Brief Title: Atezolizumab With or Without Cobimetinib in Treating Patients With Metastatic Bile Duct Cancer That Cannot Be Removed by Surgery or Gallbladder Cancer
Official Title: A Randomized Phase 2 Study of Atezolizumab in Combination With Cobimetinib Versus Atezolizumab Monotherapy in Participants With Unresectable Cholangiocarcinoma
Status: COMPLETED
Status Verified Date: 2024-02
Last Known Status: None
Delayed Posting: No
If Stopped, Why?: Not Stopped
Has Expanded Access: False
If Expanded Access, NCT#: N/A
Has Expanded Access, NCT# Status: N/A
Acronym: None
Brief Summary: This randomized phase II trial studies how well atezolizumab with or without cobimetinib works in treating patients with bile duct cancer that has spread to other places in the body metastatic and cannot be removed by surgery unresectable or gallbladder cancer Immunotherapy with monoclonal antibodies such as atezolizumab may help the bodys immune system attack the cancer and may interfere with the ability of tumor cells to grow and spread Cobimetinib is used in patients whose cancer has a mutated changed form of a gene called BRAF It is in a class of medications called kinase inhibitors It works by blocking the action of an abnormal protein that signals cancer cells to multiply This helps slow or stop the spread of cancer cells Giving atezolizumab with cobimetinib may work better at treating patients with bile duct and gallbladder cancer
Detailed Description: PRIMARY OBJECTIVE
I To assess the progression free survival PFS of patients receiving atezolizumab monotherapy and cobimetinib in combination with atezolizumab for unresectable cholangiocarcinoma
SECONDARY OBJECTIVES
I To assess the overall survival OS of patients receiving cobimetinib in combination with atezolizumab and atezolizumab monotherapy for unresectable cholangiocarcinoma
II To determine the objective response rate ORR defined as complete plus partial response of cobimetinib in combination with atezolizumab and atezolizumab monotherapy in patients with unresectable cholangiocarcinoma
III To assess the safety and tolerability of cobimetinib in combination with atezolizumab and atezolizumab monotherapy in patients with unresectable cholangiocarcinoma
IV To determine the relationship between PD-L1 expression in tumor at baseline and on treatment and response to treatment
CORRELATIVE OBJECTIVES
I To determine the effect of cobimetinib on CD8 T cell infiltration in tumor II To determine the effect of cobimetinib on T cell subpopulations systemically and in tumor PD-1PD-L1 expression on tumor and MHC 12 expression
III To determine the effect of cobimetinib on markers of immune exhaustion and pro-apoptotic factors in CD8 effector T cells
IV To explore the effect of cobimetinib on local and systemic immune activation pathways and immune suppressive pathways through expression profiling
OUTLINE Patients are randomized to 1 of 2 arms
ARM A Patients receive atezolizumab intravenously IV over 30-60 minutes on days 1 and 15 Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity Patients also undergo computed tomography CT or magnetic resonance imaging MRI and collection of blood samples throughout the trial and undergo tumor biopsy on study
ARM B Patients receive atezolizumab IV over 30-60 minutes on days 1 and 15 and cobimetinib orally PO once daily QD on days 1-21 Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity Patients also undergo CT or MRI and collection of blood samples throughout the trial and undergo tumor biopsy on study
After completion of study treatment patients are followed up every 3 months until death withdrawal of consent or study closure whichever occurs first