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Pembrolizumab and Interferon Gamma-1b in Treating Patients With Stage IB-IVB Relapsed or Refractory Mycosis Fungoides and Sezary Syndrome

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ClinicalTrials.gov Identifier: NCT03063632
Recruitment Status : Recruiting
First Posted : February 24, 2017
Last Update Posted : September 12, 2018
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)

Brief Summary:
This phase II trial studies how well pembrolizumab and interferon gamma-1b work in treating patients with stage IB-IVB mycosis fungoides and sezary syndrome that has come back or has not responded to previous treatment. Monoclonal antibodies, such as pembrolizumab, may interfere with the ability of cancer cells to grow and spread. Interferon gamma-1b may boost the immune system activity. Giving pembrolizumab and interferon gamma-1b together may work better in treating patients with stage IB-IVB mycosis fungoides and sezary syndrome.

Condition or disease Intervention/treatment Phase
Recurrent Mycosis Fungoides and Sezary Syndrome Refractory Mycosis Fungoides Stage IB Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage II Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IIA Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IIB Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage III Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IIIA Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IIIB Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IV Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IVA Mycosis Fungoides and Sezary Syndrome AJCC v7 Stage IVB Mycosis Fungoides and Sezary Syndrome AJCC v7 Biological: Interferon Gamma-1b Other: Laboratory Biomarker Analysis Biological: Pembrolizumab Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To assess the overall response rate (ORR) of MK-3475 (pembrolizumab) and interferon gamma-1b (IFN-G) (Actimmune) combination immunotherapy in subjects with previously treated mycosis fungoides (MF) or sezary syndrome (SS).

SECONDARY OBJECTIVES:

I. To explore the safety/tolerability and clinical activity of MK-3475 (pembrolizumab) and IFN-G (Actimmune) in subjects with previously treated MF or SS with respect to safety and tolerability.

II. To explore the safety/tolerability and clinical activity of MK-3475 (pembrolizumab) and IFN-G (Actimmune) in subjects with previously treated MF or SS with respect to time to response (TTR).

III. To explore the safety/tolerability and clinical activity of MK-3475 pembrolizumab) and IFN-G (Actimmune) in subjects with previously treated MF or SS with respect to duration of response (DOR).

IV. To explore the safety/tolerability and clinical activity of MK-3475 pembrolizumab) and IFN-G (Actimmune) in subjects with previously treated MF or SS with respect to progression-free survival (PFS).

V. To explore the safety/tolerability and clinical activity of MK-3475 pembrolizumab) and IFN-G (Actimmune) in subjects with previously treated MF or SS with respect to event-free survival (EFS).

VI. To explore the safety/tolerability and clinical activity of MK-3475 pembrolizumab) and IFN-G (Actimmune) in subjects with previously treated MF or SS with respect to percentage of all patients who have a response duration of at least 12 months (ORR12).

TERTIARY OBJECTIVES:

I. To investigate the relationship between the following putative biomarkers for combination immunotherapy of MK-3475 pembrolizumab) and IFN-gamma (Actimmune) and clinical outcomes (as measured by safety/tolerability and ORR, DOR, PFS, EFS) in subjects with previously treated MF/SS, including tumor/microenvironment (PD-1/PD-L1/PD-L2 expression, cytotoxic T lymphocyte [CTL]s, regulatory T cell [Treg]s, macrophages, dendritic cell [DC]s; nanostring gene expression profile), systemic immune response (flow cytometry, mass cytometry [CyTOF], Luminex multiplexed cytokine profile), and molecular/genomic immune correlates (exome sequencing, high throughput sequencing [HTS] for T cell receptor [TCR]).

OUTLINE:

Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1. Courses repeat every 3 weeks for up to 2 years in the absence of disease progression or unexpected toxicity. Patients also receive interferon gamma-1b subcutaneously (SC) 3 times per week for 12 weeks, and then follow 3 weeks on and 3 weeks off schedule for up to 2 years in the absence of disease progression or unexpected toxicity.

