A Phase I Study of Pomalidomide and Nivolumab in Patients With Virus-Associated Malignancies With or Without HIV
试验速览
- 阶段
- 1 期
- 状态
- 招募中
- 入组人数
- 58
- 试验地点
- 1
- 主要终点
- Safety and tolerability of pomalidomide with nivolumab
研究概览
简要总结
Background:
Less toxic and more effective treatments are needed for cancers caused by viruses. These cancers include Hodgkin and non-Hodgkin lymphoma, hepatocellular carcinoma, head and neck cancer, nasopharyngeal carcinoma, gastric cancer, anal cancer, cervical cancer, vaginal cancer, vulvar cancer, penile cancer, Merkel cell carcinoma, Kaposi sarcoma, and leiomyosarcoma. Researchers want to see if a combination of drugs can help.
Objective:
To find a safe dose of pomalidomide plus nivolumab in people with cancers caused by viruses.
Eligibility:
Adults ages 18 or older who have cancers caused by Epstein Barr virus (EBV), human herpes virus 8/Kaposi sarcoma herpesvirus (HHV8/KSHV), human papilloma virus (HPV), hepatitis B or C virus (HBV/HCV), and Merkel cell polyomavirus (MCPyV) that have not responded to previous treatments or have relapsed, or in adults who do not want to have surgery because of disfigurement or other risks. Adults who have HIV with any CD4 T cell count are eligible.
Design:
Participants will be screened with blood and urine tests, scans, and heart tests. They will have a physical exam. Their ability to perform normal daily activities will be assessed. They may have a tumor biopsy.
Treatment will be given in 28-day cycles. Participants will take pomalidomide as a tablet by mouth for 21 days of each cycle, for up to 24 cycles. They will get nivolumab by intravenous infusion once each cycle. They will take an aspirin each day until 30 days after their last dose of the study drugs.
Participants will keep a pill diary. They will bring it to their study visit at the end of each cycle. At these visits, some screening tests will be repeated. Participants with Kaposi sarcoma will have pictures taken of their lesions.
Participants will give blood and saliva samples for research. They may have optional anal and/or cervical swabs. They may have optional biopsies.
Participants will have a follow-up visit 30 days after they stop taking the study drugs, then every month for 100 days. Some screening tests will be repeated. Then they may by contacted by phone every 3 months for 9 months, and then every 6 months thereafter.
详细描述
Background:
- There is an unmet need for less toxic and more effective treatments for virus-associated malignancies.
- Pomalidomide induces polyfunctional T cell, NK cell, and dendritic cell activation.
- Pomalidomide has shown promising activity in Kaposi sarcoma, likely due in part to immune modulation.
- Downregulation and/or deregulation of immune surface markers by viruses can thwart immunologic therapy, which may be prevented or reversed by pomalidomide.
- PD-L1 is expressed in virus-associated malignancies and modulation of PD-1 signaling is a promising approach to treatment of virus-associated malignancies.
- Checkpoint inhibitors used alone have been shown to have some activity in certain virus-induced tumors (e.g. Hodgkin and non-Hodgkin lymphomas, Merkel cell carcinoma, and HPV-associated nasopharyngeal cancer). It is thus rational to explore combination strategies that overcome viral-mediated immune evasion and provide potentially better immunologic anti-tumor activity.
Objectives:
-Assess the safety and tolerability of pomalidomide plus nivolumab (Pom/Nivo) in participants with virus-associated malignancies
Eligibility:
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 99 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •INCLUSION CRITERIA:
- •Histologically or cytologically proven selected virus-associated tumors that are systemic, metastatic or locally advanced and not amenable to curative treatment options or are relapsed/refractory to first-line therapy as appropriate for each tumor type as outlined below. Also, participants with eligible solid tumors, who after evaluation by an expert in the area are deemed to be potentially curable after extensive surgery, but refuse such surgical procedure due to associated disfigurement and/or morbidity, may be eligible for the study with the necessary informed consent. Pathology confirmation by NCI Laboratory of Pathology is needed for eligibility.
- •The following tumor types listed below are eligible, and require assessing of virus infection of the tumor cells with EBV EBER by in situ hybridization (ISH), KSHV LANA , p16, and Merkel cell polyomavirus large T antigen by immunohistochemistry (IHC) to document the respective viral infection (EBV, KSHV, HPV, MCPvY); or detection of serum HBV surface antigen, anti-HBV core antibody, elevated HBV DNA viral load, positive HVC antibody or elevated HCV RNA viral load. The tumor types studied in the phase 1 trial will be as below. For tumors where >95% are known to be virus-associated, such as cervical cancer, confirmation of virus status is not required.
