Working…
ClinicalTrials.gov
ClinicalTrials.gov Menu

Ph II Study of Cabozantinib With Pembrolizumab in Metastatic Gastric and Gastroesophageal Adenocarcinoma

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: NCT04164979
Recruitment Status : Not yet recruiting
First Posted : November 15, 2019
Last Update Posted : November 15, 2019
Sponsor:
Collaborator:
Exelixis
Information provided by (Responsible Party):
Farshid Dayyani, University of California, Irvine

Brief Summary:
This is a phase 2 single-arm, open-label clinical trial determining efficacy of cabozantinib in combination with pembrolizumab in subjects with advanced gastric and gastroesophageal adenocarcinoma. These are subjects who have progressed, or not tolerated, at least one prior line of chemotherapy with a fluoropyrimidine and platinum agent.

Condition or disease Intervention/treatment Phase
Gastric Adenocarcinoma GastroEsophageal Cancer Drug: Cabozantinib Drug: Pembrolizumab Phase 2

Detailed Description:
Treatment on study will be administered in 21 day cycles.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 2 Study of Cabozantinib Combined With Pembrolizumab in Metastatic or Recurrent Gastric and Gastroesophageal Adenocarcinoma (mGC)
Estimated Study Start Date : December 1, 2019
Estimated Primary Completion Date : December 1, 2020
Estimated Study Completion Date : June 30, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Cabozantinib and Pembrolizumab
Subjects receive Cabozantinib 40mg PO daily on days 1-21 and Pembrolizumab 200mg IV on day 1 every 21 days.
Drug: Cabozantinib
Given PO
Other Names:
  • CABOMETYX
  • COMETRIQ

Drug: Pembrolizumab
Given IV
Other Name: KEYTRUDA




Primary Outcome Measures :
  1. Percentage of Participants with Progression-free Survival at 6 Months [ Time Frame: 6 Months ]
    This is defined as the percentage of subjects who are free of progression 6 months after study treatment start. Progression is defined death, radiographic progression or clinical deterioration attributed disease progression as judged by an investigator. Radiographic progression is defined using the Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of diameters of target lesions and an absolute increase of at least 5 mm and/or appearance of new lesions.


Secondary Outcome Measures :
  1. Percentage of Grade 3-5 Adverse Events [ Time Frame: From the start date of treatment until 4 weeks after removal of treatment due to disease progression, toxicity, delay of treatment, or withdrawal of treatment, whichever came first, an average of 1 year. ]
    To evaluate the tolerability of administering cabozantinib in combination with pembrolizumab in patients with advanced gastric and gastroesophageal adenocarcinoma from the start of treatment, duration of treatment and up to 4 weeks after completion of study treatment. Toxicity and adverse events are based on the CTCAE (NCI Common Terminology Criteria for Adverse Events) Version 5.0.

  2. Overall Response Rate as Assessed by RECIST v1.1 [ Time Frame: From date of registration until first date of disease progression, toxicity, delay of treatment, or withdrawal of treatment, whichever came first, an average of 1 year.] ]
    To assess the overall response rate to the combination of cabozantinib and pembrolizumab. Overall response rate (ORR) is defined as confirmed complete response (CR) and partial response (PR). Per Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1): Complete Response (CR) is defined as the disappearance of all target lesions; Partial Response (PR) is defined as a 30% decrease in the sum of diameters of target lesions. ORR = CR + PR

  3. Overall Survival of Patients Who Received Cabozantinib and Irinotecan [ Time Frame: From date of registration for up to 18 months after last patient is enrolled or until death from any cause, whichever came first. ]
    To evaluate overall survival in patients with advanced gastric and gastroesophageal adenocarcinoma treated with this combination of cabozantinib and irinotecan.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have histologically or cytologically confirmed gastric or gastroesophageal adenocarcinoma
  • Must have locally advanced, recurrent, or metastatic disease not amenable to curative intent surgery.
  • Must have progressed, or not tolerated, at least one line of treatment with a platinum and fluoropyrimidine containing regimen. At least one cycle of combination chemotherapy including a platinum (oxaliplatin, cisplatin, carboplatin) and fluoropyrimidine (capecitabine or 5-Fluorouracil) for advanced disease. Combination regimens with platinum/fluoropyrimidine containing a taxane and or a checkpoint inhibitor are allowed. Patients progressing within six months of perioperative chemotherapy or definitive chemoradiation for localized disease are eligible.
  • Must have received and progressed on one previous line of treatment containing a checkpoint inhibitor (if PD-L1 Combined Positive Score (CPS) score unknown or ≥ 1%). Patients with PD-L1 CPS score < 1% are eligible independent of whether they have received previous checkpoint inhibitors.
  • Age ≥ 18 years
  • Performance status: Eastern Cooperative Oncology Group (ECOG) performance status ≤2
  • Life expectancy of greater than 3 months
  • Adequate organ and marrow function as defined below:

