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Pembrolizumab and Pralatrexate in Treating Patients With Relapsed or Refractory Peripheral T-Cell Lymphomas

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ClinicalTrials.gov Identifier: NCT03598998
Recruitment Status : Recruiting
First Posted : July 25, 2018
Last Update Posted : November 20, 2019
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
City of Hope Medical Center

Brief Summary:
This phase I/II trial studies the side effects and best dose of pralatrexate when given together with pembrolizumab and how well they work in treating patients with peripheral T-cell lymphomas that has come back after a period of improvement or has not responded to treatment. Pralatrexate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving pembrolizumab and pralatrexate may work better in treating patients with peripheral T-cell lymphomas.

Condition or disease Intervention/treatment Phase
Anaplastic Large Cell Lymphoma Nodal Peripheral T-Cell Lymphoma With TFH Phenotype Recurrent Anaplastic Large Cell Lymphoma Recurrent Angioimmunoblastic T-Cell Lymphoma Recurrent Enteropathy-Associated T-Cell Lymphoma Recurrent Follicular Lymphoma Recurrent Hepatosplenic T-Cell Lymphoma Recurrent Mature T- Cell and NK-Cell Non-Hodgkin Lymphoma Recurrent Monomorphic Epitheliotropic Intestinal T-cell Lymphoma Recurrent Mycosis Fungoides Recurrent Peripheral T-Cell Lymphoma, Not Otherwise Specified Refractory Anaplastic Large Cell Lymphoma Refractory Angioimmunoblastic T-Cell Lymphoma Refractory Enteropathy-Associated T-Cell Lymphoma Refractory Follicular Lymphoma Refractory Hepatosplenic T-Cell Lymphoma Refractory Mature T-Cell and NK-Cell Non-Hodgkin Lymphoma Refractory Mycosis Fungoides Refractory Peripheral T-Cell Lymphoma, Not Otherwise Specified Subcutaneous Panniculitis-Like T-Cell Lymphoma Biological: Pembrolizumab Drug: Pralatrexate Phase 1 Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. Evaluate the safety and tolerability of a regimen combining pembrolizumab and pralatrexate in patients with relapsed or refractory peripheral T-cell lymphoma (PTCL).

II. Establish the maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of the combined pralatrexate and pembrolizumab regimen.

III. Estimate the overall response rate (ORR) according to the Lugano Classification in patients treated with pembrolizumab plus pralatrexate at the RP2D.

SECONDARY OBJECTIVES:

I. Estimate the complete response (CR) rate according to the Lugano Classification duration of response (DOR), overall survival (OS) and progression‐free survival (PFS) in patients treated with pembrolizumab plus pralatrexate.

II. Estimate the ORR and CR rate according to the International Harmonization Project response criteria.

III. Evaluate responses and disease progression according to the Lymphoma Response to Immunomodulatory therapy Criteria (LYRIC).

EXPLORATORY OBJECTIVE:

I. Explore immunologic and genomic biomarkers of response to pembrolizumab plus pralatrexate therapy.

OUTLINE: This is a phase I, dose-escalation study of pralatrexate followed by a phase II study.

Patients receive pralatrexate intravenously (IV) over 3-5 minutes on days 1 and 8 and pembrolizumab IV over 30 minutes on day 1. Courses repeat every 21 days for up to 24 months in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30 and 90 days, every 12 weeks for 1 year, and then every 18 weeks thereafter.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1/2 Study of Pembrolizumab Plus Pralatrexate for Treatment of Relapsed or Refractory Peripheral T-Cell Lymphomas
Actual Study Start Date : February 4, 2019
Estimated Primary Completion Date : April 27, 2021
Estimated Study Completion Date : April 27, 2021