- •-EBV-positive Hodgkin lymphoma meeting the following criteria:
- •Relapsed or refractory de novo classical Hodgkin lymphoma having failed standard first-line therapy; and
- •Unresponsive or progressive disease after treatment with brentuximab vedotin or may be brentuximab vedotin na(SqrRoot) ve but is ineligible or unable to receive brentuximab vedotin; and
- •Unresponsive or progressive disease after checkpoint inhibitor therapy;
- •Unresponsive or progressive disease after or is ineligible for autologous stem cell transplant (auto-SCT)
- •-EBV-positive aggressive non-Hodgkin lymphomas meeting the following criteria:
- •Relapsed/refractory disease after standard first-line chemotherapy; and
- •Relapsed disease after autologous stem cell transplant if indicated for histology (i.e diffuse large B-cell lymphoma relapsed more than one year after first line treatment) or autologous stem cell transplant is not feasible; and
- •Relapsed after CAR-T cell therapy for HIV-negative participants only if indicated for histology (i.e., diffuse large B-cell lymphoma) or CAR-T cell therapy is not feasible
- •EBV-positive nasopharyngeal cancer unresponsive or progressive disease on or after platinum-containing chemotherapy and/or radiotherapy
- •EBV-positive gastric cancer that is unresponsive or progressive disease on or after first-line chemotherapy
- •EBV-positive leiomyosarcomas that is unresponsive or progressive disease on or after 2 systemic regimens (CCRT/platinum-taxane)
- •Kaposi sarcoma impairing physical wellbeing (for example, tumor edema, pain, skin ulceration or breakdown, oral disease impairing function), no active KSHV-associated multicentric Castleman disease in past 12 months, and one or more of the following:
- •Inadequate tumor response after 6 or more cycles of liposomal doxorubicin or paclitaxel or other active cytotoxic agents (i.e. etoposide, bleomycin, anthracyclines, vincristine, vinblastine); or
- •Progressive disease while receiving liposomal doxorubicin or paclitaxel or other active cytotoxic agents (i.e. etoposide, bleomycin, anthracyclines, vincristine, vinblastine); or
- •Intolerant of liposomal doxorubicin and paclitaxel
- •Primary effusion lymphoma unresponsive or progressive disease on or after first-line combination chemotherapy
- •HPV-positive head and neck cancer that is unresponsive or progressive on or after first-line combination chemotherapy +/- radiotherapy
- •HPV-positive cervical cancer that is unresponsive or progressive on at least one systemic regimen for recurrent (does not include initial CCRT) or metastatic disease. Tumor HPV testing will not be a requirement for study eligibility for cervical cancer.
- •HPV-positive anal cancer that is unresponsive or progressive on or after first-line combination chemotherapy +/- radiotherapy
- •HPV-positive vaginal cancer that is unresponsive or progressive on or after first-line chemotherapy
- •HPV-positive penile cancer that is unresponsive or progressive on or after surgery and first-line chemotherapy
- •HPV-positive vulvar cancer that is unresponsive or progressive on or after first- line combination chemotherapy
- •MCPyV-positive Merkel cell carcinomas that is relapsed or refractory after prior checkpoint inhibitor therapy
- •HBV- or HCV-associated hepatocellular carcinoma that is not amenable to local therapy or liver transplant and has progressed on first-line therapy with sorafenib or levatinib or atezolizumab+bevacizumab
- •For solid tumors, 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 for non-nodal lesions and short axis for nodal lesions) as >=20 mm (>=2 cm) by chest x-ray or as >=10 mm (>=1 cm) with CT scan, MRI, or calipers by clinical exam.
- •For hematologic malignancies, participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (lymph nodes must measure >=15 mm in the short axis and extranodal lesions must measure >=10 mm in the short axis with CT scan. For primary effusion lymphoma, body cavity effusions may be followed as measurable disease by CT scan.
- •For KS, participants must have measurable disease per the modified ACTG criteria, defined as at least five measurable cutaneous KS lesions with no previous local radiation, surgical or intralesional cytotoxic therapy that would prevent response assessment for that lesion or in the event that participants have assessable disease, response will be evaluated per RECIST criteria per solid tumor guidelines.
- •Prior immunomodulatory therapy and checkpoint inhibitor therapy is allowed if previously tolerated without severe toxicities. Participants may not have received chemotherapy, radiotherapy, monoclonal antibody therapy, or targeted therapy within 2 weeks.
- •Age >=18 years. Because no dosing or adverse event data are currently available on the use of pomalidomide in combination with nivolumab in participants <18 years of age, children are excluded from this study.
- •ECOG performance status <=2 (Karnofsky >=60%).
