Pan-tumor neoadjuvant basket study of immune check-point inhibition and novel IO combinations (NEOASIS)

Prior treatment

• Specific for pMMR GEA cohort: Known DPD deficiency; refer local clinical guidance, for DPD status recommendation prior to starting treatment
• Conditions requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
• Live vaccines in the 4 weeks prior to inclusion
• Previous treatment with immune checkpoint inhibitors targeting including but not limited to CTLA-4, PD-1 or PD-L1
• Prior chemotherapy for any cancer
• Radiotherapy prior to surgery for disease under study
• Active malignancies other than disease under study within 3 years prior to inclusion, except for malignancies with a negligible recurrence rate (e.g. <10% in 5 years);

Other illness

• History of severe hypersensitivity reaction to any monoclonal antibody
• No intercurrent illnesses, including but not limited to infections, unstable angina pectoris
• Underlying medical conditions that, in the investigator’s opinion, will make the administration of the study drug hazardous or obscure the interpretation of toxicity determination of adverse events
• Positive test for hepatitis B virus surface antigen (HBsAg) or hepatitis C virus ribonucleic acid (HCV antibody) indicating acute or chronic infection
• History of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS);
• Active autoimmune disease or a documented history of autoimmune disease, or other medical conditions requiring systemic steroid or immunosuppressive medications, except for subjects with vitiligo, diabetes mellitus type 1, hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis or resolved childhood asthma/atopy not requiring systemic treatment
• Psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
• Clinical symptoms or radiological suspicion of perforation
• History of allergy to study drug components

Other

• Signs of distant metastases on imaging and physical examination
• Current pregnancy or breastfeeding
• Specific for pMMR GEA cohort: no HER-positive adenocarcinoma
• Clinical obstruction

• Signed written informed consent
• In case of pMMR tumors: no indication for neoadjuvant therapy according to standard of care, unless adjuvant treatment is considered a standard of care alternative
• Patients at least 18 years of age
• Non-metastatic dMMR and pMMR cancers either fitting within a specific basket or in the “other” cohort (e.g. sarcoma, cervical cancer, head and neck cancers, anal cancer, esophageal SCC)
• Eligible for study biopsy
• WHO performance status of 0 or 1
• Screening laboratory tests must meet the following criteria and should be obtained within 7 days prior to randomization/registration: WBC > 2.0 x 10^9/L, ANC > 1.5x10^9/L, platelets > 100 x 10^9/L, Hemoglobin > 5.0mmol/L. Transfusion is allowed to obtain an adequate hemoglobin level. Liver function tests: total bilirubin < 1.5 upper limit of normal (ULN) (except for subjects with Gilbert syndrome, who can have total bilirubin <3.0 mg/dL); alkaline phosphatase <1.5ULN; transaminases (ASAT/ALAT) <3 x ULN; LDH < 1.5x ULN; Creatinine clearance (Cockcroft-Gault) of >45 ml/min, Albumin > 3.0 g/dL
• Women of childbearing potential (WOCBP)* must use appropriate method(s) of contraception. WOCBP should use an adequate method to avoid pregnancy for 20 weeks after the last dose of investigational drug; Non-childbearing potential is defined as: a. Postmenopausal: ≥ 50 years of age and has not had menses for greater than 1 year. b. Amenorrheic for ≥ 2 years without a hysterectomy and bilateral oophorectomy and afollicle-stimulating hormone value in the postmenopausal range upon prestudy( screening) evaluation. c. Status is post-hysterectomy, bilateral oophorectomy, or tubal ligation.
• Women of childbearing potential must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 7 days prior to registration
• Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year. Men receiving the study treatment and who are sexually active with WOCBP (excluding azoospermic men) will be instructed to adhere to contraception for a period of 28 weeks after the last dose of investigational drug and are not allowed to donate sperm during that timeframe.