After completion of study treatment, patients are follow up for 30 days and then every 12 weeks for up to 1 year.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Trial of MK-3475 (Pembrolizumab) and Interferon Gamma 1-b Combination Immunotherapy in Patients With Previously Treated Mycosis Fungoides and Sezary Syndrome
Actual Study Start Date : October 13, 2017
Estimated Primary Completion Date : May 1, 2020
Estimated Study Completion Date : May 1, 2020


Arm Intervention/treatment
Experimental: Treatment (pembrolizumab, interferon gamma-1b)
Patients receive pembrolizumab IV over 30 minutes on day 1. Courses repeat every 3 weeks for up to 2 years in the absence of disease progression or unexpected toxicity. Patients also receive interferon gamma-1b SC 3 times per week for 12 weeks, and then follow 3 weeks on and 3 weeks off schedule for up to 2 years in the absence of disease progression or unexpected toxicity.
Biological: Interferon Gamma-1b
Given SC
Other Names:
  • Actimmune
  • gamma Interferon 1B
  • IFN-g-1b
  • IFN-gamma 1b
  • IFNg-1b
  • Interferon gamma-1b, Recombinant
  • N(Sup 2)-L-Methionyl-1-139-Interferon G
  • N(sup 2)-L-Methionyl-1-139-interferon gamma (Human Lymphocyte Protein Moiety Reduced)
  • Recombinant Interferon Gamma-1b

Other: Laboratory Biomarker Analysis
Ancillary studies

Biological: Pembrolizumab
Given IV
Other Names:
  • Keytruda
  • Lambrolizumab
  • MK-3475
  • SCH 900475




Primary Outcome Measures :
  1. Overall response rate per global assessment of mycosis fungoides (MF) and sezary syndrome (SS) (confirmed and investigator assessed) [ Time Frame: Up to 1 year ]
    Binomial proportion.


Secondary Outcome Measures :
  1. Incidence of study drug related sever adverse events assessed by the Common Terminology Criteria for Adverse Events version 4.0 [ Time Frame: Up to 1 year ]
  2. Time to response [ Time Frame: Up to 1 year ]
    Simple statistics.

  3. Duration of response [ Time Frame: Time interval between the date of first response (complete response/partial response) and the date of progression, assessed up to 1 year ]
    Kaplan-Meier method.

  4. Progression-free survival [ Time Frame: Time from enrollment to disease progression or death, whichever occurs earlier, based upon investigator assessment, assessed up to 1 year ]
    Kaplan-Meier method.

  5. Event-free survival [ Time Frame: Termination due to toxicity, initiation of next significant treatment, progressive disease, or death of any cause, assessed up to 1 year ]
    Kaplan-Meier method.

  6. Rate of overall response duration beyond 12 months (ORR12) per global assessment of MF and SS (confirmed & investigator assessed) [ Time Frame: At 12 months ]
    Binomial distribution.


Other Outcome Measures:
  1. Biomarkers in tumor and blood assessed by immunohistochemistry, mass spectrometry, Nanostring, sequencing, and enzyme-linked immunosorbent assay [ Time Frame: Up to 1 year ]
    Clinical response (as measured by the primary and secondary endpoints) to combination immunotherapy regimen as a function of biomarkers will be evaluated. All biomarker assays will be run on the clinical trial samples in a blinded manner. Time to event endpoints (DOR, PFS, EFS) will be evaluated using Kaplan-Meier curves generated by biomarker scoring group using the log-rank test. Exploratory outcomes will be summarized with descriptive statistics (primarily proportions and medians) for all biomarkers described above, and additionally, serum IL-10, regulatory T-cells, and activated CD8 T cells. Scatterplots and Kendall's tau estimates will be produced for estimating correlation of PD-1, PDL1, or PD-L2 expression measures and clinical outcome across compartments (skin, lymph node, blood). Comparison of tissue immunohistochemistry markers between pre-treatment and with clinical response or disease progression will be assessed using Wilcoxon signed-rank test.



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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:

  • Stage IB-IVB MF/SS, and who have relapsed, are refractory, or progressed after at least one standard systemic therapy; maximal stage since diagnosis will determine eligibility; current disease stage at time of entry will also be documented but will not be used for eligibility
  • Subjects must have the following minimum wash-out from previous treatments and without treatment between documentation of relapse/progression and enrollment:

    • >= 2 weeks for local radiation therapy
    • >= 8 weeks for low dose (12 Gy or less) total skin electron beam therapy (TSEBT)
    • >= 4 weeks for systemic cytotoxic anticancer agents, anticancer investigational agents that are not defined as immunotherapy, or for tumor-targeting monoclonal antibodies (mAbs) with the exception of alemtuzumab for which the washout is at least 16 weeks
    • >= 15 weeks for anti-CD137 or anti-CTLA-4 (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways)
    • >= 2 weeks from resolution (i.e., < grade 1 or at baseline) from adverse event (AE)s due to procedures performed or therapeutic agents administered
    • >= 2 weeks for retinoids, interferons, vorinostat, romidepsin and denileukin diftitox
    • >= 4 weeks for doses of systemic corticosteroidsgreater than 10 mg/day of prednisone or equivalent; patients who are on physiologic doses of corticosteroids (prednisone equivalent 10 mg/day or less) may participate, however, they must be on a stable dose for at least 4 weeks before enrollment; patients who are on low or moderate potency topical corticosteroids may participate if they are on a stable dose for at least 4 weeks before enrollment; inhaled corticosteroids are acceptable; local injections of corticosteroids are acceptable; all corticosteroids will be reported as concomitant medications
    • >= 2 weeks for phototherapy
    • >= 1 week for topical therapy (including retinoid, nitrogen mustard, or imiquimod)
  • Patients with prior treatment with IFN-gamma will be eligible, if they previously tolerated IFN-gamma, however patients must be off of IFN-gamma for at least three weeks before initiation of therapy on this trial
  • Have measurable disease based on modified severity-weighted assessment tool (mSWAT); tumor lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions
  • Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) performance scale
  • Performed within 10 days of treatment initiation: Absolute neutrophil count (ANC) >= 1500/mcL
  • Performed within 10 days of treatment initiation: Platelets >= 100000/mcL
  • Performed within 10 days of treatment initiation: Hemoglobin >= 9 g/dL or >= 5.6 mmol/L
  • Performed within 10 days of treatment initiation: Creatinine =< 1.5 x upper limit normal (ULN) OR
  • Performed within 10 days of treatment initiation: Measured or calculated creatinine clearance >= 60 mL/min for patient with creatinine levels > 1.5 x institutional ULN

    • Creatinine clearance (CrCl) should be calculated per institutional standard; glomerular filtration rate (GFR) can also be used in place of creatinine or CrCl
  • Performed within 10 days of treatment initiation: Total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for patients with total bilirubin levels > 1.5 x ULN
  • Performed within 10 days of treatment initiation: Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN OR =< 5 x ULN for patients with liver metastases
  • Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) before to study entry and for the duration of study participation; female patients of childbearing potential must have a negative urine or serum pregnancy test within 72 hours before receiving the first dose of study medication; if the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required; female patients of childbearing potential must be willing to use an adequate method of contraception for the course of the study through 120 days after the last dose of study medication; Note: abstinence is acceptable if this is the usual lifestyle and preferred contraception for the patient; male patients of reproductive potential must agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy; Note: abstinence is acceptable if this is the usual lifestyle and preferred contraception for the patient; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception before the study, for the duration of study participation, and 4 months after completion of MK-3475 (pembrolizumab) and interferon-gamma administration
  • Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Has disease that is suitable for local therapy administered with curative intent
  • Patients who have had chemotherapy or targeted small molecule therapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) before entering the study
  • Patients who have had an allogeneic stem cell transplant are excluded
  • Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2
  • Patients who have received an investigational agent or have used an investigational device within 4 weeks of the first dose of study drug
  • Has a history of a well-characterized and defined immune deficiency before the diagnosis of MF/SS or is receiving systemic steroid therapy greater than 10mg/day of prednisone or equivalent within 4 weeks or any other form of immunosuppressive therapy within 7 days before the first dose of trial treatment; the use of physiologic replacement doses of corticosteroids, along with topical, inhaled and local injection is discussed
  • Has had a prior monoclonal antibody within 4 weeks before study day 1 or who has not recovered (i.e., =< grade 1 or at baseline) from AEs due to agents administered more than 4 weeks earlier