    1. Leukocytes: ≥ 2,000/mcL
    2. absolute neutrophil count: ≥ 1000/mcL
    3. platelets: ≥ 60,000/mcl
    4. total bilirubin: within normal institutional limits
    5. AST(SGOT)/ALT(SPGT): ≤ 3 X institutional upper limit of normal or ≤ 5 X if liver metastases are present
    6. creatinine: within normal institutional limits
    7. hemoglobin: ≥ 9 g/dL
    8. Serum albumin: ≥ 2.8 g/dL
    9. Urine protein/creatinine ration (UPCR): ≤ 1 mg/mg
  • The effects of cabozantinib on the developing human fetus at the recommended therapeutic dose are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 4 months following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

    1. Has not undergone a hysterectomy or bilateral oophorectomy; or
    2. Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).
  • Ability to swallow tablets
  • Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

  • Patients who have had chemotherapy within 2 weeks prior to entering the study
  • All toxicities attributed to prior anti-cancer therapy other than alopecia must have resolved to grade 1 or baseline
  • Patients may not be receiving any other investigational agents.
  • Patients with known brain metastases or cranial epidural disease unless accurately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks before first dose of study treatment. These individuals should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Eligible subjects must be neurologically asymptomatic and without corticosteroid treatment at the time of the first dose of study treatment.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to pembrolizumab, cabozantinib or other agents used in study.
  • Concomitant anticoagulation with oral anticoagulants (eg, warfarin, direct thrombin and Factor Xa inhibitors) or platelet inhibitors (eg, clopidogrel). Allowed anticoagulants are the following:

    1. Low-dose aspirin for cardioprotection (per local applicable guidelines) is permitted.
    2. Low-dose low molecular weight heparins (LMWH) are permitted.
    3. Anticoagulation with therapeutic doses of LMWH is allowed in subjects without known brain metastases who are on a stable dose of LMWH for at least 6 weeks before first dose of study treatment, and who have had no clinically significant hemorrhagic complications from the anticoagulation regimen or the tumor.
  • The subject has prothrombin time (PT)/INR or partial thromboplastin time (PTT) test ≥ 1.3 x the laboratory ULN within 7 days before the first dose of study treatment.
  • Uncontrolled intercurrent illness including, but not limited to, the following conditions:

    1. ongoing or active infection
    2. symptomatic congestive heart failure
    3. uncontrolled hypertension defined as sustained blood pressure (BP) > 150 mm Hg systolic or > 100 mm Hg diastolic despite optimal antihypertensive treatment
    4. Stroke (including transient ischemic attack [TIA]), myocardial infarction (MI), or other ischemic event, or thromboembolic event (eg, deep venous thrombosis, pulmonary embolism) within 6 months before first dose
    5. unstable angina pectoris
    6. cardiac arrhythmia
    7. evidence of tumor invading GI tract, active peptic ulcer disease, inflammatory inflammatory bowel disease (eg, Crohn's disease), diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute pancreatitis, acute obstruction of the pancreatic duct or common bile duct, or gastric outlet obstruction.
    8. Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess within 6 months before first dose.
    9. Note: Complete healing of an intra-abdominal abscess must be confirmed before first dose.
    10. Clinically significant hematuria, hematemesis, or hemoptysis of > 0.5 teaspoon (2.5 ml) of red blood, or other history of significant bleeding (eg, pulmonary hemorrhage) within 12 weeks before first dose.
    11. Cavitating pulmonary lesion(s) or known endotracheal or endobronchial disease manifestation.
    12. Lesions invading or encasing any major blood vessels.
    13. Other clinically significant disorders that would preclude safe study participation:

      1. Serious non-healing wound/ulcer/bone fracture
      2. Uncompensated/symptomatic hypothyroidism
      3. Moderate to severe hepatic impairment (Child-Pugh B or C)
    14. psychiatric illness/social situations that would limit compliance with study requirements.
  • Major surgery within 8 weeks before first dose of study treatment. Complete wound healing from major surgery must have occurred 1 month before first dose and from minor surgery (eg, simple excision, tooth extraction) at least 10 days before first dose. Subjects with clinically relevant ongoing complications from prior surgery are not eligible.
  • Prior treatment with cabozantinib
  • Corrected QT interval calculated by the Fridericia formula (QTcF) > 500 ms per electrocardiogram (ECG) within 28 days before first dose of study treatment.

