A Phase II Study of PD-1 Blockade With or Without LAG-3 Inhibition in Combination With Infliximab for the Treatment of Metastatic Melanoma and Prevention of Adverse Events
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 入组人数
- 36
- 试验地点
- 1
- 主要终点
- Incidence of immune-related adverse events (irAE) in patients treated with anti-PD-1 plus infliximab compared to pembrolizumab plus placebo
研究概览
简要总结
The purpose of this research is to test the safety and effectiveness of the investigational combination of anti-Programmed Death (PD)-1 antibody therapy with or without LAG-3 inhibition (pembrolizumab or nivolumab+relatlimab) and infliximab in treating metastatic melanoma.
详细描述
This is a randomized, double-blind, phase 2 clinical trial that combines anti-Programmed Death (PD)-1 antibody therapy with or without LAG-3 inhibition (pembrolizumab or nivolumab+relatlimab) with the anti-Tumor Necrosis Factor (TNF)-α antibody infliximab as first line treatment for the management of patients with metastatic or recurrent melanoma.
The U.S. Food and Drug Administration (FDA) has not approved infliximab for metastatic melanoma but it has been approved for other uses. The FDA has approved pembrolizumab as a treatment option for metastatic melanoma. The FDA has approved nivolumab+relatlimab as a treatment option for metastatic melanoma.
Pembrolizumab is a blocking antibody (a protein used in the immune system to identity and neutralize bacteria, viruses, and other foreign pathogens) that binds to PD-1 (a protein that helps regulate the immune system's response in the body) and blocks the interaction with PD-L1 and PD-L2 (proteins that inhibits the body's immune response). By blocking this interaction, it might lead to an anti-tumor immune response that may decrease tumor growth.
Relatlimab is believed to work by attaching to and blocking a molecule called Lymphocyte Activation Gene-3 (LAG-3). LAG-3 is a protein that is present on different types of cells in the immune system and controls parts of the immune system by shutting it down. Scientists believe that one way cancers escape the immune system is by shutting it down. Antibodies that block LAG-3 can potentially prevent LAG-3 from shutting down the immune system, thus allowing it to recognize and help the body destroy the cancer cells.
Nivolumab is believed to work by attaching to and blocking a molecule called PD-1. PD-1 is a protein that is present on different types of cells in the immune system and controls parts of the immune system by shutting it down. Antibodies that block PD-1 can potentially prevent PD-1 from shutting down the immune system, thus allowing it to recognize and help the body destroy the cancer cells.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age greater than or equal to 18 years
- •Participants must have histologically confirmed Stage III unresectable or Stage IV metastatic melanoma
- •Patients should be treatment naïve and eligible for treatment with anti-PD-1 or anti-PD-1/LAG3 as a first line therapy (as selected by their treating physician)
- •Patients previously treated for melanoma with surgical resection alone who present with recurrent Stage III unresectable or Stage IV metastatic melanoma are eligible for enrollment
- •Patients who were previously treated with systemic neo-adjuvant or adjuvant anti-PD-1 therapy more than 6 months prior to study enrollment will be eligible. There are no restrictions to the use of prior BRAF targeted therapy.
- •Participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as > 20 mm with conventional techniques or as > 10 mm with spiral CT scan
- •Diagnostic imaging studies such as MRIs and CT scans must be performed within 30 days of the date of registration
- •Participants must have normal organ and marrow function as defined below:
- •Leukocytes (WBC) > 3,000/uL
- •Absolute neutrophil count > 1,500uL
- •Platelets > 100,000/uL
- •Total bilirubin < 1.5 X institutional upper limits of normal; total bilirubin > 1.5X above institutional upper limits of normal will be allowed if direct bilirubin is within normal limits or if patients has a documented history of Gilbert's disease
- •AST (SGOT)/ALT (SGPT) < 2.5 X institutional upper limit of normal and ≤5 ULN for patients with liver metastases
- •Baseline laboratory measurements must be documented from tests within 14 days of the date of registration
- •ECOG performance status ≤ 1 (see Appendix A)
- •Participants 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 are eligible for this trial
- •Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification which can be performed by the study investigators. To be eligible for this trial, participants should be class 2B or better
- •Ability to understand and willingness to sign a written informed consent document
- •Baseline tumor biopsies are required for all patients who have tumors that are deemed by the study investigators to be safely accessible
排除标准
- •Patients with ocular or mucosal melanoma
- •Participants previously treated with anti-PD1/PDL1/CTLA-4 monoclonal antibodies for metastatic or unresectable disease
- •Patients who are receiving other anti-neoplastic agents
- •Symptomatic or untreated leptomeningeal disease
- •Patients carrying a diagnosis of immunodeficiency or receiving systemic steroid therapy (prednisone or equivalent > 10 mg/day) or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment. Corticosteroids to prevent contrast reactions is allowable
- •Patients with 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). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
- •Prior history of inflammatory bowel disease, microscopic colitis or segmental colitis associated with diverticulosis
- •Breastfeeding and pregnant women are excluded from this study since all anti-PD-1 drugs are class D agents with the potential for teratogenic or abortifacient effects.
