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MEDI4736

Phase 4FDA approved 2017

Urothelial Cancer | Monoclonal antibody | Oncology |AstraZeneca PLC|Trials Updated: Oct 16, 2026

MEDI4736 development status

FDA approval May 1, 2017 as Imfinzi
Approval holderAstrazeneca Uk Ltd
ApplicationBLA761069
Highest phase Phase 4 (NCT04078152)
Phase scored for AZNPhase 3
Registered trials 304 across 113 sponsors since Sep 2012

Label indication IMFINZI is a programmed death-ligand 1 (PD-L1) blocking antibody indicated: • in combination with platinum-containing chemotherapy as neoadjuvant treatment, followed by IMFINZI continued as a single agent as adjuvant treatment after surgery, for the treatment of adult patients with resectable (tumors ≥ 4 cm and/or node positive) non-small cell lung cancer (NSCLC) and no known epidermal growth factor receptor (EGFR)… FDA label

MEDI4736 target and mechanism

ModalityMonoclonal antibody

Also known as MEDI4736 (Durvalumab), MEDI4736 monotherapy, MEDI4736 (Anti PD-L1), Durvalumab, IMFINZI, IV durvalumab

Success Probability

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Market & Valuation

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Trial Design

RandomizedACTIVE_CONTROLLEDDMC
Total Trials124
Total Enrollment39,342

FDA Designations

No designations recorded

MEDI4736 clinical trials

MEDI4736 · 124 trials · 129 indications

Phase 3 48Phase 2 47Phase 1 28Early Phase 1 1
NCT07877818A Study of Neoadjuvant-adjuvant Durvalumab and FLOT Chemotherapy Followed by Adjuvant Durvalumab in Chinese Patients With Resectable GC/GEJC.Gastric
NOT YET_RECRUITING140 Analytics
NCT06992609Durvalumab After Chemoradiotherapy in Limited Stage Small Cell Lung Cancer.Small Cell Lung Carcinoma
ACTIVE NOT_RECRUITING68 Analytics
NCT06746116A Study to Evaluate the Use of Durvalumab in Combination With Platinum-based Chemotherapy Followed by Durvalumab With Olaparib as First-line Treatment in Advanced or Recurrent Endometrial Cancer in SpainAdvanced or Recurrent Endometrial Cancer
ACTIVE NOT_RECRUITING45 Analytics
NCT06467357Phase 3 Study of T-DXd and Rilvegostomig Versus SoC in Advanced HER2-expressing Biliary Tract CancerBiliary Tract Cancer
RECRUITING620 Analytics
NCT05771480Durvalumab With Chemotherapy as First Line Treatment in Patients With Advanced Biliary Tract Cancers (aBTCs)Biliary Tract Cancer
ACTIVE NOT_RECRUITING142 Analytics
NCT05943106BCG in Combination With Durvalumab in Adult BCG-naïve, High-risk NMIBC ParticipantsNon-Muscle- Invasive Bladder Cancer
ACTIVE NOT_RECRUITING100 Analytics
NCT05924880A Phase 3b, Open-label, Multi-center Study on Durvalumab in Combination With Gemcitabine-based Chemotherapy as 1L Treatment for the Chinese Patients With Unresectable Biliary Tract Cancers (BTC)Biliary Tract Cancers
COMPLETED116 Analytics
NCT05883644Durvalumab and Tremelimumab as First Line Treatment in Participants With Advanced Hepatocellular Carcinoma (HCC)Advanced Hepatocellular Carcinoma
ACTIVE NOT_RECRUITING111 Analytics
NCT05557838Durvalumab Plus Tremelimumab as First-line Treatment in Chinese Patients With uHCCHepatocellular Carcinoma
ACTIVE NOT_RECRUITING214 Analytics
NCT05303532Roll Over StudY for Patients Who Have Completed a Previous Oncology Study With DurvalumabCancer
ENROLLING BY_INVITATION214 Analytics
PHASE3NOT YET_RECRUITING
A Study of Neoadjuvant-adjuvant Durvalumab and FLOT Chemotherapy Followed by Adjuvant Durvalumab in Chinese Patients With Resectable GC/GEJC.
GastricUnlock trial analytics
PHASE3ACTIVE NOT_RECRUITING
Durvalumab After Chemoradiotherapy in Limited Stage Small Cell Lung Cancer.
Small Cell Lung CarcinomaUnlock trial analytics
PHASE3ACTIVE NOT_RECRUITING
A Study to Evaluate the Use of Durvalumab in Combination With Platinum-based Chemotherapy Followed by Durvalumab With Olaparib as First-line Treatment in Advanced or Recurrent Endometrial Cancer in Spain
Advanced or Recurrent Endometrial CancerUnlock trial analytics
PHASE3RECRUITING
Phase 3 Study of T-DXd and Rilvegostomig Versus SoC in Advanced HER2-expressing Biliary Tract Cancer
Biliary Tract CancerUnlock trial analytics
PHASE3ACTIVE NOT_RECRUITING
Durvalumab With Chemotherapy as First Line Treatment in Patients With Advanced Biliary Tract Cancers (aBTCs)
Biliary Tract CancerUnlock trial analytics
PHASE3ACTIVE NOT_RECRUITING
BCG in Combination With Durvalumab in Adult BCG-naïve, High-risk NMIBC Participants
Non-Muscle- Invasive Bladder CancerUnlock trial analytics
PHASE3COMPLETED
A Phase 3b, Open-label, Multi-center Study on Durvalumab in Combination With Gemcitabine-based Chemotherapy as 1L Treatment for the Chinese Patients With Unresectable Biliary Tract Cancers (BTC)
Biliary Tract CancersUnlock trial analytics
PHASE3ACTIVE NOT_RECRUITING
Durvalumab and Tremelimumab as First Line Treatment in Participants With Advanced Hepatocellular Carcinoma (HCC)
Advanced Hepatocellular CarcinomaUnlock trial analytics
PHASE3ACTIVE NOT_RECRUITING
Durvalumab Plus Tremelimumab as First-line Treatment in Chinese Patients With uHCC
Hepatocellular CarcinomaUnlock trial analytics
PHASE3ENROLLING BY_INVITATION
Roll Over StudY for Patients Who Have Completed a Previous Oncology Study With Durvalumab
CancerUnlock trial analytics

Study Endpoints

Primary Endpoints

To compare Arm A relative to Arm B on pCR rate
Up to 24 months after the last participant is randomized

pCR rate is defined as the proportion of participants who have no residual viable tumour in the resected specimens and as determined by central pathology review.

To describe the safety profile of durvalumab for patients with LS-SCLC who have not progressed following CRT.
90 days after last dose of durvalumab of the last patient.

* Incidence of grade ≥ 3 AEs * Incidence of imAE, defined as an AE that is associated with drug exposure and is consistent with an immune-mediated mechanism of action and there is no clear alternate etiology. * Incidence of AEs that lead to treatment delays/interruptions or permanent discontinuation.

Number of patients with Adverse Events
Time from enrollment up to at least 90 days after last dose of study treatment

Safety and tolerability will be evaluated in terms of Adverse Events (AEs), Serious AEs (SAEs), and immune-mediated AEs (imAEs)

Safety Run In: To evaluate the safety and tolerability of T-DXd with rilvegostomig
Until all patients have completed at least 1 full Cycle (each cycle is 21 days)

Safety and tolerability will be evaluated by the proportion of treated patients with occurrence of AEs, SAEs and AESIs, as assessed by CTCAE v5.0.

Randomized Portion: To evaluate the efficacy of T-DXd with rilvegostomig vs Standard of Care (SoC) in terms of Overall Survival in the FAS (HER2 IHC 3+) population
From date of treatment randomization until the date of death from any cause (estimated to be assessed up to 50 months after first subject randomized)

Overall survival (OS) in FAS (HER2 IHC 3+) population OS is defined as time from randomization date until the date of death due to any cause. The comparison will include all randomized patients, regardless of whether the patient withdraws from therapy or receives another anticancer therapy. The measure of interest is the hazard ratio of OS.

Number of participants with Grade 3 or 4 possibly related adverse event (PRAE)
Within 6 months after the initiation of Investigational Medicinal Product (IMP)

PRAE is defined as an AE which has been assessed by the investigator to be possibly related to IMP.

Incidence of Grade 3 or 4 Possibly related adverse events (PRAEs)
From the date of the first dose of study treatment (Day 1) until 6 months after the initiation of study treatment

A PRAE is defined as an AE that has been assessed by the Investigator to be possibly related to study treatment. A PRAE will be included if it has onset or worsens (by Investigator report of an increase in CTCAE (common terminology criteria for adverse events) grade relative to pre-treatment) within 6 months of initiation of study intervention and it has CTCAE Grade 3 or 4 recorded within this timeframe.

The incidence of Possible related adverse events(PRAE) Grade 3 or 4
Within 6 months after the initiation of study intervention.

The primary endpoint of this study is the incidence of Grade 3/4 PRAEs (CTCAE v5.0) of durvalumab combined with gemcitabine-based chemotherapy within 6 months of starting study intervention regardless of length of infusion. PRAEs are where the investigator answered yes to the question "Do you consider that there is a reasonable possibility that the event may have been caused by the investigational product?".

Incidence of grade 3 or 4 possibly related to treatment adverse events (PRAEs)
From the date of first dose of IMP until 6 months after the initiation of study intervention

PRAE is defined as an AE which has been assessed by the investigator to be possibly related to IMP.

Objective response rate (ORR)
From the first dose of IMP until progression, or the last evaluable assessment in the absence of progression [approx. up to 33 months]

ORR is defined as the number (%) of participants with a confirmed objective tumour response (complete response \[CR\] or partial response \[PR\]) as determined by the investigator per Response Evaluation Criteria in Solid Tumours, Version 1.1 (RECIST 1.1).

≥Grade 3 Adverse Events and Adverse Events of Special Interest of Cohort 1
From the time of signature of informed consent, throughout the treatment period, and up to the follow-up period, assessed up to 44months

Safety endpoint

Number of participants with serious adverse events as assessed by Common Terminology Criteria for Adverse Events (CTCAE) v5.0
From baseline up to follow up at 90 days after the last dose of study drug.

To monitor safety and tolerability of continuous study treatment to patients who continue to benefit at the end of the clinical trial by measuring the primary outcome of Serious Adverse Events (SAEs).

Progression Free Survival (PFS)
Up to 5 years after randomization

Defined as time from randomisation until progression per RECIST 1.1 as assessed by Blinded Independent Central Review (BICR), or death due to any cause in participants with PD-L1 TC ≥ 50%. Outcomes measures were applicable with the previous version of the protocol. The study objectives are considered descriptive rather than confirmatory according to the protocol amendment.

Progression Free Surival (PFS)
Up to 5 years after first patient randomized.

Progression Free Survival (PFS) as assessed by BICR, per RECIST 1.1.

Number of Participants With Incidence of Grade 3 or Higher Adverse Events (AEs)
From first dose of study treatment until 90 days after treatment discontinuation, up to 2.5 years.

Incidence of Grade 3 or higher adverse events to evaluate safety and tolerability profile of durvalumab + Platinum (cisplatin or carboplatin) plus etoposide (EP) treatment was assessed.

Number of Participants With Incidence of Immune Mediated Adverse Events (imAEs)
From first dose of study treatment until 90 days after treatment discontinuation, up to 2.5 years.

Immune mediated adverse events (imAEs) were assessed to evaluate safety and tolerability profile of durvalumab + EP treatment. An imAE is defined as an AESI that is associated with drug exposure and is consistent with an immune-mediated mechanism of action (MOA) and where there is no clear alternate etiology.

Change in ctDNA Level Following Chemotherapy
12 weeks

Participants in Cohort 1 MRD+ will be assessed for ctDNA levels at baseline and end of treatment, expected to be 4 cycles of 3 weeks per cycle (defined as ctDNA evaluable set or ctDES). The outcome will be assessed as the number of participants with a ≥ 3 fold decrease in ctDNA level, a number without dispersion.

To assess the safety and tolerability as evaluated by adverse events occurring throughout the study (Safety Run-In part)
At completion of study treatment by the last patient and at 3 months.

Frequency of Adverse Events.

To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by vital signs (blood pressure in mmHg) (Safety Run-In part)
Up to 84 months
To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by vital signs (pulse rate) in beats per minute (Safety Run-In part)
Up to 84 months
To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by vital signs (respiration rate) in breaths per minute (Safety Run-In part)
Up to 84 months
To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by vital signs (temperature) in degrees Celsius (Safety Run-In part)
Up to 84 months
To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by abnormality in clinical chemistry by liver function (Safety Run-In part)
Up to 84 months

Clinical chemistry will be assessed by liver function assessment (ALT, AST, albumin, total bilirubin measured in units per dL)

Safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin or who refuse cisplatin as assessed by abnormality in clinical chemistry by kidney function (Safety Run-In part)
Up to 84 months

Clinical chemistry will be assessed by kidney function assessment in mg/dL

To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by abnormality in clinical chemistry by thyroid function (Safety Run-In part)
Up to 84 months

Clinical chemistry will be assessed by thyroid function assessment in units per mL.

To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as assessed by abnormality in haematology (Safety Run-In part)
Up to 84 months

Hematology will be assessed by white cell count, platelet count, absolute neutrophil count and absolute lymphocyte count.

To assess the safety and tolerability of durvalumab + tremelimumab + EV in participants with MIBC who are ineligible for cisplatin as as assessed by ECG (pulse rate) (Safety Run-In part)
Up to 84 months
Changes in WHO/ECOG performance status (Safety Run-In part)
Up to 84 months

Eastern Cooperative Oncology Group (ECOG) performance status scale range 0 to 5, where 0 is fully active, able to carry on all pre disease performance without restriction - best outcome and 5 -death - worst outcome.

Compare efficacy of durvalumab + tremelimumab + EV (Arm 1) relative to cystectomy (Arm 3) and durvalumab + EV (Arm 2) relative to cystectomy (Arm 3) on EFS (Main Study)
Up to 3 years

Event-free survival (EFS;) is defined as the time from randomization to the first occurrence of any of the following events: recurrence of disease post-radical cystectomy, the first documented progression in participants who did not receive radical cystectomy, failure to undergo radical cystectomy in participants with residual disease, or death due to any cause, up to 3 years.

Median Overall Survival (OS)
Minimum follow-up is 24 months after randomisation. Median follow-up for survival is of 33 months with range (3 months - 47 months).

OS based on the Kaplan-Meier method is defined as the duration from randomisation to the date of death due to any cause, or is censored at date last known alive.

Number of Patients With Adverse Events (AEs) Grade ≥ 3
During study treatment, until disease progression (median 6 months)

Patients with AEs grade ≥ 3 acording to NCI CTCAE v5.0

Number of Patients With Immune-mediated Adverse Events (imAE)
During study treatment, until disease progression (median 6 months)

Patients with immune-mediated adverse events (imAE) per patient

Percentage of Participants With Grade ≥3 AEs
19 months
Percentage of Participants With Immune-mediated Adverse Events (imAEs)
19 months

An immune-mediated adverse event (imAE) is defined as an AESI that is associated with drug exposure and is consistent with an immune-mediated mechanism of action and where there is no clear alternate aetiology.

Disease-free Survival (DFS)
Every 8 weeks (q8w) ± 1 week until Week 48, then every 12 weeks (q12w) ± 1 week until appearance of RECIST 1.1-defined disease recurrence or follow-up, up to 16.6 months

DFS was defined as the time from the date of randomization until any one of the following events, whichever occurred first: Date of disease recurrence using Investigator assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 OR Date of death from any cause.

Event-free survival (EFS)
Up to 5 years

EFS is the time from date of randomization until the date of disease progression or death.

Progression free survival (PFS) per RECIST 1.1 as assessed by BICR
up to approximately 56 months

To assess the efficacy in terms of PFS in PD-L1 High population

Disease-free Survival (DFS) in FAS (Using Investigator Assessments According to Response Evaluation Criteria in Solid Tumors 1.1 [RECIST 1.1])
Every 12 weeks (q12w) ± 1 week until appearance of RECIST 1.1-defined disease recurrence or until primary DFS analysis, up to 33.28 months

DFS was defined as the time from the date of randomization until either of the following events, whichever occurred first: disease recurrence using Investigator RECIST 1.1 assessments (i.e., local or regional recurrence, distant recurrence, second primary NSCLC) or death from any cause.

Recurrence-free survival (RFS) for Arm A vs Arm C
Up to 49 months after first patient randomized

RFS (per RECIST 1.1 criteria as assessed by BICR) will be defined as the time from the date of randomization until the date of the first objective radiologic recurrence or death due to any cause, whichever occurs first.

Overall Survival (OS)
From date of randomization until death due to any cause. Assessed up to maximum of approximately 27 months (from date of randomization to primary analysis data cut-off)

Overall Survival (OS) was defined as the time from the date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. The second interim analysis was pre-specified after approximately 397 OS events occurred in both arms (59% maturity).

Overall Survival (OS) Rate at 18 Months
From date of randomization until death due to any cause. Calculated at 18 months using the Kaplan-Meier technique.

Overall Survival (OS) was defined as the time from the date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. The second interim analysis was pre-specified after approximately 397 OS events occurred in both arms (59% maturity).

Overall Survival (OS) Rate at 24 Months
From date of randomization until death due to any cause. Calculated at 24 months using the Kaplan-Meier technique.

Overall Survival (OS) was defined as the time from the date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. The second interim analysis was pre-specified after approximately 397 OS events occurred in both arms (59% maturity).

Progression-Free Survival (PFS) assessed by Blinded Independent Central Review (BICR) according to RECIST 1.1 in subpopulation of patients with Stage I/II NSCLC
from randomization up to 6 years

Main Cohort

4-year Progression-Free Survival (4y-PFS) by ICR according to RECIST 1.1 criteria
from treatment start up to 5 years

Osimertinib Cohort

Progression-free Survival (PFS) Based on the Investigator Assessment According to RECIST 1.1 or Histopathologic Confirmation of Local Tumour Progression
Tumor assessments start 20 weeks after randomisation then every 12 weeks up to 164 weeks, then every 24 weeks until date of RECIST1.1 defined radiological progression. Assessed up to date of DCO (20-Jan-2022) to a maximum of 32.6 months

PFS defined as time from date of randomisation until date of tumour progression or death by any cause, regardless of whether the patient withdrew from randomized therapy or received another anticancer therapy prior to progression

Progression-free Survival (PFS) by Investigator Assessment Using Modified RECIST 1.1 - Full Analysis Set
At baseline, within 3 weeks of last dose of chemotherapy, then every 12 weeks for 3 years and thereafter every 24 weeks. Assessed until primary analysis - (05DEC2022 for Global cohort, 17MAR2025 for China cohort) - upto 46 months

To determine the efficacy of durvalumab in combination with platinum based chemotherapy and bevacizumab and continued as maintenance in combination with bevacizumab and olaparib versus SoC platinum based chemotherapy in combination with bevacizumab by assessment of PFS (using investigator assessment according to Response Evaluation Criteria in Solid Tumours version 1.1 \[RECIST 1.1\]) in the first line treatment of patients with newly diagnosed advanced ovarian cancer. Per MTP, the comparison of SoC+D+O v SoC in the Non-tbRCAm patients is a primary endpoint. SoC+D v SoC is reported separately as a secondary endpoint. Results for tBRCAm SoC+D+O are not presented as this was prespecified to be assessed only in the Non-tBRCAm patients.

Progression-free Survival (PFS) by Investigator Assessment Using Modified RECIST 1.1 - (Full Analysis Set, HRD Positive)
At baseline, within 3 weeks of last dose of chemotherapy, then every 12 weeks for 3 years and thereafter every 24 weeks. Assessed until DCO1 - (05DEC2022 for Global cohort, 17MAR2025 for China cohort) - upto 46 months

To determine the efficacy of durvalumab and olaparib assessed by PFS in the first line treatment of patients with newly diagnosed advanced ovarian cancer. Per MTP, the comparison of SoC+D+O v SoC in the Non-tBRCAm HRD positve population is a primary endpoint. SoC+D v SoC is reported separately as a secondary endpoint. Results for tBRCAm SoC+D+O are not presented as as this was prespecified to be assessed only in the Non-tBRCAm patients.

Pathological Complete Response (pCR) in modified intent-to-treat (mITT) population
Up to approximately 15 weeks after randomization

Defined as the lack of any viable tumour cells after complete evaluation in the resected lung cancer specimen and all sampled regional lymph nodes.

Event-Free Survival (EFS) in modified intent to treat (mITT) population
Up to 5.5 years after first patient randomized.

An event is defined as documented RECIST 1.1 local or distant recurrence of lung cancer; death due to any cause; disease progression that precludes surgery or discovered upon attempting surgery that prevents completion of surgery.

Progression Free Survival (PFS) for Arm B vs Arm C
Approximately 5 years

PFS per Blinded Independent Central Review (BICR) assessment will be defined as the time from the date of randomization until the date of first objective disease progression or death

Progression-Free Survival (PFS) (Modified Intent-to-Treat [mITT] Set)
Tumor scans performed at screening, every 8 weeks ±1 week up to 48 weeks, and then every 12 weeks ±1 week thereafter until confirmed PD. Assessed up to the DCO date 23-Jun-2024 (a maximum of approximately 2035 days)

The PFS per Response Evaluation Criteria in Solid Tumors 1.1. (RECIST 1.1) using blinded independent central review (BICR) assessments was defined as the time from the date of randomization until the date of objective disease progression (PD) or death (by any cause in the absence of progression) regardless of whether the participant withdrew from therapy or received another anti-cancer therapy prior to progression. The PD was defined as at least a 20% increase in the sum of diameters of target lesions (TLs) and an absolute increase of \>=5 millimeters (mm), taking as reference the smallest sum of diameters since treatment started including the baseline sum of diameters. Median PFS was calculated using the Kaplan-Meier technique.

Pathologic Complete Response (pCR) Rates at Time of Cystectomy
Up to 6 months

pCR rate is defined as the proportion of patients whose pathological staging was T0N0M0 as assessed per central pathology review using specimens obtained via radical cystectomy following the neoadjuvant treatment. The denominator for pCR will be the number of patients in the FAS.

Event-free Survival (EFS) Per Central Review Defined as Time From Randomization to Event
Up to 48 months

EFS is defined as the time from randomization to the first recurrence of disease post radical cystectomy, time of first documented progression in patients who were medically precluded for radical cystectomy, or time of expected surgery in patients who refuse to undergo a radical cystectomy or failure to undergo a radical cystectomy in participants with residual disease, or the time of death due to any cause, whichever occurs first

Durvalumab Versus Placebo: Progression-Free Survival (PFS) Assessed by Blinded Independent Central Review (BICR) Per Response Evaluation Criteria in Solid Tumors Version 1.1
Response evaluations performed every 8 weeks (q8w) ± 1 week up to 72 weeks, then every 12 weeks (q12w) ± 1 week up to 96 weeks, and then every 24 weeks (q24w) thereafter until PD, up to DCO date 15 January 2024 (a maximum of approximately 1936 days)

PFS per RECIST 1.1 assessed by BICR was defined as the time from the date of randomization until the date of objective disease progression (PD) or death (by any cause in the absence of progression) regardless of whether the participant withdrew from therapy or received another anticancer therapy prior to progression. PD was defined as at least a 20% increase in the sum of diameters of target lesions (TLs), taking as reference the smallest previous sum of diameters (nadir) - this included the baseline sum if that was the smallest on study. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 millimeters (mm) from nadir. Median PFS was calculated using Kaplan-Meier method and its confidence interval (CI) using Brookmeyer-Crowley method.

Durvalumab Versus Placebo: Overall Survival (OS)
From date of randomization until death due to any cause, up to DCO date 15 January 2024 (a maximum of approximately 1936 days)

OS was defined as the time from the date of randomization until death due to any cause. Median OS was calculated using Kaplan-Meier method and its CI using Brookmeyer-Crowley method.

The efficacy of Durvalumab + BCG (induction plus maintenance) combination therapy compared to SoC in terms of Disease free survival (DFS) in patients with NMIBC
Up to 4 years

Disease-free survival using Investigator disease assessments.