    1. Corrected QT (QTc) = QT / ∛RR

      1. QT: duration of QT interval
      2. RR: duration of RR interval
    2. Note: If a single ECG shows a QTcF with an absolute value > 500 ms, two additional ECGs at intervals of approximately 3 min must be performed within 30 min after the initial ECG, and the average of these three consecutive results for QTcF will be used to determine eligibility.
  • Receipt of any type of small molecule kinase inhibitor (including investigational kinase inhibitor) within 2 weeks before first dose of study treatment.
  • History of another primary cancer within the last 3 years with the exception of non-melanoma skin cancer, early-stage prostate cancer, or curatively treated cervical carcinoma in-situ and not treated with systemic therapy.
  • Inability to comply with study and follow-up procedures as judged by the Investigator
  • Patients must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.
  • Has squamous cell or undifferentiated gastric cancer.
  • Has received prior cytotoxic, biologic or other systemic anticancer therapy including investigational agents within 2 weeks prior to randomization.
  • Radiation therapy for bone metastasis within 2 weeks, any other radiation therapy within 4 weeks before first dose of study treatment. Systemic treatment with radionuclides within 6 weeks before the first dose of study treatment. Subjects with clinically relevant ongoing complications from prior radiation therapy are not eligible.
  • Has received a live vaccine within 30 days prior to the first dose of study intervention. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (eg, FluMist®) are live attenuated vaccines and are not 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 intervention.
  • Has severe hypersensitivity (Grade ≥ 3) to pembrolizumab or cabozantinib and/or any of their excipients.
  • Has an active autoimmune disease that has required systemic treatment in 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) is not considered a form of systemic treatment and is allowed.
  • Has a history of (non‐infectious) pneumonitis that required steroids or has current pneumonitis.
  • Has an active infection requiring systemic therapy.
  • Has a known history of human immunodeficiency virus (HIV) infection.

    1. Note: No HIV testing is required unless mandated by local health authority.

  • Has a known history of active tuberculosis (TB; Bacillus tuberculosis).
  • Has a history or current evidence of any condition (eg, known deficiency of the enzyme dihydropyrimidine dehydrogenase), therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.

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): NCT04164979


Contacts
Layout table for location contacts
Contact: Chao Family Comprehensive Cancer Center University of California, Irvine 1-877-827-7883 ucstudy@uci.edu
Contact: University of California Irvine Medical

Locations
Layout table for location information
United States, California
Chao Family Comprehensive Cancer Center, University of California, Irvine Not yet recruiting
Orange, California, United States, 92868
Contact: Farshid Dayyani, MD, PhD    877-827-8839    ucstudy@uci.edu   
UC Davis Comprehensive Cancer Center Not yet recruiting
Sacramento, California, United States, 95817
Contact: Kris Curl-Johnston    916-734-3604      
Principal Investigator: May Cho, MD         
Sponsors and Collaborators
University of California, Irvine
Exelixis
Investigators
Layout table for investigator information
Principal Investigator: Farshid Dayyani, MD, PhD Chao Family Comprehensive Cancer Center

Layout table for additonal information
Responsible Party: Farshid Dayyani, Associate Clinical Professor of Medicine, University of California, Irvine
ClinicalTrials.gov Identifier: NCT04164979     History of Changes
Other Study ID Numbers: UCI 18-124
2019-5426 ( Other Identifier: University of California, Irvine )
First Posted: November 15, 2019    Key Record Dates
Last Update Posted: November 15, 2019
Last Verified: November 2019

Layout table for additional information
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
Keywords provided by Farshid Dayyani, University of California, Irvine:
Gastric Adenocarcinoma
Gastroesophageal Adenocarcinoma
Cabozantinib
Pembrolizumab
Additional relevant MeSH terms:
Layout table for MeSH terms
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Pembrolizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents