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A Phase 2 Study of XL184 (Cabozantinib) in Combination with Nivolumab and Ipilimumab for the Treatment of Poorly Differentiated Neuroendocrine Carcinomas
This phase II trial studies how well the combination of XL184 (cabozantinib), nivolumab, and ipilimumab work in treating patients with poorly differentiated neuroendocrine tumors (i.e., neuroendocrine tumor that does not look like the normal tissue it arose from). Cabozantinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab and ipilimumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving cabozantinib, nivolumab and ipilimumab may shrink the cancer.
Primary Objectives To evaluate the overall response rate (ORR) associated with the combination of XL184 (cabozantinib), nivolumab, and ipilimumab in patients with advanced poorly differentiated neuroendocrine carcinomas (NECs), after the failure of at least one line of prior therapy. Secondary Objectives - To evaluate progression-free survival (PFS). - To measure the safety and tolerability of the combination of XL184 (cabozantinib), nivolumab, and ipilimumab in patients with advanced, poorly differentiated NECs. - To evaluate disease control rate (DCR). - To measure duration of response (DOR). - To describe the tumor molecular profile using whole exome sequencing (WES) and correlate it with treatment outcome. - To describe the tumor molecular profile using RNA sequencing (RNAseq) and correlate it with treatment outcome. Exploratory Objectives - To measure the tumor-infiltrating CD8+ T lymphocytes in pre- and on-treatment biopsies. - To measure tumor-infiltrating myeloid derived suppressor cells (MDSCs) in pre- and on treatment biopsies. - To measure tumor-infiltrating tumor-associated macrophages (TAM) in the pre and on treatment biopsies. - To measure the expression of programmed death-ligand 1 (PD-L1) in tumor cells and infiltrating immune cells.
BMS-936558 (Nivolumab); Cabozantinib (XL 184); Ipilimumab (); Nivolumab (Opdivo); Yervoy (Ipilimumab)