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Androgen Deprivation Therapy (ADT) and Pembrolizumab for Advanced Stage Androgen Receptor-positive Salivary Gland Carcinoma

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03942653
Recruitment Status : Recruiting
First Posted : May 8, 2019
Last Update Posted : February 24, 2022
Sponsor:
Collaborators:
Merck Sharp & Dohme LLC
TerSera Therapeutics LLC
Information provided by (Responsible Party):
Manish Patel, Big Ten Cancer Research Consortium

Brief Summary:
A Phase II, multi-center, single-arm, non-blinded study combining androgen deprivation therapy (ADT) and pembrolizumab for patients with metastatic or locally recurrent androgen receptor-positive salivary gland carcinoma, not amenable to surgery or radiation.

Condition or disease Intervention/treatment Phase
Salivary Gland Carcinoma Drug: Goserelin Acetate Drug: Pembrolizumab Phase 2

Detailed Description:

This is a Phase II multi-center, single-arm, non-blinded study combining androgen deprivation therapy (ADT) and pembrolizumab for patients with metastatic or locally recurrent androgen receptor-positive salivary gland carcinoma, not amenable to surgery or radiation. Eligible patients will include both those with no prior systemic therapy and those who have failed prior systemic therapy. Patients who have received previous ADT or immunotherapy will be excluded.

ADT will consist of goserelin acetate every 4 weeks with the first injection given approximately 2 weeks prior to the first dose of pembrolizumab. Pembrolizumab 200 mg will be given on day 1 of 21-day cycles, starting 2 weeks after initiation of goserelin acetate. Each 21-day period is considered a treatment cycle with therapy continuing for up to 35 cycles, until disease progression, significant toxicity, or patient refusal. Except for fatigue, we do not expect overlapping toxicities with pembrolizumab and ADT, thus the starting doses will be the FDA-approved doses.

This study will use a Simon 2-stage phase II trial design. The first stage of the Simon 2-stage design will have a sample size of nine patients. If at least two patients have an objective response by RECIST 1.1 then enrollment will proceed to stage 2 with an additional 11 patients, to a goal of 20 patients. If less than 4 patients out of 20 respond, then the combination treatment will be rejected.

Patients will be staged with CT of neck, chest, abdomen, and pelvis at baseline and every 12 weeks while on study. Treatment with both ADT and pembrolizumab will continue until disease progression or intolerable side effects.

Archival tumor biopsy tissue must be available at baseline to evaluate for expression of androgen receptor (AR), PD-L1, and tumor-infiltrating lymphocytes (TIL). An optional biopsy will be performed after 4 doses of pembrolizumab to evaluate immune response to combined therapy.

Blood will be collected at baseline, cycle 1 day 1, cycle 2 day 1 and cycle 3 day 1 to evaluate for change in lymphocyte subsets by flow cytometry.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Trial of Androgen Deprivation Therapy (ADT) and Pembrolizumab for Advanced Stage Androgen Receptor-positive Salivary Gland Carcinoma: Big Ten Cancer Research Consortium BTCRC-HN17-111
Actual Study Start Date : May 30, 2019
Estimated Primary Completion Date : January 2023
Estimated Study Completion Date : January 2024


Arm Intervention/treatment
Experimental: Goserelin Acetate + Pembrolizumab
Goserelin Acetate, 3.6 mg, every four weeks, SQ Pembrolizumab, 200mg, every three weeks, IV
Drug: Goserelin Acetate
Goserelin Acetate, SQ, Q4W

Drug: Pembrolizumab
Pembrolizumab, IV, Q3W




Primary Outcome Measures :
  1. Objective Response Rate [ Time Frame: 35 months ]
    Determine the objective response rate (ORR) of pembrolizumab when given with goserelin in patients with locally recurrent or metastatic androgen receptor-positive salivary gland carcinoma not amenable to curative-intent treatment with surgery or radiation, per RECIST 1.1 Criteria


