Study Comparing the Standard Administration of IO Versus the Same IO Administered Each 3 Months in Patients in Response After 6 Months of Standard IO

NCT ID: NCT05078047

Last Updated: 2025-06-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

646 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-08

Study Completion Date

2027-03-07

Brief Summary

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Immunotherapy (IO), such as treatment with anti-PD-1, PD-L1, or CTLA-4 inhibitors, is a rapidly expanding treatment for multiple metastatic cancers with improved survival for certain cancers. However, the optimal duration of immunotherapies is currently unknown. Our hypothesis is that a reduced dose intensity of IO could be as effective as the current standard treatment in term of prevention of the disease progression. If proved right, this study will have a positive medico-economic impact by reduction of the costs associated with the treatment and the toxicity, and an increase of the patients' quality of life.

Detailed Description

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Immunotherapy (IO) is a rapidly expanding treatment for multiple metastatic cancers with improved survival for certain cancers. For currently approved immunotherapies such as PD-1 / PD-L1 inhibitors and anti-CTLA-4, the rhythm and duration of treatment are recommended until disease progression or unacceptable toxicity. However, the optimal duration of these treatments is currently unknown.

No major dose-dependent effect of anti-PD-1 have been observed and whether the frequency of infusion of IO could improve response or maintain efficacy. Moreover, phase I studies have shown that saturation of the target (PD-1 or PD-L1) can persist far beyond the serum half-life of the IO and 3-monthly infusions of an anti-PD-1 antibody could potentially generate the same level of activity as infusions administered every 2 weeks.

In silico modeling studies have suggested that alternate scheduling with IO couldn't compromise the efficacy of the treatment. Indeed, prolonged half-lives of IO drugs, time-varying clearance plus plasma concentrations far above the threshold associated with maximal target-engagement, suggest that the rhythm of administration of IO could be slowed down.

Without substantial international data for responding patients, apart metastatic melanoma in complete response, patients and physicians are afraid of stopping treatment, by fear of relapse. Over-treatment with IO may be toxic and inefficient. The rising cost of cancer care in the era of immunotherapy is of great concern for public and private payers around the world.

Chronic administration has important consequences for patients and health systems, with multiple medical visits and the risk of chronic, progressive and sometimes fatal toxicities induced by immunotherapy.

This is a pragmatic and strategic study challenging the routine practice which compares for the first time in a randomized phase III study, the standard administration of IO versus the same agent administered each three months in patients with metastatic cancer in partial or complete response after 6 months of standard IO ( except melanoma in CR).

If our hypothesis of non-inferiority of PFS with a reduced dose intensity of IO is verified, this could replace standard treatment and have a positive medico-economic impact, allowing, on the one hand, a reduction of the costs associated with the treatment and the toxicity, and on the other hand, an increase of the patients' quality of life.

Conditions

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Lung Cancer Metastatic Renal Cell Carcinoma Head and Neck Cancer Triple Negative Breast Cancer Merkel Cell Carcinoma Hepatocellular Carcinoma Melanoma Urothelial Carcinoma Colorectal Carcinoma With Microsatellite Instability Esophageal Squamous Cell Carcinoma Endometrial Carcinoma Cervical Cancer Gastric/Gastro-esophageal Junction/Esophageal Adenocarcinoma Basal Cell Carcinoma Squamous Skin Carcinoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized 1:1 into two arms:

• Experimental arm: Reduced dose intensity of IO

IO will be administered every 3 months (at the same dose levels) until disease progression, unacceptable toxicity, death or patient's choice or investigator's decision.

• Control arm: Standard IO

Continuation of IO at the same dose levels and rhythmicity until disease progression, unacceptable toxicity, death or patient's choice.

Random allocation will be stratified by tumour type, by response status (partial response versus complete response) evaluated 6 months after the initiation of standard IO, by treatment line (first line vs others), and by type of IO
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental arm

Reduced dose intensity of IO:

IO will be administered every 3 months (at the same dose levels) until disease progression, unacceptable toxicity, death or patient's choice or investigator's decision

Group Type EXPERIMENTAL

Reduced dose intensity of IO

Intervention Type DRUG

After 6 months of treatment with standard IO, IO will be administered every 3 months (at the same dose levels) until disease progression, unacceptable toxicity, death or patient's choice or investigator's decision

Control arm

Standard IO:

Continuation of IO at the same dose levels and rhythmicity until disease progression, unacceptable toxicity, death or patient's choice.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Reduced dose intensity of IO

