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NM-IL-12 in Cutaneous T-Cell Lymphoma (CTCL) Undergoing Total Skin Electron Beam Therapy (TSEBT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02542124
Recruitment Status : Active, not recruiting
First Posted : September 4, 2015
Last Update Posted : November 16, 2018
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Neumedicines Inc.

Brief Summary:
In the proposed study, NM-IL-12 will be evaluated as immunotherapy to increase antitumor efficacy against CTCL, while reducing skin-related toxicity, when combined with low-dose TSEBT therapy. Determination of the maximum tolerated dose (MTD) for NM-IL-12 is not planned in this study, rather, a pre-defined starting dose will be explored; this dose is based on two safety and tolerability studies of NM-IL-12 in healthy volunteers.

Condition or disease Intervention/treatment Phase
Cutaneous T Cell Lymphoma (CTCL) Mycosis Fungoides Sézary Syndrome Biological: NM-IL-12 and TSEBT Phase 2

Detailed Description:

This is a single arm, open-label, non-randomized study with NM-IL-12 dosed in combination with low dose TSEBT in CTCL patients. This study is planned to be conducted in 10 patients, 18 years or older in age, undergoing low dose TSEBT of 12 Gy over a 3-week period.

The study will initially enroll 4 patients and then will be expanded to enroll 6 additional patients (total 10 patients) depending on the presence or absence of Dose Modifying Criteria (DMC). Decision whether to de-escalate will be made after first 4 patients are followed up for 28 days from the first dose of NM-IL-12.

Safety monitoring will continue throughout the whole period of drug administration and the treatment will be discontinued if intolerable toxicity or disease progression occurs during this period.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 10 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Single Arm, Open-Label Study To Evaluate The Safety, Tolerability And Preliminary Efficacy Of NM-IL-12 (rHuIL-12) In Patients With Cutaneous T Cell Lymphoma (CTCL) Undergoing Low Dose Total Skin Electron Beam Therapy (TSEBT)
Actual Study Start Date : December 2015
Estimated Primary Completion Date : February 2019
Estimated Study Completion Date : May 2019


Arm Intervention/treatment
Experimental: NM-IL-12 and TSEBT
TSEBT and subcutaneous doses of NM-IL-12
Biological: NM-IL-12 and TSEBT
The LD-TSEBT treatment will start on Day 1 of the study. NM-IL-12 will be administered subcutaneously.
Other Name: HemaMax, rHu-IL12, LD-TSEBT




Primary Outcome Measures :
  1. Safety and tolerability will be evaluated on the basis of the following parameters (Vital signs, physical examination,Toxicity according to the NCI CTCAE, Immunogenicity evaluated by the presence of anti-drug antibody) : [ Time Frame: 107 weeks ]

    General safety: Vital signs (temperature, blood pressure, pulse rate, respiratory rate) and physical examination.

    Toxicity according to the NCI CTCAE (v4.03) for AEs and clinical laboratory profile; AEs will be collected in all patients who received at least one dose of NM-IL-12 and up to four weeks post last NM-IL-12 dose.

    Immunogenicity of NM-IL-12 will be evaluated by the presence of anti-drug antibody (ADA)



Secondary Outcome Measures :
  1. Clinical Response measured by a modified severity-weighted assessment tool (mSWAT) [ Time Frame: 107 weeks ]
    Exploratory skin clinical responses measured by a modified severity-weighted assessment tool (mSWAT)

  2. Progression free survival [ Time Frame: 107 weeks ]

    Progression free survival based on every 4 week follow up after the monthly dose until one of the events below occurs first:

    • Progressive disease is documented
    • Another treatment for CTCL is administered (topical or systemic)
    • 107 weeks are completed after the patient's first dose of NM-IL-12



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. 18 years of age or older
  2. Biopsy-confirmed CD4+ mycosis fungoides or Sézary syndrome, stage IB to IIIB
  3. The patient is eligible for TSEBT
  4. Eastern Cooperative Oncology Group (ECOG) of ≤ 2.
  5. Adequate bone marrow function: WBC > 2000/μL; platelet count > 75,000/μL; Neutrophil count > 1000/μL, without use of colony stimulating factors (CSF).
  6. Required washout period for prior therapies Topical therapy: 2 weeks

