Maximizing the value of phase III trials in immuno-oncology: A checklist from the Society for Immunotherapy of Cancer (SITC)

• Type of Material: Article
• Authors: Suresh Ramalingam, Emory University; Michael B Atkins, Georgetown Lombardi Comprehens Canc Ctr; Hanzah Abu-Sbeih, University of Missouri Kansas City; Paolo A Ascierto, Istituto Nazionale Tumori IRCCS Fondazione "G Pascale"; Micheal R Bishop, University of Chicago; Daniel S Chen, Engenuity Life Sciences; Madhav Dhodapkar, Emory University; Leisha A Emens, UPMC Hillman Cancer Center; Marc S Ernstoff, NCI, Bethesda; Robert L Ferris, UPMC Hillman Cancer Center, Pittsburgh; Tim F Greten, National Cancer Institue, Bethesda; James L Gulley, National Cancer Institue, Bethesda; Roy S Herbst, Yale Cancer Center; Rachel W Humphrey, Normunity, Inc; James Larkin, Royal Marsden Hospital; Kim A Margolin, St. John's Cancer Institute; Luca Mazzarella, European Instititue of Oncology IRCCS; Meredith M Regan, Dana-Farber/Harvard Cancer Center; Brian Rini, Ingram Cancer Center; Mario Sznol, Yale School of Medicine
• Language: English
• Date: 2022-09-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/jitc-2022-005413
• Title of Journal or Parent Work: JOURNAL FOR IMMUNOTHERAPY OF CANCER
• Volume: 10
• Issue: 9
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: PD-1; PEMBROLIZUMAB; immunotherapy; CD8(+) T-CELLS; clinical trials; Oncology; CLINICAL DEVELOPMENT; NIVOLUMAB PLUS IPILIMUMAB; Immunology; SUCCESS RATES; clinical trials as topic; phase III as topic; Science & Technology; LONG-TERM; SURVIVAL; 1ST-LINE TREATMENT; Life Sciences & Biomedicine; DOUBLE-BLIND
• Research Categories: Health Sciences, Oncology

Abstract

The broad activity of agents blocking the programmed cell death protein 1 and its ligand (the PD-(L)1 axis) revolutionized oncology, offering long-term benefit to patients and even curative responses for tumors that were once associated with dismal prognosis. However, only a minority of patients experience durable clinical benefit with immune checkpoint inhibitor monotherapy in most disease settings. Spurred by preclinical and correlative studies to understand mechanisms of non-response to the PD-(L)1 antagonists and by combination studies in animal tumor models, many drug development programs were designed to combine anti-PD-(L)1 with a variety of approved and investigational chemotherapies, tumor-targeted therapies, antiangiogenic therapies, and other immunotherapies. Several immunotherapy combinations improved survival outcomes in a variety of indications including melanoma, lung, kidney, and liver cancer, among others. This immunotherapy renaissance, however, has led to many combinations being advanced to late-stage development without definitive predictive biomarkers, limited phase I and phase II data, or clinical trial designs that are not optimized for demonstrating the unique attributes of immune-related antitumor activity-for example, landmark progression-free survival and overall survival. The decision to activate a study at an individual site is investigator-driven, and generalized frameworks to evaluate the potential for phase III trials in immuno-oncology to yield positive data, particularly to increase the number of curative responses or otherwise advance the field have thus far been lacking. To assist in evaluating the potential value to patients and the immunotherapy field of phase III trials, the Society for Immunotherapy of Cancer (SITC) has developed a checklist for investigators, described in this manuscript. Although the checklist focuses on anti-PD-(L)1-based combinations, it may be applied to any regimen in which immune modulation is an important component of the antitumor effect.