A Phase II Open Label, Randomized Non-Comparative Trial of Nivolumab Alone or in Combination With Ipilimumab for the Treatment of Patients With Advanced Hypermutated Solid Tumors Detected by a Blood Based Assay

Canadian Cancer Trials Group6 sites in 2 countries4 target enrollmentMarch 11, 2019

ConditionsAdvanced Solid Tumors

InterventionsNivolumab Ipilimumab

DrugsNivolumab Ipilimumab

Overview

Phase: Phase 2
Intervention: Nivolumab
Conditions: Advanced Solid Tumors
Sponsor: Canadian Cancer Trials Group
Enrollment: 4
Locations: 6
Primary Endpoint: Objective Response Rate by RECIST 1.1
Status: Terminated
Last Updated: 2 years ago

Overview Investigators Eligibility Criteria Arms & Interventions Outcomes Sites Similar Trials

Overview

Brief Summary

The purpose of this study is to determine the safety and effectiveness of nivolumab alone or in combination with ipilimumab in patients with metastatic or unresectable tumors harbouring mutations in genes, POLE and POLD1. These mutations will be determined by plasma cfDNA. Nivolumab and ipilimumab have been given to patients across multiple types of cancer, and safe doses and schedules have been determined.

Detailed Description

Participants in this study have been diagnosed with metastatic or unresectable solid tumors that have a mutation in POLE and/or POLD1. Nivolumab alone or in conjunction with ipilimumab is predicted to be effective against tumors with POLE and/or POLD1 mutations as these genetic changes cause increased rates of mutations in the DNA of tumor cells. These high mutation rates have been associated with response to immunotherapy agents such as nivolumab and ipilimumab.

Registry

clinicaltrials.gov

Start Date

March 11, 2019

End Date

February 9, 2022

Last Updated

2 years ago

Study Type

Interventional

Study Design

Parallel

Sex

All

Investigators

Sponsor

Canadian Cancer Trials Group

Responsible Party

Sponsor

Eligibility Criteria

Inclusion Criteria

•Patients must have histologically confirmed advanced (metastatic or unresectable) solid tumors.
•Patients must have received at least 1 standard cancer therapy for their tumor type and progressed on their most recent regimen; patients may be treatment naïve if they refuse standard treatment or there is no standard treatment for their cancer.
•Prior adjuvant/neoadjuvant therapy with curative intent is considered a prior therapy if disease recurrence occurs within at least 6 months.
•Patients may not have received prior immunotherapy
•Patients must consent to blood collection for testing after registration by a central reference laboratory.
•Patients must have clinically and/or radiologically documented disease with at least one lesion measurable as defined by RECIST 1.
•Patients must be ≥ 18 years of age.
•ECOG performance status 0 or
•Patients must have adequate hematology and organ function
•Patient consent for screening must be appropriately obtained in accordance with applicable local and regulatory requirements.

Exclusion Criteria

•Patients with a history of other untreated malignancies or malignancies, which required therapy within the past 2 years. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen may be eligible after consultation with the CCTG.
•Patients with primary CNS tumors are not eligible.
•Patients with active brain metastases or leptomeningeal metastases are not eligible. Patients with brain metastases are eligible if these have been treated and clinically stable. There must also be no requirement for immunosuppressive doses of systemic corticosteroids (\> 10 mg/day prednisone equivalents). Physiologic replacement doses of systemic corticoidsteroids are permitted, even if \>10mg/day prednisone equivalents
•History of primary immunodeficiency, history of allogenic organ transplant that requires therapeutic immunosuppression and the use of immunosuppressive agents within 14 days of study drug administration\*
•Active or prior documented autoimmune or inflammatory disorders. Including, inflammatory bowel disease (e.g. colitis or Crohn's disease), diverticulitis with the exception of diverticulosis, celiac disease or other serious gastrointestinal chronic conditions associated with diarrhea), systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome (granulomatosis with polyangiitis), rheumatoid arthritis, hypophysitis, uveitis, etc., within the past 3 years prior to the start of treatment. Patients with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions considered to be of low risk for recurrence are permitted to enroll.
•History of hypersensitivity to nivolumab or ipilimumab or any excipient.
•Any previous treatment with a PD-1 or anti-PD-L1, anti-PD-L2 inhibitor, including nivolumab or an anti-CTLA4, including ipilimumab, or drug specifically targeting T-cell stimulation or immune checkpoint pathways.
•Patients with serious illnesses or medical conditions which would not permit the patient to be managed according to the protocol (including corticosteroid administration), or would put the patient at risk. This includes but is not limited to:
•History of significant neurologic or psychiatric disorder which would impair the ability to obtain consent or limit compliance with study requirements.
•Active infection requiring systemic therapy; (including any patient known to have active hepatitis B, hepatitis C or human immunodeficiency virus (HIV) or tuberculosis or any infection requiring systemic therapy).

Arms & Interventions

Nivolumab

240mg Q2W

Intervention: Nivolumab

Nivolumab + Ipilimumab

Nivolumab 240mg Q2Wk + Ipilimumab 1mg/kg Q6W

Intervention: Nivolumab

Nivolumab + Ipilimumab

Nivolumab 240mg Q2Wk + Ipilimumab 1mg/kg Q6W

Intervention: Ipilimumab

Outcomes

Primary Outcomes

Objective Response Rate by RECIST 1.1

Time Frame: 36 months

Objective Response Rate by RECIST 1.1: CR, PR, SD, or PD

Secondary Outcomes

Efficacy as Measured by Objective Response Rate(36 months)
Correlation Between POLE or POLD1 Mutations in Tumor and POLE or POLD1 Mutations in Blood(36 months)
To Evaluate Response by iRECIST(36 months)
Duration of Response(36 months)
Number and Severity of Adverse Events Using CTCAE 5.0(36 months)