Phase II Trial of Combination Anti-PD-1 and Aldesleukin for Metastatic Melanoma and Renal Cell Carcinoma
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 入组人数
- 78
- 试验地点
- 1
- 主要终点
- Response rate in treatment refractory disease
研究概览
简要总结
Background:
Aldesleukin is used to treat metastatic or advanced melanoma and renal cell carcinoma. Pembrolizumab is used to treat many cancers including melanoma. Researchers want to see if these drugs can be used together to produce better results in people with these types of cancer.
Objective:
To learn if the combination of pembrolizumab and aldesleukin can be used to treat metastatic or advanced melanoma and renal cell cancer.
Eligibility:
Adults aged 18 years or older who have metastatic or advanced melanoma or renal cell carcinoma.
Design:
Participants will be screened with:
- Medical history
- Physical exam
- Electrocardiogram
- Blood and urine tests
- Ability to perform tasks of daily living
- Imaging scans (CT, MRI, PET, and/or X-rays). They may get a contrast agent to enhance the images.
- Photographs, if needed
Some of these tests will be repeated during the study.
Participants will receive the study drugs by IV (a plastic tube that is put into a vein) for 4 days. A second cycle of treatment will be given 21 days later. They will stay in the hospital for each of the cycles in the first course of treatment. After 2 months, their cancer will be evaluated. They may receive a second course of pembrolizumab alone on Days 1 and 21. They will not have to stay in the hospital for this course.
About 30 days after treatment ends, participants will have a safety follow-up visit. Then they will have visits every 3 months for up to 1 year, and then every 6 months for up to 4 years. Follow-up can also be done by phone, email, and mail. If their cancer gets worse, they will stop having visits.
Participation will last for 5 years.
详细描述
Background:
High-dose interleukin-2 was approved by the FDA for the treatment of metastatic melanoma and renal cell carcinoma, with overall response rates of 15-16%. Complete regression of disease was seen in 6-7% of participants with many long-term durable responses. The regimen has not been widely adopted due to complexities in management and the development of alternative effective therapies, such as monoclonal antibodies targeting immune checkpoints (ipilimumab, pembrolizumab, nivolumab) or small molecule inhibitors.
Pembrolizumab was approved by the FDA for the treatment of metastatic melanoma based on a series of studies demonstrating objective response rates from 21-34%. There remains a considerable population of participants with disease that never responded to treatment, in addition to participants with short durations of response prior to recurrence.
There has been limited clinical investigation of the combination of interleukin-2 and pembrolizumab. The hypothesis under investigation is that non-specific activation of the immune system with both positive stimulation (aldesleukin) and release of negative regulation (pembrolizumab) may have meaningful clinical impact for participants with limited therapeutic options.
Objectives:
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 120 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •INCLUSION CRITERIA:
- •Participants must have histologically or cytologically confirmed cancer that falls into one of three cohorts: (1) metastatic melanoma or advanced locoregional melanoma not amenable to curative surgical resection and refractory to anti-PD-1 therapy; (2) metastatic renal cell carcinoma (clear cell histology) refractory to at least one line of PD1/PDL1 based therapy; (3) metastatic or advanced locoregional melanoma not amenable to curative surgical resection and naive to anti-PD-1 therapy.
- •Participants must have measurable disease (per RECIST v1.1 criteria), metastatic melanoma or renal cell cancer.
- •Age >=18 years of age.
- •Clinical performance status of ECOG 0 or
- •Willing to practice birth control from the time of enrollment on this study and for four months after treatment.
- •Must have a negative pregnancy test because of the potentially dangerous effects of the treatment on the fetus.
- •Seronegative for HIV antibody. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Participants who are HIV seropositive may have decreased immune-competence and thus be less responsive to the experimental treatment and more susceptible to its toxicities.)
- •Seronegative for hepatitis B antigen and for hepatitis C antibody. If hepatitis C antibody test is positive, then participant must be tested for the presence of antigen by RT-PCR and be HCV RNA negative.
- •Participants must have adequate organ and marrow function as defined below:
- •ANC > 1000/mm^3 without the support of filgrastim
- •WBC >= 3000/mm^3
- •Platelet count >= 100,000/mm^3
- •Hemoglobin > 8.0 g/d (Subject may be transfused to reach this cut-off)
- •Serum ALT/AST <= 5.0 x ULN
- •Serum creatinine <= 1.6 mg/dL
- •Total bilirubin <= 2.0 mg/dL, except in participants with Gilbert s Syndrome, who must have a total bilirubin < 3.0 mg/dL.
- •More than four weeks must have elapsed since completion of any prior systemic therapy at the time of enrollment.
- •Note: Participant may have undergone minor surgical procedures or limited field radiotherapy within the four weeks prior to enrollment, as long as related major organ toxicities have recovered to <= grade
- •Ability of subject to understand and the willingness to sign a written informed consent document.
- •Willing to sign a Durable Power of Attorney Form.
- •Subject must be co-enrolled on protocol 03-C-0277
排除标准
- •Participant is nursing because of the potentially dangerous effects of the treatment on the fetus or infant.
- •Concurrent systemic steroid therapy.
- •Active systemic infections requiring anti-infective treatment, coagulation disorders, or any other active or uncompensated major medical illnesses.
- •Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease and AIDS).
- •History of major organ autoimmune disease.
- •Grade 3 or 4 major organ irAEs following treatment with anti-PD-1/PD-L1 monotherapy, including but not limited to myocarditis, pneumonitis, colitis, and hepatotoxicity.
- •Concurrent opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Participants who have decreased immune-competence may be less responsive to the experimental treatment and more susceptible to its toxicities.)
- •History of severe immediate hypersensitivity reaction to pembrolizumab or aldesleukin.
- •History of coronary revascularization or ischemic symptoms.
- •For select participants with a clinical history prompting cardiac evaluation: last known LVEF <= 45%.
- •For select participants with a clinical history prompting pulmonary evaluation: known FEV1 <= 50%.
- •Participant is receiving any other investigational agents.
研究组 & 干预措施
1 - Pembro and IL-2
Course 1: pembrolizumab (200 mg IV) on Day 1 of each cycle with aldesleukin (600,000 IU/kg intravenous bolus every eight hours) continuing for up to 4 days (maximum 10 doses) for 2 cycles (each 21 days). Course 2: pembrolizumab (200 mg IV) on Day 1 of each cycle for 2 cycles (each 21 days).
干预措施: Pembrolizumab (Drug)
1 - Pembro and IL-2
Course 1: pembrolizumab (200 mg IV) on Day 1 of each cycle with aldesleukin (600,000 IU/kg intravenous bolus every eight hours) continuing for up to 4 days (maximum 10 doses) for 2 cycles (each 21 days). Course 2: pembrolizumab (200 mg IV) on Day 1 of each cycle for 2 cycles (each 21 days).
干预措施: Aldesleukin (Drug)
结局指标
主要结局
Response rate in treatment refractory disease
时间窗: 8 weeks after Course 1 Cycle 1 then after Course 2, every 3 months x 3 (up to one year), every 6 months x 8 (up to five years)
Determine the rate of objective response (using RECIST v1.1 criteria)
次要结局
- Progression Free Survival(Every 2-6 months for up to 5 years)
- Response rate in treatment naive melanoma(8 weeks after Course 1 Cycle 1 then after Course 2, every 3 months x 3 (up to one year), every 6 months x 8 (up to five years))
- Safety and tolerance(First dose through 30 days after last treatment)