A trial of nivolumab, ipilimumab and chemotherapy for oesophageal cancer (CheckMate 648)

Cancer type:

Oesophageal cancer

Status:

Open

Phase:

Phase 3
This trial is for people with advanced cancer of the food pipe (oesophageal cancer). It is open to people with:
  • cancer that has come back (recurrent cancer)
  • advanced cancer that can’t be removed with surgery
  • cancer that has spread elsewhere in the body (metastatic cancer) 
     

More about this trial

Chemotherapy is a common treatment for advanced oesophageal cancer. But it may continue to grow despite this treatment. So doctors want to improve treatment for people in this situation. 
 
In this trial, they are looking at 2 drugs called nivolumab and ipilimumab. They are both types of immunotherapy. They work in slightly different ways. 
 
Nivolumab blocks a protein called PD L1 on the surface of immune cells. Blocking this protein triggers the immune system  Open a glossary itemto find and kill cancer cells.
 
Ipilimumab works by attaching itself to normal immune cells. This changes the way these cells work and helps the immune system destroy cancer cells. 
 
But researchers aren’t sure if these treatments will work better than standard chemotherapy, such as fluorouracil (5FU) and cisplatin. So they want to compare them to find out more. 
 
The aims of this trial are to find out:
  • if having immunotherapy works better than chemotherapy
  • if having immunotherapy and chemotherapy works better than chemotherapy alone
  • how safe the treatment is 
  • more about quality of life Open a glossary item
  • more about the side effects
     

Who can enter

The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you. 
 
Who can take part
You may be able to join this trial if all the following apply. 
You:
  • have squamous cell cancer Open a glossary item or a mix of squamous cell cancer and adenocarcinoma  Open a glossary item(adenosquamous) cancer of the food pipe (oesophagus)
  • have advanced cancer that can’t be removed with surgery, cancer that has come back or cancer that has spread elsewhere in the body
  • have cancer that the doctor can measure on a scan
  • have a sample of tissue (biopsy Open a glossary item) available that the trial team can do some tests on or you are willing to give a new sample
  • are well enough to carry out all your normal activities, apart from heavy physical work (performance status 0 or 1)
  • are willing to use reliable contraception during the trial and for up to 7 months afterwards 
  • have satisfactory blood test results
Who can’t take part
You cannot join this trial if any of these apply. 
 
Cancer related
You:
  • have cancer that is a type called adenocarcinoma Open a glossary item
  • are suitable to have treatment such as chemoradiotherapy Open a glossary item or surgery with the aim to cure
  • have already had treatment for advanced cancer that can’t be removed with surgery, cancer that has come back or cancer that has spread elsewhere in the body
  • have cancer that has spread to the brain and is causing symptoms or needs treatment – you might be able to take part if you don’t have symptoms or it has been successfully treated
  • have a high risk of bleeding or developing a fistula Open a glossary item because the tumour has grown into nearby organs such as the main artery in the heart (aorta) or the windpipe (trachea)
  • have pain from your tumour that isn’t controlled
  • have had nivolumab, ipilimumab or any other similar drug in the past
Medical conditions:
You:
  • haven’t fully recovered from major surgery or a very bad injury
  • have side effects from past treatment unless they are mild apart from hair loss or tiredness (fatigue)
  • have an active infection that means you can’t take part in the trial
  • are poorly nourished (have malnutrition) 
  • have a condition called interstitial lung disease that is causing symptoms 
  • have numbness or tingling in your hands or feet (peripheral neuropathy Open a glossary item) unless this is mild
  • have an autoimmune disease Open a glossary item unless it is vitiligo, type 1 diabetes, hair loss (alopecia), thyroid problems that are controlled by medications or a skin condition called psoriasis that doesn’t need treatment
  • you take steroids or other drugs that dampen down the immune system unless they are creams, inhalers or you take a stable dose of adrenal replacement hormone
  • have HIV or AIDS
  • have hepatitis B or hepatitis C
  • have any other serious condition or mental health problem that the trial team think could affect you taking part
Other:
  • you are allergic or sensitive to anything the trial drugs contain
  • there is any reason you can’t have the chemotherapy drugs fluorouracil or cisplatin 
  • you are pregnant or breastfeeding
     

Trial design

This is a phase 3 trial. The researchers hope 939 people will take part worldwide including 12 from the UK. It is a randomised trial. You are put into 1 of the following treatment groups by computer:
  • nivolumab and ipilimumab
  • nivolumab and chemotherapy
  • chemotherapy

You have all your treatment as a drip into a vein. Depending on which group you are in, you have treatment for up to 2 years. You have it for as long as it is working and the side effects aren’t too bad.
 
Nivolumab and ipilimumab group
You have treatment in cycles. Each 2 week period is a cycle of treatment. You have:
  • nivolumab every 2 weeks
  • ipilimumab every 6 weeks
Nivolumab and chemotherapy group
Each 4 week period is a cycle of treatment. Day 1 is the first day of each treatment cycle. You have:
  • nivolumab on day 1 and day 15
  • fluorouracil on day 1 to 5 through a small hand held pump
  • cisplatin on day 1 
Chemotherapy group
Each 4 week period is a cycle of treatment. You have:
  • fluorouracil from day 1 to day 5 through a small hand held pump
  • cisplatin on day 1 
Quality of life
The trial team will ask you to fill out questionnaires before you start treatment and at set times during treatment. The questionnaires will ask about side effects and how you’ve been feeling. This is called a quality of life study Open a glossary item.
 
Samples for research 
The trial team will ask you to give some extra blood samples. Where possible you have these at the same time as your routine samples. 
 
They will ask to look at a sample of tissue you gave when you were first diagnosed. 
 
The researchers plan to look at:
  • biomarkers Open a glossary item
  • what happens to the drugs in your body
  • genes Open a glossary item
They might also ask you to give a new sample if your cancer gets worse. But you don’t have to agree to give this if you don’t want to. You can still take part in the trial.
 

Hospital visits

You’ll see a doctor and have some tests before you can take part. These include:
  • a physical examination
  • heart trace (ECG) Open a glossary item
  • blood tests
  • urine tests
  • CT scan or MRI scan
You might also have a CT or MRI scan of your brain.
 
You have treatment at the hospital. How often you go depends on which treatment group you are in. At each visit, you see the trial doctor for a check up and blood tests.
 
You have a CT or MRI scan every:
  • 6 weeks for a year
  • 3 months after that
You stop treatment if your cancer gets worse. You then see the trial doctor for a check up:
  • a month later 
  • at 3 months 
After that, the trial team will see you at your routine hospital appointments or they might phone you at home to see how you are getting on. 
 
Your doctor will talk to you about other treatment options.
 

Side effects

The most common side effects of nivolumab are:
The most common side effects of having nivolumab and ipilimumab together are:
  • an increased level of enzymes Open a glossary item in the liver
  • diarrhoea
  • tiredness (fatigue)
  • itching
  • feeling sick
  • skin rash
We have information about:
Your doctor will talk to you about all the possible side effects before you agree to take part.
 

Location

London
Manchester

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Ian Chau

Supported by

Bristiol Myers-Squibb

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

14911

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Charlie took part in a trial to try new treatments

A picture of Charlie

“I think it’s really important that people keep signing up to these type of trials to push research forward.”

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