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Anti-PD-L1 (atezolizumab) as an immune primer and concurrently with extended-field chemoradiotherapy for node-positive locally advanced cervical cancer
  1. Jyoti Mayadev1,
  2. Dmitriy Zamarin2,
  3. Wei Deng3,
  4. Heather Lankes4,
  5. Roisin O'Cearbhaill2,
  6. Carol A Aghajanian2 and
  7. Russell Schilder5
  1. 1 Department of Radiation Medicine and Applied Sciences, University of California San Diego Medical Center, La Jolla, California, USA
  2. 2 Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
  3. 3 Department of Biostatistics and Bioinformatics, NRG Oncology, Clinical Trial Development Division, Buffalo, New York, USA
  4. 4 Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
  5. 5 Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Jyoti Mayadev, University of California San Diego, La Jolla, California 92093-0021, USA; jmayadev{at}


Background There is a lack of data exploring the use and optimal timing of immunotherapy and chemoradiation therapy (CRT) in node-positive cervical cancer. Further translational research into mechanisms of response and resistance to immunotherapy in advanced cervical cancer is warranted.

Primary Objective(s) To determine if sequencing of atezolizumab and CRT result in differential immune activation, as determined by clonal expansion of T cell receptor beta (TCRB) repertoires in peripheral blood on day 21.

Study Hypothesis There is a difference for clonal expansion of T cell receptor beta repertoires in the peripheral blood at day 21 between the priming and concurrent atezolizumab and CRT in Arm A vs the concurrent atezolizumab and CRT in Arm B.

Trial Design Locally advanced cervical cancer patients with lymph node-positive disease will be randomized on this open-label, randomized trial with two experimental arms. Arm A will get one dose of atezolizumab prior to cisplatin CRT, and then two subsequent doses of atezolizumab during the CRT, and Arm B will get three doses during CRT. Patients will be followed for 2 years to assess outcomes.

Major Inclusion/Exclusion Criteria Patients must have histologically confirmed, newly diagnosed advanced cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma): FIGO 2009 clinical stages IB2/IIA with positive para-aortic nodes, or FIGO 2009 clinical stages IIB/IIIB/IVA with positive pelvic or para-aortic lymph nodes. Exclusion criteria include those who had a prior hysterectomy or lymph node dissection.

Primary Endpoint(s) Clonal expansion of TCRB) repertoires in peripheral blood on day 21.

Sample Size The sample size will be 40 patients.

Estimated Dates for Completing Accrual and Presenting Results We estimate accrual to finish by the summer of 2020 with presentation of results to follow in 2021.

Trial Registration NCT03738228.

  • Cervical Cancer
  • Radiation
  • Gynecology

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  • Contributors All the authors contributed to the clinical trial design, manuscript preparation, and editing of this report of the clinical trial: Trial Registration: NCT03738228.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.