Trabectedin Combined With Durvalumab in Patients With Advanced Pretreated Soft-tissue Sarcomas and Ovarian Carcinomas.

This is a multicenter, prospective phase Ib trial based on a dose escalation study design (3+3 traditional design) assessing three dose levels of Trabectedin given with durvalumab, followed by two expansion cohorts once the MTD is established.

Inclusion criteria

• Histology :

• Soft-tissue sarcoma histologically confirmed. In care outside a center of the RRePS Network, a central review is necessary (Pr. Coindre team),
• histologically confirmed ovarian carcinoma (carcinosarcoma included), or ovarian carcinoma without known g/s BRCA mutation
• Ovarian carcinoma must have received at least one line of platinum-containing regimen
• Metastatic or unresectable locally advanced disease, not amenable to curative therapy
• Age ≥ 18 years,
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 1,
• Life expectancy > 3 months,
• Patients must have measurable disease (lesion in previously irradiated filed can be considered as measurable if progressive at inclusion according to RECIST 1.1) defined as per RECIST v1.1 with at least one lesion that can be measured in at least one dimension (longest diameter to be recorded) as > 10 mm with spiral CT scan.
• Documented disease progression according to RECIST v1.1 before study entry,
• Patient must comply with the collection of tumor biopsies,
• At least 1 line of chemotherapy in the palliative setting with use of Anthracyclines (for STS),
• At least three weeks since last chemotherapy, immunotherapy or any other pharmacological treatment and/or radiotherapy,
• Adequate hematological, renal, metabolic and hepatic function:

• Hemoglobin ≥ 9 g/dl (patients may have received prior red blood cell [RBC] transfusion, if clinically indicated); absolute neutrophil count (ANC) ≥ 1.5 x 109/l, and platelet count ≥ 100 x 109/l.
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST) ≤ 2.5 x upper limit of normality (ULN) (≤ 5 in case of extensive liver involvement) and alkaline phosphatase (AP) ≤ 2.5 x ULN.
• Total bilirubin ≤ ULN.
• Albumin ≥ 25 g/l.
• Calculated creatinine clearance (CrCl) > 60 ml/min (according to Cockroft Gault formula).
• Thyroid function within normal laboratory ranges (TSH, free T3, free T4).
• Creatine Phosphokinase (CPK) ≤ 2.5 x ULN
• Women of childbearing potential must have a negative serum pregnancy test within 72 hours prior to receiving the first dose of trial medication. Both women and men must agree to use a highly effective method of contraception throughout the treatment period and for six months after discontinuation of treatment.
• No prior or concurrent malignant disease diagnosed or treated in the last 2 years except for adequately treated in situ carcinoma of the cervix, basal or squamous skin cell carcinoma, or in situ transitional bladder cell carcinoma,
• Recovery to grade ≤ 1 from any adverse event (AE) derived from previous treatment (excluding alopecia of any grade and non-painful peripheral neuropathy grade ≤ 2) according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE, version 4.0),
• Voluntarily signed and dated written informed consent prior to any study specific procedure,
• Patients with a social security in compliance with the French law .

Exclusion criteria

• Previous treatment with Trabectedin or an anti-PD-1, anti-PD-L1, anti-PD-L2, including durvalumab
• Current or prior use of immunosuppressive medication medication including any use of oral glucocorticoids, within 21 days before the first dose of durvalumab, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses
• Active or prior documented inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis),
• Has an active autoimmune disease requiring systemic treatment within the past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insuddiciency) is not considered a form of systemic treatment,
• Has evidence of active non-infectious pneumonitis,
• Has an active infection requiring systemic therapy,
• Currently active bacterial or fungus infection (> grade 2 CTC [CTCAE] HIV1, HIV2, hepatitis A or hepatitis B or hepatitis C infections,
• Known central nervous system malignancy (CNS),
• Men or women of childbearing potential who are not using an effective method of contraception as previously described; women who are pregnant or breast feeding,
• Previous enrolment in the present study,
• Patient unable to follow and comply with the study procedures because of any geographical, social or psychological reasons,
• Has received a live vaccine within 30 days prior to the first dose of trial treatment.

Note: the killed virus vaccines used for seasonal influenza vaccines for injection are allowed; however intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed.

• Known hypersensitivity to any involved study drug or any of its formulation components,
• Tumors not accessible for biopsy,
• Known history of active tuberculosis
• Person under judicial protection or deprived of liberty,
• Cardiac dysfunction: LVEF < 40% at Baseline or clinically symptomatic cardiac dysfunction (any % of LVEF at Baseline)
• Concomitant use of strong inhibitor or inductors of cytochrome CYP3A4 taken within 21 days prior to the first dose of study drug