Secondary Outcome Measures :
  1. Progression Free Survival [ Time Frame: 12 Months ]
    Determine progression free survival (PFS) at 12 months, according to RECIST 1.1 criteria

  2. Disease Control Rate [ Time Frame: 35 Months ]
    Disease control rate as defined by stable disease plus objective response (SD+PR+CR), according to RECIST 1.1 criteria

  3. Overall Survival [ Time Frame: 12 Months ]
    Determine overall survival (OS) at 12 months, according to RECIST 1.1 criteria

  4. Number of participants with grade 3, 4, 5 adverse events [ Time Frame: 35 months ]
    To evaluate the safety and tolerability of pembrolizumab when given with goserelin, grade 3,4,5 adverse events will be summarized according to CTCAE v5 criteria.



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:

  • Written informed consent and HIPAA authorization for release of personal health information. NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
  • Age ≥ 18 years at the time of consent.
  • Locally advanced, recurrent, or metastatic salivary gland carcinoma that is not amenable to curative surgery or radiation
  • ECOG Performance Status of 0 or 1 within 28 days prior to registration.
  • Local, pathologic testing of androgen receptor-positive salivary gland carcinoma will be performed as standard of care. Archival tissue must be available for central confirmation of androgen receptor-positive disease and for correlative studies. AR positivity will be defined according to IHC staining of tumor tissue with at least 20% of tumor staining positive with moderate intensity (1+ or greater).
  • Measurable disease according to RECIST v1.1 for solid tumors within 28 days prior to registration.
  • For patients who have been treated with prior therapy, patients must have documented progression of disease on their prior therapy for entry into the study.
  • Patients with prior chemotherapy, radiation, or surgery as part of curative intent therapy are allowed. Any number of prior lines of systemic therapy is permitted for entry into this study so long as prior therapy did not include anti-androgen therapy or immune checkpoint blockade.
  • If prior cancer treatment, the subject must have recovered from toxic effects of prior cancer treatment (other than alopecia) to ≤ Grade 1.
  • Adequate organ function as defined below; all screening labs to be obtained within 28 days prior to registration.

    • Absolute neutrophil count (ANC) ≥1500/µL
    • Platelets ≥75,000/µL
    • Hemoglobin ≥8.0 g/dL or ≥5 mmol/L
    • Creatinine (Cr) OR Measured or calculated creatinine clearance (GFR can also be used in place of Cr or creatinine clearance) ≤1.5 × ULN OR

      ≥30 mL/min for participant with creatinine levels >1.5 × institutional ULN

    • Total bilirubin ≤1.5 ×ULN OR direct bilirubin ≤ULN for participants with total bilirubin levels >1.5 × ULN
    • AST (SGOT) and ALT (SGPT) ≤2.5 × ULN (≤5 × ULN for participants with liver metastases) o International normalized ratio (INR) OR prothrombin time (PT) & aPTT ≤1.5 × ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants
  • A male participant must agree to use contraception during the treatment period and for at least 8 months after the last dose of study treatment and refrain from donating sperm during this period.
  • Females of childbearing potential must have a negative serum pregnancy test within 72 hours prior to registration. NOTE: Females are considered of child bearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months
  • Females of childbearing potential and males with partners of childbearing potential must be willing to abstain from heterosexual activity or to use a highly effect form of contraception from the time of informed consent until 8 months after treatment discontinuation.
  • As determined by the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study

Exclusion Criteria:

