DOMVANALIMAB for Neuroendocrine carcinoma (gastro-enteropancreatic or unknown primary)

Inclusion criteria

• {"criterion_text":"- Man or woman aged ≥ 18 years old,\n- Patient with asymptomatic and/or previously treated brain metastasis\n- Poorly differentiated neuroendocrine carcinoma (NEC) [or mixed tumor with NEC component is > 30%, the patient is eligible] with ki 67 > 20% from a gastrointestinal tract (from esophagus to anal canal) or biliopancreatic primary or an unknown primary cancer, locally advanced and/or metastatic,\n- Centralized review of the diagnostic by a consulting pathologist specialized in NET (TENPATH network), *please submit the pathologist's report and the molecular biology report if available\n- Recommendation of a second-line chemotherapy after progression (documented using the RECIST criteria v.1.1) and after a first-line chemotherapy treatment by cisplatin (or carboplatin) + etoposide or in the event of progression in the 6 months following the discontinuation of this first-line treatment,\n- Patient presenting at least one measurable target lesion according to the RECIST criteria v.1.1, in an area not previously irradiated,\n- General condition ≤ 1 (ECOG-PS),\n- Patient of childbearing age accepting to use a highly effective method of contraception during treatment and until 6 months after discontinuation of chemotherapy and 4 months after the last dose of domvanalimab and zimberelimab. Men sexually active must agree to use a highly effective method of contraception during treatment and for at least 6 months after discontinuation of chemotherapy and 4 months after the last dose of domvanalimab and zimberelimab, (In case of a “urine pregnancy test”, it must be a highly sensitive urine pregnancy test, in accordance with the recommendations of the CTFG regarding pregnancy risk management (Recommendations related to contraception and pregnancy testing in clinical trials)\n- Patient who signed the informed consent form\n- Patient affiliated to National French social security system"}

Exclusion criteria

• {"criterion_text":"- Well differentiated neuroendocrine tumor whatever the grade\n- Partial and complete dihydropyrimidine dehydrogenase (DPD) deficiency: uracil level ≥ 16 ng/ml\n- Known Gilbert's syndrome\n- Total bilirubin level >1.5 x the upper limit of normal (ULN); ASAT and/or ALAT > 5 x ULN; TP < 50 % (Except for patient’s treated with Vitamin K antagonists or direct oral anticoagulants with INR <3 )\n- Neutrophils <1.5x109/l, platelets <100x109/l, hemoglobin < 9 g/dl\n- Chronic uncontrolled diarrhea, unresolved intestinal occlusion or subocclusion\n- History of anaphylactic reaction or known intolerance to atropine (sulfate) or to loperamide or to antiemetics administered in association with Folfiri\n- All treatment with concomitant anticonvulsive agents, CYP3A4 inducers (phenytoin, phenobarbital, carbamazepine); patients with these treatments should have stopped them, for at least 7 days before inclusion in the study\n- Chronic medical condition requiring the ongoing use of supra-physiologic doses of systemic corticosteroids (>10 mg/day of oral prednisone or equivalent) or systemic immunosuppressive medications. Immunosuppressive medications, including chronic systemic corticosteroids at supraphysiologic doses should have been stopped 14 days before the first dose (except for participants who require hormone replacement therapy such as hydrocortisone)\n- Active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment\n- History of (non-infectious) pneumonitis that required steroids, or current pneumonitis\n- First-line chemotherapy other than cisplatin (or carboplatin) and etoposide\n- Antécédents de pneumonie (non infectieuse) ayant nécessité l'administration de stéroïdes ou pneumonie actuelle\n- Live attenuated vaccines within 28 days prior enrolment\n- Any concurrent anticancer therapy, including chemotherapy, radiotherapy (except palliative radiotherapy), immunotherapy, biologic, or hormonal treatment. Concurrent use of hormones for noncancer-related conditions is permitted\n- Known hypersensitivity to any investigational product (IP), or any excipient contained in the formulations of the study interventions\n- Known immunodeficiency or human immunodeficiency virus (HIV) infection with HIV viral load ≥200 copies/mL or CD4+ T-cell count <350 cells/μL, or taking medications that may interfere with metabolism of study drugs\n- Known acute hepatitis B, known chronic hepatitis B infection with active untreated disease, or known active hepatitis C infection. In participants with a history of HBV or HCV, participants with detectable viral loads will be excluded\n- Serious infection requiring antibiotics within the last 14 days before enrolment.\n- Prior immunotherapy, anti-PDL1/PD1 and/or anti-TIGIT and/or anti-CTLA4 type\n- Prior malignancy active within the previous 2 years except for locally curable cancers that have been apparently cured, such as basal or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix, breast, or prostate cancer\n- pregnant or breastfeeding woman\n- Lack of efficient contraception (for men or women of reproductive age)\n- All medical, geographical, social, and psychological conditions or a legal situation that will not allow the patient to finish the study or sign an informed consent form\n- Patient with symptomatic brain metastasis\n- Any of the following uncontrolled progressive diseases in the 6 months before randomization: liver failure, renal insufficiency, respiratory distress, congestive heart failure (NYHA III-IV), unstable angina, myocardial infarction, significant arrhythmia"}

Primary endpoints

• {"endpoint_text":"- the overall survival defined as the length of time from randomization, that patients included in the study are still alive. Patients alive at last follow-up will be considered censored.","definition_or_measurement_approach":"Overall survival measured from randomization until death; patients alive at last follow-up are censored."}

Secondary endpoints

• {"endpoint_text":"- 12-months (6-months) overall survival rate defined as the percentage of patients included in the study who are still alive 12-months (6-months) after randomization.","definition_or_measurement_approach":"Percentage of patients alive at 12 and 6 months after randomization."}
• {"endpoint_text":"- Progression-free survival (PFS), defined as the time from randomization to disease progression or death, whatever the cause. Alive and no progressive patients at last follow-up will be considered as censored.","definition_or_measurement_approach":"Time from randomization to documented disease progression (per RECIST v1.1) or death; censoring at last follow-up if alive without progression."}
• {"endpoint_text":"- Objective response rate (ORR) by local radiological evaluation using RECIST 1.1, defined as the proportion of patients with RECIST 1.1 complete or partial response. Patients with no radiological evaluation and patients with non-evaluable RECIST 1.1 response will be excluded.","definition_or_measurement_approach":"Proportion of patients with complete or partial response per RECIST 1.1 on local radiological assessment; non-evaluable or missing radiology excluded."}
• {"endpoint_text":"- Duration of Responses (DoR), defined as the time from response (complete or partial) to progression or death, estimated in patients who reached a response and are RECIST 1.1 evaluable.","definition_or_measurement_approach":"Time from first documented response (CR or PR) to progression or death among responders evaluable per RECIST 1.1."}
• {"endpoint_text":"- Disease control rate by local radiological evaluation using RECIST 1.1, defined as the proportion of RECIST 1.1 evaluable patients in objective response or with stable disease.","definition_or_measurement_approach":"Proportion of RECIST 1.1-evaluable patients achieving CR, PR, or stable disease."}
• {"endpoint_text":"- Toxicity assessed by NCI CTCAE v5.0 grading,","definition_or_measurement_approach":"Adverse events graded per NCI CTCAE v5.0."}
• {"endpoint_text":"- Patients-reported outcomes according to EQ 5D-5L & QLQ-C30 questionnaire for patients recruited prospectively","definition_or_measurement_approach":"Quality of life assessed using EQ-5D-5L and EORTC QLQ-C30 questionnaires in prospectively recruited patients."}

France

Earliest CTIS Part Ii Submission Date

15-12-2025

Latest Decision Or Authorization Date

22-02-2026

Processing Time Days

69

Number Of Sites

23

Number Of Participants

77

Primary sponsor

Full Name

Hospices Civils De Lyon

Organisation Type

Hospital/Clinic/Other health care facility

Country Of Registered Address

France