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Pembrolizumab + Imprime PGG for Metastatic Non-small Cell Lung Cancer After Progression on First-Line Therapy: Big Ten Cancer Research Consortium BTCRC-LUN15-017

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ClinicalTrials.gov Identifier: NCT03003468
Recruitment Status : Recruiting
First Posted : December 28, 2016
Last Update Posted : June 26, 2018
Sponsor:
Collaborators:
Merck Sharp & Dohme Corp.
Biothera
Information provided by (Responsible Party):
Lawrence Feldman, MD, Big Ten Cancer Research Consortium

Brief Summary:
This is an open label, multi-institutional, single arm study with a dose escalation phase Ib cohort, followed by a phase II cohort of pembrolizumab and Imprime PGG. No randomization or blinding is involved.

Condition or disease Intervention/treatment Phase
Non-Small Cell Lung Cancer Drug: Imprime PGG Drug: MK-3475 Phase 1 Phase 2

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 36 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Masking Description: Open Label
Primary Purpose: Treatment
Official Title: A Phase Ib/II Study of Anti-PD-1 Antibody Pembrolizumab and Imprime PGG for Patients With Metastatic Non-small Cell Lung Cancer After Progression on First-Line Therapy: Big Ten Cancer Research Consortium BTCRC-LUN15-017
Study Start Date : December 2016
Estimated Primary Completion Date : September 2018
Estimated Study Completion Date : March 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lung Cancer

Arm Intervention/treatment
Experimental: Arm A - Phase Ib

Dose Escalation Cohort Cohort 1 will consist of 3-6 patients who will receive pembrolizumab 200mg IV on Day 1 of each 21 day cycle. Imprime PGG will be administered at 2mg/kg on Day 1,8, and 15 of cycles 1-4, and on Day 1 of cycles 5-16. On Day 1 of each cycle, the Imprime PGG intravenous infusion is given first followed 15-30 minutes later by the pembrolizumab.

Experimental: Arm A - Phase II Investigational Treatment The maximum safe dose of Imprime PGG in combination with pembrolizumab (as determined in the phase Ib cohort) will be given on Day 1,8, and 15 for cycles 1-4, and on Day 1 of cycles 5-16.

Cohort 2 will consist of 3-6 patients who will receive pembrolizumab 200mg IV on Day 1 and Imprime PGG at 4mg/kg on Day 1,8, and 15 for Cycles 1-4 and on Day 1 only for Cycles 5-16. On Day 1 of each cycle, the Imprime PGG intravenous infusion is given first followed 15-30 minutes later by the pembrolizumab.

Drug: Imprime PGG
Arm A: Phase Ib Cohort 1: 2mg/kg IV; Arm A: Phase Ib Cohort 2: 4mg/kg IV

Drug: MK-3475
200mg IV
Other Names:
  • pembrolizumab
  • Keytruda

Drug: Imprime PGG
Arm B: Phase II treatment: administered at the maximum safe dose of 2mg or 4 mg as established in the Phase Ib cohort study.




Primary Outcome Measures :
  1. Phase Ib: Maximum Tolerated Dose [ Time Frame: From the start of combination treatment until completion of the first cycle of treatment (21 days) ]
    Phase Ib: Maximum tolerated dose (MTD) for subjects receiving Imprime PGG with pembrolizumab without experiencing dose-limiting toxicity(s) (DLT) per Common Terminology Criteria for Adverse Events (CTCAE) v4.

  2. Phase II: Progression Free Survival [ Time Frame: From the date of enrollment until the criteria for disease progression is met as defined by RECIST 1.1 or death from any cause, whichever occurs first (up to 1 year from start of treatment) ]
    Progression-free survival (PFS) with Imprime PGG and pembrolizumab combination therapy.


Secondary Outcome Measures :
  1. Adverse Effects [ Time Frame: From start of treatment D1 and every treatment visit thereafter (up to 11 months [16 cycles]) ]
    Number of Participants with Adverse Events as a Measure of Safety and Tolerability per Common Terminology Criteria for Adverse Events (CTCAE) v4.

  2. Clinical Benefit Ratio [ Time Frame: From the start of treatment D1 assessed every 6 weeks +/- 1 week while on study treatment (up to 11 months [16 cycles]) ]
    Clinical Benefit Ratio (complete, partial response, or stable disease) as assessed per RECIST 1.1.

  3. Overall Survival (OS) [ Time Frame: from the start of the treatment until death from any cause (up to 1 year from start of treatment) ]
    To determine the overall survival for this patient population at 1 year.