Progression-Free Survival (PFS)
Tumour scans performed at screening, 16 weeks ±1 week after randomization, then every 8 weeks ±1 week up to 48 weeks, and then every 12 weeks ±1 week thereafter until confirmed PD. Assessed up to the DCO date (a maximum of approximately 1988 days).

The PFS per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1) using blinded independent central review (BICR) assessments was defined as the time from the date of randomization until the date of objective PD or death (by any cause in the absence of progression) regardless of whether the participant withdrew from therapy or received another anti-cancer therapy prior to progression. The PD was defined as at least a 20% increase in the sum of diameters of target lesions. Median PFS was calculated using the Kaplan-Meier technique.

Overall Survival (OS) - Treme 300 mg x1 Dose + Durva 1500 mg vs Sora 400 mg
From the date of randomization until death due to any cause, assessed up to the data cut-off date (27Aug2021, to a maximum of approximately 46 months).

OS was defined as the time from the date of randomization until death due to any cause, regardless of whether the participant withdrew from randomized therapy or received another anticancer therapy. Any participant not known to have died at the DCO date was censored based on the last recorded date on which the participant was known to be alive. If the last known date alive or if the date of death was after the DCO date, participants were censored at the DCO date. This primary outcome measure presents OS analysis of Treme 300mg x1 dose + Durva 1500 mg vs Sora 400 mg at the time of the final analysis DCO (27Aug2021).

Number of Participants With Adverse Events of Special Interest (AESIs)
From screening to safety follow up visit (90 days after last dose), up to approximately 3 years.

Incidence, severity, nature, seriousness, intervention/treatment, outcome, and causality of AESIs were assessed. AESIs included events with a potential inflammatory or immune-mediated mechanism that required interventions such as steroids, immunosuppressants, and/or hormone replacement therapy.

Progression-Free Survival (PFS); D + SoC Compared With SoC Alone
Tumor scans performed at baseline, Week 6, Week 12 and then every 8 weeks relative to date of randomization until radiological progression. Assessed until global cohort DCO of 24 July 2019 (maximum of approximately 25 months).

PFS (per RECIST version 1.1 \[RECIST 1.1\] using Blinded Independent Central Review \[BICR\] assessments) was defined as time from date of randomization until date of objective disease progression or death (by any cause in the absence of progression), regardless of whether the patient withdrew from randomized therapy or received another anticancer therapy prior to progression. Median PFS was calculated using the Kaplan-Meier technique. The final analysis of PFS in the global cohort was pre-specified after approximately 497 BICR PFS events occurred across the D + SoC and SoC alone treatment arms (75% maturity).

Overall Survival (OS); D + SoC Compared With SoC Alone
From baseline until death due to any cause. Assessed until global cohort DCO of 12 March 2021 (maximum of approximately 45 months).

OS was defined as the time from the date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. The final analysis of OS in the global cohort was pre-specified after approximately 532 OS events occurred across the D + SoC and SoC alone treatment arms (80% maturity).

Overall Survival (OS) in the Global Cohort; Assessed at Global Cohort Interim Analysis; D + EP Compared With EP
From baseline until death due to any cause. Assessed until global cohort interim analysis DCO (maximum of approximately 23 months).

OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. An interim analysis of OS in the global cohort was pre-specified after approximately 318 OS events occurred each between the D + EP and EP groups (60% maturity), and between the D + T + EP and EP groups (60% maturity). At the global cohort interim analysis DCO (11 March 2019), comparison of OS in the D + EP versus (vs) EP groups had crossed the pre-specified boundary. Since these results were considered final in terms of formal statistical testing, they are presented here as a primary outcome measure. Analysis of OS for D + EP vs EP and for D + T + EP vs EP at the time of the global cohort final analysis is presented separately in the subsequent primary outcome measure.

OS in the Global Cohort; Assessed at Global Cohort Final Analysis; D + EP Compared With EP and D + T + EP Compared With EP
From baseline until death due to any cause. Assessed until global cohort final analysis DCO (maximum of approximately 33 months).

OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. This primary outcome measure presents OS for the analysis of D + EP vs EP and D + T + EP vs EP at the time of the global cohort final analysis DCO (27 January 2020). Analysis of D + EP vs EP at the global cohort interim analysis DCO is presented in the previous primary outcome measure. Analysis of D + T + EP vs D + EP (global cohort final analysis) is presented as a secondary outcome measure.

OS in the China Cohort; Assessed at China Cohort First Analysis; D + EP Compared With EP
From baseline until death due to any cause. Assessed until China cohort first analysis DCO (maximum of approximately 19 months).

OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. An analysis of OS for D + EP vs EP in the China cohort was pre-specified at approximately 60% maturity (to ensure a similar maturity to the interim analysis of the Global cohort). This primary outcome measure presents OS for analysis of D + EP vs EP at the China cohort first analysis DCO (06 January 2020), and is comparable in terms of maturity with the interim analysis of OS for D + EP vs EP in the Global cohort. Analysis of OS for D + EP vs EP and for D + T + EP vs EP at the time of the China cohort second analysis is presented separately in the subsequent primary outcome measure.

OS in the China Cohort; Assessed at China Cohort Second Analysis; D + EP Compared With EP and D + T + EP Compared With EP
From baseline until death due to any cause. Assessed until China cohort second analysis DCO (maximum of approximately 29 months).

OS was defined as the time from date of randomization until death due to any cause. Any patient not known to have died at the time of analysis was censored based on the last recorded date on which the patient was known to be alive. Median OS was calculated using the Kaplan-Meier technique. An analysis of OS for D + T + EP vs EP in the China cohort was pre-specified at approximately 80% maturity (to ensure a similar maturity to the final analysis of the Global cohort). This primary outcome measure presents OS for analysis of D + EP vs EP and D + T + EP vs EP at the time of the China cohort second analysis DCO (02 November 2020), and is comparable in terms of maturity with the final analysis of OS for D + EP vs EP and D + T + EP vs EP in the Global cohort. Analysis of D + EP vs EP at the China cohort first analysis DCO is presented in the previous primary outcome measure. Analysis of D + T + EP vs D + EP (China cohort second analysis) is presented as a secondary outcome measure.

OS in Participants With LREM
From date of randomization until death due to any cause. Assessed up to a maximum of approximately 69 months (DCO 27 October 2022)

OS is defined as the time from the date of randomization until death due to any cause (date of death or censoring-date of randomization + 1). Any participant not known to have died at the time of analysis was censored based on the last recorded date on which the participant was known to be alive.

Overall Survival (OS); Global Cohort: Blood Tumor Mutational Burden (bTMB) ≥20 Mutations Per Megabase (Mut/Mb) Analysis Set
From baseline (Day 1, Week 0) until death due to any cause, assessed up to the Global cohort DCO date (a maximum of approximately 44 months).

The OS was defined as the time from the date of randomization until death due to any cause (ie, date of death or censoring - date of randomization + 1). Any participant not known to have died at the time of analysis was censored based on the last recorded date on which the participant was known to be alive. Median OS was calculated using the Kaplan-Meier technique.

OS; China Cohort: China Programmed Cell Death Ligand 1 (PD-L1) Negative NSCLC Analysis Set
From baseline (Day 1, Week 0) until death due to any cause, assessed up to the China cohort DCO date (a maximum of approximately 44 months).

The OS was defined as the time from the date of randomization until death due to any cause (ie, date of death or censoring - date of randomization + 1). Any participant not known to have died at the time of analysis was censored based on the last recorded date on which the participant was known to be alive. Median OS was calculated using the Kaplan-Meier technique.

To Assess the Efficacy of Durvalumab + Tremelimumab Combination Therapy Versus SoC in Terms of OS in Full Analysis Set
From randomization date until death due to any cause, assessed up to the data cut-off date (27JAN2020, a maximum of 5 years).

The OS was defined as the time from the date of randomization until death due to any cause (ie, date of death or censoring - date of randomization + 1). Any participant not known to have died at the time of analysis were censored based on the last recorded date on which the participant was known to be alive. Median OS was calculated using the Kaplan-Meier technique.

To Assess the Efficacy of Durvalumab Monotherapy Versus SoC in Terms of OS in PD-L1-High Analysis Set
From randomization date until death due to any cause, assessed up to the data cut-off date (27JAN2020, a maximum of 5 years).

The OS was defined as the time from the date of randomization until death due to any cause (ie, date of death or censoring - date of randomization + 1). Any participant not known to have died at the time of analysis were censored based on the last recorded date on which the participant was known to be alive. Median OS was calculated using the Kaplan-Meier technique.

Overall Survival (OS) Status in the PD-L1 TC/IC High Subgroup - Durvalumab Versus Standard of Care (SOC)
From date of randomization until time of final analysis, an average of approximately 4 years

Number of participants with Overall Survival (OS)

Overall Survival (OS) Median Duration in the PD-L1 TC/IC High Subgroup
From date of randomization until time of final analysis, an average of approximately 4 years

Time from the date of randomization until death due to any cause (i.e., date of death or censoring - date of randomization + 1)

Overall Survival (OS); PD-L1 (TC >=25%) Analysis Set Population, Durvalumab Monotherapy Vs SoC Chemotherapy and Durvalumab + Tremelimumab Vs SoC Chemotherapy
From baseline (Day 1, Week 0) until death due to any cause, assessed up to the data cut-off date (a maximum of approximately 3 years).

The OS was defined as the time from the date of randomization until death due to any cause (ie, date of death or censoring - date of randomization + 1). Any participant not known to have died at the time of analysis were censored based on the last recorded date on which the participant was known to be alive. Median OS was calculated using the Kaplan-Meier technique.

Progression-Free Survival (PFS); PD-L1 (TC >=25%) Analysis Set Population, Durvalumab + Tremelimumab Vs SoC Chemotherapy
Tumour scans performed at baseline then every 6 weeks up to 48 weeks relative to the date of randomization, then every 8 weeks thereafter until confirmed disease progression. Assessed up to the data cut-off date (a maximum of approximately 3 years).

The PFS per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1) using blinded independent central review (BICR) assessments was defined as the time from the date of randomization until the date of objective disease progression or death (by any cause in the absence of progression) regardless of whether the participant withdraw from randomized therapy or received another anti-cancer therapy prior to progression (ie, date of PFS event or censoring - date of randomization + 1). Progressive disease (PD) was defined as at least a 20% increase in the sum of diameters of target lesions (TLs) and an absolute increase of at least 5 millimeter (mm), taking as reference the smallest sum of diameters since treatment started including the baseline sum of diameters. Median PFS was calculated using the Kaplan-Meier technique.

Patient Overall survival (OS)
from randomisation until date of death from any cause (follow-up until 8 years post-treatment)

defined as the interval in whole days between date of randomisation and date of death from any cause

Patient Event Free Survival (EFS)
From randomisation until date of progression/persistence/recurrence/death (follow-up until 8 years post-treatment)

defined as the interval in whole days between date of randomisation until date of progression/persistence/recurrence/death

Progression Free Survival Based on Blinded Independent Central Review (BICR) According to Response Evaluation Criteria in Solid Tumors (RECIST 1.1)
Tumor scans performed at baseline then every ~8 weeks up to 48 weeks, then every ~12 weeks thereafter until confirmed disease progression. Assessed until 13 Feb 2017 DCO; up to a maximum of approximately 3 years.

PFS was defined as the time from randomization until the date of objective disease progression (RECIST 1.1) or death (by any cause in the absence of progression). Progression was defined using RECIST 1.1 as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. PFS was calculated using the Kaplan-Meier technique.

Overall Survival
From baseline until death due to any cause. Assessed until 22 Mar 2018 DCO; up to a maximum of approximately 4 years.

OS was defined as the time from the date of randomization until death due to any cause. OS was calculated using the Kaplan-Meier technique.

Efficacy of durvalumab and AZD6738 combination therapy in subjects with relapsed SCLC subjects as 2nd or 3rd line therapy: Objective response rate(ORR)
Up to 30 months

Objective response rate(ORR) by RECIST 1.1

pathological complete response (pCR= ypT0 ypN0)
22 weeks

To compare the pathological complete response (pCR= ypT0 ypN0) rates of neoadjuvant treatment of sequential, nab-Paclitaxel followed by EC +/- the PD-L1 antibody MEDI4736 in patients with early triple negative breast cancer.

Efficacy- 1-year progression free survival (PFS)
1 year

1-year progression free survival (PFS) depicted as the 1-year in-field-progression-free survival and 1-year distant metastasis free survival

Feasibility - Number of treatment discontinuations due to toxicity
During treatment

number of treatment discontinuations due to toxicity

Clinical response to therapy (durvalumab)
26 weeks

Changes in ctDNA levels (from baseline to C1/C2) compared with objective RECIST radiological response at 26 weeks

Progression-free Survival using RECIST 1.1
32 months
3 year event-free survival
3 years

Event-free survival (EFS), is defined as the time from randomization to the time when a failure event is observed. Failure is define by Local-regional progression or recurrence, Distant metastasis, Non-protocol RT, chemotherapy, Surgery or death.

TTP
From date of randomization until the date of first documented progression, assessed up to 60 months

Time to progression

Disease-free survival
5 years

defined as the time from the randomization to the time of the first event that is either recurrent (local or distant) bladder cancer, a new primary bladder cancer or death from any cause

Impact of neoadjuvant treatment with durvalumab plus olaparib in the molecular profile of resectable urothelial bladder cancer (Pathological complete response rate (pCRR))
24 weeks

pCRR will be analysed based on the percentage of patients who obtained a pathological complete response. Pathologic response will be evaluated on cystectomy tumor sample

Progression-free survival
From inclusion to disease progression or death, up to 3.5 years

The progression-free survival (PFS) is the length of time during and after the treatment of a disease that a patient lives with the disease but it does not get worse.

Progression free survival (PFS) per RECIST 1.1
From the date of first dose until the date of objective PD per RECIST 1.1 or death, whichever came first. It will be assessed when approximately 69 PFS events have occurred (60% maturity), approximately 8 months after the last patients dosed.

Efficacy endpoint

Safety and Adverse Events (AEs)
Through study completion; an average of 1 year

Incidence of Adverse Events, Graded According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 5.0

The safety of neoadjuvant durvalumab combined with ddMVAC prior to radical cystectomy (RC).
Up to 6 months

Incidence of Grade 3 or 4 possibly treatment-related adverse events observed from the first dose of neoadjuvant study treatment until RC or the corresponding prespecified endpoint-window end date for participants who do not undergo RC

Complete Response
6 months

Complete response will be determined by bladder biopsy and urinary cytology for malignancy for subjects with a CIS component at 6 months CT/MRI urography will be used to rule out extravesical disease. (Cohort A)

Overall survival rate
at 12 months

Overall survival rate after 12 months (OS@12months) defined as proportion of patients alive 12 months after enrollment

Progression-free survival (PFS) in randomized participants
From randomization until death, withdrawal of consent, or the end of the study (approximately 48 months)

PFS is defined as the time from randomization until the date of confirmed PD (per Response Evaluation Criteria in Solid Tumours, Version 1.1 \[RECIST 1.1\] as assessed by the Investigator) or death due to any cause. The measure of interest is the hazard ratio (HR) and the corresponding 95% confidence interval (CI).

PFS at 6 months
From randomization until death, withdrawal of consent, or the end of the study (approximately 48 months)

PFS is defined as the time from randomization until the date of confirmed PD (per RECIST 1.1 as assessed by the Investigator) or death due to any cause. The measure of interest is the PFS rate and the corresponding 95% CI at 6 months.

PFS at 12 months
From randomization until death, withdrawal of consent, or the end of the study (approximately 48 months)

PFS is defined as the time from randomization until the date of confirmed PD (per RECIST 1.1 as assessed by the Investigator) or death due to any cause. The measure of interest is the PFS rate and the corresponding 95% CI at 12 months.

Resection rate
At day of surgery (Within 40 days of the last dose of neoadjuvant treatment)

Resection rate is defined as the proportion of all participants who underwent definitive surgery. Participants who undergo (ie, start) surgery with the goal of complete tumour resection will be counted as meeting this endpoint.

Number of participants with pathological complete response (pCR)
From randomization to approximately 15 weeks after the first dose of study interventions
Number of participants with adverse events (AEs) and serious adverse events (SAEs)
Until Day 90 after the last dose of study interventions (Up to approximately 3 years)
Maintenance Participants Alive and Progression Free (APF12) Per RECIST 1.1 [Efficacy]
Up to 12 months

12 month landmark PFS, APF12, where PFS is defined as the time from the first dose of study intervention in the induction phase until objective disease progression (as assessed by the investigator per RECIST v1.1) or death from any cause, whichever comes first.

Number of Patients With Grade 3 and Grade 4 Possibly-related Adverse Events (PRAEs)
From first dose of durvalumab treatment until 6 months after initiation of durvalumab treatment

The safety and tolerability profile of durvalumab as defined by Grade 3 and Grade 4 PRAEs within 6 months from the initiation of durvalumab treatment. A PRAE was any TEAE with a possible relatedness to durvalumab, or where the relatedness was missing. If relatedness of a TEAE was missing at the primary DCO (30 March 2023) the TEAE was considered a PRAE.

Clinical Benefit
up to 11 months from the start of study treatment

Clinical Benefit is the count of participants who have achieved a CR (Complete Response), PR (Partial Response), or SD (Stable Disease), assessed by RECIST 1.1 response criteria Response Evaluation Criteria in Solid Tumors (RECIST) is a standard measure of how well cancer patients respond to treatment. Possible scores are CR (total disappearance of all target lesions), PR (at least a 30% decrease of the sum of the longest diameter of all target lesions), PD (Progressive Disease; at least a 20% increase of the sum of the longest diameter of all target lesions), and SD (neither a sufficient decrease for PR, or sufficient increase for PD). This outcome measure will report the count of subjects who achieved any Clinical Benefit, Clinical Benefit for 3 months, and Clinical Benefit for 6 months.

Part 1: Occurrence of adverse events (AEs) and serious adverse events (SAEs), graded according to NCI CTCAE v5.0
Safety will be assessed up to the follow-up period, approximately 24 months.

Occurrence of AEs and SAEs graded according to NCI CTCAE v5.0

Part 1: Ocurrence of dose-limiting toxicities (DLTs)
Safety will be assessed up to the follow-up period, approximately 24 months.

Occurrence of dose limiting toxicities

Part 1: Changes from baseline in laboratory parameters
Safety will be assessed up to the follow-up period, approximately 24 months.

Changes in laboratory parameters (every in appropriate units) compared to baseline results.

Part 1: Changes from baseline in vital signs
Safety will be assessed up to the follow-up period, approximately 24 months.

Changes in vital signs results compared to baseline results.

Part 1: Changes from baseline in electrocardiogram (ECG) results
Safety will be assessed up to the follow-up period, approximately 24 months.

Changes in ECG results compared to baseline results.

Part 2, Part 3, Part 4 and Part 5: Endpoint assessed by Investigator per RECIST v1.1: Confirmed Objective Response Rate (ORR)
(Endpoint: ORR) Efficacy will be assessed at an average of approximately 12 months

Confirmed ORR per RECIST 1.1 is the percentage of patients with Complete Response or Partial Response that is subsequently confirmed.

Substudy A: Number and severity of adverse events
2 years

To determine the safety and toxicity profile of rechallenging with durvalumab in patients who previously discontinued immunotherapy due to irAE.

Substudy B: To facilitate continued treatment with durvalumab (+/- Tremelimumab) for patients currently enrolled on completed CCTG trials
2 years
Substudy B: Number and severity of adverse events
2 years
Progression-free survival at 12 months
Assessed from the date of enrolment to completion of treatment at 12 months.

The PFS rate at 1-year is the primary endpoint of this trial and it is defined as the rate of patients without a PFS event at 1-year after enrolment. The rate will be estimated as the percentage of patients without a PFS event over the total number of patients who have completed a 1-year follow-up period after the enrolment. PFS is defined as the time from the date of enrolment until documented progression or death, if progression is not documented. Progression is defined as the development of new metastatic lesions or local progression of resected or irradiated metastases or primary tumour, assessed according to RECIST criteria version 1.1

Safety Run-in: Evaluation of the immune related or radiation therapy related toxicity of special interest
7 months

Immune related or radiation therapy related toxicity of special interest are identifitied as: * Any Grade 4 immune-related AE * Any ≥ Grade 3 colitis * Any ≥ Grade 3 renal failure/nephritis * Any ≥ Grade 3 non-infectious pneumonitis irrespective of duration * Any Grade 3 immune-related AE, excluding colitis, renal failure/nephritis and pneumonitis, that does not downgrade to ≤ Grade 2 within 3 days after onset of the event despite maximal medical supportive care including systemic corticosteroids or does not downgrade to ≤ Grade 1 or baseline within 14 days * Liver transaminase elevation ≥ 5 ULN or total bilirubin \> 3 × ULN will be considered a DLT regardless of duration or reversibility * Any increase in AST or ALT \> 3 × ULN and concurrent increase in total bilirubin \> 2 × ULN

Safety Run-in: Evaluation of the feasibility of the primary surgery
7 months

Feasibility of performing surgery within 6 weeks after the last neo-adjuvant treatment. This would indicate that there were no significant delays or toxicities that would results in surgery being delayed.

Phase II: Demonstration of the tumour response in arms 2 or 3 versus arm 1
24 months

To demonstrate improved tumour response of the primary tumour and nodal metastases in arms 2 or 3 versus arm 1 using residual cancer burden (RCB 0-1 vs. RCB 2-3) at time of surgery.

Number of Patients With Grade 3 and Grade 4 Treatment-related Adverse Events (TRAEs)
Up to 6 months

Safety and tolerability of Durvalumab as defined by Grade 3 and Grade 4 TRAEs following IV infusion administration was assessed.

Major Pathological Response Rate
Day 1 through Day 42

Major pathological response rate is defined as percentage of participants with \<=10% residual viable tumor cells in the resected specimen.

Objective Response (OR) Rate as a Measure of Antitumor Activity of Durvalumab Alone vs Durvalumab in Combination With Novel Agents
ORR at 16 weeks after randomization is the timing for radiologic assessment of the primary endpoint

ORR was defined as the percentage of participants with at least one visit response of Complete Response (CR) or Partial Response (PR) per RECIST 1.1 for target lesions: CR: Disappearance of all target lesions; PR: \>=30% decrease in the sum of the longest diameter of target lesions; OR = CR + PR.

Proportion of Patients With Pathological Response
12 weeks

Pathological response is defined as the absence of muscle- invasive bladder cancer at post-treatment biopsy (≤cT1). Cystoscopy and bladder biopsy six weeks since the end of radiotherapy.

Objective Response Rate
RECIST 1.1 was assessed for each participant every 8 weeks from study initiation until the end of study treatment. The time from first RECIST 1.1 assessment to the final at the end of study was 8.5 months.

Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Percentage of Participants With Objective Response Per Response Evaluation Criteria in Solid Tumours Version 1.1 (RECIST v1.1)
Baseline (<=28 days before treatment), then every 6 weeks for 24 weeks from Cycle 1 Day 1, then every 8 weeks (every 9 weeks in Module 6) until disease progression or 90 days after study drug discontinuation (approximately 2 years)

Objective response was defined as participants with a confirmed investigator-assessed response complete response (CR) or partial response (PR) based on RECIST v 1.1. The CR is defined as disappearance of all target (TL) and non-target lesions (NTL), and any pathological lymph node (whether target or nontarget) must have reduction in short axis to \<10 mm. The PR is defined as at least a 30% decrease in the sum of the diameters of TLs, taking as reference the baseline sum diameters, as long as criteria for progressive disease (PD) are not met. Confirmation of CR and PR is required by a repeat, consecutive assessment no less than 4 weeks from date of first documentation. Percentage of participants with objective response was reported.

Incidence of Dose-limiting Toxicities (DLTs) Defined as the Rate of Drug-related Grade 3-5 Adverse Events Assessed Using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.03 (Phase I)
Up to 8 weeks

The maximum tolerated dose is defined as the highest dose studied, for which the observed incidence of DLT is less than 33%. Number of Participants with Dose-limiting Toxicities (DLTs) in Phase I and Phase II will be reported.