- •Participants must have adequate organ and marrow function as defined below:
- •leukocytes no lower limit
- •absolute neutrophil count >=1,000/mcL
- •platelets >=75,000/mcL
- •total bilirubin <= institutional upper limit of normal (ULN), except for participants with Gilbert disease or in whom the elevated bilirubinemia is due to ART (must be grade <= 2)
- •AST(SGOT)/ALT(SGPT) <=3x institutional ULN
- •glomerular filtration rate (GFR) >=30 mL/min/1.73 m^2
- •Participants with any HIV status are eligible; for HIV-positive participants:
- •Must be on antiretroviral therapy (ART) >4 weeks and with evidence of viral suppression defined as HIV viral load <400 copies/mL
- •Must have no major (e.g. AIDS-defining) opportunistic infections within the last 6 months except for the following which will be allowed:
- •Esophageal candidiasis treated within last 6 months or currently improving with antifungal treatment
- •Oral and/or genital HSV treated within last 6 months or currently improving with antiviral treatment
- •Mycobacterium avium infection in last 6 months or that has been treated for at least 1 month
- •For participants with evidence of chronic hepatitis B virus (HBV) infection, participants must be on suppressive therapy.
- •Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For participants with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
- •Able to take aspirin 81mg daily or a substitute thromboprophylaxis such as low molecular weight heparin at a prophylactic dose.
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排除标准
- •Participants who have had anticancer treatment within the last 2 weeks, unless the cancer treatment is for a 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, such as local treatment for carcinoma in situ or hormonal therapy for prostate or breast carcinoma.
- •Participants who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > Grade 1) with the following exceptions:
- •Elevated triglyceride attributed to ART and/or HIV (must be <= Grade 2)
- •Laboratory or clinical abnormalities that are assessed as more likely to be from the underlying tumors, HIV disease, or other non-treatment causes will not be considered an exclusion criterion.
- •Alopecia, neuropathy and ototoxicity (i.e., AEs that are not expected to improve within the washout period)
- •Participants who are receiving any other investigational agents.
- •Participants will be excluded if they are on systemic steroid therapy that cannot be discontinued, with the exception of the use of prednisone or equivalent <0.125mg/kg/day as replacement therapy. Inhaled or topical steroids are permitted.
- •History of allergic reactions attributed to pomalidomide and/or nivolumab or compounds of similar chemical or biologic composition to pomalidomide and/or nivolumab.
- •Participants who have received prior allogeneic stem cell or organ transplant.
- •Participants with severe uncontrolled intercurrent illness.
- •Cirrhosis with Child-Pugh score of B or C
- •Participants with psychiatric illness/social situations that would limit compliance with study requirements.
- •Pregnant and nursing persons are excluded from this study because pomalidomide is a thalidomide analog. Thalidomide is a known human teratogen that causes severe birth defects or embryo-fetal death. These potential risks may also apply to nivolumab based on its mechanism of action and data from animal studies. In animal reproduction studies, administration of nivolumab to cynomolgus monkeys from the onset of organogenesis through delivery resulted in increased abortion and premature infant death.
研究组 & 干预措施
1/Dose De-Escalation
Treatment with pomalidomide at de-escalating doses if necessary and nivolumab at a fixed dose - CLOSED
干预措施: Nivolumab (Drug)
2/Dose Escalation
Treatment with pomalidomide at escalating doses and nivolumab at a fixed dose
干预措施: Nivolumab (Drug)
2/Dose Escalation
Treatment with pomalidomide at escalating doses and nivolumab at a fixed dose
干预措施: Pomalidomide (Drug)
3/Dose Expansion
Nivolumab + pomalidomide (at optimal dose determined in dose escalation portion of the study) for up to 30 participants
干预措施: Pomalidomide (Drug)
3/Dose Expansion
Nivolumab + pomalidomide (at optimal dose determined in dose escalation portion of the study) for up to 30 participants
干预措施: Nivolumab (Drug)
1/Dose De-Escalation
Treatment with pomalidomide at de-escalating doses if necessary and nivolumab at a fixed dose - CLOSED
干预措施: Pomalidomide (Drug)
结局指标
主要结局
Safety and tolerability of pomalidomide with nivolumab
时间窗: 24 months of treatment, until confirmed progression, unacceptable toxicity or trial withdrawal
The fraction of participants with toxicity noted at each dose level will be reported by grade and type of toxicity identified. Maximum tolerated dose will also be reported.
次要结局
- anti-tumor activity and clinical benefits(Every month (+/-1week) for 100 days after stopping treatment; then every 3 months (+/-2 weeks) for 1 year following end-of-treatment; then every 6 months)