A Phase IB/II Study of Nivolumab In Combination With ALT-803 In Patients With Pretreated, Advanced, or Metastatic Non-Small Cell Lung Cancer
Overview
- Phase
- Phase 1
- Intervention
- Nivolumab
- Conditions
- Non-small Cell Lung Cancer
- Sponsor
- Medical University of South Carolina
- Enrollment
- 67
- Locations
- 4
- Primary Endpoint
- Presence or Absence of a Dose Limiting Toxicity (DLT) of ALT-803 in Combination With Nivolumab
- Status
- Completed
- Last Updated
- 2 months ago
Overview
Brief Summary
The purpose of the study is to define the safety and tolerability of this drug combination. The study will also define the response rate of patients with advanced and unresectable NSCLC.
Detailed Description
This study has a dose escalation (Ib) and dose expansion phase (II). The ALT-803 treatment in the Phase Ib portion of the study will escalate until a recommended dose level is decided. This dose level will be used in the phase II portion of the study. The Phase II potion of the study will include two groups: Nivolumab naive and Nivolumab progressing. Patients will be enrolled to one of the arms based on their previous treatment with Nivolumab.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Histologically or cytologically confirmed diagnosis of NSCLC who present with Stage IIIB/Stage IV disease (according to version 7 of the International Association for the Study of Lung Cancer Staging Manual in Thoracic Oncology) or recurrent disease following radiation therapy or surgical resection.
- •Patient must be eligible for treatment with nivolumab. Patients previously treated with nivolumab, pembrolizumab or atezolizumab, and who have progressed are eligible.
- •Patients with targetable with EGFR or ALK mutations are eligible after disease recurrence or progression after at least one targeted therapy for advanced or metastatic disease.
- •Measurable disease as defined by RECIST 1.1 criteria.
- •Age ≥ 18 years
- •Performance status: ECOG performance status of ≤1 (Appendix A)
- •Adequate organ system function within 14 days of registration:
- •ANC ≥ 750/μL (≥0.75 X 109/L) PLT ≥ 100,000/μL (≥ 30 X 109/L) HGB \> 8g/dL Total bilirubin \< 2.0 x ULN AST \< 3.0 X ULN ALT \< 3.0 X ULN eGFR\* \> 45mL/min
- •\*using Cockcroft \& Gault equation (see Appendix B)
- •Negative serum pregnancy test if WOCBP (non-childbearing is defined as greater than one year postmenopausal or surgically sterilized).
Exclusion Criteria
- •While prior therapy with nivolumab, pembrolizumab, or atezolizumab is allowed, any prior therapy with other anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-CTLA-4 antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways) is not allowed.
- •NYHA Class III or IV heart failure (Appendix C), uncontrollable supraventricular arrhythmias, any history of a ventricular arrhythmia, or other clinical signs of severe cardiac dysfunction.
- •Symptomatic congestive heart failure, unstable angina pectoris, or myocardial infarction within 6 months of registration.
- •Marked baseline prolongation of QT/QTc interval (e.g. demonstration of a QTc interval greater than 500 milliseconds).
- •Patients with CNS metastases with the following exceptions: Patient untreated CNS metastases with 5 or fewer sites of disease, with no single site larger than 20mm, are eligible if they are asymptomatic and not requiring steroids at any dose. Patients with asymptomatic CNS metastases may be treated with radiosurgery before or during therapy on trial without treatment delays. Patients with treated, symptomatic CNS metastases are eligible if they are neurologically returned to baseline (except for residual signs or symptoms related to the CNS treatment) for at least 2 weeks prior to registration AND either off corticosteroids, or on a stable or decreasing dose of ≤ 10 mg daily prednisone (or equivalent).
- •Known autoimmune disease requiring active treatment. Subjects with a condition requiring systemic treatment with either corticosteroids (\>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of registration are excluded. Inhaled or topical steroids, and adrenal replacement steroid doses \< 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.