3 Month Progression Free Survival (PFS) in the All Eligible Patients by Group/Arm
At 3 months

Progression free survival (PFS) rate will be assessed at 3 months in the platinum resistant group using Kaplan-Meier methods. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

6 Month Progression Free Survival (PFS) in the Platinum Sensitive Group (Phase II)
At 6 months

6-month progression-free survival rate is the probability of patients remaining alive and progression-free at 6 months from study entry estimated using Kaplan-Meier methods. Per RECIST 1.0 criteria: progressive disease (PD) is at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. PD for the evaluation of non-target lesions is the appearance of one or more new lesions and/or unequivocal progression of non-target lesion

Overall Response Rate
2 years

Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Number of Subjects With Major Pathological Response (MPR)
Durvalumab start date to surgical resection, up to 10 weeks

MPR is defined as ≤10% residual viable tumor in the resected specimen.

Number of Participants With Overall Response
Until disease progression [PD] (Up to 3.5 Years)

Overall Response Rate (ORR) using Investigator assessments according to Response Evaluation Criteria In Solid Tumors (RECIST) 1.1. ORR was defined as the number (percentage) of participants with a confirmed Complete Response (CR) or confirmed Partial Response (PR) and was estimated for each treatment arm with corresponding 2-sided 95% exact confidence intervals (CIs). A confirmed response of CR/PR meant that a response of CR/PR was recorded at one visit and confirmed by repeat imaging, preferably at the next regularly scheduled imaging visit, and not less than 4 weeks after the visit when the response was first observed, with no evidence of progression between the initial and CR/PR confirmation visit.

Objective Response Rate (ORR) in All Patients Using Investigator Assessments According to Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
From date of first infusion until confirmed disease progression or death (up to approximately 18 months for the data analysis cut-off)

ORR was defined as the percentage of patients with at least one visit response of confirmed complete response (CR) or partial response (PR). CR was defined as disappearance of all target lesions (TLs) since baseline. Any pathological lymph nodes selected as TLs must have had reduction in short axis to \<10 millimeters (mm). PR was defined as at least a 30% decrease in the sum of diameters of TLs, taking as reference the baseline sum of diameters. A confirmed response meant that a response of CR/PR was recorded at 1 visit and confirmed by repeat imaging, preferably at the next regularly scheduled imaging visit and not less than 4 weeks after the visit when response was first observed with no evidence of progression between the initial and CR/PR confirmation visits. Results are reported as percentage of patients with a confirmed response and percentage of patients with confirmed or unconfirmed responses (i.e., including single visit responses).

Objective Response Rate at 6 Months
After 6 months

Objective response rate, primary analysis, based on BICR assessments according to RECIST v1.1. The number (%) of patients with a response excludes unconfirmed responses

Objective Response Rate at 12 Months
After 12 months

Objective response rate (per RECIST 1.1 as assessed by blinded independent central review \[BICR\]) is defined as the number (%) of patients with a confirmed complete response or confirmed partial response and will be based on all treated patients who are PD-L1-positive with measurable disease at baseline per BICR. Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1. criteria are: Complete response \[CR\] = disappearance of all target lesions since baseline; and partial response \[PR\] = at least a 30% decrease in the sum of the diameters of target lesions.

Number of participants treated with radiotherapy and durvalumab with treatment-related adverse events as assessed using CTCAE v4.0. To determine the maximum tolerated dose (MTD).
First 28 days of treatment

A minimum of 3 patients will initially be enrolled in each cohort, if none of the first 3 patients experiences a dose limiting toxicity (DLT), the doses in that cohort will be deemed safe and tolerable and escalation may continue. DLTs will be grade 4 neutropenia or thrombocytopenia, grade 3 hemolysis, grade 4 immune related AEs. If 1 of the first 3 evaluable patients in a cohort experiences a DLT, the cohort will be expanded to at least 6 patients. If there are no further DLTs in the first 6 DLT-evaluable patients, the doses in that cohort will be deemed safe and tolerable and escalation may continue. If a DLT is observed in ≥ 33% of patients (e.g., 2 or more of up to 6 patients), the dose combination at which this occurs will be considered intolerable and the MTD will have been exceeded for radiotherapy If the MTD is exceeded in any cohort, the highest dose combination at which fewer than 33% experience a DLT will be declared the combination MTD.

Tolerability as defined as tolerable dose
Completion of first 12 weeks of treatment within phase I portion of study (estimated to be 14 months)

* Defined as Dose Level 2 if 0 or 1 dose limiting toxicities (DLTs) are seen in patients at that dose level, or Dose Level 1 if 2+ DLTs are seen in Dose Level 2 but only 0 or 1 DLTs are seen in patients at Dose Level 1. * A DLT is defined as the occurrence of an adverse event (AE) that is at least possibly related to the investigational product (IP) or investigational regimen (IR)

Safety as defined by frequency of toxicities assessed by CTCAE v 5.0
From start of treatment through 90 days after treatment (estimated to be 9 months)
Maximum Tolerated Dose and Dose Limiting Toxicities
Study start date to study end date, or death, whichever comes first, up to 24 months

The Maximum Tolerated Dose (MTD) and Dose Limiting Toxicities (DLT) will be discovered by using the 3+3 study design.

Safety and tolerability of Azacitidine and/or Romidepsin in combination with nab-Paclitaxel/Gemcitabine
at Days -7, -4, 1, 8, 15, 22 at cycle 1 (each cycle is 28 days)

Dose limiting toxicities occurring during treatment cycle 1 of a respective dose level and regarded to be related to the studied drug combination. Common terminology criteria for adverse events (CTCAE) 5.0 will be used to assess toxicities.

Immune targeting with Durvalumab in combination with low-dose Lenalidomide
up to 13 cycles (each cycle is 28 days)

The efficacy and safety of this experimental (immune) consolidation therapy during this clinical trial will be monitored by imaging changes every 8 weeks.

Recommended dose for expansion (RDE)
at the end of cycle 3 (each cycle is 28 days)

Identification of the recommended dose for expansion of Azacitidine and/or Romidepsin in combination with nab-Paclitaxel/Gemcitabine.

Area under the concentration-time curve
From first dose of study intervention (Day 1), at predefined intervals throughout the administration of durvalumab (approximately 17 months).

To characterise the AUC of SC durvalumab.

Observed lowest concentration before the next dose is administered (Ctrough)
From first dose of study intervention (Day 1), at predefined intervals throughout the administration of durvalumab (approximately 17 months).

To characterise the Ctrough of SC durvalumab

Number of participants with dose limiting toxicities in the first 10 weeks of treatment
10 weeks
Progression Free Survival
12 months

Duration of time from diagnosis to time of progression

Proportion of participants who have resectable disease
24 weeks

Based on overall downstaging of disease post-treatment

Progression Free Survival (Phase II)
6 months

From study enrollment to time of progression

Number of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs) in Part 1
Day 1 through 90 days after the last dose of study drug (approximately 2.8 years)

An adverse event (AE) is any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. A serious adverse event (SAE) is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. The TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug.

Number of Participants With Dose Limiting Toxicities (DLTs) in Part 1
From Day 1 to 28 days after the first dose of novel oncology therapy (durvalumab and oleclumab)

DLT: Any study drug related Grade (G)3 or higher toxicity including: any G3/G4 immune-mediated AE, any G3/4 noninfectious pneumonitis/colitis, transaminase elevation (TE) \>8x upper limit of normal (ULN) or total bilirubin (TBL) \>5xULN, increase in aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \>=3xULN along with TBL \>=2xULN, isolated liver TE \>5 but =\<8xULN or isolated TBL \>3 but =\<5xULN that does not downgrade to G1 or less within 14 days of onset, G3 nausea/vomiting/diarrhea that does not resolve to G2 or less within 3 days of maximal supportive care (MSC), G3/4 febrile neutropenia, G3/4 neutropenia not associated with fever/systemic infection, G4 anemia, G3 anemia with clinical sequelae/requires \>2 units of red blood cells transfusion, thrombocytopenia (G4 \>=7 days, G3 that did not improve by at least 1 grade within 7 days, G3/4 associated with G3/higher hemorrhage).

Number of Participants With at Least 2-Grade Shift From Baseline to Worst Toxicity Grade in Clinical Laboratory Parameters in Part 1
Baseline (Day 1) through 90 days after the last dose of study drug (approximately 2.8 years)

Number of participants with at least common terminology criteria for adverse events (CTCAE v5.0) 2-grade shift from baseline (last assessment prior to first dose) to worst toxicity grade in clinical laboratory parameters are reported. Clinical laboratory parameter analysis included hematology, clinical chemistry, coagulation, and urinalysis.

Number of Participants With Abnormal Vital Signs Reported as TEAEs in Part 1
Day 1 through 90 days after the last dose of study drug (approximately 2.8 years)

Number of participants with abnormal vital signs reported as TEAEs are reported. Abnormal vital signs are defined as any abnormal finding in the vital sign parameters (body temperature, blood pressure, and pulse rate).

Percentage of Participants With Objective Response (OR) Per Response Evaluation Criteria in Solid Tumours Version 1.1 (RECIST v1.1) in Part 2
Randomization through end of study (approximately 2.6 years)

The OR is defined as best overall response (BOR) of confirmed complete response (CR) or confirmed partial response (PR) based on RECIST v1.1 criteria. The CR is defined as disappearance of all target lesions (TLs) and non-target lesions (NTLs), normalization of tumor marker level, any pathological lymph nodes (target and non-target) must have reduction in short axis \< 10 mm, and no new lesion. The PR is defined as at least a 30% decrease in the sum of the diameters (SoD) of TLs (compared to baseline) and no new lesions. Confirmation of CR and PR is required by a repeat, consecutive assessment no less than 4 weeks from the date of first documentation. In Part 2, randomization occurred between Day -8 and the same date as dosing.

Dose-Finding Phase: Maximum Serum Concentration (Cmax) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, Cycle 1 Day 15, pre-infusion and post-infusion on Cycle 2 Day 1, pre-infusion and post-infusion in Cycle 3, 4, 6, 8, 10 and 12

Serum samples were collected from the participants at the defined timepoints. Cmax was determined using standard non-compartmental methods.

Dose-Finding Phase: Minimum Serum Concentration (Cmin) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, Cycle 1 Day 15, pre-infusion and post-infusion on Cycle 2 Day 1, pre-infusion and post-infusion in Cycle 3, 4, 6, 8, 10 and 12

Serum samples were collected from the participants at the defined timepoints. Cmin was determined using standard non-compartmental methods.

Dose-Finding Phase: Area Under the Serum Concentration-Time Curve (AUC) From Zero to 14 (AUC 0-14) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1 and Cycle 1 Day 8

Serum samples were collected from the participants at the defined timepoints. AUC (0-14) was determined using standard non-compartmental methods.

Dose-Finding Phase: AUC From Zero to 28 (AUC 0-28) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, and Cycle 1 Day 15

Serum samples were collected from the participants at the defined timepoints. AUC (0-28) was determined using standard non-compartmental methods.

Dose-Finding Phase: Time to Cmax (Tmax) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, Cycle 1 Day 15, pre-infusion and post-infusion on Cycle 2 Day 1, pre-infusion and post-infusion in Cycle 3, 4, 6, 8, 10 and 12

Serum samples were collected from the participants at the defined timepoints. Tmax was determined using standard non-compartmental methods.

Dose-Finding Phase: Apparent Terminal Elimination Half-life Associated With the Terminal Slope of the Semi-logarithmic Concentration Time Curve (t½λz) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, Cycle 1 Day 15, pre-infusion and post-infusion on Cycle 2 Day 1, pre-infusion and post-infusion in Cycle 3, 4, 6, 8, 10 and 12

Serum samples were collected from the participants at the defined timepoints. T½λz was determined using standard non-compartmental methods.

Dose-Finding Phase: Dose-Normalized AUC (0-14) (AUC [0-14]/D) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1 and Cycle 1 Day 8

Serum samples were collected from the participants at the defined timepoints. AUC(0-14)/D was determined using standard non-compartmental methods.

Dose-Finding Phase: Dose-Normalized AUC (0-28) (AUC [0-28]/D) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, and Cycle 1 Day 15

Serum samples were collected from the participants at the defined timepoints. AUC(0-28)/D was determined using standard non-compartmental methods.

Dose-Finding Phase: Dose-Normalized Cmax (Cmax/D) of Durvalumab
Pre-infusion and post-infusion on Cycle 1 Day 1, Cycle 1 Day 8, Cycle 1 Day 15, pre-infusion and post-infusion on Cycle 2 Day 1, pre-infusion and post-infusion in Cycle 3, 4, 6, 8, 10 and 12

Serum samples were collected from the participants at the defined timepoints. Cmax/D was determined using standard non-compartmental methods.

Dose-Finding Phase: Cmax of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, Cycle 2 Day 15, pre-infusion and post-infusion in Cycle 3, 4, and 5

Serum samples were collected from the participants at the defined timepoints. Cmax was determined using standard non-compartmental methods.

Dose-Finding Phase: Cmin of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, Cycle 2 Day 15, pre-infusion and post-infusion in Cycle 3, 4, and 5

Serum samples were collected from the participants at the defined timepoints. Cmin was determined using standard non-compartmental methods.

Dose-Finding Phase: (AUC 0-14) of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, and Cycle 2 Day 8

Serum samples were collected from the participants at the defined timepoints. AUC (0-14) was determined using standard non-compartmental methods.

Dose-Finding Phase: (AUC 0-28) of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, and Cycle 2 Day 15

Serum samples were collected from the participants at the defined timepoints. AUC (0-28) was determined using standard non-compartmental methods.

Dose-Finding Phase: Tmax of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, Cycle 2 Day 15, pre-infusion and post-infusion in Cycle 3, 4, and 5

Serum samples were collected from the participants at the defined timepoints. Tmax was determined using standard non-compartmental methods.

Dose-Finding Phase: T½λz of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, Cycle 2 Day 15, pre-infusion and post-infusion in Cycle 3, 4, and 5

Serum samples were collected from the participants at the defined timepoints. T½λz was determined using standard non-compartmental methods.

Dose-Finding Phase: AUC (0-14)/D of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1 and Cycle 2 Day 8

Serum samples were collected from the participants at the defined timepoints. AUC(0-14)/D was determined using standard non-compartmental methods.

Dose-Finding Phase: AUC (0-28)/D of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, and Cycle 2 Day 15

Serum samples were collected from the participants at the defined timepoints. AUC(0-28)/D was determined using standard non-compartmental methods.

Dose-Finding Phase: Cmax/D of Tremelimumab
Pre-infusion and post-infusion on Cycle 2 Day 1, Cycle 2 Day 8, Cycle 2 Day 15, pre-infusion and post-infusion in Cycle 3, 4, and 5

Serum samples were collected from the participants at the defined timepoints. Cmax/D was determined using standard non-compartmental methods.

Dose-Finding Phase: Number of Participants With Adverse Events (AE), Serious AE (SAE), AE Leading to Discontinuation of Durvalumab and Tremelimumab, AE of Special Interest (AESI) or AE of Possible Interest (AEPI) Related to Durvalumab and Tremelimumab
From Day 1 up to 15 months

An AE was defined as any untoward medical occurrence in a participant temporally associated with the use of study treatment, whether or not considered related to the study treatment. SAEs were any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, was a medically important event. Some AEs and higher-level terms were considered AESI or AEPIs and this list of categories were provided by the patient safety team.

Dose-Expansion Phase Only: Objective Response Rate (ORR)
From first dose of study treatment until death or up to approximately 4 years (clinical DCO of 20 Apr 2023)

ORR as per RECIST 1.1 was defined as the percentage of participants with at least 1 investigator-assessed visit response of complete response (CR) or partial response (PR) that was subsequently confirmed on another scan not less than 4 weeks after visit observed response. CR was defined as disappearance of all target lesions (TLs), any pathological lymph nodes selected as TLs with reduction in short axis to \< 10 millimeter (mm). PR was defined as at least a 30% decrease in the sum of diameters of TLs, with reference to baseline sum of diameters as long as criteria for PD are not met.

Dose-Expansion Phase Only: Duration of Response (DOR)
From first dose of study treatment until death or up to approximately 4 years (clinical DCO of 20 Apr 2023)

Duration of response was the time from the first documentation of CR/PR (which was subsequently confirmed) until the date of documented progression, or death which coincides with the progression free survival (PFS) endpoint. For participants who did not progress following a response, the DOR was censored during the PFS censoring time. It was calculated using Kaplan-Meier technique.

Dose-Expansion Phase Only: Best Objective Response (BOR)
From first dose of study treatment until death or up to approximately 4 years (clinical DCO of 20 Apr 2023)

BOR was calculated based on the overall visit responses from each RECIST 1.1 assessment. Categorization of BOR for solid tumors were based on RECIST 1.1 using the following response categories: CR, PR, stable disease (SD), progression of disease (PD), and not evaluable (NE). CR: disappearance of all TLs. Any pathological lymph nodes selected as TLs had a reduction in short axis to \<10 mm. PR: 30% decrease in the sum of diameters of TLs. SD: Neither sufficient decrease in sum of diameters to qualify for PR nor sufficient increased to qualify for PD. PD: \>= 20 % increase in the sum of diameters to TLs and an increase of \>= 5 mm. NE: Only relevant if any of the TLs were not assessed or NE or had a lesion intervention at visit. Non-CR/Non-PD: Persistence of 1+ non-target lesion (s). Non-CR/non-PD was relevant to participants who did not have measurable disease at baseline.

Dose-Expansion Phase Only: Disease Control Rate (DCR)
At 16 and 24 Weeks

DCR was defined as the percentage of participants who achieved a BOR of unconfirmed CR or PR, respectively, or who had SD. CR was defined as disappearance of all TLs, any pathological lymph nodes selected as TLs with reduction in short axis to \< 10 mm. PR was defined as at least a 30% decrease in the sum of diameters of TLs, with reference to baseline sum of diameters as long as criteria for PD are not met. SD: Neither sufficient decrease in sum of diameters to qualify for PR nor sufficient increased to qualify for PD.

Dose-Expansion Phase Only: PFS
From first dose of study treatment until death or up to approximately 4 years (clinical DCO of 20 Apr 2023)

PFS as per RECIST 1.1 was defined as the time from the date of first dose of study treatment until the date of objective disease progression or death by any cause in the absence of progression, regardless of whether the participant withdrew from study therapy or received another anti-cancer therapy prior to progression (date of PFS event or censoring - date of first dose + 1). Confidence interval was calculated using Kaplan-Meier technique.

Dose-Expansion Phase Only: Overall Survival (OS)
From first dose of study treatment until death or up to approximately 4 years (clinical DCO of 20 Apr 2023)

OS was defined as the time from the date of first dose of study treatment until death due to any cause regardless of whether the patient withdraws from study treatment or received another anti-cancer therapy (i.e date of death or censoring - date of first dose + 1).

Dose-Expansion Phase Only: Survival Rate at 12 Months and 24 Months
At 12 and 24 Weeks

Survival rates were defined as the Kaplan-Meier estimate of OS at 12 and 24 months.

Phase I:The adverse events (AEs)
Through the Phase I, approximately 7 months

Safety and tolerability will be assessed by monitoring frequency, duration and severity of adverse events (AEs).

Phase II: Clinical Benefit of oleclumab in combination with chemotherapy and durvalumab by the comparing the CB rate at 24 weeks from the 1st dose of study drug administration between patients treated with or without the anti-CD73 antibody oleclumab
At 24 weeks from the 1st study drug administration

CB is defined as a patient who achieved CR or PR or demonstrated SD at 24 weeks from the 1st dose of study drug administration based on RECIST v1.1.

Assessment of AEs by CTCAE v5.0
From informed consent until the safety follow-up visit 3 months after the last dose of study drug, or until the final data cut-off (DCO) date, whichever is earlier.

Assessment of safety and tolerability of each treatment arm

Dose Limiting Toxicity (DLT) Events
From the time of first dose until completion of the first cycle (28 days for Arms 2-5, 21 days for Arms 6-7 (no safety run-in for Arms 1 and 8))

The occurrence of a severe adverse event (meeting pre-specified criteria) that is at least possibly related to durvalumab and/or the novel oncology therapy in 6 DLT-evaluable patients

Number of subjects with Dose Limiting Toxicities (DLTs)
From first dose of durvalumab until 28 days after completion of radiation therapy
Number of subjects with Adverse Events (AEs)
From first dose of durvalumab up to 90 days after the last dose of study treatment
Phase 1: Determine the recommended phase 2 dose (RP2D) from BCG-unresponsive non-muscle invasive bladder cancer (NMIBC)
6 months

Determine the recommended phase 2 dose (RP2D) from BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) patients treated with each of the following immunotherapy study regimens: Durvalumab (cohort 1) Durvalumab + intravesical BCG (cohort 2) Durvalumab + radiation (cohort 3) Durvalumab + intravesical Gemcitabine + intravesical Docetaxel (cohort 4) Durvalumab + Tremelimumab + intravesical Gemcitabine + intravesical Docetaxel (cohort 5) Intravesical NAI + intravesical Gemcitabine (cohort 6) Intravesical NAI + intravesical Gemcitabine + intravesical Docetaxel (cohort 7) Subcutaneous NAI + intravesical NAI + intravesical Gemcitabine + intravesical Docetaxel (cohort 8) The RP2D of each immunotherapy study arm is defined as the dose level at which \< 2 out of 6, \< 4 out of 9, or \< 5 out of 12 patients enrolled within an individual study arm experience dose-limiting toxicity.

Phase 2: Determine the complete response rate within individual phase 2 expansion cohorts of BCG-unresponsive, BCG-relapsing/persistent, and high-risk BCG-naïve NMIBC subjects treated with each study regimen
6 months

The complete response rate within each study arm is defined as the proportion of patients within each arm that demonstrate no evidence of recurrent or persistent high grade urothelial carcinoma of the bladder of any stage at any post-treatment disease assessment.

Evaluation of the safety of Durvalumab plus Tremelimumab in combination with FOLFOX chemotherapy
1 month

Criteria RECIST 1.1

Maximum plasma concentration (Cmax)
approximately 6 months after the last evaluable patient in Phase 1 portion is first dosed

Only for phase 1 portion of the study

Trough plasma concentration (Ctrough)
approximately 6 months after the last evaluable patient is first dosed in phase 1 portion

Only for phase 1 portion of the study

Area under the plasma drug concentration-time curve from time zero to Day 28 post-dose (AUC 0-28)
approximately 6 months after the last evaluable patient is first dosed in phase 1 portion

Only for phase 1 portion of the study

Adverse event
Approximately 12 months after the last evaluable patient from Ph 1 is 1st dosed or the last patient has withdrawn from study or the study discontinued by Sponsor
unacceptable toxicity
1 year

"Unacceptable toxicity" is defined as any of the following toxicities: \>1 episode of grade 3/4 neutropenia or thrombocytopenia \<75,000/μL (despite prior dose reduction) during chemoradiation any toxicity that results in \>2 week cumulative delay in chemoradiation any toxicity that is attributed to durvalumab which results in a delay of \>8 weeks in surgery, i.e. surgery \>16 weeks from the end of radiation, for a potentially operable patient any reason that is attributed to durvalumab which leads to death within 30 days of surgery. All toxicity will be graded according to the National Cancer Institute (NCI) Common Toxicity Criteria, version 4.0.3.

pathologic complete response rate
1 year
Dose Limiting Toxicity Rate of PVX-410 in Combination With Durvalumab
4 Weeks

To assess the safety of the vaccine and PDL1 inhibitor.

