DuRvalumab With Chemotherapy as First Line Treatment in Advanced Pleural Mesothelioma (DREAM3R)

Primary Outcome Measures

1. Overall Survival [ Time Frame: Minimum follow-up is 24 months after randomisation. ]
   Defined as the time from randomisation to the date of death due to any cause.

Secondary Outcome Measures

1. Progression-Free Survival (PFS) [ Time Frame: Performed at baseline, then at weeks 6, 12, 18, 26, 34, 42, 50 and then every 12 weeks until disease progression (minimum follow-up is 24 months after randomisation). ]
   Defined as the interval from date of randomisation to the date of first evidence of disease progression or death, whichever occurs first.
2. Objective Tumour Response Rate (OTRR) [ Time Frame: Performed at baseline, then at weeks 6, 12, 18, 26, 34, 42, 50 and then every 12 weeks until disease progression (minimum follow-up is 24 months after randomisation). ]
   Percentage of participants with either Complete Response (CR) or Partial Response (PR) assessed according to modified Response Criteria in Solid Tumors (RECIST) 1.1 for response in malignant pleural mesothelioma.
3. Classify and grade participants adverse events as assessed by CTCAE V5.0 [ Time Frame: 90 days after last dose of durvalumab or 30 days after last dose of chemotherapy, whichever is longer. ]
   Classify and grade participants abnormal laboratory values and/or adverse events.
4. Health-Related Quality of Life (QOL): QLQ-C30 [ Time Frame: Performed at baseline, then at weeks 6, 12, 18, 26, 34, 42, 50 and then every 12 weeks until disease progression (minimum follow-up is 24 months after randomisation). ]
   European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), Importance of QOL issues assessed using a four-point scale (1 = not at all, 4 = very much).
5. Health-Related QOL: LC29 [ Time Frame: Performed at baseline, then at weeks 6, 12, 18, 26, 34, 42, 50 and then every 12 weeks until disease progression (minimum follow-up is 24 months after randomisation). ]
   EORTC Quality of Life Lung Cancer Module (QLQ-LC29), Importance of QOL issues assessed using a four-point scale (1 = not at all, 4 = very much).
6. Health-Related QOL: EQ-5D-5L [ Time Frame: Performed at baseline, then at weeks 6, 12, 18, 26, 34, 42, 50 and then every 12 weeks until disease progression (minimum follow-up is 24 months after randomisation). ]
   Euro-Quality of Life (EuroQoL) 5 dimension 5 level (EQ-5D-5L) questionnaire, comprising of 5 questions with a score from 1 (no problem) to 5 (extreme problem) and a visual analog scale from 0 (worst) to 100 (best).
7. Health Care Usage Costs: Hospitalization [ Time Frame: Minimum follow-up is 24 months after randomisation. ]
   Australian Sites Only: Hospitalization costs calculated by applying Australian unit costs to Australian Refined Diagnostic Related Groups (AR DRG) costs for hospitalizations.
8. Health Care Usage Costs: Scheduled Visits to Health Professionals [ Time Frame: Minimum follow-up is 24 months after randomisation. ]
   Australian Sites Only: Scheduled costs for visits to health professionals collected via Medical Benefits Schedule (MBS).
9. Health Care Usage Costs: Medications [ Time Frame: Minimum follow-up is 24 months after randomisation. ]
   Australian Sites Only: Scheduled costs for medications collected via the Pharmaceutical Benefits Schedule (PBS).

