hospital Recruiting
Bournemouth, United Kingdom
Contact: Tom Geldart         
Addenbrooke's Hospital Not yet recruiting
Cambridge, United Kingdom
Contact: David Gilligan         
Velindre Cancer Centre Recruiting
Cardiff, United Kingdom
Contact: Jason Lester         
Ninewells Hospital Recruiting
Dundee, United Kingdom
Contact: Angela Scott         
Beatson West of Scotland Cancer Centre Recruiting
Glasgow, United Kingdom
Contact: Nicola Steele         
Harrogate District Hospital Recruiting
Harrogate, United Kingdom
Contact: Samuel Chan         
Raigmore Hospital Recruiting
Inverness, United Kingdom, IV2 3UJ
Principal Investigator: Carol MacGregor         
University Hospitals Morecambe Bay Recruiting
Lancaster, United Kingdom
Contact: Amy Ford         
Leicester Royal Infirmary Recruiting
Leicester, United Kingdom
Contact: Dean Fennell         
Barts Cancer Institute Not yet recruiting
London, United Kingdom
Contact: Peter Szlosarek         
University College London Hospitals NHS Foundation Trust Recruiting
London, United Kingdom
Contact: Dionysis Papadatos-Pastos         
Wythenshawe Hospital Recruiting
Manchester, United Kingdom
Contact: Raffaele Califano         
Mount Vernon Cancer Centre Recruiting
Northwood, United Kingdom
Contact: Andreas Polychronis         
Southampton General Hospital Recruiting
Southampton, United Kingdom
Contact: Christian Ottensmeier         
Southend Hospital Recruiting
Southend-on-Sea, United Kingdom
Contact: Gairin Dancey         
Lister Hospital Recruiting
Stevenage, United Kingdom
Contact: Andreas Polychronis         
Musgrove Park Hospital Recruiting
Taunton, United Kingdom
Contact: Petra Jankowska         
Sponsors and Collaborators
University of Southampton
Bristol-Myers Squibb
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Principal Investigator: Dean Fennell University of Leicester
Principal Investigator: Gareth Griffiths Southampton Clinical Trials Unit, University of Southampton

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: University of Southampton Identifier: NCT03063450     History of Changes
Other Study ID Numbers: 22864
2016-003111-35 ( EudraCT Number )
CA209-841 ( Other Grant/Funding Number: Bristol-Myers Squibb )
A21400 ( Other Grant/Funding Number: Cancer Research UK )
First Posted: February 24, 2017    Key Record Dates
Last Update Posted: August 5, 2019
Last Verified: August 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by University of Southampton:
anti PD-L1
quality of life
immune checkpoint inhibition
Additional relevant MeSH terms:
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Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Mesothelial
Antineoplastic Agents, Immunological
Antineoplastic Agents