Number of subjects reporting adverse events and number (percentage) of subjects reporting serious adverse events
Screening through 90 days after the last dose of study medication
Number of subjects experiencing dose-limiting toxicities
First dose of study medications through 28 days after the administration of MEDI4736 or MEDI4736 and tremelimumab, 35 days after administration of MEDI4736 and AZD9150

Changes from baseline in laboratory parameters, vital signs, and ECGs

Confirm the recommended phase II dose of durvalumab given to patients with advanced/recurrent HER-2 positive metastatic breast cancer (MBC) who are receiving treatment with trastuzumab
18 months
Laboratory findings (including: clinical chemistry, hematology, and urinalysis)
Throughout the study, approximately three years

To assess the safety and tolerability profile of first-line chemotherapy in combination with durvalumab + tremelimumab

Incidence of Adverse Events
Throughout the study, approximately three years

To assess incidence of Adverse Events for the safety and tolerability profile of first-line chemotherapy in combination with durvalumab and tremelimumab

Tumor assessment based on RECIST 1.1 (for cohort 6 only)
Throughout the study, approximately three years (for cohort 6 only)

To estimate the objective response rate (ORR) of durvalumab + tremelimumab + chemotherapy (for cohort 6 only)

Number of Participants With Dose-Limiting Toxicities (DLT)
Cohort 1: From time of first dose of MEDI4736 on Day 1 up to Day 28 of Cycle 1 and Cohort 2: From time of first dose of AZD5069 and MEDI4736 on Day 1 up to Day 28 of Cycle 1 or until a participant experiences a DLT, whichever occurs first.

DLT period was defined as first treatment cycle for Cohort 1, and first dose of AZD5069 and MEDI4736 to end of Cycle 1 or until a participant experienced a DLT, whichever occurs first for Cohort 2. A DLT was defined as any of below listed laboratory abnormalities or adverse events (AE) related to MEDI4736 collected during DLT period. * Liver transaminase elevation \>= 5× but \<= 8× upper limit of normal (ULN) that doesn't resolve to Grade 2 within 5 days * Transaminase elevation \> 8× ULN or total bilirubin \> 5× ULN * Any Grade 4 immune-related AE (irAE) not attributed to local tumor response, Grade \>=3 colitis, Grade \>=2 pneumonitis that doesn't resolve to \<= Grade 1 within 7 days, Grade 3 irAE, that doesn't resolve to Grade \<=1 or baseline status within 14 days * Any Grade \>=3 non-irAE toxicity that doesn't resolve to Grade \<=1 or baseline status within 14 days A DLT was defined as any Grade 3 or worse AE related to AZD5069 that occurs from first dose of AZD5069 up to end of DLT period.

Number of Participants With AEs
From first dose of study treatment administration (Day 1) until 90 days after the last dose of IP or initiation of the first subsequent anticancer therapy (whichever occurred first), approximately 30 months.

An AE is the development of an undesirable medical condition or deterioration of a pre-existing medical condition following or during exposure to study treatment, whether or not considered causally related to study treatment. An undesirable medical condition can be symptoms, signs or abnormal results of an investigation. A serious AE (SAE) is an AE that fulfills one or more following criteria: death, life-threatening, in-patient hospitalization or prolongation of existing hospitalization, persistent or significant disability/incapacity or substantial disruption of ability to conduct normal life functions, congenital abnormality or birth defect, and an important medical event that may jeopardize participant or may require medical intervention to prevent one of outcomes listed above. AEs leading to discontinuation of study treatment were those with action taken was 'Drug Permanently Discontinued' for any study treatment. Only treatment emergent AEs were presented.

Objective Response Rate (ORR) in Cohort 2
RECIST assessments performed at baseline (within 28 days before start of study treatment), every 6 weeks +/-7 days for first 48 weeks, then every 12 weeks +/-7 days thereafter until confirmed objective disease progression. Up to approximately 30 months.

ORR is defined as the percentage of participants with a confirmed overall response of complete response (CR) or partial response (PR). A confirmed response of CR/PR means that a response of CR/PR is recorded at 1 visit and confirmed by repeat imaging, preferably at the next regularly scheduled imaging visit and not less than 4 weeks after the visit when the response was first observed with no evidence of progression between the initial and CR/PR confirmation visit. CR is defined as disappearance of all target lesions (TLs) since baseline. Any pathological lymph nodes selected as TLs must have a reduction in short axis to \<10 millimeters (mm). PR is defined as at least a 30% decrease in the sum of diameters of TLs, taking as reference the baseline sum of diameters as long as criteria for PD were not met. ORR was determined using Investigator assessments according to Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1).

Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs) in Phase 1b
Day 1 up to 90 days after the last dose (approximately 4 years and one month)

An adverse event (AE) is any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. A serious adverse event (SAE) is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug.

Number of Participants With Dose Limiting Toxicities (DLTs) in Phase 1b
From first dose of Study drug (Day 1) through 28 days after the administration of MEDI4736 and tremelimumab

A DLT was defined as any Grade 3 or higher toxicity that occurs during the DLT evaluation period (From first dose of Study drug \[Day 1\] through 28 days after the administration of MEDI4736 and tremelimumab). The DLTs are: any Grade 4 immune-related adverse event (irAE), any Grade \>=3 non-irAE, \>= Grade 3 colitis, Grade 3 or 4 noninfectious pneumonitis irrespective of duration, Grade 2 pneumonitis, liver transaminase elevation \> 8 × upper limit of normal (ULN) or total bilirubin \> 5 × ULN. Immune-related AEs are defined as AEs of an immune nature (ie, inflammatory) in the absence of a clear alternative etiology.

Number of Participants With Clinical Laboratory Abnormalities Reported as TEAEs in Phase 1b
Day 1 up to 90 days after the last dose (approximately 4 years and one month)

Number of participants with clinical laboratory abnormalities reported as TEAEs are reported. Clinical laboratory abnormalities are defined as any abnormal findings in analysis of serum chemistry, hematology, and urine.

Number of Participants With Abnormal Vital Signs and Physical Examinations Reported as TEAEs in Phase 1b
Day 1 up to 90 days after the last dose (approximately 4 years and one month)

Number of participants with abnormal vital signs reported as TEAEs are reported. Abnormal vital signs are defined as any abnormal findings in the vital signs parameters (temperature, blood pressure \[BP\], pulse rate \[or pulse oximetry at screening\], and respiratory rate). Abnormal physical examinations are defined as any abnormal impact on measurements of height and weight.

Number of Participants With Abnormal Electrocardiograms Reported as TEAEs in Phase 1b
Day 1 up to 90 days after the last dose (approximately 4 years and one month)

Number of participants with abnormal electrocardiograms (ECGs) reported as TEAEs are reported. Abnormal ECGs are defined as any abnormal findings in heart rate, PR, RR, QRS and QT intervals from the primary lead of the digital 12-lead ECG.

Eastern Cooperative Oncology Group (ECOG) Performance Status at Baseline in Phase 1b
Baseline (Day 1)

The ECOG scale of performance status describes the level of functioning of participants in terms of their ability to care for themselves, daily activity, and physical ability. ECOG Performance Status Scorings are: 0= fully active, able to carry on all pre-disease performance without restriction; 1= restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature (for example, light house work, office work); 2= ambulatory and capable of all self-care but unable to carry out any work activities, up and about more than 50% of waking hours; 3= capable of only limited selfcare, confined to bed or chair more than 50% of waking hours; 4= completely disabled, cannot carry on any self-care, totally confined to bed or chair; 5= dead. The baseline performance status of participants is presented.

Percentage of Participants With Objective Response (OR) in Phase 2
From Day 1 up to End of the Treatment (EOT), 90 days post-EOT, every 3 months (Q3M) after Day 90 post-EOT up to 12 months post-EOT, and every 6 months after month 12 post-EOT (approximately up to 4 years and one month)

OR: best overall response (BOR) of confirmed complete response (CR) or partial response (PR) per RECIST v1.1. BOR: best response (CR, PR, stable disease \[SD\], progressive disease \[PD\], and not evaluable) among all overall responses recorded from date of randomization for Arm A, B, C participants or date of first dose of study drug for Arms D, E participants until progression, or last evaluable disease assessment or discontinuation from the study, whichever occurred first. CR: disappearance of all target/non-target lesions; PR: at least 30% decrease in sum of diameters (SOD) of target lesions from baseline; SD: neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD from smallest SOD on study; PD: at least 20% increase in SOD of target lesions from smallest sum on study (at least 5mm), appearance of one or more new lesions, substantial worsening in non-target disease, increase in tumor burden leading to discontinuation of therapy.

Progression Free Survival at 6 (PFS-6) Month in Phase 2
From Day 1 upto 6 months

The PFS-6 is the 6-month progression-free survival rate, which was the percentage of participants who were progression free and alive at 6 months. PFS was defined as the time from the date of first dose of study drug for Arm A, B, and C participants or the date of first dose of study drug for Arm D and Arm E participants to the earlier of the dates of the first objective documentation of radiographic disease progression (per RECIST v1.1) or death due to any cause. PFS was censored at the date of their last evaluable tumor assessment. Kaplan Meier method was used to evaluate PFS-6.

Number of subjects reporting adverse events
Screening through 3 months after the last dose of study medication
Number of subjects reporting serious adverse events
Screening through 3 months after the last dose of study medication
Change from Baseline in laboratory evaluations
Screening through 3 months after the last dose of study medication
Change from Baseline in electrocardiograms
Screening through 3 months through last dose of study medication
Change from Baseline in vital signs
Screening through 3 months after the last dose of study medication
Number of subjects experiencing a dose-limiting toxicity
First dose of study medication through 4 weeks after the first dose of study medication
Change from Baseline in electrocardiogram evaluations
Screening through 3 months after the last dose of study medication
Overall Response Rate in Select Tumor Types
First dose of study medication through 15 months after the last subject enters re-treatment
Number of Participants With Dose Limiting Toxicities (DLTs)
From first dose of study drug (Day 1) until the planned 3rd dose of durvalumab (Day 29)

Dose limiting toxicities are defined as any Grade 3 or higher treatment-related (related to any study drug) toxicity that occurs during the DLT evaluation period. Number of participants with DLTs are reported.

Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)
From first dose of study drug (Day 1) up to 90 days after the last dose (up to 4.5 years)

An adverse event (AE) is any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Serious adverse event is any AE that resulted in death, life threatening, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, is a congenital anomaly/birth defect in offspring of a study participant, is an important medical event that may jeopardize the participant or may require medical intervention. TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug.

Number of Participants With Abnormal Vital Signs and Physical Examinations Reported as TEAEs
From first dose of study drug (Day 1) up to 90 days after the last dose (up to 4.5 years)

Number of participants with abnormal vital signs and physical examinations reported as TEAEs are reported.

Number of Participants With Abnormal Clinical Laboratory Parameters Reported as TEAEs
From first dose of study drug (Day 1) up to 90 days after the last dose (up to 4.5 years)

Number of participants with abnormal clinical laboratory parameters reported as TEAEs are reported.

Number of Participants With Abnormal Electrocardiograms (ECGs) and Echocardiograms (ECHOs) Reported as TEAEs
From first dose of study drug (Day 1) up to 90 days after the last dose (up to 4.5 years)

Number of participants with abnormal electrocardiograms (ECGs) and echocardiograms (ECHOs) reported as TEAEs are reported.

Objective response
At least 24 weeks as compared to baseline

Best overall response of confirmed complete response (CR) or confirmed partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 as defined as the best response among all overall responses recorded from the start of treatment until progression, or the last evaluable disease assessment in the absence of progressive disease (PD) prior to the initiation of subsequent anti-cancer therapy, or discontinuation from the study, whichever occurs first.

Number of subjects experiencing dose-limiting toxicities (DLTs)
Depending upon the cohort, the DLT evaluation period is from the 1st dose of study medication until (1) the 3rd dose of MEDI4736 and tremelimumab (2) the 2nd dose of MEDI4736 and tremelimumab or (3) the 3rd dose of MEDI4736 and 2nd dose of tremelimumab

The maximum tolerated dose (MTD), which is the highest dose within a cohort where no more than 1 out of 6 subjects experience DLTs or the highest protocol-defined dose for each agent in the absence of exceeding the MTD, will be evaluated using the following safety assessments: adverse events, serious advents, laboratory evaluations, vital signs, physical examinations, and electrocardiogram (ECG) results. Measurements will be aggregated to determine whether a subject has experienced a DLT as assessed by the investigator.

Number of participants experiencing dose-limiting toxicities, adverse events (AEs), serious adverse events (SAEs)
90 days after the last dose of MEDI4736

Safety profile will be assessed through number of participants experiencing adverse events (AEs), serious adverse events (SAEs), laboratory evaluations, vital signs, and physical examinations.

Number of Participants With Dose-limiting Toxicities in the Dose-escalation Phase
For MEDI4736 0.1 to MEDI4736 10 mg/kg arms: from Day 1 to Day 28 of first dose; for MEDI4736 15 mg/kg arm: from Day 1 to Day 42 of first dose

A DLT was defined as any Grade 3 or higher treatment-related toxicity that occurred during the DLT-evaluation period including any \>= Grade 3 colitis or \>= Grade 3 immune-related adverse event (irAE; AEs of immune nature in the absence of a clear alternative etiology) including rash, pruritus, or diarrhea that did not downgrade to =\< Grade 2 within 3 days after onset of the event despite maximal supportive care including systemic corticosteroids. The DLT-evaluation period for 0.1 to 10 mg/kg arms was from Day 1 to Day 28 of first dose and for 15 mg/kg arm was from Day 1 to Day 42 of first dose.

Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs) in the Dose-escalation, Dose-exploration, and Dose-expansion Phase
From Day 1 through 90 days after the last dose of study drug (approximately 5.25 years)

An adverse event (AE) is any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. A serious adverse event (SAE) is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. The TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug.

Number of Participants With Abnormal Clinical Laboratory Parameters Reported as TEAEs in the Dose-escalation, Dose-exploration, and Dose-expansion Phase
From Day 1 through 90 days after the last dose of study drug (approximately 5.25 years)

Number of participants with abnormal clinical laboratory parameters reported as TEAEs are reported. Abnormal clinical laboratory parameters defined as any abnormal finding during analysis of coagulation, urine, hematology, and serum chemistry.

Number of Participants With Abnormal Vital Signs Reported as TEAEs in the Dose-escalation, Dose-exploration, and Dose-expansion Phase
From Day 1 through 90 days after the last dose of study drug (approximately 5.25 years)

Number of participants with abnormal vital signs reported as TEAEs are reported. Abnormal vital signs are defined as any abnormal finding in the vital sign parameters (body weight, body temperature, blood pressure, pulse rate, and respiratory rate).

Number of Participants With Change From Baseline in QT/QTc Interval in Local Electrocardiogram in the Dose-escalation, Dose-exploration, and Dose-expansion Phase
From Baseline (Day 1) through 90 days after the last dose of study drug (approximately 5.25 years)

Number of participants with change from baseline in notable QT/QTc interval in local electrocardiogram (ECG) are reported. The data for \>0 participants with notable QT/QTc interval in local ECG from baseline are reported.

Objective Response Rate (ORR) Assessed by Blinded Independent Central Review (BICR) in Participants With Non-squamous NSCLC Who Had Received 2 or More Prior Lines of Therapy in the Dose-expansion Phase
From Day 1 through disease progression, study withdrawal, or initiation of another anticancer therapy, whichever occurred first (approximately 5.25 years)

The ORR assessed by BICR in participants with non-squamous NSCLC who had received 2 or more prior lines of therapy is reported. The ORR is defined as best overall response (BOR) of confirmed complete response (CR) or confirmed partial response (PR) based on Response Evaluation Criteria in Solid Tumours Version 1.1 (RECIST v1.1). The CR is defined as disappearance of all target and non-target lesions and no new lesions. A confirmed CR is defined as two CRs that were separated by at least 28 days with no evidence of progression in-between. The PR is defined as \>= 30% decrease in the sum of diameters of target lesions (compared to baseline) and no new nontarget lesion. A confirmed PR is defined as two PRs or an un-confirmed PR and an un-confirmed CR that were separated by at least 4 weeks with no evidence of progression in-between.

ORR Assessed by BICR in Participants With Squamous NSCLC Who Had Received 1 and 2 or More Prior Lines of Therapy in the Dose-expansion Phase
From Day 1 through disease progression, study withdrawal, or initiation of another anticancer therapy, whichever occurred first (approximately 5.25 years)

The ORR assessed by BICR in participants with squamous NSCLC who had received 1 and 2 or more prior lines of therapy is reported. The ORR is defined as BOR of confirmed CR or confirmed PR based on RECIST v1.1. The CR is defined as disappearance of all target and non-target lesions and no new lesions. A confirmed CR is defined as two CRs that were separated by at least 28 days with no evidence of progression in-between. The PR is defined as \>= 30% decrease in the sum of diameters of target lesions (compared to baseline) and no new nontarget lesion. A confirmed PR is defined as two PRs or an un-confirmed PR and an un-confirmed CR that were separated by at least 4 weeks with no evidence of progression in-between.

ORR Assessed by BICR in Participants With UC Post-platinum (Programmed Cell Death Ligand [PD-L1] Status High) Who Had Received at Least 1 Line of Prior Therapy (2L+) in the Dose-expansion Phase
From Day 1 through disease progression, study withdrawal, or initiation of another anticancer therapy, whichever occurred first (approximately 5.25 years)

The ORR assessed by BICR in participants with UC post-platinum PD-L1 status high 2L+ is reported. The ORR is defined as BOR of confirmed CR or confirmed PR based on RECIST v1.1. The CR is defined as disappearance of all target and non-target lesions and no new lesions. A confirmed CR is defined as two CRs that were separated by at least 28 days with no evidence of progression in-between. The PR is defined as \>= 30% decrease in the sum of diameters of target lesions (compared to baseline) and no new nontarget lesion. A confirmed PR is defined as two PRs or an un-confirmed PR and an un-confirmed CR that were separated by at least 4 weeks with no evidence of progression in-between.

Number of Patients With Dose-Limiting Toxicity (DLTs)
6 weeks beginning from the first durvalumab

Grading of DLTs will follow the guidelines provided in the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

Secondary Endpoints

To compare Arm A relative to Arm B on event-free survival at 24 months (EFS24)
Up to 24 months after the last participant is randomized
To compare Arm A relative to Arm B on overall survival (OS)
Up to 24 months after the last participant is randomized
To compare Arm A relative to Arm B on event-free survival (EFS)
Up to 24 months after the last participant is randomized
Unlock Study Endpoints

Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Arm AEXPERIMENTALDurvalumab +FLOT followed by durvalumab
Arm BPLACEBO_COMPARATORPlacebo +FLOT followed by Placebo
DurvalumabEXPERIMENTALDurvalumab after completion of CRT
Single ArmEXPERIMENTALDurvalumab + Chemotherapy (chemotherapy phase) plus Durvalumab + Olaparib (maintenence phase)
Trastuzumab deruxtecan + rilvegostomigEXPERIMENTALTrastuzumab deruxtecan (T-DXd; DS-8201a) in combination with rilvegostomig arm
Trastuzumab deruxtecanEXPERIMENTALTrastuzumab deruxtecan (T-DXd; DS-8201a) arm
Standard of CareACTIVE_COMPARATORGemcitabine and cisplatin in combination with durvalumab arm
Durvalumab + Gemcitabine based chemotherapyEXPERIMENTALParticipants will receive durvalumab 1500mg every 3 or 4 weeks, in combination with continuation of all or some of the original background gemcitabine based chemotherapy every 3 or 2 weeks for up to a maximum of 8 cycles of chemotherapy. Durvalumab 1500mg is given as a 60-minute IV infusion in the first cycle (Day 1) and as a 30-minute IV infusion in following cycles. Upon completing 8 cycles of background gemcitabine-chemotherapy, or after discontinuing any of the combination chemotherapies due to toxicity before completing 8 cycles, participants are eligible to continue receiving durvalumab 1500 mg IV every 4 weeks either alone or in combination with gemcitabine-based chemotherapy (with the exception of paclitaxel), as per investigator's discretion.
Durvalumab + BCGEXPERIMENTALParticipants will receive Durvalumab for 13 cycles every 4 weeks (q4w) for a maximum 12 months. All participants will receive BCG (supplied by the site) intravesically, as induction weekly for 6 weeks. Patients will subsequently receive BCG for maintenance for 3 weekly doses at 3,6,12,18, and up to 24 months, at the physician's discretion.
durvalumab in combination with gemcitabine-based chemotherapyEXPERIMENTALsingle-arm
Durvalumab plus TremelimumabEXPERIMENTALParticipants will receive a single priming dose of Tremelimumab plus Durvalumab at Day 1 (Week 0), followed by Durvalumab monotherapy starting at Week 4 and continuing until clinical progression, confirmed RECIST 1.1-defined radiological progression, unacceptable toxicity, withdrawal of consent, or any intervention discontinuation criteria.
cohort 1EXPERIMENTALdurvalumab in combination with tremelimumab
cohort 2EXPERIMENTALdurvalumab in combination with tremelimumab
Arm A: Durvalumab + DomvanalimabEXPERIMENTALDurvalumab and domvanalimab as an IV infusion q4w, starting on Day 1 for up to a maximum of 12 months
Arm B: Durvalumab + PlaceboACTIVE_COMPARATORDurvalumab + placebo as an IV infusion q4w starting on Day 1 for up to a maximum of 12 months
Arm A: Durvalumab and OleclumabEXPERIMENTALDurvalumab on Day 1 of each 28-day cycle + Oleclumab on Days 1 and 15 of cycles 1 and 2, then on Day 1 of each subsequent 28-day cycle for up to 12 months
Arm B: Durvalumab and MonalizumabEXPERIMENTALDurvalumab + Monalizumab on Day 1 of each 28-day cycle for up to 12 months. Placebo infusion will be administered on Day 15 of cycles 1 and 2 only
Arm C: Durvalumab and PlaceboACTIVE_COMPARATORDurvalumab on Day 1 of each 28-day cycle + Placebo on Days 1 and 15 of cycles 1 and 2, then on Day 1 of each subsequent 28-day cycle for up to 12 months
Durvalumab - (cisplatin or carboplatin) - EtoposideEXPERIMENTALParticipants will receive durvalumab dose A administered via intravenous (IV) infusion concurrently with platinum-based chemotherapy and etoposide every 3 weeks (q3w). Thereafter, durvalumab monotherapy will be continued every 4 weeks post-chemotherapy unless specific treatment discontinuation criteria are met.
Cohort 1 minimal residual disease positive (MRD+)EXPERIMENTALSubjects with detectable ctDNA will receive 4 cycles of platinum doublet chemotherapy \[carboplatin/pemetrexed\], tremelimumab (75 mg IV every 21 days) and durvalumab (1500 mg IV every 21 days), except subjects with squamous cell carcinoma histology will receive carboplatin/paclitaxel. Subjects will be evaluated with PET/CT and/or computed tomography (CT) thorax every 12 weeks. Following ctDNA evaluation, in the absence of progression or toxicity, subject will continue with durvalumab to complete 1 year of treatment as standard of care.
Cohort 2 minimal residual disease negative (MRD )EXPERIMENTALSubjects with undetectable ctDNA at study enrollment will receive standard of care durvalumab (10 mg/kg every 2 weeks, or equivalent, for 1 year). If subjects in Cohort 2 MRD progress prior to close of study, blood will be drawn for ctDNA testing.
Durvalumab + Tremelimumab + Enfortumab VedotinEXPERIMENTALParticipants will receive 3 preoperative 21-day cycles of Durvalumab + Enfortumab Vedotin and 2 cycles of Tremelimumab, followed by radical cystectomy, followed by 1 cycle of postoperative Tremelimumab and 9 cycles of Durvalumab. Each postoperative cycle is 28 days.
Durvalumab + Enfortumab vedotinEXPERIMENTALParticipants will receive 3 preoperative 21-day cycles of Durvalumab + Enfortumab Vedotin, followed by radical cystectomy, followed by 9 cycles of Durvalumab. Each postoperative cycle is 28 days.
Cystectomy with or without approved Adjuvant Therapy.ACTIVE_COMPARATORParticipants may receive SoC (nivolumab approved as adjuvant treatment for MIBC based on high risk criteria) per approved label in the country OR Participants receive standard of care surgery (radical cystectomy) alone.
Experimental Arm: Durvalumab + Chemotherapy, then Durvalumab MaintenanceEXPERIMENTALDurvalumab + Standard Chemotherapy for 4 to 6 cycles, followed by Maintenance with Durvalumab
Control Arm: Chemotherapy, then ObservationACTIVE_COMPARATORStandard Chemotherapy for 4 to 6 cycles, followed by Observation
Control Arm: Ipilimumab and NivolumabACTIVE_COMPARATORIpilimumab every 6 weeks and Nivolumab every 2 or 3 weeks for up to 2 years.
Durvalumab in Combination with Platinum-EtoposideEXPERIMENTALDurvalumab 1500 mg via IV infusion will be concurrently administered with first-line chemotherapy (EP) on an every 3 week (q3w) schedule for 4 to 6 cycles, and will continue to be administered post-chemotherapy on an every 4 week (q4w) schedule until confirmed progressive disease (PD) or unacceptable toxicity.
Durvalumab plus 4-6 cycles chemotherapyEXPERIMENTALParticipants will receive treatment with durvalumab + etoposide and either cisplatin or carboplatin (EP) for 4 to 6 cycles. Durvalumab will be administered at a dose of 1500 mg every 3 weeks (Q3W) with first-line chemotherapy (EP) and will continue to be administered as monotherapy every 4 weeks (Q4W) post-chemotherapy until progressive disease (PD). Prophylactic cranial irradiation (PCI) is allowed at the investigators' discretion as per SoC guidance for ES-SCLC. Patients will attend a safety follow up visit 90 days after last dose of durvalumab.
PlaceboPLACEBO_COMPARATORIntravenous administration of placebo
Arm 1: Durvalumab + definitive CRTEXPERIMENTALDurvalumab + concurrent chemoradiation
Arm 2: Placebo + definitive CRTPLACEBO_COMPARATORPlacebo + concurrent chemoradiation
Durvalumab + SoC chemotherapyEXPERIMENTALIntravenous administration of Experimental and Standard of Care Therapy
Placebo + SoC chemotherapyPLACEBO_COMPARATORIntravenous administration of Placebo and Standard of Care Therapy
Arm CPLACEBO_COMPARATORDurvalumab placebo (Q3W) + bevacizumab placebo (Q3W)
Treatment ArmEXPERIMENTALDurvalumab + Gemcitabine + Cisplatin
Placebo ArmPLACEBO_COMPARATORPlacebo + Gemcitabine + Cisplatin
SoC SBRT + Durvalumab Therapy (Main Cohort)EXPERIMENTALSBRT Durvalumab (PD-L1 monoclonal antibody) 1500 mg every 4 weeks \[q4w\] intravenously \[iv\] for up to 26 cycles or until progression or other discontinuation criteria are met.
SoC SBRT + Placebo Therapy (Main Cohort)PLACEBO_COMPARATORSBRT Placebo (matching placebo for infusion) every 4 weeks iv for up to 26 cycles or until progression or other discontinuation criteria are met.
SoC SBRT + Osimertinib Therapy (Osimertinib cohort, single-arm, open-label separate cohort)EXPERIMENTALSBRT Osimertinib 80mg every day \[qd\] for oral administration up to 36 months or until progression. Osimertinib treatment should start within 7 to 14 days after completion of SBRT
Durvalumab (intravenous infusion)EXPERIMENTALdurvalumab + standard of care concurrent chemoradiation therapy(SoC CCRT) followed by durvalumab monotherapy up to 24 months or until PD from the date of randomization
Placebo (matching placebo for intravenous infusion)PLACEBO_COMPARATORplacebo + standard of care concurrent chemoradiation therapy(SoC CCRT)
Arm 1ACTIVE_COMPARATORPlatinum-based chemotherapy in combination with bevacizumab and durvalumab placebo (saline IV infusion) followed by maintenance bevacizumab, durvalumab placebo (saline IV infusion) and olaparib placebo (tablets).
Arm 2EXPERIMENTALPlatinum-based chemotherapy in combination with bevacizumab and durvalumab followed by maintenance bevacizumab, durvalumab and olaparib placebo.
Arm 3EXPERIMENTALPlatinum-based chemotherapy in combination with bevacizumab and durvalumab followed by maintenance bevacizumab, durvalumab and olaparib.
tBRCAm cohortEXPERIMENTALPlatinum-based chemotherapy in combination with bevacizumab and durvalumab followed by maintenance bevacizumab, durvalumab and olaparib. Bevacizumab is optional according to local practice.
Arm 1: Durvalumab with platinum-based chemotherapyEXPERIMENTALPatients will receive durvalumab 1500 mg in combination with platinum-based chemotherapy every 3 weeks for up to 4 cycles prior to surgery, followed by durvalumab 1500 mg monotherapy every 4 weeks for up to 12 cycles after surgery unless disease is deemed unresectable, disease recurrence, or unacceptable toxicity The platinum-based chemotherapy will be based on tumour histology and Investigator discretion: * cisplatin with pemetrexed * carboplatin with pemetrexed * carboplatin with paclitaxel * cisplatin with gemcitabine (or carboplatin with gemcitabine for patients who have comorbidities or who are unable to tolerate cisplatin per the investigator's judgment)
Arm 2: Placebo with platinum-based chemotherapyPLACEBO_COMPARATORPatients will receive placebo in combination with platinum-based chemotherapy every 3 weeks for up to 4 cycles prior to surgery, followed by placebo monotherapy every 4 weeks for up to 12 cycles after surgery unless disease is deemed unresectable, disease recurrence, or unacceptable toxicity The platinum-based chemotherapy will be based on tumour histology and Investigator discretion: * cisplatin with pemetrexed * carboplatin with pemetrexed * carboplatin with paclitaxel * cisplatin with gemcitabine (or carboplatin with gemcitabine for patients who have comorbidities or who are unable to tolerate cisplatin per the investigator's judgment)
Durvalumab TherapyEXPERIMENTALDurvalumab (PD-L1 monoclonal antibody)1500 mg every 4 weeks \[q4w\] intravenously \[iv\] until clinical progression/deterioration or confirmed radiological progression)
Placebo TherapyPLACEBO_COMPARATORPlacebo (matching placebo for infusion every 4 weeks iv until clinical progression/deterioration or confirmed radiological progression)
Durvalumab in Combination with SoC ChemotherapyEXPERIMENTALDurvalumab every 3 weeks in concurrence with chemotherapy, followed by durvalumab monotherapy every 4 weeks. All patients will receive one of the following standard of care chemotherapy regimens every 3 weeks for 6 cycles: * cisplatin+ gemcitabine * If the patient is cisplatin-ineligible, carboplatin + gemcitabine
Durvalumab in Combination with Tremelimumab+SoC ChemotherapyEXPERIMENTALDurvalumab and Tremelimumab every 3 weeks in concurrence with chemotherapy, followed by durvalumab monotherapy every 4 weeks Tremelimumab will be provided for 4 cycles. All patients will receive one of the following standard of care chemotherapy regimens every 3 weeks for 6 cycles: * cisplatin+ gemcitabine * If the patient is cisplatin-ineligible, carboplatin + gemcitabine
SoC ChemotherapyACTIVE_COMPARATORPatients will receive one of the following standard of care chemotherapy regimens every 3 weeks for 6 cycles: * cisplatin+ gemcitabine * If the patient is cisplatin-ineligible, carboplatin + gemcitabine
Durvalumab + PlaceboEXPERIMENTALDurvalumab monotherapy: Durvalumab (1500 mg intravenous \[IV\]) q4w in combination with placebo saline solution (IV) q4w for up to 4 doses/cycles each, followed by durvalumab 1500 mg q4w. The first durvalumab monotherapy 1500 mg dose q4w will be 4 weeks after the final dose of durvalumab in combination with placebo saline solution.
Durvalumab + TremelimumabEXPERIMENTALDurvalumab in combination with tremelimumab: Durvalumab (1500 mg IV) q4w in combination with tremelimumab (75 mg IV) q4w for up to 4 doses/cycles each, followed by durvalumab 1500 mg q4w. The first durvalumab monotherapy 1500 mg dose q4w will be 4 weeks after the final dose of durvalumab in combination with tremelimumab.
Placebo + PlaceboPLACEBO_COMPARATORPlacebo: Placebo saline solution (IV) q4w in combination with a second placebo saline solution (IV) q4w for up to 4 doses/cycles each, followed by a single placebo saline solution q4w. The first placebo saline solution monotherapy dose q4w will be 4 weeks after the final dose of the 2 placebo saline solutions in combination.
Durvalumab plus BCG (induction + maintenance)EXPERIMENTALDurvalumab (MEDI4736) plus Bacillus Calmette-Guerrin (BCG) combination therapy
Durvalumab plus BCG (induction only)EXPERIMENTALDurvalumab (MEDI4736) plus Bacillus Calmette-Guerrin (BCG) combination therapy
BCG treatment (Standard of care therapy)ACTIVE_COMPARATORBacillus Calmette-Guerrin (BCG) standard of care treatment
Arm 1: Durvalumab + platinum-based chemotherapy and radiationEXPERIMENTALDurvalumab ((MEDI4736) in concurrence with platinum-based chemo-radiation therapy. All patients will receive 1 of the following platinum-based standard of care chemotherapy options, based on Investigator discretion, in addition to radiation therapy: * cisplatin/etoposide * carboplatin/paclitaxel * pemetrexed/cisplatin * pemetrexed/carboplatin At the completion of standard of care chemoradiation therapy (SoC CRT), patients with complete response, partial response or stable disease will continue to receive durvalumab as consolidation treatment.
Arm 2: Placebo + platinum-based chemotherapy and radiationPLACEBO_COMPARATORPlacebo in concurrence with platinum-based chemo-radiation therapy. All patients will receive 1 of the following platinum-based standard of care chemotherapy options, based on Investigator discretion, in addition to radiation therapy: * cisplatin/etoposide * carboplatin/paclitaxel * pemetrexed/cisplatin * pemetrexed/carboplatin At the completion of standard of care chemoradiation therapy (SoC CRT), patients with complete response, partial response or stable disease will continue to receive placebo as consolidation treatment.
Arm 4ACTIVE_COMPARATORSorafenib
Combination therapyEXPERIMENTALCombination therapy (durvalumab + tremelimumab) : Patients will receive the combination therapy followed by monotherapy via intravenous (IV) infusion once Q4W: * Durvalumab 1,500 mg + tremelimumab 75 mg on Week 0, for up to a maximum of 4 doses (or cycles) and * Durvalumab 1,500 mg starting 4 weeks after the last infusion of the combination or discontinuation of tremelimumab.
MonotherapyEXPERIMENTALMonotherapy (Durvalumab 1,500 mg): Patients will receive durvalumab 1,500 mg via IV infusion Q4W on Week 0.
Treatment Arm 1EXPERIMENTALdurvalumab + tremelimumab combination therapy + SoC chemotherapy
Treatment Arm 2EXPERIMENTALdurvalumab monotherapy + SoC chemotherapy
Treatment Arm 3ACTIVE_COMPARATORSoC chemotherapy alone
Arm 1: DurvalumabEXPERIMENTALAnti-PD-L1 monoclonal Antibody monotherapy
Arm 2: Standard of CareACTIVE_COMPARATORStandard of Care Platinum-Based chemotherapy
MEDI4736EXPERIMENTALMEDI4736 monotherapy
MEDI4736 + TremelimumabEXPERIMENTALMEDI4736 + tremelimumab combination therapy
Arm 1 (control): chemoradiotherapyACTIVE_COMPARATORConcomitant chemoradiotherapy, 3-weekly cisplatin 100mg/m2 or weekly 40mg/m2 with Intensity Modulated Radiotherapy (IMRT) using 70 gray (Gy) in 35F(fractions) +/- neck dissection as indicated by clinical and radiological assessment 3-months post treatment. This is the international gold standard.
Arm 5: Durvalumab + Arm 1EXPERIMENTALOne dose of induction durvalumab 1500mg by intravenous (IV) infusion followed by arm 1 within four weeks. Within one-two weeks after the completion of arm 1, durvalumab 1500mg every four weeks will be initiated for a total of 6 months
MEDI4736 (durvalumab) monotherapy in Sub-study AEXPERIMENTALMEDI4736 (durvalumab) by intravenous infusion. Sub-study A for patients with PD-L1 positive tumors.
Standard of Care in Sub-study AACTIVE_COMPARATORInvestigator choice from Vinorelbine, Gemcitabine and Erlotinib. Sub-study A for patients with PD-L1 positive tumors.
MEDI4736 (durvalumab) + tremelimumab in Sub-study BEXPERIMENTALMEDI4736 (durvalumab) by intravenous infusion and tremelimumab by intravenous infusion. Sub-study B for patients with PD-L1 negative tumors.
Standard of Care in Sub-study BACTIVE_COMPARATORInvestigator choice from Vinorelbine, Gemcitabine and Erlotinib. Sub-study B for patients with PD-L1 negative tumors.
MEDI4736 (durvalumab) monotherapy in Sub-study BEXPERIMENTALMEDI4736 (durvalumab) by intravenous infusion. Sub-study B for patients with PD-L1 negative tumors.
tremelimumab in Sub-study BEXPERIMENTALtremelimumab by intravenous infusion. Sub-study B for patients with PD-L1 negative tumors.
Durvalumab(MEDI4736) and AZD6738 combinationEXPERIMENTAL -
TaxaneACTIVE_COMPARATORNab-Paclitaxel 125 mg/m² weekly for 12 weeks
EpirubicinACTIVE_COMPARATOREpirubicin 90 mg/m² 2-weekly for 8 weeks
CyclophosphamideACTIVE_COMPARATORCyclophosphamide 600 mg/m² 2-weekly for 8 weeks
Arm 1 - stopped after interims analysesEXPERIMENTALPatients in arm 1 will receive a single dose of durvalumab of 1500 mg administered on day 1, 14 days prior to initiation of the radiotherapy. Radiotherapy with 35 fractions over 7 weeks (administered as daily fractions of 2 Gy given 5 days every week for 7 weeks) will start on day 14. On week 5, 9, 13 and 17 patients will receive durvalumab (1500 mg) and tremelimumab (75 mg) for up to 4 doses/cycles and then continue 1500 mg durvalumab q4w starting on week 21 to complete a total of 12 months of therapy (overall 9 single doses durvalumab including the initial dose on day 1).
STRIDE (durvalumab + tremelimumab)ACTIVE_COMPARATOR -
STRIDE (durvalumab + tremelimumab) + LenvatinibEXPERIMENTAL -
Cisplatin or Carboplatin + Etoposide + Durvalumab + CeralasertibEXPERIMENTALInitial Phase: Cycles 1-4 Cisplatin or Carboplatin: Day 1 Etoposide: Days 1-3 Durvalumab, 1500 mg: Day 1 q 3 weeks Maintenance Phase, Cycles 5+ Durvalumab, 1500 mg: Day 8 q 4 wks. Ceralasertib at 240mg po BID twice a day: Days 1-7
Radiation/CisplatinACTIVE_COMPARATORAll patients will receive standard fractionation radiation therapy (RT) scheme: 70 Gy in 35 fractions over 7 weeks (i.e. 2 Gy per fraction) Cisplatin IV 100 mg/m2 days 1, 22, 43 concurrently with RT
Radiation/Durvalumab + Adjuvant DurvalumabEXPERIMENTALAll patients will receive standard fractionation radiation therapy (RT) scheme: 70 Gy in 35 fractions over 7 weeks (i.e. 2 Gy per fraction) Concurrent Phase: Durvalumab IV 1500 mg, days -7 and 22 (the second dose is given concurrently with RT). Adjuvant Phase (to start 4 weeks after completion of concurrent phase): Durvalumab IV 1500 mg q4 weekly for 6 doses.
Radiation/Durvalumab + Adjuvant Durvalumab/TremelimumabEXPERIMENTALARM CLOSED TO ACCRUAL WITH AMENDMENT #1
SurveillanceNO_INTERVENTION -
Durvalumab plus OlaparibEXPERIMENTALDurvalumab 1500 mg every 4 weeks for up to a maximum of 2 months (up to 2 doses/cycles) plus Olaparib 300 mg b.i.d. up to 56 days (2 cycles of 28 days each cycle).
Durvalumab maintenanceOTHERPatients will receive durvalumab intravenously 1500 mg every 4 weeks until disease progression, unacceptable toxicity, death or patient's decision for a maximum of 24 months. For patients receiving prophylactic cranial irradiation as per standard of care, the first dose of durvalumab may be delayed by up to 42 days from the end of the CRT. Radiological assessments will be planned every 12 weeks (± 7 days) of maintenance treatment. The first dose of durvalumab should be administered within 3 days of inclusion.
Experimental Arm - Liver-RT + DurvalumabEXPERIMENTALParticipants will receive treatment in sequence with standard of care systemic therapy
Standard of Care Arm - Durvalumab + Gemcitabine + CisplatinEXPERIMENTALParticipants will receive treatment in sequence with standard of care systemic therapy
ddMVAC cohortEXPERIMENTALDurvalumab + chemotherapy, approximately 120 participants
gem/cis cohortEXPERIMENTALDurvalumab + chemotherapy; approximately 30 participants; closed to further enrolment
Cohort A: Durvalumab and Monalizumab for CIS +/- high grade papillary urothelial cancerEXPERIMENTALDurvalumab 1500mg IV and monalizumab 1500mg IV will be administered to all patients once every 4 weeks. A cycle is equal to 4 weeks. This will continue until disease progression, unacceptable toxicity, or for a maximum of 1 year.
Cohort B: Durvalumab and Monalizumab for high grade papillary urothelial cancer without CISEXPERIMENTALDurvalumab 1500mg IV and monalizumab 1500mg IV will be administered to all patients once every 4 weeks. A cycle is equal to 4 weeks. This will continue until disease progression, unacceptable toxicity, or for a maximum of 1 year.
Combination of olaparib and durvalumab after four cycles of standard 1st line treatmentEXPERIMENTALStudy treatment (olaparib and durvalumab) starts with the initiation of maintenance therapy and is administered at a 28-day cycle until progression, unacceptable toxicity, or discontinuation for other reasons. Induction therapy (four cycles of carboplatin/cisplatin, etoposide, durvalumab (the administration of one induction cycle without durvalumab is permitted)) is administered as part of standard of care.
systemic plus ID-RFAEXPERIMENTALsystemic treatment: - combination treatment for 8 cycles (Q3W): * Gemcitabine, 1,000 mg/m2 IV, on day 1 and 8, * Cisplatin, 25 mg/m2 IV, on day 1 and 8 * Durvalumab, 1,500 mg IV, on day 1 followed by * Durvalumab maintenance, 1,500 mg IV, PLUS • 2 endoscopic intraductal RFA
Arm A: Durvalumab + Tremelimumab + Platinum-based ChemotherapyEXPERIMENTALParticipants will receive durvalumab plus tremelimumab every 3 weeks (q3w) for four 21-day cycles in combination with chemotherapy followed by maintenance treatment period (durvalumab plus pemetrexed maintenance) every 4 weeks (q4w) until clinical progression or confirmed RECIST 1.1- defined radiological progression as assessed by the investigator, unacceptable toxicity, withdrawal of participant consent, or EOS, whichever comes first. During the maintenance treatment period, participants will receive additional doses of tremelimumab at Cycle 6 (Week 16) and Cycle 28 (Week 104 - at Investigator's discretion) along with durvalumab and pemetrexed.
Arm B: Pembrolizumab + Platinum-based ChemotherapyEXPERIMENTALParticipants will receive pembrolizumab regimen q3w for four 21-day cycles in combination with chemotherapy as induction treatment followed by maintenance treatment (pembrolizumab plus pemetrexed maintenance) q3w for up to 24 months, until clinical progression or confirmed RECIST 1.1- defined radiological progression as assessed by the investigator, unacceptable toxicity, withdrawal of participant consent, or EOS, whichever comes first.
Yttrium 90 glass microspheres TARE in combination with Durvalumab and BevacizumabEXPERIMENTALParticipants will undergo Yttrium 90 glass microspheres TARE according to the dosimetry recommendation.