Arm Intervention/treatment
Experimental: Treatment (pralatrexate and pembrolizumab)
Patients receive pralatrexate IV over 3-5 minutes on days 1 and 8 and pembrolizumab IV over 30 minutes on day 1. Courses repeat every 21 days for up to 24 months in the absence of disease progression or unacceptable toxicity.
Biological: Pembrolizumab
Given IV
Other Names:
  • Keytruda
  • Lambrolizumab
  • MK-3475
  • SCH 900475

Drug: Pralatrexate
Given IV
Other Names:
  • 10-propargyl-10-deazaaminopterin
  • Folotyn
  • PDX




Primary Outcome Measures :
  1. Maximum tolerated dose defined as the highest doe level at which < 2 out of 6 evaluable subjects experienced dose limiting toxicities (Phase I) [ Time Frame: Up to 21 days ]
    Toxicities will be breaded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

  2. Overall response rate (ORR) according to Lugano classification (Phase II) [ Time Frame: Up to 48 months ]

Secondary Outcome Measures :
  1. Complete response (CR) rate according to Lugano classification [ Time Frame: Up to 48 months ]
  2. ORR according to the International Harmonization Project response criteria [ Time Frame: Up to 48 months ]
  3. CR rate according to the International Harmonization Project response criteria [ Time Frame: Up to 48 months ]
  4. Duration of response (DOR) based on Lymphoma Response to Immunomodulatory therapy Criteria (LYRIC) criteria [ Time Frame: Up to 48 months ]
  5. Overall survival (OS) [ Time Frame: From initiation of study therapy to death from any cause, assessed up to 48 months ]
  6. Progression‐free survival (PFS) [ Time Frame: From initiation of study therapy to the first observation of disease relapse/progression or death from any cause, whichever occurs first, assessed up to 48 months ]
  7. Incidence of adverse events assessed by NCI CTCAE version (v)5.0 [ Time Frame: Up to 90 days after last dose ]
    Observed toxicities will be summarized by type (organ affected or laboratory determination such as absolute neutrophil count, severity (by NCI CTCAE v5.0 and nadir or maximum values for lab measures), date of onset, duration, reversibility, and attribution.

  8. Incidence of unacceptable toxicity assessed by NCI CTCAE version 5.0 [ Time Frame: Up to 90 days after last dose ]


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:

  • Documented willingness and ability to sign an informed consent of the participant and/or legally authorized representative.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Patients must have a histologically confirmed diagnosis of mature peripheral T‐cell or natural killer (NK)‐cell lymphoma according to the World Health Organization (WHO) classification, with hematopathology review at the participating institution. Eligible histologies are:

    • Peripheral T-cell lymphoma, not otherwise specified
    • Anaplastic large cell lymphoma, ALK-negative
    • Anaplastic large cell lymphoma, ALK-positive
    • Angioimmunoblastic T-cell lymphoma
    • Nodal peripheral T-cell lymphoma with TFH phenotype
    • Follicular T-cell lymphoma
    • Indolent T-cell lymphoproliferative disorder of the gastrointestinal (GI) tract
    • Extranodal NK-/T-cell lymphoma
    • Enteropathy-associated T cell lymphoma
    • Monomorphic epitheliotropic intestinal T-cell lymphoma
    • Hepatosplenic T-cell lymphoma
    • Subcutaneous panniculitis-like T-cell lymphoma
    • Transformed mycosis fungoides
  • Patients must have failed at least one prior regimen, including:

    • Recurrence of disease after a documented complete response (CR).
    • Progression of disease after a partial response (PR) to the prior regimen.
    • Partial response, stable disease (SD) or progressive disease (PD) at the completion of the prior treatment regimen. If a patient has PR to prior regimen without PD, there must be biopsy‐proven** residual disease that is measurable

      • Exception can be granted by the principal investigator (PI) if a biopsy is not feasible and/or safe
  • Patient must have measurable disease by computerized tomography (CT) or positron emission tomography (PET) scan, with one or more sites of disease >= 1.5cm in longest dimension.
  • Be willing to provide tissue from a fresh core or excisional biopsy of a tumor lesion prior to starting study therapy or from archival tissue of a biopsy that was performed after the most recent systemic therapy. Exception can be granted by the PI if a biopsy is not feasible and/or safe
  • Patients must have received one dose of vitamin B12 (1 mg intramuscularly [IM]) within 10 weeks prior to first dose of pralatrexate, and must have begun folic acid supplementation (1 mg orally, once daily) within 10 days of first dose of pralatrexate. Note: If folic acid was not started but methylmalonic acid (MMA) and homocysteine (HCY) levels were checked and are in normal range at screening, the investigator can decide to start study therapy immediately. Vitamin B12 and folic acid supplementation is standard of care for pralatrexate therapy.
  • Absolute neutrophil count (ANC) >= 1,000/mm^3. In Phase 2 portion of study, ANC < 1000/mm^3 but >= 500/mm^3 is allowable if patients have demonstrated bone marrow involvement by lymphoma (within 14 days prior to day 1 of protocol therapy).

    • Note: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement.
  • Platelets >= 75,000/mm^3. In Phase 2 portion of study, Platelets < 75,000/mm^3 but >= 25,000/mm^3 is allowable if patients have demonstrated bone marrow involvement by lymphoma (within 14 days prior to day 1 of protocol therapy)

    • Note: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement.
  • Total serum bilirubin =< 1.5 X upper limit of norma (ULN) or =< 3X ULN for Gilbert's disease. Direct bilirubin =< ULN for subjects with total bilirubin levels > 1.5 ULN (within 14 days prior to day 1 of protocol therapy).
  • Aspartate aminotransferase (AST) =< 2.5 x ULN (within 14 days prior to day 1 of protocol therapy)
  • Alanine aminotransferase (ALT) =< 2.5 x ULN (within 14 days prior to day 1 of protocol therapy)
  • Creatinine clearance of >= 60 mL/min per the Cockcroft‐Gault formula (within 14 days prior to day 1 of protocol therapy). If creatinine clearance (CrCl) is >= 60 mL/min as measured by 24 hour urine collection, this will be allowable.
  • If not receiving anticoagulants: International normalized ratio (INR) OR prothrombin (PT) =< 1.5 x ULN (within 14 days prior to day 1 of protocol therapy).

    • If on anticoagulant therapy: PT must be within therapeutic range of intended use of anticoagulants.
  • If not receiving anticoagulants: Activated partial thromboplastin time (aPTT) =< 1.5 x ULN (within 14 days prior to day 1 of protocol therapy)

    • If on anticoagulant therapy: aPTT must be within therapeutic range of intended use of anticoagulants.
  • Female of childbearing potential: negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study medication (within 14 days prior to day 1 of protocol therapy). If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
  • Woman of childbearing potential (WOCBP): Use two effective methods of contraception (hormonal or barrier method) or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days post last dose of pembrolizumab. WOCBP defined as not being surgically sterilized or have not been free from menses for >1 year.

    • Male: Use two effective methods of contraception (barrier method) or abstain from heterosexual activity with the first dose of study therapy through 120 days post last dose of pembrolizumab.

Exclusion Criteria:

  • Patients with adult T-cell leukemia/lymphoma
  • Prior allogeneic hematopoietic stem cell transplantation within the last 5 years.
  • Prior autologous hematopoietic stem cell transplant within the last 60 days.
  • Patients who received prior therapy with an anti‐PD‐1, anti-PD‐L1, or anti‐PD‐L2 agent without having had evidence of objective response.
  • Patients who received prior therapy with pralatrexate without having had evidence of objective response.
  • Investigational agent or anti‐cancer monoclonal antibody (mAb) within 21 days prior to day 1 of therapy or who has not recovered (i.e. =<1 or at baseline) from adverse events due to agents administered more than 21 days earlier.
  • Prior chemotherapy, targeted small molecule therapy, or radiation therapy within 14 days prior to day 1 of therapy or who has not recovered (i.e. =< 1 or at baseline) from adverse events due to a previously administered agent. * Note: Subjects with =< grade 2 neuropathy are an exception and may qualify for the study.
  • Antineoplastic biologic therapy or major surgery within 21 days of the first dose of trial medication. If subjects received major surgery more than 21 days ago, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy.
  • Received live vaccine within 30 days prior to day 1 of protocol therapy.
  • Systemic steroid therapy or on any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
  • Diagnosis of immunodeficiency.
  • Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer.
  • Congestive heart failure class III/IV according to the New York Heart Association (NYHA) Functional classification.
  • Known severe hypersensitivity reaction to pembrolizumab, pralatrexate, leucovorin or any excipients.
  • Active autoimmune disease that has required systemic treatment in the past 2 years (replacement therapies for hormone deficiencies are allowed). Hemolytic anemia associated with the lymphoma does not exclude a patient from the study.
  • Known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
  • Known active hepatitis B (e.g., hepatitis B virus surface antigen (HBsAg) reactive) or hepatitis C (e.g., hepatitis C virus ribonucleic acid [HCV RNA] [qualitative] is detected).
  • History of tuberculosis (TB) infection (Bacillus tuberculosis).
  • Active central nervous system (CNS) involvement by lymphoma, including parenchymal and/or lymphomatous meningitis. Subjects with prior CNS involvement by lymphoma must have a baseline magnetic resonance imaging (MRI) and lumbar puncture at screening that demonstrate no active lymphoma in the CNS.
  • Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis.
  • Active, uncontrolled infection requires systemic therapy.
  • Female: Pregnant or breastfeeding.
  • Expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 120 days after the last dose of trial treatment.
  • Has known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the trial.
  • History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  • Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures.
  • Perspective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics).

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): NCT03598998


Locations
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United States, California
City of Hope Medical Center Recruiting
Duarte, California, United States, 91010
Contact: Alex F. Herrera    626-256-4673 ext 62405    aherrera@coh.org   
Principal Investigator: Alex F. Herrera         
United States, Georgia
Emory University Hospital/Winship Cancer Institute Not yet recruiting
Atlanta, Georgia, United States, 30322
Contact: Pamela B. Allen    404-778-1900    pamela.b.allen@emory.edu   
Principal Investigator: Pamela B. Allen         
United States, Nebraska
University of Nebraska Medical Center Not yet recruiting
Omaha, Nebraska, United States, 68198
Contact: Matthew A. Lunning    402-559-3848    mlunning@unmc.edu   
Principal Investigator: Matthew A. Lunning         
Sponsors and Collaborators
City of Hope Medical Center
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Alex F Herrera City of Hope Medical Center

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Responsible Party: City of Hope Medical Center
ClinicalTrials.gov Identifier: NCT03598998     History of Changes
Other Study ID Numbers: 17501
NCI-2018-01420 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
17501 ( Other Identifier: City of Hope Comprehensive Cancer Center )
First Posted: July 25, 2018    Key Record Dates
Last Update Posted: November 20, 2019
Last Verified: November 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Lymphoma
Lymphoma, Follicular
Lymphoma, Non-Hodgkin
Lymphoma, T-Cell
Lymphoma, Large-Cell, Anaplastic
Lymphoma, T-Cell, Peripheral
Enteropathy-Associated T-Cell Lymphoma
Lymphoma, T-Cell, Cutaneous
Mycoses
Mycosis Fungoides
Intestinal Diseases
Immunoblastic Lymphadenopathy
Panniculitis
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphadenopathy
Gastrointestinal Diseases
Digestive System Diseases
Connective Tissue Diseases
Skin Diseases
Pembrolizumab
10-deazaaminopterin
Aminopterin
Antineoplastic Agents, Immunological
Antineoplastic Agents
Folic Acid Antagonists