NCT05175235

Nivolumab and Pembrolizumab Dose Optimisation in Solid Tumours With CURATE.AI Platform and Sequential ctDNA Measurements

• Status: Unknown
• Phase: Phase 1 / Phase 2
• Study type: Interventional
• Enrollment: 10 (estimated)
• Sponsor: National University Hospital, Singapore · Academic / Other
• Sex: All
• Age: 21 Years – 99 Years
• Healthy volunteers: Not accepted

Summary

CURATE.AI - a small data, AI-derived technology platform - allows personalised guidance of an individual's dose modulations based only on that individual's data. Additionally, CURATE.AI is mechanism-independent, and dynamically adapts to changes experienced by the subject, providing dynamic dose optimisation throughout the duration of the subject's treatment. This study aims to demonstrate the feasibility of applying CURATE.AI in standard of care settings for treatment of solid tumours with Nivolumab. An additional objective is to explore sequential ctDNA measurements as a response marker collected at a higher frequency of probing, with modulated doses.

Detailed description

The first stage of the trial aims to identify patients who are responsive to the given treatment, determined from both SOC - radiology via criteria such as RECIST/immune-related RECIST (irRECIST) as well as the intended response marker for CURATE.AI. These patients will then proceed with the second stage of the trial. The second stage of the trial aims to obtain a personalised CURATE.AI profile for each participant, based on their phenotypic response to a set of drug doses. The doses will be recommended by the CURATE.AI team, when relevant to the clinical decision-making process. For participants who started on the selected therapy prior to their engagement with the study, the previously recorded data, limited to: administered doses, corresponding phenotypic responses and treatment-related toxicities (optional) may be included in the CURATE.AI process. Once an actionable profile is obtained, dose recommendations are based on the profile and aimed to treat the participant. Since there are no prior clinical trials using CURATE.AI in participant treated with combinational or single-agent immunotherapy with drugs such as nivolumab or pembrolizumab, this trial will comprise of participants diagnosed with the main tumour types: non-small cell lung cancer (NSCLC), gastric cancer (GC), hepatocellular carcinoma (HCC) or nasopharyngeal carcinoma (NPC), or other eligible tumours undergoing or planned for palliative-intent immune-oncology combinational or single-agent therapy with nivolumab/ pembrolizumab. Nivolumab and Pembrolizumab are an immune checkpoint inhibitors and a novel therapeutic treatment modalities recently approved by the FDA and are becoming the standard of care treatment for a range of oncological indications, including NSCLC, GC, HCC and NPC. However, they are associated with significant semi-annual costs - approximately $140,000 per patient in the United States. In light of the evidence supporting dose personalization and dose reduction in immune-oncology treatments, patients may stand to benefit from CURATE.AI's personalized dose optimisation in maximizing clinical outcomes at reduced costs. Together with the increasing adoption of circulating tumour DNA (ctDNA) as an effective response marker for tumour burden in NSCLC, GC, HCC and NPC, CURATE.AI is ideally suited for pairing these findings with healthcare economics research towards the development of novel healthcare workflows integrating AI and serial measurements of ctDNA response to sustain the scalable implementation of N-of-1 dosing optimisation in cancer treatments.

Conditions

• Solid Tumor

Interventions

Type	Name	Description
DEVICE	CURATE.AI	Efficacy and toxicity measurements at the end of each two-/three- week dosing cycle, together with an information on given drugs and their doses, and other patient data, will be used by CURATE.AI to recommend the dose of nivolumab/pembrolizumab for the next cycle. The clinical investigators will decide whether or not to administer or prescribe the dose recommendation from CURATE.AI.
DRUG	Nivolumab, Pembrolizumab	Treatment with the selected regimen will take up to a maximum duration of 12 months, in two-/three- week cycles. CURATE.AI dose recommendations will be generated before each chemotherapy cycle; fixed throughout the cycle; Maximum total cumulative dose per cycle of nNivolumab/pembrolizumab in the predetermined safety range is set at 100% of standard starting dose (i.e. , 240 mg/m2 once every 2 weeks for single agent Nivolumab and 200 mg/m2 once every 3 weeks for single agent Pembrolizumab). Minimum total cumulative dose per cycle of nivolumab/pembrolizumab in the predetermined safety range is set at 30% of the standard starting dose (i.e. 8072 mg/m2 once every 2 weeks for single agent Nivolumab and 60 mg/m2 once every 3 weeks for single agent Pembrolizumab). Subject-specific dosing range may alter those numbers to suit the specific circumstances of the subject, thus giving the subject specific safe dosing range.

Timeline

• Start date: 2021-08-19
• Primary completion: 2023-05-31
• Completion: 2023-08-01
• First posted: 2022-01-03
• Last updated: 2023-03-03

Locations

1 site across 1 country: Singapore