Inclusion Criteria

• Adults (18 years or over) with a histological diagnosis of malignant pleural mesothelioma that is not amenable to curative surgical resection.
• Measurable disease as per modified RECIST 1.1 (mRECIST 1.1) criteria for assessment of response in malignant pleural mesothelioma, without prior radiotherapy to these sites.
• Body weight >30 kg,
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
• Tumour tissue (Formalin-Fixed Paraffin-Embedded [FFPE]) available from diagnostic biopsy for PD-L1 testing and other correlative biomarker testing at a central laboratory.
• Life expectancy of at least 12 weeks.
• Adequate blood tests (done within 14 days prior to randomisation) and with values within the ranges specified below. Blood transfusions are permissible if completed at least 7 days prior to treatment start.
  • Haemoglobin ≥ 9.0 g/L
  • Absolute neutrophil count ≥ 1.5 x 10^9/L
  • Platelets ≥ 100 x 10^9/L
  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN) (except participants with Gilbert’s Syndrome, who are eligible with bilirubin ≤ 2.5 ULN)
  • Alanine transaminase ≤ 2.5 x upper limit of normal (ULN), unless liver metastases or invasion are present, in which case it must be ≤ 5 x ULN
  • Aspartate aminotransferase ≤ 2.5 x ULN, unless liver metastases or invasion are present, in which case it must be ≤ 5 x ULN
  • Creatinine clearance (CrCl) ≥ 60 mL/min (Cockcroft-Gault formula)
• Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements. Each patient must sign a consent form prior to enrolment in the trial to document their willingness to participate.
• Willing and able to comply with all study requirements, including treatment, timing and/or nature of required assessments.
• Women of childbearing potential must use a reliable means of contraception during treatment and for at least 90 days thereafter. Breastfeeding is not permissible during or for at least 90 days after the final study treatment. Men must have been surgically sterilised or use a barrier method of contraception if they are sexually active with a woman of child bearing potential.
• Evidence of post-menopausal status or negative serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause.

Exclusion Criteria

• Prior chemotherapy or other systemic anti-cancer or immunotherapy for MPM.
• Diagnosis on cytology or fine needle aspiration biopsy only.
• Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g. colitis or Crohn’s disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves’ disease, rheumatoid arthritis, hypophysitis, uveitis, etc.]). The following are exceptions to this criterion:
  1. Patients with vitiligo or alopecia
  2. Patients with hypothyroidism (e.g. following Hashimoto syndrome) stable on hormone replacement
  3. Any chronic skin condition that does not require systemic therapy
  4. Patients without active disease in the last 5 years may be included
  5. Patients with celiac disease controlled by diet alone
• Any condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone or equivalent dose of an alternative corticosteroid) or other immunosuppressive medications within 28 days of durvalumab administration. Intranasal, inhaled or topical steroids or local steroid injections (e.g. intra-articular injection) are permitted in the absence of active autoimmune disease. Standard steroid premedication given prior to chemotherapy or as prophylaxis for imaging contrast allergy should not be counted for this criterion.
• Participants with symptomatic or uncontrolled brain metastases or leptomeningeal disease are excluded.
• Prior therapy with an anti-PD-1, anti-PD-L1 (including durvalumab), anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T cell co-stimulation or immune checkpoint pathways.
• Current treatment or treatment within the last 12 months with any investigational anti-cancer products.
• Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study.
• Mean QT interval corrected for heart rate using Fridericia’s formula (QTcF) ≥ 470 msec in screening ECG measured using standard institutional method or history of familial long QT syndrome.
• Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of durvalumab. Note: Local surgery of isolated lesions for palliative intent is acceptable.
• No other malignancy that requires active treatment. Participants with a past history of adequately treated carcinoma in situ, non-melanoma skin cancer or lentigo maligna without evidence of disease or superficial transitional cell carcinoma of the bladder are eligible.
• Hearing loss or peripheral neuropathy considered by the investigators to contraindicate cisplatin administration.
• History of allergy or hypersensitivity to investigational product, cisplatin, pemetrexed or any excipient.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive cardiac failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, active peptic ulcer disease or gastritis, serious chronic gastrointestinal conditions associated with diarrhoea, active bleeding diatheses.
• Hepatitis B, hepatitis C or human immunodeficiency virus (HIV). Exceptions include past or resolved Hepatitis B (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) and patients positive for hepatitis C (HCV) antibody if polymerase chain reaction is negative for HCV RNA. HIV testing is not required in absence of clinical suspicion of HIV.
• Known history of primary immunodeficiency, allogeneic organ transplant, pneumonitis or active tuberculosis.
• Receipt of live attenuated vaccination within 30 days prior to enrolment or within 30 days of receiving durvalumab.
• Specific comorbidities or conditions or concomitant medications which may interact with the investigational product(s).
• Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results.
• Serious medical or psychiatric conditions or social situation that might limit compliance with study requirements, substantially increase risk of incurring adverse events or compromise the ability of the patient to give written informed consent.