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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:

  • Male or female ≥ 18 years of age at time of consent.
  • Subjects with histologically or cytologically confirmed non-small cell lung cancer (NCSLC).
  • Subjects with stage IV non-small cell lung cancer as defined by American Joint Committee on Cancer (AJCC).
  • Phase Ib: Subjects who progressed after first-line platinum-based chemotherapy and who are candidates for second-line therapy.
  • Phase II: Subjects who have progressed on first-line systemic therapy (either platinum-based chemotherapy with or without immune checkpoint inhibitor or immune checkpoint inhibitor as first line therapy) who are candidates for second-line systemic therapy.
  • Phase II: Subjects with an EGFR or ALK mutation who are no longer candidates for TKI therapy and have progressed on standard systemic therapy (either platinum-based chemotherapy with or without immune checkpoint inhibitor or immune checkpoint inhibitor as first line therapy).
  • Phase II only: Measurable disease according to RECIST v1.1 (Section 8) obtained by imaging within 28 days prior to study registration. Phase Ib: subjects may enroll with or without measurable disease.
  • Phase II only: Subjects must have presence of peripheral blood levels of IgG anti-β-glucan antibody (ABA) of ≥ 20 μg/mL as determined by an ELISA test within 90 days prior to study registration.
  • Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 within 28 days prior to study registration.
  • Life expectancy of 6 months or greater as determined by the treating physician.
  • Adequate hepatic function within 28 days prior to study registration defined as meeting all of the following criteria:

    • total bilirubin ≤ 1.5 × upper limit of normal (ULN) OR direct bilirubin ≤ ULN for subjects with total bilirubin levels > 1.5 x ULN (except subject with Gilbert's Syndrome, who can have total bilirubin < 3.0 mg/dl)
    • aspartate aminotransferase (AST) ≤ 2.5 × ULN or ≤ 5 × ULN for subjects with known hepatic metastases
    • alanine aminotransferase (ALT) ≤ 2.5 × ULN or ≤ 5 × ULN for subjects with known hepatic metastases
  • Adequate renal function within 28 days prior to study registration defined by either of the following criteria:

    • Serum creatinine ≤ 3 mg/dL
    • if serum creatinine > 3mg/dL, estimated glomerular filtration rate (GFR) ≥ 20 mL/min
  • Adequate hematologic function within 28 days prior to study registration defined as meeting all of the following criteria:

    • hemoglobin ≥ 9 g/dL; subjects requiring transfusion will be eligible to start study
    • and absolute neutrophil count (ANC) ≥ 1.5 × 109/L
    • and platelet count ≥ 100 × 109/L
  • Adequate coagulation functioning within 28 days prior to study registration defined by either of the following criteria:

    • INR < 1.5 × ULN
    • for subjects receiving anticoagulant, the subjects must, in the investigator's opinion, be clinically stable with no evidence of active bleeding while receiving anticoagulant therapy. The INR for subjects on warfarin should be in the therapeutic range. Low molecular weight heparin (LMWH) is allowed.
  • Provided written informed consent and HIPAA authorization for release of personal health information, approved by an Institutional Review Board (IRB). NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
  • Women of childbearing potential (WOCP) must not be pregnant or breast-feeding. A negative serum or urine pregnancy test is required within 72 hours of study registration. If the urine test cannot be confirmed as negative, a serum pregnancy test will be required.
  • Women of childbearing potential (WOCP) must be willing to use two effective methods of birth control such as an oral, implantable, injectable, or transdermal hormonal contraceptive, an intrauterine device (IUD), use of a double barrier method (condoms, sponge, diaphragm, or vaginal ring with spermicidal jellies or cream), or total abstinence for the course of the study until 120 days after the last dose of study drug. NOTE: Women are considered to be of childbearing potential unless they are postmenopausal (≥45 years of age and has not had menses for greater than 12 consecutive months), surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy) or not heterosexually active for the duration of the study and at least 120 days after the last dose of study drug.
  • Men who are not surgically sterile (vasectomy) must agree to use an acceptable method of contraception. Male subjects with female sexual partners who are pregnant, possibly pregnant, or who could become pregnant during the study must agree to use condoms from the first dose of study drug through at least 120 days after the last dose of study drug. Total abstinence for the same study period is an acceptable alternative.
  • Willingness and ability to comply with scheduled visits (including geographical distance), treatment plans, laboratory tests, and other study procedures.