- •Subjects with a history of interstitial lung disease and/or pneumonitis.
- •Known HIV-positive.
- •Active systemic infection requiring parenteral antibiotic therapy. All prior infections must have resolved following optimal therapy.
- •Positive hepatitis C serology or active hepatitis B infection. Chronic asymptomatic viral hepatitis is allowed.
Arms & Interventions
Cohort 2: ALT-803 10 µg/kg + Nivolumab 3 mg/kg
Participants receive ALT-803 10 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: Nivolumab
Cohort 1: ALT-803 6 µg/kg + Nivolumab 3 mg/kg
Participants receive ALT-803 6 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: ALT-803
Cohort 1: ALT-803 6 µg/kg + Nivolumab 3 mg/kg
Participants receive ALT-803 6 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: Nivolumab
Cohort 2: ALT-803 10 µg/kg + Nivolumab 3 mg/kg
Participants receive ALT-803 10 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: ALT-803
Cohort 3: ALT-803 15 µg/kg + Nivolumab 3 mg/kg
Participants receive ALT-803 15 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: ALT-803
Cohort 3: ALT-803 15 µg/kg + Nivolumab 3 mg/kg
Participants receive ALT-803 15 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: Nivolumab
Cohort 4: ALT-803 20 µg/kg + Nivolumab 3 mg/kg (RP2D)
Participants receive ALT-803 20 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: ALT-803
Cohort 4: ALT-803 20 µg/kg + Nivolumab 3 mg/kg (RP2D)
Participants receive ALT-803 20 µg/kg + Nivolumab 3 mg/kg IV per protocol
Intervention: Nivolumab
Arm A: RP2D ALT-803 + Nivolumab (Nivo-naïve)
Participants receive ALT-803 20 µg/kg + Nivolumab 3 mg/kg IV; Nivolumab-naïve population
Intervention: ALT-803
Arm A: RP2D ALT-803 + Nivolumab (Nivo-naïve)
Participants receive ALT-803 20 µg/kg + Nivolumab 3 mg/kg IV; Nivolumab-naïve population
Intervention: Nivolumab
Arm B: RP2D ALT-803 + Nivolumab (Nivo-progressor)
Participants receive ALT-803 20 µg/kg + Nivolumab 3 mg/kg IV; prior Nivolumab exposure
Intervention: ALT-803
Arm B: RP2D ALT-803 + Nivolumab (Nivo-progressor)
Participants receive ALT-803 20 µg/kg + Nivolumab 3 mg/kg IV; prior Nivolumab exposure
Intervention: Nivolumab
Exploratory Arm 1
ALT-803 ± Nivolumab for biomarker analysis only
Exploratory Arm 2
ALT-803 ± Nivolumab for biomarker analysis only
Outcomes
Primary Outcomes
Presence or Absence of a Dose Limiting Toxicity (DLT) of ALT-803 in Combination With Nivolumab
Time Frame: Cycles 1-4: Weeks 1-6 of each cycle
A continual reassessment method (CRM) design will be used to identify the maximum tolerated dose (MTD) for Phase Ib patients
Objective Response Rate
Time Frame: While on study, at the end of each 6 week cycle; if off study, every 3 months, UP TO 3 YEARS
The phase II portion of the study looks to define the objective response rate (using immune-related RECIST) of ALT-803 added to nivolumab in patients with advanced and unresectable non-small cell lung cancer. Objective response rate will be defined by the best overall response, which is the best response recorded from the start of the treatment until disease progression/recurrence (taking as reference for progressive disease, the smallest measurements recorded since the treatment started). The subject's best response assignment will depend on the achievement of both measurement and confirmation criteria.
Secondary Outcomes
- Progression-Free Survival (PFS)(Up to 6 months)
- Overall Survival (OS)(From first dose until death or last known alive, up to 15 months.)
- Duration of Response (DoR)(Up to 6 months)