- •Uncontrolled intercurrent illness including, but not limited to:
- •A. Ongoing or active infection
- •B. Edema > Grade 1
- •C. Documented myocardial infarction or unstable/uncontrolled cardiac disease (eg, unstable angina, severe arrhythmias, congestive heart failure [New York Heart Association (NYHA) > Class II]) within 6 months of study entry
- •D. Arterial thrombosis or vascular ischemic events, such as transient ischemic attack, cerebral infarction, within 6 months prior to study entry
- •E. Serious or non-healing wound
- •F. History of any medical condition including cardiovascular disease or chronic obstructive pulmonary disease (COPD), that in the opinion of the investigator, may increase the risks associated with study participation or study treatments or may interfere with the conduct of the study or interpretation of study results
- •G. Psychiatric illness/social situations that, in the opinion of the investigator, would limit compliance with study requirements
- •H. An elevated high-sensitivity troponin T level at baseline will be allowable as long as the patient has no evidence of active, clinically relevant cardiac disease.
- •Patients with a history of a different malignancy are ineligible except for the following circumstances:
- •A. Individuals with a history of other malignancies are eligible if they have been disease-free for at least 3 years and are deemed by the investigator to be at low risk for recurrence of that malignancy
- •B. Individuals with the following cancers are eligible if diagnosed and treated within the past 3 years: cervical cancer in situ and basal cell or squamous cell carcinoma of the skin
- •Patients with a history of Hepatitis B infection (HBsAg reactive or HBCAB reactive) or Hepatitis C (HCV RNA is detected). Participants with a history of hepatitis C virus (HCV) infection may be enrolled if they have been treated and cured
- •Patients with a history of latent or active granulomatous infection, including tuberculosis, histoplasmosis, or coccidiomycosis
- •Has received a live vaccine within 30 days of planned start of study therapy
- •Current bacterial infection requiring antibiotic treatment, or systemic fungal infection
- •Patients with a known hypersensitivity to pembrolizumab, nivolumab, or relatlimab or any of its excipients
- •Previous adverse reaction or hypersensitivity to infliximab
- •Any prior immune-related adverse event while on adjuvant anti-PD-1-based immunotherapy with the following exceptions: any endocrine toxicity, any grade 1 or 2 toxicity that completely resolved; if there is uncertainty about the grade of prior toxicity, this will be adjudicated by the PI.
研究组 & 干预措施
Anti-PD-1 therapy + Placebo
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and placebo.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Placebo. will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Placebo (Drug)
Anti-PD-1 therapy + Infliximab
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and infliximab.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Infliximab will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Pembrolizumab (Drug)
Anti-PD-1 therapy + Infliximab
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and infliximab.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Infliximab will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Infliximab (Drug)
Anti-PD-1 therapy + Infliximab
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and infliximab.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Infliximab will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Relatlimab (Drug)
Anti-PD-1 therapy + Infliximab
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and infliximab.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Infliximab will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Nivolumab (Drug)
Anti-PD-1 therapy + Placebo
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and placebo.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Placebo. will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Pembrolizumab (Drug)
Anti-PD-1 therapy + Placebo
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and placebo.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Placebo. will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Relatlimab (Drug)
Anti-PD-1 therapy + Placebo
Participants will be randomly assigned to receive physician's choice of anti-PD-1 therapy (pembrolizumab or nivolumab+relatlimab) and placebo.
- Pembrolizumab will be administered every 3 weeks for up to 2 years
- Nivolumab+relatlimab will be administered every 4 weeks for up to 2 years
- Placebo. will be administered on weeks 0, 2, and 6 (+/- 3 days) for a total of 3 doses
干预措施: Nivolumab (Drug)
结局指标
主要结局
Incidence of immune-related adverse events (irAE) in patients treated with anti-PD-1 plus infliximab compared to pembrolizumab plus placebo
时间窗: 12 weeks
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
次要结局
- Incidence of anti-PD-1 antibody cessation due to immune-related adverse events (irAEs)(12 weeks up to 2 years)
- Response rate of patients receiving combination anti-PD-1 antibody/infliximab compared with anti-PD-1 antibody/placebo(Time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented up to 2 years)
- Cumulative steroid exposure (dose x duration) used for management of irAEs for anti-PD-1 antibody/infliximab compared to anti-PD-1 antibody/placebo patients(12 weeks up to 2 years)
- Incidence of colitis in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo(12 weeks up to 2 years)
- Incidence of severe immune-related adverse events (irAEs) (grade 3-5) in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo(12 weeks up to 2 years)
- Incidence of clinically apparent infections in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo(12 weeks up to 2 years)
- Progression free survival rate of patients receiving combination anti-PD-1 antibody /infliximab compared with anti-PD-1 antibody/placebo(Time from randomization (or registration) to the earlier of progression or death due to any cause up to 2 years.)
- Incidence of diarrhea in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo(12 weeks up to 2 years)
- Overall survival rate of patients receiving combination anti-PD-1 antibody/infliximab compared with anti-PD-1 antibody/placebo(Time from randomization (or registration) to death due to any cause, or censored at date last known alive up to 2 years)
研究者
Ryan J Sullivan
Principal Investigator
Massachusetts General Hospital