Arm 1: Oleclumab + Durvalumab + Platinum doublet chemotherapy (CTX)EXPERIMENTALParticipants will receive Durvalumab + Oleclumab + CTX as neoadjuvant treatment and Durvalumab + Oleclumab as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on the tumour histology and Investigator's discretion, as part of their treatment regimen prior to surgery: Carboplatin/Paclitaxel Pemetrexed/Cisplatin Pemetrexed/Carboplatin
Arm 2: Monalizumab + Durvalumab + CTXEXPERIMENTALParticipants will receive Durvalumab + Monalizumab + CTX as neoadjuvant treatment and Durvalumab + Monalizumab as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on the tumour histology and Investigator's discretion, as part of their treatment regimen prior to surgery: Carboplatin/Paclitaxel Pemetrexed/Cisplatin Pemetrexed/Carboplatin
Arm 3: Volrustomig (Dose Exploration) + CTXEXPERIMENTALParticipants will receive Volrustomig + CTX as neoadjuvant treatment and Volrustomig as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on the tumour histology and Investigator's discretion, as part of their treatment regimen prior to surgery: Carboplatin/Paclitaxel Pemetrexed/Cisplatin Pemetrexed/Carboplatin
Arm 4: Dato-DXd + durvalumab + single agent platinumEXPERIMENTALParticipants will receive Dato-DXd + durvalumab + single agent platinum as neoadjuvant treatment and durvalumab as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on physician choice of as part of their treatment regimen prior to surgery: Carboplatin or Cisplatin
Arm 5: AZD0171 + durvalumab + CTXEXPERIMENTALParticipants will receive AZD0171 + durvalumab + CTX as neoadjuvant treatment and AZD0171 + durvalumab as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on the tumour histology and Investigator's discretion, as part of their treatment regimen prior to surgery: Carboplatin/Paclitaxel Pemetrexed/Cisplatin Pemetrexed/Carboplatin
Arm 6: Rilvegostomig + CTXEXPERIMENTALParticipants will receive Rilvegostomig + CTX as neoadjuvant treatment and Rilvegostomig as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on the tumour histology and Investigator's discretion, as part of their treatment regimen prior to surgery: Carboplatin/Paclitaxel Pemetrexed/Cisplatin Pemetrexed/Carboplatin
Arm 7: Dato-DXd + Rilvegostomig + single agent platinumEXPERIMENTALParticipants will receive Dato-DXd + Rilvegostomig + single agent platinum as neoadjuvant treatment and Rilvegostomig as adjuvant treatment. Participants will receive one of the following chemotherapy regimens, based on physician choice of as part of their treatment regimen prior to surgery: Carboplatin or Cisplatin
Arm I: Durvalumab monotherapy + hypofractionated radiotherapy (RT)EXPERIMENTALParticipants undergo standard of care RT over 5 fractions once a day (QD) for 5 days. Within 3-10 days after completion of RT, participants receive durvalumab IV over 1 hour on day 1. Treatment repeats every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
Arm II: Progression on prior programmed death-ligand 1 (PD-L1) checkpoint inhibitorsEXPERIMENTALParticipants with progression on prior PD-L1 immune checkpoint inhibitor undergo standard of care hypofractionated radiotherapy (RT) over 5 fractions QD for 5 days and then receive a single, fixed dose of tremelimumab (300 mg IV) administered on Day 1, in combination with a fixed dose of durvalumab (1500 mg IV) every 28 days (+/-4 days for Cycles 2+), initiated within 3-10 days of completing RT, until confirmed radiographic progression or other criteria for discontinuation.
Arm III: No previous PD-L1 checkpoint inhibitor therapyEXPERIMENTALParticipants without prior PD-L1 immune checkpoint inhibitor therapy undergo standard of care hypofractionated radiotherapy (RT) over 5 fractions QD for 5 days and then receive a single fixed dose of tremelimumab (300 mg IV) administered on Day 1, in combination with durvalumab at fixed dose of 1500 mg IV every 28 days (+/-4 days for Cycles 2+), initiated within 3-10 days of completing RT, until confirmed radiographic progression or other criteria for discontinuation.
AZD2811 + DurvalumabEXPERIMENTALInduction: Durvalumab + Platinum Chemotherapy (Carboplatin or cisplatin \& Etoposide) Maintenance: AZD2811 + Durvalumab
Cohort AEXPERIMENTALPatients received standard radiotherapy \[60 gray (Gy) ± 10% or hypofractionated BED\] prior to study entry.
Cohort BEXPERIMENTALPatients received palliative radiotherapy \[40 to \< 54 Gy or hypofractionated BED\] prior to study entry.
Arm A: Chemo-ImmunoEXPERIMENTALArmA receives chemotherapy on D1 and immunotherapy on D8 of a 28-day cycle for the first 2cycles. After the first 2cycles, patients on Arm A and Arm B will be administered chemotherapy and immunotherapy on D1 of a 21day cycle for cycles 3 and 4. After 4cycles of chemo-immunotherapy, patients receive maintenance therapy with durvalumab and pemetrexed until treatment discontinuation. Maintenance therapy is administered on D1 of a 21day cycle.
Arm B: Immuno-ChemoEXPERIMENTALArmB receives immunotherapy on D1 and chemotherapy on D8 of a 28-day cycle for the first 2cycles. After the first 2cycles, patients on Arm A and Arm B will be administered chemotherapy and immunotherapy on D1 of a 21day cycle for cycles 3 and 4. After 4cycles of chemo-immunotherapy, patients receive maintenance therapy with durvalumab and pemetrexed until treatment discontinuation. Maintenance therapy is administered on D1 of a 21day cycle.
Arm 1AEXPERIMENTALT-DXd and 5-fluorouracil (5-FU)
Arm 1BEXPERIMENTALT-DXd and capecitabine
Arm 1CEXPERIMENTALT-DXd and durvalumab
Arm 1D(b)EXPERIMENTALT-DXd, capecitabine, and oxaliplatin
Arm 1E(a)EXPERIMENTALT-DXd, 5-FU, and durvalumab
Arm 1E(b)EXPERIMENTALT-DXd, capecitabine, and durvalumab
Arm 2AACTIVE_COMPARATORTrastuzumab, 5-FU or capecitabine, and cisplatin or oxaliplatin
Arm 2BEXPERIMENTALT-DXd monotherapy
Arm 2CEXPERIMENTALT-DXd, 5-FU or capecitabine
Arm 2DEXPERIMENTALT-DXd, pembrolizumab and 5-FU or capecitabine
Arm 2EEXPERIMENTALT-DXd and pembrolizumab
Arm 2FEXPERIMENTALT-DXd, pembrolizumab and 5-FU or capecitabine
Arm 3AEXPERIMENTALT-DXd, Volrustomig and 5-FU or capecitabine
Arm 3BEXPERIMENTALT-DXd, Volrustomig and 5-FU or capecitabine
Arm 4AEXPERIMENTALT-DXd, Rilvegostomig and 5-FU or capecitabine
Arm 4BEXPERIMENTALT-DXd, Rilvegostomig and 5-FU or capecitabine
Part 5 Main CohortEXPERIMENTALT-DXd, Volrustomig and 5-FU or capecitabine
Part 5 Cohort 2EXPERIMENTALT-DXd, Volrustomig and 5-FU or capecitabine
MIMIPACEXPERIMENTALIntervention: MIS-MWA plus immunotherapy using the combination of durvalumab with tremelimumab
Cohort 1: High RiskACTIVE_COMPARATOR -
Cohort 2: Standard Risk - Arm AACTIVE_COMPARATOR -
Cohort 2: Standard Risk - Arm BACTIVE_COMPARATOR -
Immunotherapy, chemotherapy, radiotherapy and surgeryEXPERIMENTALDurvalumab 1500 mg administered intravenously every 3 weeks for the first 4-6 cycles (during chemotherapy); Tremelimumab 75mg administered intravenously every 3 weeks for the first 4-6 cycles (only cohort 2) 4-6 cycles of chemotherapy, carboplatin AUC5 every 3 weeks plus paclitaxel 175 mg/m2, every 3 weeks; Stereotactic body radiotherapy (SBRT) of all oligo-metastatic lesions, in a maximum of 10 treatment fractions over 2 weeks, starting after week one of chemotherapy cycle 1 and completed within four weeks after start of durvalumab treatment; Restaging at 3 months; if no disease progression, proceed to definitive local treatment (surgical resection of primary tumour or radiotherapy at a minimum dose of 60-66Gy to the primary tumour). Durvalumab continues at 1500 mg intravenously every 4 weeks until progression of disease or for a maximum of 1 year from start of treatment.
Chemotherapy and radiotherapyEXPERIMENTALThe combination of weekly paclitaxel 80 mg/m² IV followed by q2w dose-dense doxorubicin-cyclophosphamide (ddAC) (60 mg/m² doxorubicin IV and 600 mg/m² cyclophosphamide IV) and pre-operative radiation therapy on the primary tumour (3x8 Gy).
Chemotherapy and pre-operative radiotherapy plus durvalumabEXPERIMENTALThe combination of weekly paclitaxel 80 mg/m² IV followed by q2w dose-dense doxorubicin-cyclophosphamide (ddAC) (60 mg/m² doxorubicin IV and 600 mg/m² cyclophosphamide IV) and pre-operative radiation therapy on the primary tumour (3x8 Gy) with the addition of the anti-PD-L1 antibody durvalumab IV 1500 mg q4w.
Chemotherapy & pre-op radiotherapy + durvalumab + oleclumabEXPERIMENTALThe combination of weekly paclitaxel 80 mg/m² IV followed by q2w dose-dense doxorubicin-cyclophosphamide (ddAC) (60 mg/m² doxorubicin IV and 600 mg/m² cyclophosphamide IV) and pre-operative radiation therapy on the primary tumour (3x8 Gy) with the addition of the anti-PD-L1 antibody durvalumab IV 1500 mg q4w and the addition of the anti-CD73 antibody oleclumab IV 3000 mg q2w for 4 administrations, followed by q4w for 3 administrations.
WHO/ECOG PS 0 to 1 CohortEXPERIMENTAL100-120 participants will receive 1500 mg Durvalumab (MEDI4736) monotherapy via IV infusion q4w for up to a maximum of 24 months (up to 26 doses/cycles) with the last administration at Week 104. The study drug should be discontinued prior to 24 months if there is clinical progression or confirmed radiological progression or if there is unacceptable toxicity, withdrawal of consent, or another discontinuation criterion is met.
WHO/ECOG PS 2 CohortEXPERIMENTALup to 30 participants will receive 1500 mg Durvalumab (MEDI4736) monotherapy via IV infusion q4w for up to a maximum of 24 months (up to 26 doses/cycles) with the last administration at Week 104. The study drug should be discontinued prior to 24 months if there is clinical progression or confirmed radiological progression or if there is unacceptable toxicity, withdrawal of consent, or another discontinuation criterion is met.
Durvalumab 1500 mgEXPERIMENTALParticipants will receive durvalumab 1500 mg intravenously (IV) every 4 weeks (Q4W; on Week 1 Day 1) until disease progression, unacceptable toxicity, or other reason of treatment discontinuation over a 28-day treatment period. Surgical resection will be planned between Day 29 and Day 42. After surgical resection, participants will be followed up to Day 105 (starting from Week 1 Day 1).
Durvalumab 1500 mg + Oleclumab 3000 mgEXPERIMENTALParticipants will receive durvalumab 1500 mg IV Q4W (on Week 1 Day 1) and oleclumab 3000 mg IV every 2 weeks (Q2W; on Week 1 Day 1 and Week 3 Day 1) until disease progression, unacceptable toxicity, or other reason of treatment discontinuation over a 28-day treatment period. Surgical resection will be planned between Day 29 and Day 42. After surgical resection, participants will be followed up to Day 105 (starting from Week 1 Day 1).
Durvalumab 1500 mg + Monalizumab 750 mgEXPERIMENTALParticipants will receive durvalumab 1500 mg IV Q4W (on Week 1 Day 1) and monalizumab 750 mg IV Q2W (on Week 1 Day 1 and Week 3 Day 1) until disease progression, unacceptable toxicity, or other reason of treatment discontinuation over a 28-day treatment period. Surgical resection will be planned between Day 29 and Day 42. After surgical resection, participants will be followed up to Day 105 (starting from Week 1 Day 1).
Durvalumab 1500 mg + Danvatirsen 200 mgEXPERIMENTALParticipants will receive danvatirsen 200 mg IV on Days 1, 3, and 5 of Week 0 (7-day danvatirsen lead-in period), followed by durvalumab 1500 mg IV Q4W (on Week 1 Day 1) and danvatirsen 200 mg IV every week (on Week 1 Day 1, Week 2 Day 1, Week 3 Day 1, and Week 4 Day 1) until disease progression, unacceptable toxicity, or other reason of treatment discontinuation over a 28-day treatment period. Surgical resection will be planned between Day 29 and Day 42. After surgical resection, participants will be followed up to Day 105 (starting from Week 1 Day 1).
Durvalumab/Olaparib Combination TherapyEXPERIMENTALDurvalumab/Olaparib Combination Therapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/Olaparib (maintenance phase)
Durvalumab MonotherapyEXPERIMENTALDurvalumab Monotherapy: Durvalumab/SoC chemotherapy (initial therapy phase) followed by Durvalumab/placebo (maintenance phase)
Control Arm (Durvalumab monotherapy)EXPERIMENTALdurvalumab IV
Arm A (durvalumab + oleclumab):EXPERIMENTALdurvalumab IV and oleclumab IV
Arm B (durvalumab + monalizumab)EXPERIMENTALdurvalumab IV and monalizumab IV
Durvalumab and CetuximabEXPERIMENTALDurvalumab 500mg as a 120-minute intravenous infusion every two weeks. Cetuximab 400mg/m2 IV loading dose followed by weekly Cetuximab 250mg/m2 IV Treatment with Durvalumab continues until progression and Cetuximab may continue as maintenance
Arm 1: Durvalumab/PlaceboEXPERIMENTALDurvalumab 1500 mg intravenous (IV) every 4 weeks (q4w) starting on week 1 day 1/Placebo orally (PO) twice a day (BID) starting on week 1 day 1.
Arm 2: Durvalumab/OlaparibEXPERIMENTALDurvalumab 1500 mg IV q4w starting on week 1 day 1/Olaparib PO 300 mg BID adjusted based on patient's creatinine clearance.
Module 1 Cohort A.1.HRR: Durvalumab 1500 mg + Olaparib 300 mgEXPERIMENTALParticipants with detectable aberrations, mutation detected in a homologous recombination repair gene (HRRm) will receive IV infusion of durvalumab 1500 mg every 4 weeks (Q4W) in combination with oral olaparib 300 mg (2 × 150 mg) tablets twice a day (BD) until disease progression is confirmed.
Module 1 Cohort A.1.LKB: Durvalumab 1500 mg + Olaparib 300 mgEXPERIMENTALParticipants with detectable aberrations in liver kinase B1 (LKB1) will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral olaparib 300 mg (2 × 150 mg) tablets BD until disease progression is confirmed.
Module 1 Cohort B.1.PRI: Durvalumab 1500 mg + Olaparib 300 mgEXPERIMENTALParticipants who had anti-programmed cell death-1 (PD-1)/programmed cell death ligand 1 (PD-L1) containing therapy but had progression of disease within ≤ 24 weeks from the start of treatment (primary resistance; PRI) will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral olaparib 300 mg (2 × 150 mg) tablets BD until disease progression is confirmed.
Module 1 Cohort B.1.ACQ: Durvalumab 1500 mg + Olaparib 300 mgEXPERIMENTALParticipants who had progressive disease \> 24 weeks from the start of anti PD-1/PD-L1 containing therapy while still on that treatment (acquired resistance; ACQ) will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral olaparib 300 mg (2 × 150 mg) tablets BD until disease progression is confirmed.
Module 2 Cohort B.2.PRI: Durvalumab 1500 mg + Danvatirsen 200 mgEXPERIMENTALParticipants who had anti-PD-1/PD-L1 containing therapy but had progression of disease within ≤ 24 weeks from the start of treatment (PRI) will receive IV infusion of AZD9150 (danvatirsen) 200 mg as loading dose on Days 1, 3, 5 of Cycle 0 (7-day-lead-in period). Thereafter, participants will receive AZD9150 200 mg every week (QW) on Days 1, 8, 15, and 22 of each 28-day cycle in combination with IV infusion of durvalumab 1500 mg Q4W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 2 Cohort B.2.ACQ: Durvalumab 1500 mg + Danvatirsen 200 mgEXPERIMENTALParticipants who had progressive disease \> 24 weeks from the start of anti PD-1/PD-L1 containing therapy while still on that treatment (ACQ) will receive IV infusion of AZD9150 (danvatirsen) 200 mg as loading dose on Days 1, 3, 5 of Cycle 0 (7-day-lead-in period). Thereafter, participants will receive AZD9150 200 mg every week (QW) on Days 1, 8, 15, and 22 of each 28-day cycle in combination with IV infusion of durvalumab 1500 mg Q4W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 3 Cohort A.3.ATM: Durvalumab 1500 mg + AZD6738 240 mgEXPERIMENTALParticipants who are ataxia telangiectasia mutated (ATM)-deficiecy will receive oral AZD6738 240 mg tablet BD for 7 days in Cycle 0 (Days 1 to 7). Thereafter, participants will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral AZD6738 240 mg tablet BD in each cycle between Days 22 and 28 in each 28-day cycle, until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Module 3 Cohort B.3.PRI: Durvalumab 1500 mg + AZD6738 240 mgEXPERIMENTALParticipants who had anti-PD-1/PD-L1 containing therapy but had progression of disease within ≤ 24 weeks from the start of treatment (PRI) will receive oral AZD6738 240 mg tablet BD for 7 days in Cycle 0 (Days 1 to 7). Thereafter, participants will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral AZD6738 240 mg tablet BD between Days 22 and 28 in each 28-day cycle, until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Module 3 Cohort B.3.ACQ: Durvalumab 1500 mg + AZD6738 240 mgEXPERIMENTALParticipants who had progressive disease \> 24 weeks from the start of anti PD-1/PD-L1 containing therapy while still on that treatment (ACQ) will receive oral AZD6738 240 mg tablet BD for 7 days in Cycle 0 (Days 1 to 7). Thereafter, participants will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral AZD6738 240 mg tablet BD between Days 22 and 28 in each 28-day cycle, until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Module 4 Cohort A.4.RIC: Durvalumab 1500 mg + Vistusertib 125 mgEXPERIMENTALParticipants with detectable genetic amplifications in rapamycin-insensitive companion of mechanistic target of rapamycin complex-2 (RICTOR) will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral vistusertib 125 mg tablets BD on an intermittent dosing schedule of 2 days on, 5 days off, until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Module 5 Cohort A.5.73H: Durvalumab 1500 mg + Oleclumab 3000 mgEXPERIMENTALParticipants with high expression of cluster of differentiation 73 (CD73) will receive IV infusion of oleclumab 3000 mg every 2 weeks (Q2W) for 2 cycles and then Q4W thereafter in combination with IV infusion of durvalumab 1500 mg Q4W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 5 Cohort B.5.PRI: Durvalumab 1500 mg + Oleclumab 3000 mgEXPERIMENTALParticipants who had anti-PD-1/PD-L1 containing therapy but had progression of disease within ≤ 24 weeks from the start of treatment (PRI) will receive IV infusion of oleclumab 3000 mg Q2W for 2 cycles and then Q4W thereafter in combination with IV infusion of durvalumab 1500 mg Q4W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 5 Cohort B.5.ACQ: Durvalumab 1500 mg + Oleclumab 3000 mgEXPERIMENTALParticipants who had progressive disease \> 24 weeks from the start of anti PD-1/PD-L1 containing therapy while still on that treatment (ACQ) will receive IV infusion of oleclumab 3000 mg Q2W for 2 cycles and then Q4W thereafter in combination with IV infusion of durvalumab 1500 mg Q4W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 6 Cohort A.6.HER2e: Durvalumab 1120 mg + Trastuzumab deruxtecan 5.4mg/kgEXPERIMENTALParticipants whose tumours express human epidermal growth factor receptor 2 (HER2) mutations will receive IV infusion of trastuzumab deruxtecan (T-DXd) 5.4 mg/kg every 3 weeks (Q3W) in combination with IV infusion of durvalumab 1120 mg Q3W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 6 Cohort A.6.HER2m: Durvalumab 1120 mg + Trastuzumab deruxtecan 5.4mg/kgEXPERIMENTALParticipants whose tumours harbour selected HER2 mutations will receive IV infusion of T-DXd 5.4 mg/kg Q3W in combination with IV infusion of durvalumab 1120 mg Q3W, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 7 Cohort B.7.ACQ: Durvalumab 1500 mg + Cediranib 20 mgEXPERIMENTALParticipants who had progressive disease \> 24 weeks from the start of anti PD-1/PD-L1 containing therapy while still on that treatment (ACQ) will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral cediranib (AZD2171) 20 mg tablets daily for 5 days on, 2 days off (starting on Cycle 1 Day 1 of durvalumab), until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 8 Cohort A.8.ATM: Ceralasertib 240 mgEXPERIMENTALParticipants who are ATM-deficient or with detectable aberrations in the ATM gene will receive oral ceralasertib (AZD6738) 240 mg tablets BD from Day 1 to Day 14 of each 28-day cycle, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 9 Cohort B.9.PRI: Durvalumab 1500 mg + Ceralasertib 240 mgEXPERIMENTALParticipants who had anti-PD-1/PD-L1 containing therapy but had progression of disease within ≤ 24 weeks from the start of treatment (PRI) will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral ceralasertib (AZD6738) 240 mg tablets BD for 14 days from Day 15 to Day 28 of each 28-day cycle, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 9 Cohort B.9.ACQ: Durvalumab 1500 mg + Ceralasertib 240 mgEXPERIMENTALParticipants who had progressive disease \> 24 weeks from the start of anti PD-1/PD-L1 containing therapy while still on that treatment (ACQ) will receive IV infusion of durvalumab 1500 mg Q4W plus oral ceralasertib (AZD6738) 240 mg tablets BD for 14 days from Day 15 to Day 28 of each 28-day cycle, until objective radiological disease progression, as long as, in the investigator's opinion, they were benefiting from treatment and did not meet any other discontinuation criteria.
Module 10 Cohort C.10.160: Durvalumab 1500 mg + Ceralasertib 160 mgEXPERIMENTALParticipants, independent of their molecular aberration status, will receive oral ceralasertib (AZD6738) 160 mg tablet BD for 7 days in Cycle 0 (Days 1 to 7). Thereafter, participants will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral ceralasertib 160 mg tablet BD between Days 22 and 28 in each 28-day cycle, until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Module 10 Cohort C.10.240: Durvalumab 1500 mg + Ceralasertib 240 mgEXPERIMENTALParticipants, independent of their molecular aberration status, will receive oral ceralasertib (AZD6738) 240 mg tablet BD for 7 days in Cycle 0 (Days 1 to 7). Thereafter, participants will receive IV infusion of durvalumab 1500 mg Q4W in combination with oral ceralasertib 240 mg tablet BD between Days 22 and 28 in each 28-day cycle, until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Module 11 Cohort C.11.240: AZD6738 240 mgEXPERIMENTALParticipants, independent of their molecular aberration status, will receive oral AZD6738 tablet 240 mg for 7 days (Days 1 to 7) in each 28-day cycle until objective radiological disease progression, however, participants may continue treatment if benefiting from treatment in the investigator opinion or did not meet any other discontinuation criteria.
Durvalumab and TremelimumabEXPERIMENTALCycles/courses 1-3: Durvalumab 1.5g q4wks Tremelimumab 75 mg q4wks Cycles/courses ≥4: Durvalumab 1.5g q4wks Tremelimumab 75 mg q12wks
DoxorubicinACTIVE_COMPARATORDoxorubicin 75 mg/qm q3wks for 6 courses
Treatment (olaparib, tremelimumab, durvalumab)EXPERIMENTALPatients receive olaparib PO BID, and tremelimumab IV over 1 hour and durvalumab IV over 1 hour on day 1. Treatment with olaparib continues for up to 12 months in the absence of disease progression or unacceptable toxicity. Treatment with tremelimumab repeats every 4 weeks for up to 4 courses and treatment with durvalumab repeats every 4 weeks for up to 13 courses in the absence of disease progression or unacceptable toxicity.
durvalumab and tremelimumab plus Radiotherapy (RT)EXPERIMENTALPatients will receive 1500 mg durvalumab via IV infusion q4w for up to 4 doses/cycles and 75 mg tremelimumab via IV infusion q4w for up to 4 doses/cycles, and then continue 1500 mg durvalumab q4w starting on Week 16. Tremelimumab will be administered first. Durvalumab infusion will start approximately 1 hour after the end of tremelimumab infusion. The duration will be approximately 1 hour for each infusion. Radiotherapy (RT) will be performed using external beam ionizing radiation as standard therapy in accordance with institutional standard practice. RT will be initiated within 7 days after the first of durvalumab and tremelimumab.
