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Phase I/II Eval Safety & Prelim Activity Nivolumab Comb W/Vorolanib Pts W/Refractory Thoracic Tumors

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ClinicalTrials.gov Identifier: NCT03583086
Recruitment Status : Recruiting
First Posted : July 11, 2018
Last Update Posted : March 28, 2019
Sponsor:
Collaborators:
Bristol-Myers Squibb
Xcovery Holdings, INC
Information provided by (Responsible Party):
Leora Horn, MD, Vanderbilt-Ingram Cancer Center

Brief Summary:
This is a two-agent, open-label, non-randomized, Phase 1/2 dose escalation and dose expansion study of combinatorial oral vorolanib plus infusional nivolumab in patients with Non-Small Cell Lung Cancer naïve to checkpoint inhibitor therapy, Non-Small Cell Lung Cancer who have progressed on checkpoint inhibitor therapy, Small Cell Lung Cancer ( who have progressed on platinum-based chemotherapy, and thymic carcinoma.

Condition or disease Intervention/treatment Phase
Thymic Carcinoma Non-small Cell Lung Cancer Refractory Thoracic Tumors Small-Cell Lung Cancer Drug: VEGFR/PDGFR Dual Kinase Inhibitor X-82 Biological: Nivolumab Phase 1 Phase 2

Detailed Description:

Primary Objectives:

  • Phase I: To assess the safety and tolerability of nivolumab and vorolanib in combination in patients with refractory non small cell lung cancer naïve to checkpoint inhibitor therapy, non small cell lung cancer progressed on prior checkpoint inhibitor therapy considered primary refractory, non small cell lung cancer progressed on prior checkpoint inhibitor therapy considered acquired resistance, small cell lung cancer progressed on platinum-based chemotherapy, and thymic carcinoma.
  • Phase II: To evaluate the efficacy as measured by response to the combination nivolumab and vorolanib in patients with refractory non small cell lung cancer naïve to checkpoint inhibitor therapy, non small cell lung cancer progressed on prior checkpoint inhibitor therapy considered primary refractory, non small cell lung cancer progressed on prior checkpoint inhibitor therapy considered acquired resistance, small cell lung cancer progressed on platinum-based chemotherapy, and thymic carcinoma as compared to historical controls.

Secondary Objectives:

  • Phase I: To assess antitumor activity as measured by response rate for this novel combination.
  • Phase II: To assess, safety, progression free survival and overall survival

Exploratory Objectives:

• To assess the effects of combinatorial treatment on specific pharmacodynamic and pharmacogenetic biomarkers including PD-L1 expression and tumor mutation burden.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 177 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 1/2 Study to Evaluate the Safety and Preliminary Activity of Nivolumab in Combination With Vorolanib in Patients With Refractory Thoracic Tumors
Actual Study Start Date : July 10, 2018
Estimated Primary Completion Date : July 2023
Estimated Study Completion Date : July 2024

Resource links provided by the National Library of Medicine

Drug Information available for: Nivolumab

Arm Intervention/treatment
Experimental: Treatment (vorolanib, nivolumab)
Participants receive vorolanib PO QD on days 1-56 and nivolumab IV over 60 minutes every 2 weeks on days 1, 15, 29, and 43. Courses repeat every 56 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
Drug: VEGFR/PDGFR Dual Kinase Inhibitor X-82
Given by mouth

Biological: Nivolumab
Given by IV




Primary Outcome Measures :
  1. Phase II recommended combination dose per Common Terminology Criteria for Adverse Events (CTCAE) criteria version 4.03 [ Time Frame: At 28 days ]
  2. Phase II best response per Response Evaluation Criteria in Solid Tumors (RECIST) [ Time Frame: Up to 1 year. ]
    Antitumor activity will be assessed by objective response rate.

  3. Phase II best response per Response Evaluation Criteria in Solid Tumors (RECIST) [ Time Frame: Up to 1 years. ]
    Antitumor activity will be assessed by progression free survival.

  4. Phase II best response per Response Evaluation Criteria in Solid Tumors (RECIST) [ Time Frame: Up to 1 year ]
    Antitumor activity will be assessed by duration of response.

  5. Phase II best response per Response Evaluation Criteria in Solid Tumors (RECIST) [ Time Frame: Up to 1 year ]
    Antitumor activity will be assessed by disease control rate.

  6. Phase II best response per Response Evaluation Criteria in Solid Tumors (RECIST) [ Time Frame: Up to 1 year. ]
    Antitumor activity will be assessed by 1 year survival.