After 6 months of treatment with standard IO, IO will be administered every 3 months (at the same dose levels) until disease progression, unacceptable toxicity, death or patient's choice or investigator's decision

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Patients must have signed a written informed consent form prior to any trial specific procedures.
2. Patient aged ≥18 years old.
3. Metastatic disease (or locally advanced disease not suitable for local treatment) of initial tumor histologically confirmed including: lung cancer, renal cell cancer, head and neck cancer, urothelial carcinoma, triple negative breast cancer, Merkel cancer, hepatocellular carcinoma, melanoma, colorectal carcinoma with microsatellite instability \[MSI\], esophageal squamous cell carcinoma, endometrial carcinoma,cervical cancer, gastric/gastro-oesophageal junction adenocarcinoma, basal cell carcinoma or squamous skin carcinoma.
4. Patients in partial or complete response after 6 months of standard immunotherapy (whatever the line of therapy) according to the RECIST or PERCIST v1.0 criteria (confirmed by local radiological assessment).

For metastatic melanoma only patients in partial response. Patients with metastatic or advanced cancer treated by immunotherapy as maintenance therapy can be included without any lesion at IO initiation. In this case, response after 6 months of standard immunotherapy will be evaluated by the non-appearance of a new lesion.
5. Eligible to maintain the same standard IO treatment.
6. Patient with Eastern cooperative oncology group (ECOG) performance status ≤1.
7. Patients with brain metastases are allowed, provided they are stable according to the following definitions: treated with surgery or stereotactic radiosurgery and without evidence of progression prior to randomization and have no evidence of new or enlarging brain metastases.
8. Patients treated by IO previously combined with chemotherapy are allowed.
9. Patients with Tyrosine Kinase Inhibitor (TKI)-IO or pemetrexed-IO or bevacizumab-IO are allowed.
10. Evidence of post-menopausal status, or negative urinary or serum pregnancy test for pre-menopausal patients.
11. Both sexually active women of childbearing potential and males (and their female partners) patients must agree to use adequate contraception method for the duration of the study treatment and after completing treatment according to the most recent version of the IO Summary of product characteristics (SmPC).
12. Patient is willing and able to comply with the protocol for the duration of the trial including undergoing treatment and scheduled visits, and examinations including follow-up.
13. Patient must be affiliated to a Social Security System.

Exclusion Criteria

1. Metastatic melanoma in complete response.
2. Metastatic renal cell carcinoma with International Metastatic Renal Cell Carcinoma Database (IMDC) favourable-risk treated TKI/IO combination.
3. Hematologic malignancies (leukaemia, myeloma, lymphoma…)
4. Active infection requiring systemic therapy.
5. Patients enrolled in another therapeutic study within 30 days before the inclusion in and during MOIO study.
6. Patient unable to comply with study obligations for geographic, social, or physical reasons, or who is unable to understand the purpose and procedures of the study.
7. Person deprived of their liberty or under protective custody or guardianship.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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UNICANCER

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gwenaëlle GRAVIS-MESCAM, MD

Role: PRINCIPAL_INVESTIGATOR

Institut Paoli Calmettes, Marseille

Locations

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Institut de cancérologie de l'Ouest