durvalumab and tremelimumab plus ablationEXPERIMENTALPatients will receive 1500 mg durvalumab via IV infusion q4w for up to 4 doses/cycles and 75 mg tremelimumab via IV infusion q4w for up to 4 doses/cycles, and then continue 1500 mg durvalumab q4w starting on Week 16. Tremelimumab will be administered first. Durvalumab infusion will start approximately 1 hour after the end of tremelimumab infusion. The duration will be approximately 1 hour for each infusion. The ablation will be performed percutaneously under image guidance as standard therapy at the discretion of the interventional radiologist in accordance with institutional standard practice. Ablation will be performed within 7 days after the first of durvalumab and tremelimumab.
Arm 1 (Durvalumab monotherapy)EXPERIMENTALDurvalumab (MEDI4736) 1.12 g administered pre-operatively every 3 weeks for 2 cycles followed by surgical resection. Durvalumab monotherapy 1.5 g will be given for 12 months post-operatively.
Arm 2 (Durvalumab plus SBRT)EXPERIMENTALDurvalumab (MEDI4736) 1.12 g administered pre-operatively every 3 weeks for 2 cycles plus radiotherapy delivered in 3 daily fractions starting concurrently with the first cycle of durvalumab (MEDI4736) followed by surgical resection. Durvalumab monotherapy 1.5 g will be given for 12 months post-operatively.
MEDI4736 monotherapyEXPERIMENTALMEDI4736 via IV infusion.
tremelimumab+MEDI4736EXPERIMENTALMEDI4736+tremelimumab via IV infusion.
TremelimumabEXPERIMENTALTremelimumab monotherapy
Radiotherapy plus DurvalumabEXPERIMENTALA minimum of 3 patients will initially be enrolled in each cohort of this arm. Patients will be allocated to a radiotherapy dose and site cohort from the schedule at registration. There will be no intra-patient dose or site escalations. Cohorts will escalate in number of anatomical sites of radiotherapy and dose of radiotherapy given subject to safety. Durvalumab will be administered at a fixed dose every 4 weeks IV.
Phase I Dose Level 1: Durvalumab + AcalabruitinibEXPERIMENTAL* Acalabrutinib 100 mg twice per day by mouth on days 1-28 * Durvalumab 1500 mg intravenous on day 1 of a 28 day cycle
Phase I Dose Level 2: Durvalumab + AcalabruitinibEXPERIMENTAL* Acalabrutinib 200 mg twice per day by mouth on days 1-28 * Durvalumab 1500 mg intravenous on day 1 of a 28 day cycle
Expansion Cohort: Durvalumab + AcalabrutinibEXPERIMENTAL* Acalabrutinib 100 mg or 200 mg (depends on tolerable dose found in Phase I portion of study) twice per day by mouth on days 1-28 * Durvalumab 1500 mg intravenous on day 1 of a 28 day cycle
Dose Escalation and ExpansionEXPERIMENTALPart 1 of this trial will use a traditional 3+3 design will be used for this trial (i.e. cohort sizes of 3 patients for the first and second cohort at each dose level). Dose escalation will occur as long as there are minimal dose limiting toxicities.The expectation is that 9 patients will be enrolled to the trial during part 1.This is based on the expectation that all dose levels are safe (i.e. patients will not experience DLTs at all dose levels). The range of patients needed will be 6-12 patients. Part 2 of this trial will be an expansion cohort. A total of 8 additional patients will be enrolled at the dose level determined to be the MTD in part 1 of the study. These 8 patients will be used to confirm that the MTD is a safe combination, as well as provide additional patients to investigate the efficacy for the treatment combination. Note: Standard of care surgery will follow 3-6 weeks after medication and radiation treatment.
Romidepsin/nab-Paclitaxel/Gemcitabine (Arm A)EXPERIMENTALPart 1a: Romidepsin (2 mg/m² or 3.3 mg/m² or 7 mg/m²) will be administered in combination with nab-Paclitaxel (125 mg/m²)/Gemcitabine (1000 mg/m²) on Day 1, Day 8 and Day 15 (every 28 days) of each treatment cycle. Study treatment is given until intolerable toxicity or will escalate until the recommended dose for expansion for a maximum of 3 cycles.
Azacitidine/nab-Paclitaxel/Gemcitabine (Arm B)EXPERIMENTALPart 1a: Azacitidine (20 mg/m² or 30 mg/m² or 40 mg/m²) will be administered on Days -7 to Day -3 of each treatment cycle. Additionally nab-Paclitaxel (125 mg/m²)/Gemcitabine (1000 mg/m²) will be given on Day 1, Day 8 and Day 15 (every 28 days) of each treatment cycle. Study treatment is given until intolerable toxicity or will escalate until the recommended dose for expansion for a maximum of 3 cycles.
Romidepin/Azacitidine/nab-Paclitaxel/Gemcitabine (Arm C)EXPERIMENTALPart 1a: The intervention to be administered depends on the determined dose in Arm A and Arm B. Additionally nab-Paclitaxel (125 mg/m²)/Gemcitabine (1000 mg/m²) will be given on Day 1, Day 8 and Day 15 (every 28 days) of each treatment cycle. Study treatment is given until intolerable toxicity or will escalate until the recommended dose for expansion for a maximum of 3 cycles.
nab-Paclitaxel/Gemcitabine (Standard Arm)ACTIVE_COMPARATORnab-Paclitaxel (125 mg/m²)/Gemcitabine (1000 mg/m²) will be administered on Day 1, Day 8 and Day 15 (every 28 days) of each treatment cycle.
Arm C or B or AEXPERIMENTALIn Part 1b (expansion part) of the study, one of the treatment arms (Arm C over Arm B over Arm A) will be continued. Treatment will only be performed with the study drug that were tolerable in Part 1a (dose escalation).
Durvalumab/LenalidomideEXPERIMENTALPart 2: All patients from Part 1 who have not progressed after three cycles receive standard fixed dose Durvalumab (1500 mg) on Day 1 of each 28-day treatment cycle by IV infusion in combination with orally administered low-dose Lenalidomide (10 mg) on Days 1 to 21 until documented disease progression. Study treatment is given for a maximum of 13 cycles.
Part 1: SC Durvalumab DL1EXPERIMENTALParticipants will receive DL1 of SC durvalumab + rHu followed by IV durvalumab at predefined intervals.
Part 1: SC Durvalumab DL2EXPERIMENTALParticipants will receive DL2 of SC durvalumab + rHu followed by IV durvalumab at predefined intervals.
Part 2: Expansion Cohort, SC Durvalumab Dose Level XEXPERIMENTALParticipants will receive dose level X (determined from data analysis in Part 1) of SC durvalumab + rHu followed by IV durvalumab at predefined intervals.
Durvalumab + SABREXPERIMENTALDurvalumab + Stereotactic Ablative Body Radiotherapy
Part 1 (S1): FOLFOX + Bevacizumab + Durvalumab + OleclumabEXPERIMENTALParticipants in Part 1 safety run-in arm (S1) will receive intravenous (IV) infusions of FOLFOX (5-fluorouracil \[5-FU\]: 2400 mg/m\^2 over 46-48 hours \[Day 1 and 2 of every 14-day Cycle\], oxaliplatin: 85 mg/m\^2, folinic acid: 400 mg/m\^2) and bevacizumab 5 mg/kg on Day 1 of every Cycle (14-day cycle) in combination with IV durvalumab 1500 mg every 4 weeks (Q4W) and IV oleclumab 3000 mg every 2 weeks (Q2W) till 4 doses (Cycle 4) then Q4W starting on Cycle 5 Day 1 until disease progression, unacceptable toxicity, withdrawal of participant consent, or another discontinuation criterion will be met.
Part 2 (C1): FOLFOX + BevacizumabEXPERIMENTALParticipants in Part 2 control 1 arm (C1) will receive IV infusions of FOLFOX (5-FU: 2400 mg/m\^2 over 46-48 hours \[Day 1 and 2 of every 14-day Cycle\], oxaliplatin: 85 mg/m\^2, folinic acid: 400 mg/m\^2) in combination with IV bevacizumab 5 mg/kg on Day 1 of every Cycle (14-day cycle) until disease progression, unacceptable toxicity, withdrawal of participant consent, or another discontinuation criterion will be met.
Part 2 (E1): FOLFOX + Bevacizumab + Durvalumab + OleclumabEXPERIMENTALParticipants in Part 2 experimental 1 arm (E1) will receive IV infusions of FOLFOX (5-FU: 2400 mg/m\^2 over 46-48 hours \[Day 1 and 2 of every 14-day Cycle\], oxaliplatin: 85 mg/m\^2, folinic acid: 400 mg/m\^2) and bevacizumab 5 mg/kg on Day 1 of every Cycle (14-day cycle) in combination with IV durvalumab 1500 mg Q4W and IV oleclumab 3000 mg Q2W till 4 doses (Cycle 4) then Q4W starting on Cycle 5 Day 1 until disease progression, unacceptable toxicity, withdrawal of participant consent, or another discontinuation criterion will be met.
Durvalumab / Tremelimumab Combination TherapyEXPERIMENTALPart 1 (dose finding) Durvalumab + tremelimumab Combination Treatment. Durvalumab and tremelimumab are initially administered at dose level 1 and dose escalated based on results from PK modeling and tolerance to determine the RP2D. Both drugs are administered every 4 weeks as intravenous infusions. Tremelimumab is only administered with durvavalumab for 4 doses, from cycles 2-5. (sarcoma, NB and NHL) Part 2 (dose expansion phase) Durvalumab + tremelimumab Combination Treatment. Durvalumab and tremelimumab are administered at the RP2D, every 4 weeks as intravenous infusions. Tremelimumab is only administered with durvalumab for 4 doses, from cycles 1-4. Tremelimumab may be added for 4 doses at time of progressive disease. Cohorts: solid tumors, sarcomas, NHL restricted to PMBCL and ALCL subtypes)
Phase I and Phase II Arm AEXPERIMENTALPatients are treated with paclitaxel, carboplatin, durvalumab and oleclumab.
Phase II Arm BACTIVE_COMPARATORPatients are treated with paclitaxel, carboplatin and durvalumab.
A1EXPERIMENTALDurvalumab
A2EXPERIMENTALDurvalumab + danvatirsen
A3EXPERIMENTALDurvalumab + oleclumab
A4EXPERIMENTALMEDI5752
B1EXPERIMENTALDurvalumab + Investigator's choice of chemotherapy
B2EXPERIMENTALDurvalumab + Investigator's choice of chemotherapy + danvatirsen
B3EXPERIMENTALDurvalumab + investigator's choice of chemotherapy + oleclumab
B4EXPERIMENTALMEDI5752
A5EXPERIMENTALAZD2936
B5EXPERIMENTALAZD2936 + chemotherapy
Arm 5EXPERIMENTALdurvalumab + paclitaxel + oleclumab
Arm 6EXPERIMENTALdurvalumab + trastuzumab deruxtecan
Arm 7EXPERIMENTALdurvalumab + datopotamab deruxtecan
Arm 8EXPERIMENTALdurvalumab + datopotomab deruxtecan (patients with PD-L1 positive status)
HNSCC Arm 1EXPERIMENTALDurvalumab + cisplatin with radiation in patients with locally advanced squamous cell carcinoma of the head and neck (HNSCC)
NSCLC Arm 1EXPERIMENTALDurvalumab + cisplatin and etoposide with radiation in patients with locally advanced, unresectable (Stage III) non-small-cell lung cancer (NSCLC)
NSCLC Arm 2EXPERIMENTALDurvalumab + carboplatin and paclitaxel with radiation in patients with locally advanced, unresectable (Stage III) non-small-cell lung cancer (NSCLC)
NSCLC Arm 3EXPERIMENTALInvestigator's choice of carboplatin and pemetrexed OR cisplatin and pemetrexed
SCLC Arm 1EXPERIMENTALPatients should start with cisplatin, but if cisplatin is not tolerated, they have the option to switch to carboplatin
SCLC Arm 2EXPERIMENTALPatients with limited-stage small-cell lung cancer (SCLC) should start with cisplatin, but if cisplatin is not tolerated, they have the option to switch to carboplatin
SCLC Arm 3EXPERIMENTALPatients should start with cisplatin, but if cisplatin is not tolerated, they have the option to switch to carboplatin. Note: Arm 3 will only be opened if the regimen in SCLC Arm 1 is safe and tolerable.
SCLC Arm 4EXPERIMENTALPatients should start with cisplatin, but if cisplatin is not tolerated, they have the option to switch to carboplatin Note: Arm 4 will only be opened if the regimen in SCLC Arm 2 is safe and tolerable.
Phase 1: Cohort 1EXPERIMENTALDurvalumab monotherapy
Phase 1: Cohort 2EXPERIMENTALDurvalumab plus BCG
Phase 1: Cohort 3EXPERIMENTALDurvalumab plus External Beam Radiotherapy (EBRT) (BCG re-treatment) - Cross-over to Durvalumab Monotherapy
Phase 1: Cohort 4EXPERIMENTALDurvalumab + Gemcitabine/Intravesical Docetaxel (Gem/Doc) The sequence of administration is flexible to allow for scheduling of both the infusion and intravesical treatments.
Phase 1: Cohort 5EXPERIMENTALNOTE: Cohort 5 was abandoned prior to any patients enrolled. Durvalumab + Tremelimumab + Gem/Doc The sequence of administration is flexible to allow for scheduling of both the infusion and intravesical treatments. For the intravenous medications, durvalumab should be administered first followed by tremelimumab.
Phase 1: Cohort 6EXPERIMENTALIntravesical NAI plus Gemcitabine
Phase 2: Cohort 4 ExpansionEXPERIMENTALDurvalumab + Gemcitabine/Intravesical Docetaxel (Gem/Doc) The sequence of administration is flexible to allow for scheduling of both the infusion and intravesical treatments.
Phase 1: Cohort 7EXPERIMENTALIntravesical NAI plus Gemcitabine and Docetaxel
Phase 1: Cohort 8EXPERIMENTALSubcutaneous NAI plus Intravesical NAI plus Gemcitabine and Docetaxel
Phase 1: Cohort 9EXPERIMENTALAdditional Regimens TBD
Durvalumab + Tremelimumab + FOLFOXOTHER* Durvalumab for 12 months * Tremelimumab for up to 4 doses/cycles * FOLFOX
durvalumab+tremelimumabEXPERIMENTALdurvalumab plus tremelimumab
Esophageal CancerEXPERIMENTALThis is a phase Ib/II trial of durvalumab (MEDI4736), a monoclonal antibody against programmed death ligand-1 (PD-L1)), and tremelimumab, an anti-CTLA-4 antibody, in combination with chemoradiation for patients with locally advanced (TanyN+M0 or T3-4NanyM0) esophageal or gastroesophageal (GE) junction adenocarcinoma.
PVX-410 and DurvalumabEXPERIMENTALEach patient will receive 6 PVX-410 vaccine injections and 2 infusions of Durvalumab. * The injection of PVX-410 will be co-administered with Hiltonol every 2 weeks for 6 injections. * The infusion of Durvalumab will be given on the day of the 4th and 6th PVX-410 injection, for a total of 2 infusions.
MEDI4736 and tremelimumabEXPERIMENTAL -
MEDI4736 and AZD9150EXPERIMENTAL -
Durvalumab plus TrastuzumabEXPERIMENTALDurvalumab q3w until PD Trastuzumab q3w x 6
Cohort 3EXPERIMENTALTriple-negative breast cancer (TNBC)
Cohort 4EXPERIMENTALTriple-negative breast cancer (TNBC)
Cohort 5EXPERIMENTALGastric/gastro-esophageal junction (GEJ)
Cohort 6EXPERIMENTALPancreatic ductal adenocarcinoma (PDAC)
Cohort 7EXPERIMENTALEsophageal squamous cell carcinoma (ESCC)
MEDI4736 +nab-paclitaxel + gemcitabineEXPERIMENTALMEDI4736 in combination with nab-paclitaxel + gemcitabine chemotherapy regimen via IV infusion
MEDI4736+AZD5069EXPERIMENTALMEDI4736 via IV infusion and oral AZD5069
Phase 1b-M20 mg/kg (Q4W) + T 1 mg/kg (Q4W) Fw M10 mg/kg (Q2W)EXPERIMENTALParticipants in second-line therapy with gastric or gastroesophageal junction (GEJ) adenocarcinoma will receive intravenous (IV) infusion of 20 mg/kg MEDI4736 every 4 weeks (Q4W) for 4 months (up to 4 doses) in combination with IV 1 mg/kg tremelimumab Q4W for 4 months (up to 4 doses in total). Thereafter, participants will receive MEDI4736 monotherapy (10 mg/kg) every 2 weeks (Q2W) to complete a total of 12 months of therapy (up to 18 additional doses).
Phase 2 Arm A-(M20 mg/kg (Q4W) + T1 mg/kg Fw M10 mg/kg (Q2W)EXPERIMENTALParticipants in second-line therapy with metastatic or recurrent gastric or GEJ adenocarcinoma will receive IV infusion of 20 mg/kg MEDI4736 Q4W for 4 months (up to 4 doses) in combination with IV 1 mg/kg tremelimumab Q4W for 4 months (up to 4 doses in total). Thereafter, participants will receive MEDI4736 monotherapy (10 mg/kg) every 2 weeks (Q2W) to complete a total of 12 months of therapy (up to 18 additional doses).
Phase 2 Arm B-M10 mg/kg (Q2W)EXPERIMENTALParticipants in second-line therapy with metastatic or recurrent gastric or GEJ adenocarcinoma will receive IV infusion of 10 mg/kg MEDI4736 Q2W for 12 months (up to 26 doses).
Phase 2 Arm C-T10 mg/kg (Q4W)EXPERIMENTALParticipants in second-line therapy with metastatic or recurrent gastric or GEJ adenocarcinoma will receive IV infusion of 10 mg/kg tremelimumab Q4W for 7 doses and then Q12W for 2 doses for 12 months (for a total of up to 9 doses).
Phase 2 Arm D-M20 mg/kg (Q4W) + T1 mg/kg Fw M10 mg/kg (Q2W)EXPERIMENTALParticipants in third-line therapy with metastatic or recurrent gastric or GEJ adenocarcinoma will receive IV infusion of 20 mg/kg MEDI4736 Q4W for 4 months (up to 4 doses) in combination with IV 1 mg/kg tremelimumab Q4W for 4 months (up to 4 doses in total). Thereafter, participants will receive MEDI4736 monotherapy (10 mg/kg) every 2 weeks (Q2W) to complete a total of 12 months of therapy (up to 18 additional doses).
Phase 2 Arm E-M20 mg/kg (Q4W) + T1 mg/kg Fw M10 mg/kg (Q2W)EXPERIMENTALParticipants in second and third-line therapy with metastatic or recurrent gastric or GEJ adenocarcinoma and a positive IFN-γ gene expression signature will receive IV infusion of 20 mg/kg MEDI4736 Q4W for 4 months (up to 4 doses) in combination with IV 1 mg/kg tremelimumab Q4W for 4 months (up to 4 doses in total). Thereafter, participants will receive MEDI4736 monotherapy (10 mg/kg) every 2 weeks (Q2W) to complete a total of 12 months of therapy (up to 18 additional doses).
Cohort A1: Durvalumab (3 mg/kg) + Dabrafenib +TrametinibEXPERIMENTALParticipants will receive intravenous (IV) dose of 3 milligrams per kilogram (mg/kg) durvalumab every 2 weeks (Q2W) from Day 1 up to 12 months along with oral 150 mg dabrafenib capsule twice daily (BID) and oral 2 mg trametinib tablet once daily (QD) until confirmed disease progression (PD), initiation of alternate cancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue treatment. Post-durvalumab treatment period, participants who developed PD and meet the criteria for re-administration, will receive durvalumab 3 mg/kg up to an additional 12 months and continued the treatment of dabrafenib and trametinib.
Cohort A2: Durvalumab (10 mg/kg) + Dabrafenib +TrametinibEXPERIMENTALParticipants will receive IV dose of 10 mg/kg durvalumab Q2W from Day 1 up to 12 months along with oral doses of dabrafenib 150 mg capsule BID and trametinib 2 mg tablet QD until confirmed PD, initiation of alternate cancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue treatment. Post-durvalumab treatment period, participants who developed PD and meet the criteria for re-administration, will receive durvalumab 10 mg/kg up to an additional 12 months and continued the treatment of dabrafenib and trametinib.
Cohort B: Durvalumab (10 mg/kg) +Trametinib (Concurrent)EXPERIMENTALParticipants will receive concurrent doses of IV 10 mg/kg durvalumab Q2W from Day 1 up to 12 months along with oral dose of trametinib 2 mg tablet QD until confirmed PD, initiation of alternate cancer therapy, unacceptable toxicity, withdrawal of consent, or other reasons to discontinue treatment. Post-durvalumab treatment period, participants who developed PD and meet the criteria for re-administration, will receive durvalumab 10 mg/kg up to an additional 12 months and continued the treatment of trametinib.
Cohort C: Durvalumab (10 mg/kg) +Trametinib (Sequential)EXPERIMENTALParticipants will receive sequential doses of oral trametinib tablet 2 mg QD from Day 1 to Day 42 and IV durvalumab 10 mg/kg Q2W starting from Day 29 (Week 5) up to 12 months. Post-durvalumab treatment period, participants who developed PD and meet the criteria for re-administration, will receive durvalumab 10 mg/kg up to an additional 12 months.
Dose EscalationEXPERIMENTALMEDI4736 and tremelimumab received by intravenous infusion.
MEDI4736 Q2WEXPERIMENTALEvaluate MEDI4736 given every 2 weeks
MEDI4736 Q3WEXPERIMENTALEvaluate MEDI4736 given every 3 weeks
MEDI4736 Dose ExpansionEXPERIMENTALevaluate MEDI4736 given every 2 weeks
MEDI4736 Q4WEXPERIMENTALEvaluate MEDI4736 given every 4 weeks
MEDI4736 combined with another drugEXPERIMENTALevaluate MEDI4736 in combination with another drug given every 4 weeks
Escalation Cohort (MEDI4736 0.1 mg/kg Q2W)EXPERIMENTALParticipants will receive intravenous (IV) infusion of MEDI4736 (durvalumab) 0.1 mg/kg every 2 weeks (Q2W) in the dose-escalation phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Escalation Cohort (MEDI4736 0.3 mg/kg Q2W)EXPERIMENTALParticipants will receive IV infusion of MEDI4736 0.3 mg/kg Q2W in the dose-escalation phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Escalation Cohort (MEDI4736 1 mg/kg Q2W)EXPERIMENTALParticipants will receive IV infusion of MEDI4736 1 mg/kg Q2W in the dose-escalation phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Escalation Cohort (MEDI4736 3 mg/kg Q2W)EXPERIMENTALParticipants will receive IV infusion of MEDI4736 3 mg/kg Q2W in the dose-escalation phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Escalation Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-escalation phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Escalation Cohort (MEDI4736 15 mg/kg Q3W)EXPERIMENTALParticipants will receive IV infusion of MEDI4736 15 mg/kg every 3 weeks (Q3W) in the dose-escalation phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Exploration Durvalumab 20 mg/kg (Q4W)EXPERIMENTALParticipants will receive IV infusion of MEDI4736 20 mg/kg every 4 weeks (Q4W) in the dose-exploration phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion SCCHN Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with squamous cell carcinoma of the head and neck (SCCHN) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion Non-SCCHN Cohort HPV positive (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with non-SCCHN human papilloma virus positive (Non-SCCHN HPV+) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion NSCLC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with non-small-cell lung cancer (NSCLC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion HCC Total Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with hepatocellular carcinoma (HCC Total) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion ACM Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with advance cutaneous melanoma (ACM) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion UM Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with uveal melanoma (UM) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion GEC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with gastroesophageal cancer (GEC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion TNBC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with triple-negative breast cancer (TNBC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion PAC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with pancreatic adenocarcinoma (PAC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion UC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with urothelial carcinoma (UC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion GBM Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with glioblastoma multiforme (GBM) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose- expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion OC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with ovarian cancer (OC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion STS Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with soft- tissue sarcoma (STS) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion SCLC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with small-cell lung cancer (SCLC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion MSI-high Cancer Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with microsatellite instability (MSI)-high cancer will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose-expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Expansion NPC Cohort (MEDI4736 10 mg/kg Q2W)EXPERIMENTALParticipants with nasopharyngeal carcinoma (NPC) will receive IV infusion of MEDI4736 10 mg/kg Q2W in the dose- expansion phase for maximum of 12 months or until confirmed progressive disease, initiation of alternative cancer therapy, unacceptable toxicity, withdrawal of consent, or development of other reason for treatment discontinuation, whichever occurs first.
Radioiodine (RAI) in Combination with Durvalumab (Medi4736)EXPERIMENTALEnrolled patients will be treated with durvalumab 1500 mg IV every 4 weeks. In Cycle 1/Week 3, Thyrogen 0.9 mg IM will be administered on two consecutive calendar days followed by 100 mCi (+/- 10 mCi) of RAI the next calendar day. Durvalumab will be continued every 4 weeks.

Interventions

NameTypeDescription
FLOT ChemotherapyDRUGA combination treatment made up of flurouroacil + leucovorin + oxaliplatin + docetaxel
DurvalumabDRUGHuman monoclonal antibody
Durvalumab + Chemotherapy phaseDRUGDurvalumab (IV) with SoC (carboplatin + paclitaxel chemotherapy: patients should receive at least 4, but preferably 6 cycles) every three weeks.
Durvalumab + Olaparib phaseDRUGdurvalumab (IV) with olaparib (tablets) every four weeks until progression.
GemcitabineDRUGStandard of care chemotherapy by intravenous infusion
CisplatinDRUGStandard of care chemotherapy by intravenous infusion
Trastuzumab deruxtecanDRUGExperimental therapy by intravenous infusion
RilvegostomigDRUGExperimental therapy by intravenous infusion
Gemcitabine monotherapyDRUGGemcitabine monotherapy as background gemcitabine-based chemotherapy every 3 weeks (i.e., 8 cycles of durvalumab)
Gemcitabine + cisplatinDRUGGemcitabine plus cisplatin as background gemcitabine-based chemotherapy every 3 weeks (i.e., 8 cycles of durvalumab) for WHO/ECOG PS 2 participants only
Gemcitabine + oxaliplatinDRUGGemcitabine + oxaliplatin as background gemcitabine-based chemotherapy every 3 weeks (i.e., 8 cycles of durvalumab)
Gemcitabine + carboplatinDRUGGemcitabine + carboplatin as background gemcitabine-based chemotherapy every 3 weeks (i.e., 8 cycles of durvalumab)
Gemcitabine + cisplatin + S-1DRUGGemcitabine + cisplatin + S-1 as background gemcitabine-based chemotherapy every 2 weeks (i.e, 4 cycles of durvalumab)
Gemcitabine + S-1DRUGGemcitabine + S-1 as background gemcitabine-based chemotherapy every 3 weeks (i.e., 8 cycles of durvalumab)
Gemcitabine + cisplatin + albumin-bound paclitaxelDRUGGemcitabine + cisplatin + albumin-bound paclitaxel as background gemcitabine-based chemotherapy every 3 weeks (i.e., 8 cycles of durvalumab)
BCGBIOLOGICALParticipants will receive BCG via intravesical as induction weekly for 6 weeks starting at Week 1, Day 1 and subsequently for maintenance for 3 weekly doses up to 3, 6, 12, 18, and 24 months, at the physician's discretion as Standard of care.
TremelimumabDRUGParticipants will receive single dose of 300 mg through IV infusion at Day 1
DomvanalimabDRUGDomvanalimab IV (Intravenous infusion)
PlaceboOTHERPlacebo IV (Intravenous infusion)
OleclumabDRUGOleclumab IV (intravenous infusion)
MonalizumabDRUGMonalizumab IV (intravenous infusion)
CarboplatinDRUGParticipants will receive carboplatin via IV administration Day 1 of each cycle.
EtoposideDRUGParticipants will receive etoposide via IV administration on days 1 to 3 of each cycle.
PemetrexedDRUG500mg/m2 on Day 1 of every 21-day cycle
PaclitaxelDRUG175mg/m2 on Day 1 of every 21-day cycle
AVENIO ctDNA Surveillance KitDEVICERoche Sequencing and Life Science kit to detect minimal residue disease (MRD)
Enfortumab VedotinDRUGNectin-4-directed antibody and microtubule inhibitor conjugate
Radical CystectomyPROCEDUREFor cisplatin-ineligible or cisplatin-refusal patients
Standard ChemotherapyDRUGCisplatin 75 mg/m² or Carboplatin AUC 5 IV every 3 weeks + Pemetrexed 500 mg/m² IV every 3 weeks) for 4 to 6 cycles, followed by Observation
Ipilimumab and NivolumabDRUGIpilimumab 1 mg/kg every 6 weeks and Nivolumab 360 mg every 3 weeks or 3 mg/kg every 2 weeks for up to 2 years
Durvalumab plus chemotherapyDRUGDrug: Durvalumab IV infusions every 3 weeks for 4-6 cycles and every 4 weeks thereafter until PD or other discontinuation criteria. Drug: Carboplatin 4-6 cycles every 3 weeks Drug: Cisplatin 4-6 cycles every 3 weeks Drug: Etoposide 4-6 cycles every 3 weeks
cisplatin + fluorouracilDRUGcisplatin + fluorouracil, as per Standard of Care
cisplatin + capecitabineDRUGcisplatin + capecitabine, as per Standard of Care
RadiationRADIATION50-64Gy in total
Durvalumab + SoC chemotherapyDRUGExperimental Treatment
Placebo + SoC chemotherapyOTHERPlacebo Comparator
BevacizumabDRUGBevacizumab IV (intravenous)
(Osimertinib cohort, single-arm, open-label separate cohort)DRUGOsimertinib 80 mg every day \[qd\] orally for up to 36 months or until progression or other discontinuation criteria are met. Osimertinib treatment should start from 7 to 14 days after completion of SBRT
external beam radiation therapy (EBRT) + brachytherapyRADIATIONRadiation therapy per standard of care
OlaparibDRUGOlaparib tablets
Placebo olaparibDRUGPlacebo tablets to match olaparib
Durvalumab placeboDRUGMatching placebo for intravenous infusion
Carboplatin+PaclitaxelDRUGStandard of care chemotherapy
SurgeryPROCEDUREExpected within 40 days from the last dose of Investigational Product following the completion of neoadjuvant treatment.
Transarterial Chemoembolization (TACE)PROCEDURETACE (chemo and embolic agent injection into the hepatic artery)
Cisplatin + GemcitabineDRUGCisplatin IV (intravenous)+ Gemcitabine IV(intravenous), as standard of care.
Carboplatin + GemcitabineDRUGCarboplatin IV (intravenous)+ Gemcitabine IV(intravenous), as standard of care.
Durvalumab (MEDI4736)BIOLOGICALInvestigational product
Bacillus Calmette-Guerin (BCG)BIOLOGICALStandard of care
Cisplatin/ EtoposideDRUGCisplatin/ Etoposide, as per standard of care
Carboplatin/ PaclitaxelDRUGCarboplatin /Paclitaxel, as per standard of care
Pemetrexed/ CisplatinDRUGPemetrexed / Cisplatin, as per standard of care
Pemetrexed/ CarboplatinDRUGPemetrexed / Carboplatin , as per standard of care
Tremelimumab (Regimen 1)DRUGTremelimumab IV (intravenous infusion).
Tremelimumab (Regimen 2)DRUGTremelimumab IV (intravenous infusion).
SorafenibDRUGSorafenib, as per standard of care
Durvalumab (Regimen 1)DRUGDurvalumab IV (intravenous infusion).
Durvalumab (Regimen 2)DRUGDurvalumab IV (intravenous infusion).
MEDI4736 (Durvalumab)BIOLOGICALA human monoclonal antibody (mAb) of the immunoglobulin G (IgG) 1 kappa subclass that blocks the interaction of PD-L1 (but not programmed cell death ligand-2) with PD-1 on T cells and CD80 (B7.1) on immune cells (IC).
MEDI4736 (Durvalumab) + TremelimumabBIOLOGICALDurvalumab: A human mAb of IgG 1 kappa subclass that blocks the interaction of PD-L1 (but not programmed cell death ligand-2) with PD-1 on T cells and CD80 (B7.1) on IC. Tremelimumab: A human Ig G2 mAb that completely blocks the interaction of human CTLA-4 (cluster of differentiation \[CD\]152) with CD80 and CD86 and increase release of cytokines (interleukin \[IL\]-2 and interferon \[IFN\]-γ) from human T cells, peripheral blood mononuclear cells and whole blood.
Abraxane + carboplatinDRUGStandard of care chemotherapy (squamous and non-squamous patients): Abraxane 100 mg/m2 on Days 1, 8, and 15 of each 21-day cycle. Carboplatin Area under the plasma drug concentration-time curve (AUC) 5 or 6 via IV infusion on Day 1 of each 21-day cycle for 4 to 6 cycles (ie, 4 cycles for Treatment Arms 1 and 2 and 4 to 6 cycles for Treatment Arm 3).
Pemetrexed + carboplatinDRUGStandard of care chemotherapy (non-squamous patients only): Pemetrexed 500 mg/m2 and carboplatin AUC 5 or 6 via IV infusion on Day 1 of each 21-day cycle for 4 to 6 cycles (ie, 4 cycles for Treatment Arms 1 and 2 and 4 to 6 cycles for Treatment Arm 3); then continue pemetrexed 500 mg/m2 maintenance \[i.e., q4w for Treatment Arms 1 and 2. For Treatment Arm 3, Pemetrexed maintenance therapy can be given either q3w or q4w (dependent on Investigator decision and local standards)\] until objective disease progression.
Pemetrexed + cisplatinDRUGStandard of care chemotherapy (non-squamous patients only): Pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 via IV infusion on Day 1 of each 21-day cycle, for 4 to 6 cycles (ie, 4 cycles for Treatment Arms 1 and 2 and 4 to 6 cycles for Treatment Arm 3); then continue pemetrexed 500 mg/m2 maintenance \[i.e., q4w for Treatment Arms 1 and 2. For Treatment Arm 3, Pemetrexed maintenance therapy can be given either q3w or q4w (dependent on Investigator decision and local standards)\] until objective disease progression.
Paclitaxel + carboplatinDRUGChemotherapy Agents
Durvalumab +TremelimumabBIOLOGICAL -
MEDI4736BIOLOGICALAnti-PD-L1 antibody
MEDI4736+TremelimumabBIOLOGICAL -
CetuximabBIOLOGICALMonoclonal Antibody
5-fluorouracil (5FU)DRUGChemotherapy Agent
MEDI4736 + TremelimumabDRUGMEDI4736 + Tremelimumab combination therapy
Standard of CareDRUGStandard of Care
MEDI4736 (Durvalumab)+TremelimumabBIOLOGICAL -
RadiotherapyPROCEDURE -
VinorelbineDRUGVinorelbine by intravenous infusion. Administered at a dose of 30 mg/m2 iv on Days 1, 8, 15 and 22 of a 28-day cycle.
ErlotinibDRUGErlotinib administered at a dose of 150 mg once daily as a tablet for oral administration
MEDI4736 (durvalumab) in combination with tremelimumab (anti-CTLA4)DRUGMEDI4736 (durvalumab) in combination with tremelimumab (anti-CTLA4) treatment by intravenous infusion
tremelimumab (anti-CTLA4)DRUGtremelimumab (anti-CTLA4) treatment by intravenous infusion
MEDI4736 (Anti PD-L1)DRUGMEDI4736 1.5g total i.v. every 4 weeks As monotherapy for the first two weeks (0.75g absolute) (part 1) followed by: MEDI4736 in combination with nab-paclitaxel 125 mg/m² every week for 12 weeks (part 2) followed by MEDI4736 in combination with epirubicin 90mg/m² plus cyclophosphamide 600 mg/m² every 2 weeks for 4 cycles (part 3).
nab-PaclitaxelDRUGnab-Paclitaxel 125 mg/m² weekly for 12 weeks
EpirubicinDRUGEpirubicin 90 mg/m² 2-weekly for 8 weeks
CyclophosphamideDRUGCyclophosphamide 600 mg/m² 2-weekly for 8 weeks
STRIDE (durvalumab + tremelimumab)DRUGAs first treatment
LenvatinibDRUGDaily
CeralasertibDRUGCeralasertib
MethotrexateDRUGChemotherapy agent.
VinblastineDRUGChemotherapy agent
DoxorubicinDRUGChemotherapy agent
ID-RFAPROCEDUREendoscopic intraductal RFA
PembrolizumabDRUGParticipants will receive IV pembrolizumab q3w for four 21-days cycles as induction treatment. Pembrolizumab will also be given in the maintenance treatment phase q3w until clinical progression or confirmed RECIST 1.1- defined radiological progression as assessed by the investigator, unacceptable toxicity, withdrawal of participant consent, or EOS, whichever comes first.
Transarterial Radioembolization (TARE)PROCEDUREYttrium 90 glass microspheres will be administered
Dato-DXdDRUGParticipants will receive datopotamab deruxtecan (Dato-DXd) via intravenous route.
AZD0171DRUGParticipants will receive AZD0171 via intravenous route.
Pemetrexed/CisplatinDRUGPemetrexed/Cisplatin as chemotherapy
Pemetrexed/CarboplatinDRUGPemetrexed/Carboplatin as chemotherapy
Carboplatin/PaclitaxelDRUGCarboplatin/Paclitaxel, as chemotherapy
VolrustomigDRUGParticipants will receive Volrustomig via intravenous route.
Hypofractionated Radiation TherapyRADIATIONUndergo hypofractionated RT
AZD2811DRUGIV infusions through maintenance phase until PD or other discontinuation criteria.
Fluorouracil (5-FU)DRUG5-FU: administered as an IV infusion
CapecitabineDRUGCapecitabine: administered orally
OxaliplatinDRUGOxaliplatin: administered as an IV infusion
TrastuzumabBIOLOGICALTrastuzumab: administered as an IV infusion
Durvalumab 50 MG/MLDRUGCombination of Durvalumab (fixed dose of 1500 mg) and Tremelimumab (fixed dose of 75 mg) will be given 2 weeks before surgery. Minimally invasive surgical microwave ablation (MIS-MWA) of the pancreatic tumor will be performed two weeks after the first dose of Durvalumab and Tremelimumab After 4 doses of Durvalumab and Tremelimumab, only Durvalumab 1500mg is provided q4w until disease progression. Systemic gemcitabine will be started 6 weeks after MIS-MWA. Gemcitabine will be given at a dose of 1000 mg /m² body surface, once a week for 3 weeks, followed with a week of rest.
Minimally Invasive Surgical Microwave Ablation (MIS-MWA)PROCEDUREMinimally invasive surgical microwave ablation (MIS-MWA) of the pancreatic tumor will be performed two weeks after the first dose of Durvalumab and Tremelimumab
PrednisoneDRUG0.5mg/kg; PO, Daily cycles 1 \& 2
Stereotactic body radiation therapy (SBRT)RADIATIONSBRT of all oligo-metastatic lesions
Surgical resection - definitive local treatment.PROCEDURESurgical resection of primary tumour for patients with single station, non-bulky tumours.
Radical radiotherapy - definitive local treatment.RADIATIONConventional or moderately hypo-fractionated radiotherapy to the primary tumour for other tumour stages, or in case of medical inoperability.
Stereotactic Body RadiotherapyRADIATIONPre-operative radiation therapy (boost dose) 3x8 Gy on the primary tumour at week 5 given in 3 fractions. The 3 fractions will be spread at the minimum over 3 days and at the maximum over 6 days.
DanvatirsenCOMBINATION_PRODUCTDanvatirsen 200 mg IV will be administered on Days 1, 3, and 5 of Week 0 (7-day danvatirsen lead-in period) and later every week (on Week 1 Day 1, Week 2 Day 1, Week 3 Day 1, and Week 4 Day 1) until disease progression, unacceptable toxicity, or other reason of treatment discontinuation over a 28-day treatment period.
Placebo for OlaparibDRUGMatching tablet
Nab-paclitaxel+carboplatinDRUGStandard of Care chemotherapy (squamous and non-squamous patients)
Gemcitabine+carboplatinDRUGStandard of Care chemotherapy (squamous patients only)
Pemetrexed+carboplatinDRUGStandard of Care chemotherapy (non-squamous patients only)
Gemcitabine+cisplatinDRUGStandard of Care chemotherapy (squamous patients only)
Pemetrexed+cisplatinDRUGStandard of Care chemotherapy (non-squamous patients only)
Durvalumab + OleclumabDRUGDurvalumab + Oleclumab
Durvalumab + MonalizumabDRUGDurvalumab + Monalizumab
VistusertibDRUGParticipants will receive oral tablets of vistusertib as stated in arm description.
CediranibDRUGParticipants will receive oral tablets of cediranib as stated in arm description.
Durvalumab and TremelimumabBIOLOGICALimmun checkpoint inhibitor
Laboratory Biomarker AnalysisOTHERCorrelative studies
Radiotherapy (RT)RADIATIONRadiotherapy (RT) will be performed using external beam ionizing radiation as standard therapy in accordance with institutional standard practice.
ablationPROCEDUREAblation will be performed percutaneously under image guidance as standard therapy at the discretion of the interventional radiologist in accordance with institutional standard practice.
Durvalumab plus SBRTOTHERIntravenously plus radiotherapy
AZD1775 and carboplatin (CBPT)DRUGAZD1775 twice daily (oral) for 2.5 days from Day 1 + CBDP area under the curve 5 (Day1) (IV); every 3 weeks.
AZD6738 and olaparibDRUGAZD6738 once a day (oral) for 7 days from Day 1 + olaparib twice a day(oral) for 28 days from Day 1, every 4 weeks
MEDI4736 monotherapyDRUGMEDI4736 via IV infusion.
tremelimumab+MEDI4736DRUGtremelimumab+MEDI4736 via IV infusion.
Radiotherapy (cohort 6 only)RADIATIONCohort 6 patients (only) will receive: Day 8-Day 10: External Beam Radiotherapy to target site(s)- daily (ie. 5 further fractions to a total of 10 fractions)
AcalabrutinibDRUGPatients will take acalabrutinib orally every 12 hours (+/- 3 hours) daily.
Standard of Care TherapyPROCEDUREPatients will proceed to surgical resection 3-6 weeks after radiation as recommended by the ENT surgeon.
RomidepsinDRUGPowder and solvent for solution for infusion; Intravenous use
AzacitidineDRUGPowder for suspension for injection; Subcutaneous use
Lenalidomide capsuleDRUGHard capsule for oral use
SC durvalumab + rHuDRUGDurvalumab + rHu will be administered subcutaneously.
IV durvalumabDRUGDurvalumab will be administered intravenously.
Stereotactic Ablative Body Radiotherapy (SABR)RADIATIONSABR delivered as 6.6 Gy/fraction x 5 fractions given within two weeks will be administered weekdays and will begin D8.
FOLFOXDRUGParticipants will receive IV infusion of FOLFOX (5-FU, oxaliplatin, and folinic acid) as stated in arm description.
Durvalumab / Tremelimumab Combination TherapyDRUGStarting dose: durvalumab: 20mg/kg tremelimumab: 1mg/kg at cycles 2 to 5 only co-administered with durvalumab. The Recommended Phase 2 dose will be used for the dose expansion phase.
MEDI9447DRUGPatients will be randomized between chemotherapy (paclitaxel and carboplatin) with immunotherapy including durvalumab with or without oleclumab (1:1 ratio).
MEDI5752DRUGMEDI5752 IV Every 3 weeks (q3w)
AZD2936DRUGAZD2936 IV
CapivasertibDRUGCapivasertib oral bid 4-week cycles; 3 weeks on (dosing on days 2,3,4 and 5) and 1 week off
Datopotamab deruxtecanDRUGDatopotamab deruxtecan iv 3-week cycles (once weekly) q3w
Cisplatin (dose level 4)DRUGIV
Cisplatin (dose level 3)DRUGIV
Carboplatin (dose level 1)DRUGIV
Carboplatin (dose level 2)DRUGIV
Etoposide (dose level 1)DRUGIV
Etoposide (dose level 2)DRUGIV
External beam radiation (dose level 1)RADIATIONradiation therapy
External beam radiation (dose level 2)RADIATIONradiation therapy
External beam radiation (hyperfractionated)RADIATIONradiation therapy
Cisplatin (dose level 1)DRUGIV
Cisplatin (dose level 2)DRUGIV
External beam radiation (standard)RADIATIONradiation therapy
Durvalumab (Cohort 1-3)DRUGDurvalumab 1120 mg intravenously Day 1 every 21 days x 8 cycles.
External Beam Radiotherapy (EBRT)RADIATIONEBRT 6 Gy x 3; Cycle 1 Day 1, 3, and 5
Bacillus Calmette-Guérin (BCG)BIOLOGICALDose level 0 (starting dose) = Full-dose Dose level-1 = 1/3rd-dose BCG. Dose level -1 is expected to be utilized during the phase II portion of the study due to the ongoing and persistent shortage of BCG in the US.
DocetaxelDRUGDocetaxel 37.5 mg intravesical weekly (+/- 2 days) x 6 doses.
Durvalumab (Cohort 4/5)DRUGDurvalumab 1500 mg intravenously Day 1 (+/- 2 days) every 28 days x 6 cycles.
To be determinedOTHEROther regimens to be determined
Intravesical NAI (Cohorts 6-7)DRUGFor all cohorts containing intravesical NAI treatment, starting in Week 1, induction intravesical NAI 400 ug will be administered weekly x 6 doses via a foley catheter into an empty bladder and maintained in the bladder for 60 minutes.
Subcutaneous NAI (Cohort 8)DRUGFor all cohorts containing subcutaneous NAI treatment, starting in Week 1, NAI 10 ug/kg will be administered biweekly for 3 doses via subcutaneous injection.
Durvalumab, Tremelimumab and ,FOLFOXDRUGStudy will be performed in 2 step: STEP 1 (phase Ib) will assess the safety of the combination of Durvalumab 750mg q2w + tremelimumab 75mg q4w + FOLFOX during the 2 first cycles of treatment (1 month) STEP 2 (phase II) will assess the efficacy of the combination of Durvalumab 750mg q2w + tremelimumab 75mg q4w + FOLFOX
tremelimumab + durvalumabDRUG20 mg/kg durvalumab (MEDI4736) via IV infusion q4w and 1 mg/kg tremelimumab via IV infusion q4w for up to 4 doses/cycles, and then continue 20 mg/kg durvalumab (MEDI4736) q4w starting on Week 16 for up to confirmed disease progression
carboplatin AUC 2/paclitaxelDRUG -
External beam radiation (EBRT)RADIATIONRadiation will be delivered starting on a Monday or Tuesday between Days 29-30, based on the first induction durvalumab dose administered on Day 1. Patients will be treated 5 days/week at 1.80 Gy/day, to a total planned dose of 41Gy in 23 fractions. Induction Day 15 has a -1/+2 day window, and Day 29 has a -1/+1 day window.
esophagogastrectomyPROCEDUREPatients undergo surgical resection 6-10 weeks after the completion of chemoradiation.
PVX-410BIOLOGICALThis is a Vaccine that will be injected intramuscularly as a mixture with an adjuvant.
HiltonolDRUGThis is an intramuscular injection of an adjuvant to enhance the immune response to vaccine.
AZD9150DRUGAZD9150 is an antisense oligonucleotide (ASO) administered via intravenous infusion
carboplatin + etoposideDRUGIV infusion
nab-paclitaxel (paclitaxel-albumin) + carboplatinDRUGIV infusion
oxaliplatin + 5-fluorouracil (5FU) + leucovorin (calcium folinate/folinic acid)DRUGIV infusion and bolus administration
nab-paclitaxel (paclitaxel-albumin) + gemcitabineDRUGIV infusion
cisplatin + 5-fluorouracil (5FU)DRUGIV infusion
MEDI4736 in combination with nab-paclitaxel and gemcitabineDRUGMEDI4736 in combination with nab-paclitaxel + gemcitabine chemotherapy regimen via IV infusion
MEDI4736 in combination with AZD5069DRUGMEDI4736 via IV infusion and oral AZD5069
DabrafenibDRUGOral dose of 150 mg dabrafenib capsule.
TrametinibDRUGOral dose of 2 mg trametinib tablet.
Radioiodine (RAI)RADIATION100 mCi (+/- 10 mCi) of 131I will be administered a day after Thyrogen injections have been administered for two consecutive calendar days.
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Eligibility Criteria

Age Range18 Years to N/A
SexALL
Healthy VolunteersNo

Inclusion Criteria: * 1\. Capable of giving signed informed consent. 2. Male and/or Female, Age ≥ 18 years at the time of screening. 3. Histologically documented gastric or gastroesophageal junction adenocarcinoma with resectable disease, GEJC includes Siewert\* type 2 and 3 tumour and Siewert\* ty...

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Frequently asked questions about MEDI4736

What is MEDI4736?

MEDI4736 is an investigational monoclonal antibody being developed by AstraZeneca PLC (ticker AZN) for the treatment of advanced solid malignancies, breast cancer, and other solid tumors. It is also known as durvalumab and is currently in Phase 3 clinical development.

What is MEDI4736 used for?

MEDI4736 is being studied in advanced solid malignancies, advanced solid tumors, breast cancer, diffuse large B-cell lymphoma, gastric or gastroesophageal junction adenocarcinoma, and metastatic pancreatic ductal adenocarcinoma. It is not yet approved for any indication and remains an investigational therapy in clinical trials.

Who is developing MEDI4736?

MEDI4736 is being developed by AstraZeneca PLC, which trades under the ticker AZN. The company is the sponsor of the clinical trials evaluating the drug across multiple cancer types.

What phase is MEDI4736 in?

MEDI4736 is in Phase 3 clinical development. It has not been approved by the FDA or any regulatory agency for commercial use and is considered an investigational agent. The Phase 3 program includes a completed study in advanced solid malignancies.

What clinical trials is MEDI4736 in?

MEDI4736 has been evaluated in several trials, including NCT03084471, a completed Phase 3 study in advanced solid malignancies; NCT03616886, an active Phase 1 trial in triple negative breast cancer; NCT02685059, a completed Phase 2 trial in breast cancer; and NCT02583477, a completed Phase 1 trial in metastatic pancreatic ductal adenocarcinoma.

Is MEDI4736 the same as durvalumab?

Yes, MEDI4736 is the same as durvalumab. The names are used interchangeably in the scientific literature and clinical trial records. Other variations include MEDI4736 monotherapy and MEDI4736 in combination with other agents such as tremelimumab, nab-paclitaxel, and gemcitabine.