  7. Phase II best response [ Time Frame: Up to 1 year ]
    Antitumor activity will be assessed by correlation between the biomarkers and clinical outcomes.


Secondary Outcome Measures :
  1. Progression-free survival [ Time Frame: Up to 2 years ]
    Duration of Response (DOR) will also be assessed using Kaplan-Meier (KM) product-limit method. Median value of DOR, along with two-sided 95% CI using Brookmeyer and Crowley method will be reported.

  2. Overall survival [ Time Frame: At 1 year ]
  3. Objective response rate as related to PD-L1 status measured as < 1%, 1-49%, and > 50%. [ Time Frame: At 1 year ]
    Summarized by binomial response rate and their corresponding two-sided 95% exact CIs using Clopper-Pearson method.

  4. Disease control rate [ Time Frame: Up to 2 years ]
    Summarized by binomial response rate and their corresponding two-sided 95% exact CIs using the Clopper-Pearson method.



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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:

  • Signed and dated written informed consent.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Having progressed on at least one prior line of therapy, histologically or cytologically confirmed diagnosis of one of the following:

    * Dose escalation and expansion cohorts:

    • Checkpoint inhibitor naive non-small cell lung cancer patients must have progressed on front-line therapy cytotoxic chemotherapy and may have received up to two prior treatment regimens provided no regimens included an anti-PD1 or PD-L1 agent or an oral VEGF TKI. Prior bevacizumab or ramucirumab is allowed.
    • Progressed on checkpoint inhibitor non-small cell lung cancer patients must have progressed on front-line checkpoint inhibitor therapy and may have received up to two prior treatment regimens provided no regimens included an oral VEGF TKI. Prior bevacizumab or ramucirumab is allowed.
    • Thymic carcinoma patients must not be eligible for surgical resection at the time of enrollment and may have received any number of prior lines of therapy provided no regimens included an anti-PD1 or PD-L1 agent or an oral VEGF TKI. Prior bevacizumab or ramucirumab is allowed.
    • Small Cell Lung Cancer patients must have progressed on platinum-based chemotherapy and may have received up to three prior lines of therapy provided no prior regimen included an oral VEGF TKI; prior regimens can include an anti-PD-1 or PD-L1 agent.
  • At least one measurable lesion as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 which can be followed by computed tomography (CT) or magnetic resonance imaging (MRI).
  • Absolute neutrophil count (ANC) >= 1,500/uL within 14 days prior to first dose of protocol-indicated treatment.
  • Platelets >= 100,000/uL within 14 days prior to first dose of protocol-indicated treatment.
  • Hemoglobin >= 9.0 g/dL within 14 days prior to first dose of protocol-indicated treatment.
  • Serum creatinine =< 1.5 times institutional upper limit of normal (ULN), or calculated creatinine clearance >= 40 mL/min (per the Cockcroft-Gault formula) within 14 days prior to first dose of protocol-indicated treatment.
  • Total bilirubin =< 1.5 x ULN (except subjects with Gilbert syndrome, who must have total bilirubin < 3.0 mg/dL) within 14 days prior to first dose of protocol-indicated treatment.
  • Alanine aminotransferase and aspartate aminotransferase =< 2.5 x ULN, (=< 5.0 x ULN with documented liver metastases) within 14 days prior to first dose of protocol-indicated treatment.
  • Women must not be breastfeeding.
  • Women of childbearing potential (WOCBP) must have a negative serum pregnancy test within 24 hours prior to receiving first dose of protocol-indicated treatment.

    • WOCBP is defined as any female who has experienced menarche who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or is not postmenopausal.
    • Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 years of age in the absence of other biological or physiological causes.
    • If menopausal status is considered for the purpose of evaluating childbearing potential, women < 62 years of age must have a documented serum follicle stimulating hormone (FSH) level within laboratory reference range for postmenopausal women, in order to be considered postmenopausal and not of childbearing potential.
  • Women of childbearing potential must agree to follow instructions for acceptable contraception from the time of signing consent, and for 23 weeks after their last dose of protocol-indicated treatment.
  • Men not azoospermic who are sexually active with WOCBP must agree to follow instructions for acceptable contraception, from the time of signing consent, and for 31 weeks after their last dose of protocol-indicated treatment.