Angers, , France

Site Status RECRUITING

Clinique Sainte Catherine

Avignon, , France

Site Status RECRUITING

Centre Hospitalier de la Côte Basque

Bayonne, , France

Site Status RECRUITING

CHU Besançon

Besançon, , France

Site Status WITHDRAWN

CHU Bordeaux - Hôpial Saint André

Bordeaux, , France

Site Status RECRUITING

CH Boulogne sur Mer

Boulogne-sur-Mer, , France

Site Status NOT_YET_RECRUITING

Centre François Baclesse

Caen, , France

Site Status RECRUITING

Centre Jean Perrin

Clermont-Ferrand, , France

Site Status RECRUITING

Centre Hospitalier Intercommunal

Créteil, , France

Site Status RECRUITING

CHU Henri Mondor

Créteil, , France

Site Status RECRUITING

Centre Georges François Leclerc

Dijon, , France

Site Status RECRUITING

GH Mutualiste de Grenoble

Grenoble, , France

Site Status NOT_YET_RECRUITING

CHD Vendée

La Roche-sur-Yon, , France

Site Status NOT_YET_RECRUITING

Centre Oscar Lambret

Lille, , France

Site Status RECRUITING

Clinique Chenieux

Limoges, , France

Site Status RECRUITING

Hospices Civils de Lyon

Lyon, , France

Site Status RECRUITING

Centre Léon Bérard

Lyon, , France

Site Status RECRUITING

Hôpital La Timone -APHM

Marseille, , France

Site Status WITHDRAWN

Centre Antoine Lacassagne

Nice, , France

Site Status RECRUITING

CHU Nîmes/Institut de cancérologie du Gard

Nîmes, , France

Site Status RECRUITING

Institut Curie

Paris, , France

Site Status WITHDRAWN

Hôpital Saint Louis

Paris, , France

Site Status RECRUITING

Hôpital Pitié Salpêtrière

Paris, , France

Site Status WITHDRAWN

Hôpital Européen Georges Pompidou

Paris, , France

Site Status WITHDRAWN

Hôpital Cochin APHP

Paris, , France

Site Status RECRUITING

Hôpital Saint Antoine APHP

Paris, , France

Site Status RECRUITING

CHU Poitiers

Poitiers, , France

Site Status RECRUITING

Insitut Godinot

Reims, , France

Site Status WITHDRAWN

Centre Eugene Marquis

Rennes, , France

Site Status RECRUITING

CHI Elbeuf

Saint-Aubin-lès-Elbeuf, , France

Site Status RECRUITING

Institut Curie

Saint-Cloud, , France

Site Status WITHDRAWN

Institut de cancérologie de l'Ouest

Saint-Herblain, , France

Site Status RECRUITING

Centre Hospitalier Mémorial de Saint-Lô

Saint-Lô, , France

Site Status RECRUITING

Clinique Mutualiste de l'Estuaire

Saint-Nazaire, , France

Site Status RECRUITING

ICANS

Strasbourg, , France

Site Status RECRUITING

Hôpital Foch

Suresnes, , France

Site Status RECRUITING

HIA Sainte Anne

Toulon, , France

Site Status RECRUITING

IUCT

Toulouse, , France

Site Status RECRUITING

CHU Bretonneau

Tours, , France

Site Status RECRUITING

Centre Gustave Roussy

Villejuif, , France

Site Status NOT_YET_RECRUITING

Countries

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France

Central Contacts

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Clotilde SIMON

Role: CONTACT

+33 (0) 1 73 79 79 11

Facility Contacts

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Elouen BOUGHALEM

Role: primary

Werner HILGERS

Role: primary

Louis FRANCOIS

Role: primary

Charlotte DOMBLIDES

Role: primary

Guillaume MARIE

Role: primary

Pierre-Emmanuel BRACHET

Role: primary

Maureen BERNADACH

Role: primary

Isabelle MONNET

Role: primary

Carolina SALDANA

Role: primary

Alice HERVIEU

Role: primary

Valentine RUSTE

Role: primary

Frank PRIOU

Role: primary

Alessandra FORESTIER

Role: primary

Sabrina FALKOWSKI

Role: primary

Denis MAILLET

Role: primary

Olivier TREDAN

Role: primary

Delphine BORCHIELLINI

Role: primary

Nadine HOUEDE

Role: primary

Hélène GAUTHIER

Role: primary

Jennifer ARRONDEAU

Role: primary

Thierry ANDRE

Role: primary

Nicolas ISAMBERT

Role: primary

Laurence CROUZET

Role: primary

Pierre-Alexandre HAUSS

Role: primary

Judith RAIMBOURG

Role: primary

Dingyu XIAO

Role: primary

Tifenn L'HARIDON

Role: primary

Philippe BARTHELEMY

Role: primary

Raffaele RATTA

Role: primary

Laurys BOUDIN

Role: primary

Iphigénie KORAKIS

Role: primary

Mathilde CANCEL

Role: primary

Yohann LORIOT

Role: primary

References

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Gravis G, Marino P, Olive D, Penault-LLorca F, Delord JP, Simon C, Lamrani-Ghaouti A, Sabatier R, Ciccolini J, Boher JM. A non-inferiority randomized phase III trial of standard immunotherapy by checkpoint inhibitors vs. reduced dose intensity in responding patients with metastatic cancer: the MOIO protocol study. BMC Cancer. 2023 May 2;23(1):393. doi: 10.1186/s12885-023-10881-8.

Reference Type DERIVED
PMID: 37131154 (View on PubMed)

Other Identifiers

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UC-IMM-2101

Identifier Type: -

Identifier Source: org_study_id

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