Exclusion Criteria:

  • Surgery within 4 weeks prior to study registration except for minor procedures. NOTE: Hepatic biliary stent placement is allowed. NOTE: Subject must have adequately recovered from the toxicity and/or complications of major surgery prior to study registration, as determined by the treating physician.
  • Known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with neurological symptoms must undergo a head CT scan or brain MRI to exclude brain metastasis. NOTE: Subjects with previously treated brain metastases may participate provided
  • they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline),
  • have no evidence of new or enlarging brain metastases, and
  • are not using steroids for at least 7 days prior to study registration. This exception does not include carcinomatous meningitis, which is excluded regardless of clinical stability.
  • Previously received a solid organ transplant or allogeneic progenitor/stem cell transplant.
  • Received a live vaccine within 30 days prior to the first dose of trial treatment. Examples of live vaccines include, but are not limited to: measles, mumps, rubella, chicken pox, yellow fever, rabies, BCG, and typhoid (oral) vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. Flu-Mist®) are live attenuated vaccines and are not allowed.
  • History of blood clots, pulmonary embolism, or deep vein thrombosis unless on adequate anticoagulant therapy as determined by the treating investigator (subject must be on stable dose for 2 weeks).
  • Known history of human immunodeficiency virus [(HIV) HIV 1/2 antibodies].
  • Known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected).
  • Diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to study registration.
  • Has 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) or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. NOTE: Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  • Received prior chemotherapy, an immune checkpoint inhibitor, or radiation therapy within 2 weeks prior to study registration or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events from previously administered agents. NOTE: Subjects with alopecia, grade ≤ 2 sensory neuropathy or other grade ≤ 2 AEs not constituting a safety risk based on investigator judgement are an exception to this criterion and can still be considered for the study.
  • Any clinically significant infection defined as any acute viral, bacterial, or fungal infection that requires specific treatment. NOTE: Anti-infective treatment must be completed ≥ 7 days prior to study registration.
  • Has history of (non-infectious) pneumonitis that required steroids, evidence of interstitial lung disease or active, non-infectious pneumonitis.
  • Known history of active tuberculosis.
  • Any other severe, uncontrolled medical condition, including uncontrolled diabetes mellitus (defined as a Hemoglobin A1C ≥ 9% in subjects with a prior history of diabetes, 28 days prior to study registration) or unstable congestive heart failure (Stage III-IV of the New York Heart Association Functional Classification)
  • Previous known allergy or intolerance to pembrolizumab or any of its excipients
  • Previous exposure or known allergy to Imprime PGG or any of its excipients
  • Known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
  • Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration, interfere with protocol compliance, or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for enrollment in this study.
  • Presence of any non-healing wound, fracture, or ulcer within 28 days prior to study registration.
  • Any mental or medical condition that prevents the subject from giving informed consent or participating in the trial.
  • No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, Gleason ≤ grade 7 prostate cancers, or other cancer for which the subject has been disease-free for at least 5 years.
  • Treatment with any therapeutic investigational agent within 28 days prior to study registration.

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): NCT03003468


Contacts
Contact: Michael Nunley 317.634.5842 ext 17 mnunley@hoosiercancer.org
Contact: Lawrence Feldman, M.D. 312.996.1581 lawfeld@uic.edu

Locations
United States, Illinois
University of Illinois at Chicago Recruiting
Chicago, Illinois, United States, 60612
Contact: Lawrence Feldman, M.D.    312-996-1588    lawfeld@uic.edu   
United States, Indiana
Indiana Univeristy Melvin and Bren Simon Cancer Center Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Vanessa Williams    317-274-0292    vanewill@iu.edu   
Principal Investigator: Nasser Hanna, MD         
United States, Iowa
University of Iowa Hospital and Clinics Recruiting
Iowa City, Iowa, United States, 52242
Contact: Mary Schall    319-356-3516    mary-schall@uiowa.edu   
Principal Investigator: Muhammad Furgan, MD         
United States, New Jersey
Rutgers Cancer Institute of New Jersey Recruiting
New Brunswick, New Jersey, United States, 08903
Contact: Michelle Orlick    732-235-6048    orlickmi@cinj.rutgers.edu   
Principal Investigator: Jyoti Malhotra, MD         
Sponsors and Collaborators
Lawrence Feldman, MD
Merck Sharp & Dohme Corp.
Biothera
Investigators
Study Chair: Lawrence Feldman, M.D. Big Ten Cancer Research Consortium

Additional Information:
Responsible Party: Lawrence Feldman, MD, M.D., Big Ten Cancer Research Consortium
ClinicalTrials.gov Identifier: NCT03003468     History of Changes
Other Study ID Numbers: BTCRC-LUN15-017
First Posted: December 28, 2016    Key Record Dates
Last Update Posted: June 26, 2018
Last Verified: June 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Lawrence Feldman, MD, Big Ten Cancer Research Consortium:
Anti-PD-1
Pembrolizumab
Imprime PGG
MK-3475

Additional relevant MeSH terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Pembrolizumab
Antineoplastic Agents