Exclusion Criteria:

  • =< 28 days before first dose of protocol-indicated treatment:

    • Anti-cancer treatment with bevacizumab.
    • Major surgery requiring general anesthesia or significant traumatic injury.
  • =< 14 days before first dose of protocol-indicated treatment:

    • Anti-cancer therapy with an approved or investigational agent (including chemotherapy, hormonal therapy, targeted therapy, immunotherapy, or biological therapy).
    • Radiosurgery or radiotherapy. (Note: A tumor lesion situated in a previously irradiated area is considered a measurable/target lesion only if subsequent disease progression has been documented in the lesion.)
    • Initiation of a new erythropoietin, darbepoietin, and/or bisphosphonate therapy.
    • Minor surgery. (Note: Placement of a vascular access device is not considered minor or major surgery.)
    • Serious or uncontrolled infection.
    • Infection requiring parenteral antibiotics. (Note: Patients with a non-serious infection under active treatment and controlled with oral antibiotics initiated at least 10 days prior to initiation of protocol-indicated treatment are not excluded - e.g. urinary tract infection controlled with oral antibiotics.)
    • Unexplained fever > 38.0 degree Celsius (C).
  • =< 7 days before first dose of protocol-indicated treatment: * Receipt of granulocyte colony‐stimulating factor (G-CSF) or granulocyte‐macrophage colony stimulating factor (GM-CSF).
  • Concurrent use of any medications or substances (e.g. herbal supplement or food) known to be a strong inhibitor or strong inducer of CYP3A4.

    • Although corticosteroids are considered to be strong inducers of CYP3A4, physiologic replacement doses of corticosteroids =< 10 mg daily prednisone or equivalent are allowed.
  • Inadequate recovery from toxicity attributed to prior anti-cancer therapy.

    * With the exception of alopecia, fatigue, or peripheral neuropathy, patients must have recovered to =< grade 1 (National Cancer Institute-Common Terminology Criteria for Adverse Events [NCI-CTCAE] version [v] 4.03) residual toxicity prior to first dose of protocol-indicated treatment.

  • Known history of allergy or intolerance which, in the opinion of the investigator, was an unacceptable adverse reaction attributed by the investigator to any prior anti-neoplastic therapy specifically targeting vascular endothelial growth factor or the VEGF receptor - i.e. pazopanib (Votrient), bevacizumab (Avastin), sorafenib (Nexavar), sunitinib (Sutent), axitinib (Inlyta), etc.
  • Known history of allergy or intolerance which, in the opinion of the investigator, was an unacceptable adverse reaction attributed by the investigator to any prior anti-neoplastic therapy specifically targeting T-cell costimulation or immune checkpoint pathways - i.e. nivolumab (Opdivo), pembrolizumab (Keytruda), atezolizumab (Tecentriq), ipilimumab (Yervoy), etc.
  • Non-healing wounds on any part of the body.
  • Known or suspected clinically significant active bleeding.
  • Inability to swallow oral medication; or the presence of a poorly controlled gastrointestinal disorder that could significantly affect the absorption of oral study drug - e.g. Crohn's disease, ulcerative colitis, chronic diarrhea (defined as > 4 loose stools per day), malabsorption, or bowel obstruction.
  • NSCLC patients with radiographic evidence of major airway or blood vessel invasion by cancer, radiographic evidence of intra-tumor cavitation, or gross hemoptysis (>= one teaspoon) within the preceding 2 months.
  • Significant cardiovascular disease or condition including:

    • Congestive heart failure (CHF) currently requiring therapy.
    • Class III or IV cardiovascular disease according to the New York Heart Association (NYHA) functional criteria.
    • Need for antiarrhythmic medical therapy for a ventricular arrhythmia.
    • Severe conduction disturbance (e.g. 3rd degree heart block).
    • Unstable angina pectoris (i.e. last episode =< 6 months prior to first dose of protocol-indicated treatment).
    • Uncontrolled (per investigator judgment) hypertension.
    • Myocardial infarction within 6 months prior to starting trial treatment.
    • Fridericia's correction formula (QTcF) > 450 ms in men, or > 470 ms in women.
  • Deep vein thrombosis or pulmonary embolism =< 4 weeks before first dose of protocol-indicated treatment, unless adequately treated and stable.

    * Patients receiving therapeutic non-coumarin anticoagulation are eligible, provided they are on a stable dose (per investigator judgment) of anticoagulant.