    • Phototherapy (PUVA): 4 weeks
    • Local Skin Radiation Therapy (< 10% skin surface): 4 weeks
    • Retinoids: 4 weeks
    • Interferons: 4 weeks
    • Low dose methotrexate: 4 weeks
    • HDAC inhibitors: 8 weeks
  7. Women of child-bearing potential must have negative serum pregnancy test and use accepted highly effective methods of birth control throughout the study and for 90 days after dosing and must agree to use effective contraception.
  8. Male patients must be willing to use an appropriate method of contraception (e.g., condoms) or abstain from sexual intercourse and inform any sexual partners that they must also use a reliable method of contraception during the study and for 90 days after dosing.
  9. Adequate hepatic function: bilirubin ≤1.5 x upper limit of normal (ULN), AST ≤2.5 x ULN, ALT ≤2.5 x ULN, alkaline phosphatase (liver fraction) ≤2.5 x ULN
  10. Adequate renal function: creatinine ≤1.5 x ULN
  11. Ability to comply with the treatment schedule

Exclusion Criteria:

  1. Biopsy confirmed CD8+ CTCL histology
  2. Large cell transformation
  3. Prior systemic use of any immunosuppressive chemotherapy (except low dose methotrexate) and/or monoclonal antibody treatment for CTCL
  4. Prior courses of TSEBT (Note: localized skin-directed radiotherapy is allowed if administered at least 4 weeks prior to initiation on study).
  5. Concomitant use of any anti-cancer therapy or immune modifier.
  6. Prior allogeneic hematopoietic cell transplant.
  7. Any ongoing infection whether receiving or not receiving antibiotics or have received intravenous antibiotics, antiviral, or antifungal agents within 2 weeks prior to the start of the study drug.
  8. Known history of human immunodeficiency virus (HIV), hepatitis B or C
  9. For women on estrogen based contraceptives, family history of venous thromboembolism (VTE) and/or risk factors predisposing for VTE and other medical conditions known to be associated with VTE.
  10. History of prior malignancy with the exception of cervical intraepithelial neoplasia, non-melanoma skin cancer, and adequately treated localized prostate carcinoma (PSA <1.0). Patients with a history of other malignancies must have undergone potentially curative therapy and have no evidence of that disease for five years
  11. Uncontrolled intercurrent illness, condition, or circumstances that could limit compliance with the study, including, but not limited to the following: acute or chronic graft versus host disease, uncontrolled diabetes mellitus or hypertension, or psychiatric conditions
  12. Any other medical issue, including laboratory abnormalities, deemed by the Investigator to be likely to interfere with patient participation
  13. Unresolved toxicity from previous anticancer therapy or incomplete recovery from surgery
  14. Major surgery within 12 weeks of enrolment
  15. Medically significant cardiac event or unstable cardiovascular function defined as:

    • Symptomatic ischemia, unstable angina pectoris
    • Uncontrolled clinically significant cardiac arrhythmia
    • Symptomatic heart failure NYHA Class ≥ 3
    • Myocardial infarction or cardiac surgery within 6 months prior to enrollment
  16. Cerebrovascular event (transient ischemic attack, stroke or CNS bleeding) within the last 12 months.
  17. Major bleeding within the last 6 months.
  18. Use of any investigational agents within 30 days prior to enrollment and for the duration of the study
  19. Pregnant or lactating
  20. Unwilling or unable to provide informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02542124


Locations
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United States, California
Stanford Cancer Center
Stanford, California, United States, 94305
United States, New York
Columbia University Medical Center
New York, New York, United States, 10032
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
Neumedicines Inc.
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Youn H Kim, MD Stanford University
Additional Information:
Publications:

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Responsible Party: Neumedicines Inc.
ClinicalTrials.gov Identifier: NCT02542124    
Other Study ID Numbers: NM-ONC-001
1R44CA192576-01 ( U.S. NIH Grant/Contract )
First Posted: September 4, 2015    Key Record Dates
Last Update Posted: November 16, 2018
Last Verified: November 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Neumedicines Inc.:
CTCL
Total Skin Electron Beam Therapy (TSEBT)
Mycosis fungoides
Sézary syndrome
recombinant human Interleukin-12 (rHuIL-12)
T Cell
Additional relevant MeSH terms:
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Mycoses
Lymphoma
Lymphoma, T-Cell
Mycosis Fungoides
Sezary Syndrome
Lymphoma, T-Cell, Cutaneous
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Interleukin-12
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Antineoplastic Agents