  • Women of childbearing age with a positive serum pregnancy test within 72 hours prior to study registration.
  • Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX40, CD137).
  • Has received prior androgen deprivation therapy including orchiectomy, gonadotropin-releasing hormone (GnRH) agonists/antagonists, androgen receptor blocker, abiraterone, or enzalutamide.
  • Has received prior systemic anti-cancer therapy including investigational agents within 14 days prior to registration.
  • Has had an allogenic tissue or solid organ transplant.
  • Has received prior palliative radiotherapy within 7 days of start of study treatment. Participants must have recovered from all radiation-related toxicities and require less than 10mg of prednisone (or equivalent corticosteroid) daily.
  • Has received a live vaccine or live-attenuated vaccine within 28 days prior to the first dose of study drug. Administration of killed vaccines is allowed.
  • Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug.
  • Has a known additional malignancy that is progressing or has required active treatment within the past 2 years. Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (e.g. breast ductal carcinoma in situ, cervical cancer in situ) that have undergone potentially curative therapy are not excluded.
  • Has known active CNS metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable, i.e. without evidence of progression for at least 14 days by repeat imaging (note that the repeat imaging should be performed during study screening), clinically stable, and without requirement of steroid treatment for at least 14 days prior to first dose of study treatment.
  • Has ≥Grade 3 hypersensitivity to pembrolizumab and/or any of its excipients.
  • 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). Replacement therapy (eg, levothyroxine, 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/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
  • Has an active infection requiring systemic therapy.
  • Has a known history of Human Immunodeficiency Virus (HIV).
  • Has a known history of active TB (Bacillus Tuberculosis).
  • Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  • Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  • Is pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of trial treatment.

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): NCT03942653


Contacts
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Contact: Manish Patel, MD 6126246940 Patel069@umn.edu
Contact: Ahran Lee 317-634-5842 ext 38 alee@hoosiercancer.org

Locations
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United States, Illinois
Northwestern University Feinberg School of Medicine Recruiting
Chicago, Illinois, United States, 60611
Contact: Catie Humphreys    312-695-1355    catherine-collins@northwestern.edu   
Principal Investigator: Victoria Villaflor, MD         
University of Illinois Cancer Center Recruiting
Chicago, Illinois, United States, 60612
Contact: Lauren Talasnik    312-996-6275    talasnik@uic.edu   
Principal Investigator: Lawrence Feldman, MD         
United States, Iowa
University of Iowa Hospitals and Clinics Recruiting
Iowa City, Iowa, United States, 52242
Contact: Marian Anderson    319-353-4578    marian-andersen@uiowa.edu   
Principal Investigator: Douglas Laux, MD         
United States, Maryland
Univeristy of Maryland Recruiting
Baltimore, Maryland, United States, 21201
Contact: Amelia Barkman    410-706-3761    AmeliaSchmidt@umm.edu   
Sub-Investigator: Ranee Mehra, MD         
United States, Michigan
University of Michigan Health System Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Dawud Ellayan    734-615-1749    dellayan@med.umich.edu   
Principal Investigator: Francis Worden, MD         
United States, Minnesota
University of Minnesota: Masonic Cancer Center Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Manish Patel, M.D.    612-624-6940    Patel069@umn.edu   
United States, Wisconsin
University of Wisconsin Recruiting
Madison, Wisconsin, United States, 53705
Contact: Sarah Stewart    608-263-7898    slstewart@wisc.edu   
Principal Investigator: Justin Bruce, MD         
Sponsors and Collaborators
Manish Patel
Merck Sharp & Dohme LLC
TerSera Therapeutics LLC
Investigators
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Principal Investigator: Manish Patel, MD University of Minnesota
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Responsible Party: Manish Patel, Sponsor-Investigator, Big Ten Cancer Research Consortium
ClinicalTrials.gov Identifier: NCT03942653    
Other Study ID Numbers: BTCRC-HN17-111
First Posted: May 8, 2019    Key Record Dates
Last Update Posted: February 24, 2022
Last Verified: February 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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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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Carcinoma
Salivary Gland Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Mouth Neoplasms
Head and Neck Neoplasms
Neoplasms by Site
Mouth Diseases
Stomatognathic Diseases
Salivary Gland Diseases
Pembrolizumab
Goserelin
Antineoplastic Agents, Immunological
Antineoplastic Agents
Antineoplastic Agents, Hormonal