  • Patients with active interstitial lung disease and non-infectious pneumonitis or a history of active interstitial lung disease or pneumonitis requiring treatment with steroids or that may interfere with the detection or management of suspected drug-related pulmonary toxicity. Patients with lung cancer with a remote history of pneumonitis following chemo-radiation treatment that has resolved are allowed.

    * Note: Patients with chronic obstructive pulmonary disease (COPD) whose disease is controlled (per investigator judgment) at trial entry are not excluded.

  • Central nervous system (CNS) metastasis, unless asymptomatic and stable with no change in CNS disease status for at least two (2) weeks prior to initiating protocol-indicated treatment.

    * Anticonvulsant and/or corticosteroid prophylaxis (=< 10 mg/day prednisone or equivalent daily) will be allowed if patient is on a stable or decreasing dose of such treatment for at least 14 days prior to initiating protocol-indicated treatment.

  • Any condition requiring systemic treatment with either corticosteroids (> 10 mg/day prednisone or equivalent daily) or other immunosuppressive medications within 14 days prior to initiating protocol-indicated treatment.

    * In the absence of active autoimmune disease: Subjects are permitted the use of corticosteroids with minimal systemic absorption (e.g. topical, ocular, intra-articular, intranasal, and inhalational) =< 10 mg/day prednisone or equivalent daily; and physiologic replacement doses of systemic corticosteroids =< 10 mg/day prednisone or equivalent daily (e.g. hormone replacement therapy needed in patients with hypophysitis).

  • Active, known or suspected autoimmune disease.

    * Subjects with type I diabetes mellitus; hypothyroidism only requiring hormone replacement; skin disorders such as vitiligo, psoriasis or alopecia not requiring systemic treatment; or conditions not expected by the investigator to recur in the absence of an external trigger are permitted to enroll.

  • Uncontrolled (per investigator judgment) type I or type II diabetes mellitus.
  • Known positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS).
  • Any positive test for hepatitis B or hepatitis C virus indicating acute or chronic infection.

    * Hepatitis B and C testing required =< 28 days prior to initiating protocol-indicated treatment, including at least: hepatitis B surface antigen (HBV sAg); and hepatitis C virus antibody (HCV Ab) or hepatitis C virus ribonucleic acid (HCV RNA).

  • Solid tumor transplantation.
  • Immunization with any attenuated live vaccine within 1 week prior to initiating protocol-indicated treatment.
  • Active second malignancy or history of a previous second malignancy within the last 3 years.

    * Exceptions include the following permitted conditions - provided a complete remission was achieved at least 3 years prior to initiating protocol-indicated treatment and no additional therapy (with the exception of allowable anti-estrogen/androgen therapy or bisphosphonates) is ongoing or required during the trial period: non-melanoma skin cancers (e.g. basal or squamous cell); superficial bladder cancer; or carcinoma in situ of the prostate, cervix, or breast.

  • Known psychiatric condition, social circumstance, or other medical condition reasonably judged by the investigator to unacceptably increase the risk of study participation; or to prohibit the understanding or rendering of informed consent or anticipated compliance with and interpretation of scheduled visits, treatment schedule, laboratory tests and other study requirements.

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): NCT03583086


Contacts
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Contact: Vanderbilt-Ingram Service Information Program 800-811-8480 cip@vanderbilt.edu

Locations
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United States, Tennessee
Vanderbilt-Ingram Cancer Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Clinical Trials Information Program    800-811-8480    cip@vanderbilt.edu   
Principal Investigator: Leora Horn, MD         
Sponsors and Collaborators
Vanderbilt-Ingram Cancer Center
Bristol-Myers Squibb
Xcovery Holdings, INC
Investigators
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Principal Investigator: Leora Horn, MD Vanderbilt-Ingram Cancer Center

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Responsible Party: Leora Horn, MD, Principal Investigator, Vanderbilt-Ingram Cancer Center
ClinicalTrials.gov Identifier: NCT03583086     History of Changes
Other Study ID Numbers: VICC THO 1802
CA209-982 ( Other Identifier: Bristol Myers Squibb )
First Posted: July 11, 2018    Key Record Dates
Last Update Posted: March 28, 2019
Last Verified: March 2019

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

Additional relevant MeSH terms:
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Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Small Cell Lung Carcinoma
Thymoma
Thoracic Neoplasms
Respiratory Tract Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Neoplasms, Complex and Mixed
Neoplasms by Histologic Type
Thymus Neoplasms
Lymphatic Diseases
Nivolumab
Antineoplastic Agents, Immunological
Antineoplastic Agents