    • Note: the following will not be exclusionary: patients may have any grade alopecia or lymphopenia and still participate if other inclusion/exclusion criteria are met; patients may have grade 1 or 2 neuropathy at baseline and still participate if other inclusion/exclusion criteria are met
  • Has a known additional malignancy that is progressing or requires active treatment; exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin that has undergone potentially curative therapy, or in situ cervical cancer
  • Patients with known brain metastases should be excluded from this clinical trial; patients with carcinomatous meningitis should also be excluded; patients with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging using the identical imaging modality for each assessment, either magnetic resonance imaging [MRI] or computed tomography [CT] scan, for at least 4 weeks before 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 before trial treatment
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to MK-3475 (pembrolizumab) and interferon-gamma; patients who are hypersensitive to Escherichia (E). coli are also excluded
  • Has an 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 (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
  • Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis
  • Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating investigator
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, interstitial lung disease or active, non-infectious pneumonitis, congestive heart failure New York Heart Association (NYHA) grade >= 3, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with MK-3475 (pembrolizumab); patients are excluded from this study if pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment
  • Patients who are human immunodeficiency virus (HIV) positive may participate IF they meet the following eligibility requirements:

    • They must be stable on their anti-retroviral regimen, and they must be healthy from an HIV perspective
    • They must have a CD4 count of greater than 250 cells/mcL
    • They must not be receiving prophylactic therapy for an opportunistic infection
    • Must be on antiretroviral therapy and there must be minimal interactions or overlapping toxicity of the antiretroviral therapy with the experimental cancer treatment
    • HIV viral load must be < 200 copies/ mm^3 by standard clinical assays
  • Has known active hepatitis B (e.g., hepatitis B virus surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected)

    • Note: the following will not be exclusionary:

      • A positive hepatitis B serology indicative of previous immunization (i.e., HBsAb positive and hepatitis B virus core antibody [HBcAb] negative), or a fully resolved acute hepatitis B virus (HBV) infection
      • Patients with chronic HBV suppressed by appropriate antiretroviral therapy with activity against HBV, as outlined in Department of Health and Human Services (DHHS) guidelines
      • Positive HCV serology but no detectable HCV RNA, indicative of spontaneously cleared HCV infection
      • Patients who have been successfully treated for HCV as long as therapy for HCV has been completed
  • Has received a live vaccine within 30 days before to the first dose of trial treatment; examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, seasonal flu (some), H1N1 flu, rabies, Bacille Calmette-Guerin (BCG), and typhoid vaccine; seasonal flu vaccines that do not contain live virus are permitted
  • Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial

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): NCT03063632


Locations
United States, California
Stanford Cancer Institute Palo Alto Recruiting
Palo Alto, California, United States, 94304
Contact: Site Public Contact    650-498-7061    ccto-office@stanford.edu   
Principal Investigator: Youn H. Kim         
United States, Missouri
Washington University School of Medicine Recruiting
Saint Louis, Missouri, United States, 63110
Contact: Site Public Contact    800-600-3606    info@siteman.wustl.edu   
Principal Investigator: Neha Mehta-Shah         
United States, New York
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Site Public Contact    212-639-7592      
Principal Investigator: Alison J. Moskowitz         
United States, Pennsylvania
University of Pennsylvania/Abramson Cancer Center Suspended
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
Principal Investigator: Youn Kim Cancer Immunotherapy Trials Network

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT03063632     History of Changes
Other Study ID Numbers: NCI-2017-00265
NCI-2017-00265 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
CITN-13
CITN-13 ( Other Identifier: Cancer Immunotherapy Trials Network )
CITN-13 ( Other Identifier: CTEP )
P30CA015704 ( U.S. NIH Grant/Contract )
U01CA154967 ( U.S. NIH Grant/Contract )
First Posted: February 24, 2017    Key Record Dates
Last Update Posted: September 12, 2018
Last Verified: June 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Mycoses
Mycosis Fungoides
Syndrome
Sezary Syndrome
Disease
Pathologic Processes
Lymphoma, T-Cell, Cutaneous
Lymphoma, T-Cell
Lymphoma, Non-Hodgkin
Lymphoma
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Pembrolizumab
Interferons
Interferon-gamma
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents