Moffitt Cancer Center: Clinical Trial 19940

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Clinical Trial 19940

Cancer Type: Thoracic
Interventions:BMS-936558 (Nivolumab); Ipilimumab; Nivolumab; Plinabulin; Yervoy (Ipilimumab)

Study Type: Treatment
Phase of Study: Phase I/II
Investigators:

Alberto Chiappori

Call 813-745-6100
or 1-800-679-0775

Overview

Study Title

A Phase I/II Study of Nivolumab, Ipilimumab and Plinabulin in Patients with Recurrent Small Cell Lung Cancer: Big Ten Cancer Research Consortium BTCRC-LUN17-127

Summary

Objective

Primary Phase I: The primary objective of the Phase I dose escalation study is to establish the maximum tolerated dose (MTD) of plinabulin in combination with nivolumab and ipilimumab for patients with recurrent SCLC. Primary Phase II: The primary objective of the Phase II, 2-arm randomized study is to determine if the addition of plinabulin to double checkpoint inhibition (PD-1 and CTLA-4) for recurrent SCLC will improve progression-free survival (PFS, the time from treatment assignment to the date of the first documented tumor progression, or death due to any cause, whichever occurred first). Secondary: To assess toxicity and tolerability of the combination of nivolumab, ipilimumab and plinabulin. To compare the frequency of immune-related adverse events (irAEs) between the nivolumab/ipilimumab arm vs the nivolumab/ipilimumab/plinabulin arm. To determine the proportion of patients with a confirmed objective response in the 2 arms of the Phase II part (defined as the number of patients with a best overall response of complete response or partial response divided by the number of assigned patients). To estimate clinical benefit rate (CBR: complete response, partial response, or stable disease). To estimate 6-month (± 4 weeks) PFS. To estimate overall survival (OS) and 1-year OS. Exploratory: To compare biomarkers of inflammation (high sensitivity C-reactive protein [hsCRP], erythrocyte sedimentation rate [ESR], serum amyloid A [SAA]) between the nivolumab/ipilimumab arm vs the nivolumab/ipilimumab/plinabulin arm. To correlate tumor mutational burden with PFS and ORR.

Inclusion Criteria

Males and females 18 years or older at time of consent.

Histological or cytological confirmed extensive-stage SCLC with availability of representative baseline tumor tissue (10 slides; archived or on-study biopsy). If patient already has FoundationOne testing results, baseline tumor tissue is not required to meet eligibility.

Patients who progressed after at least 1 platinum-based chemotherapy regimen. Patients with platinum resistance (defined as recurrence or progression of disease within 90 days of completion of the platinum-based regimen) are eligible.

Measurable disease according to RECIST v1.1 obtained by imaging within 28 days prior to study registration.

Treatment to be initiated at least 2 weeks since last dose of prior systemic anticancer therapy (chemotherapy, radiation, and/or surgery).

Recovery to grade 1 of any clinically significant toxicity (excluding alopecia) prior to initiation of study drugs.

Female patients of childbearing potential have a negative pregnancy test at baseline. Women of childbearing potential must have a negative urine pregnancy test (positive urine tests are to be confirmed by serum test) documented within 14 days of study registration and within the 24-hour period prior to the first dose of study drug.

Sexually active women of childbearing potential enrolled in the study must agree to use 2 forms of accepted methods of contraception during the course of the study and for 23 weeks after their last dose of study drug.

Male patients who are sexually active and who are partners of premenopausal women: agreement to use 2 forms of contraception as noted above during the treatment period and for 31 weeks after the last dose of study drug.

Absolute neutrophil count ≥1,000/µL

Platelet count ≥100,000/µL

Hemoglobin ≥9.0 g/dL

Total bilirubin ≤1.5 x upper limit of normal (ULN) or ≤3 x ULN for subjects with Gilbert's disease

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3.0 x ULN (≤5 x ULN if evidence of hepatic involvement by malignant disease)

Creatinine ≤ 1.5 x ULN or estimated glomerular filtration rate (eGFR) ≥40 mL/min/1.73m2

Lipase and Amylase ≤1.5 x ULN. Subjects with Lipase >1.5 x ULN may enroll if there are neither clinical nor radiographic signs of a pancreatitis.

Exclusion Criteria

Active interstitial lung disease (ILD) or pneumonitis or a history of ILD or pneumonitis requiring treatment with steroids

Pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 23 weeks (female) or 31 weeks (male) after the last dose of study drug.

Must not have received PD-1, PD-L1 or CTLA-4 targeted therapy previously

Treatment with any investigational agent within 28 days prior to registration for protocol therapy.

Known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Patients with neurological symptoms must undergo a head computed tomography (CT) scan or brain magnetic resonance imaging (MRI) to exclude brain metastasis. Patients whose brain metastases have been treated may participate provided they show radiographic stability (defined as 2 brain images obtained after treatment to the brain metastases at least 4 weeks apart and show no evidence of intracranial progression)

Known history of human immunodeficiency virus (HIV) or active hepatitis B (by surface antigen expression or polymerase chain reaction [PCR]) or active hepatitis C (by PCR) infection.

Diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to study registration.

Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs) or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. Vitiligo, alopecia, hypothyroidism only requiring hormone replacement, psoriasis not requiring systemic treatment, celiac disease controlled by diet alone or conditions not expected to recur in the absence of an external trigger are permitted.

A condition requiring systemic treatment with corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days prior to administration of study drugs.

History of psychiatric illness or social situations that would limit compliance with study requirements. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating investigator.

Prior malignancies (except non-melanoma skin cancers, and the following in situ cancers: bladder, gastric, colon, endometrial, cervical/dysplasia, melanoma, or breast) unless a complete remission was achieved at least 2 years prior to study entry.

Documented history of a cerebral vascular event (stroke or transient ischemic attack), unstable angina, myocardial infarction, or cardiac symptoms consistent with New York Heart Association (NYHA) Class III-IV within 6 months prior to their first dose of study drugs.

Evidence of ongoing inadequately controlled hypertension (defined as baseline systolic blood pressure >160 mmHg or diastolic blood pressure >100 mmHg).

Any active grade 3 or higher viral, bacterial, or fungal infection within 2 weeks of the first dose of the study drugs. Routine antimicrobial prophylaxis is permitted.