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Nivolumab and BO-112 Before Surgery for the Treatment of Resectable Soft Tissue Sarcoma

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ClinicalTrials.gov Identifier: NCT04420975
Recruitment Status : Recruiting
First Posted : June 9, 2020
Last Update Posted : June 21, 2021
Sponsor:
Collaborators:
Highlight Therapeutics
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Jonsson Comprehensive Cancer Center

Brief Summary:
This phase I trial studies the side effects of BO-112 when given together with nivolumab before surgery in treating patients with soft tissue sarcoma that can be removed by surgery (resectable). Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Immunotherapy with BO-112, may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. Giving nivolumab and BO-112 before surgery may work better in treating patients with soft tissue sarcoma compared to nivolumab alone.

Condition or disease Intervention/treatment Phase
Leiomyosarcoma Myxofibrosarcoma Resectable Dedifferentiated Liposarcoma Resectable Soft Tissue Sarcoma Resectable Undifferentiated Pleomorphic Sarcoma Soft Tissue Fibrosarcoma Spindle Cell Sarcoma Stage I Retroperitoneal Sarcoma American Joint Committee on Cancer (AJCC) v8 Stage I Soft Tissue Sarcoma of the Trunk and Extremities AJCC v8 Stage IA Retroperitoneal Sarcoma AJCC v8 Stage IA Soft Tissue Sarcoma of the Trunk and Extremities AJCC v8 Stage IB Retroperitoneal Sarcoma AJCC v8 Stage IB Soft Tissue Sarcoma of the Trunk and Extremities AJCC v8 Stage II Retroperitoneal Sarcoma AJCC v8 Stage II Soft Tissue Sarcoma of the Trunk and Extremities AJCC v8 Storiform-Pleomorphic Malignant Fibrous Histiocytoma Synovial Sarcoma Undifferentiated Pleomorphic Sarcoma With Osteoclast-Like Giant Cells Undifferentiated Pleomorphic Sarcoma, Inflammatory Variant Procedure: Definitive Surgical Resection Drug: Immunotherapeutic Agent Biological: Nivolumab Radiation: Radiation Therapy Phase 1

Detailed Description:

PRIMARY OBJECTIVE:

I. To explore the safety of BO-112 in combination with nivolumab in soft tissue sarcoma patients undergoing preoperative radiotherapy, as assessed by the frequency and severity of adverse events (AEs) using Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0 toxicity criteria.

SECONDARY OBJECTIVES:

I. Determine the change in T cell infiltration at surgical resection from baseline as measured by immunohistochemistry.

II. Assess treatment effect (necrosis score) of BO-112 in combination with nivolumab in soft tissue sarcoma patients receiving preoperative hypofractionated radiotherapy, compared to patients treated on a recently completed phase 2 study of preoperative hypofractionated radiotherapy alone.

III. Evaluate the 2-year rate of local and distant metastasis of BO-112 in combination with nivolumab in patients with localized resectable soft tissue sarcoma receiving preoperative hypofractionated radiotherapy, as compared to historical patients receiving preoperative radiotherapy alone.

EXPLORATORY OBJECTIVES:

I. Evaluate the dynamics of the intratumoral T cell phenotype. II. Assess the capacity to grow ex vivo tumor infiltrating lymphocytes from patients treated with BO-112 in combination with nivolumab.

III. Analyze changes in T-cell receptor (TCR) repertoire in tumor infiltrating lymphocytes and peripheral blood mononuclear cells (PBMCs) between baseline, post-treatment, and ex vivo cultured tumor infiltrating lymphocyte (TIL) samples.

OUTLINE:

Patients receive BO-112 intratumorally on days 1, 8, and 15 and nivolumab intravenously (IV) over 30-60 minutes on days 8 and 22 in the absence of disease progression or unacceptable toxicity. Patients also undergo standard of care radiation therapy on days 8-12 for a total of 5 fractions. Patients then undergo standard of care definitive surgical resection on day 26 to 50.

After completion of study treatment, patients are followed up at 2 weeks, 3 months, and between 6-12, 12-18, and 18-24 months.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 25 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I Study of Nivolumab and Intratumoral BO 112 for Resectable Soft Tissue Sarcoma
Actual Study Start Date : October 14, 2020
Estimated Primary Completion Date : January 31, 2024
Estimated Study Completion Date : January 31, 2025


Arm Intervention/treatment
Experimental: Treatment (BO-112, nivolumab)
Patients receive BO-112 intratumorally on days 1, 8, and 15 and nivolumab IV over 30-60 minutes on days 8 and 22 in the absence of disease progression or unacceptable toxicity. Patients also undergo standard of care radiation therapy on days 8-12 for a total of 5 fractions. Patients then undergo standard of care definitive surgical resection on day 26 to 50.
Procedure: Definitive Surgical Resection
Undergo definitive surgical resection

Drug: Immunotherapeutic Agent
Given BO-112 intratumorally
Other Names:
  • Biological Response Modifier
  • Biomodulators
  • BRM
  • Immune Mediators
  • Immune Modulators
  • Immune Regulators
  • Immunomodulating Agent
  • Immunomodulators
  • Immunomodulatory Agent
  • Immunopotentiators
  • Immunotherapy Agent

Biological: Nivolumab
Given IV
Other Names:
  • BMS-936558
  • MDX-1106
  • NIVO
  • ONO-4538
  • Opdivo

Radiation: Radiation Therapy
Undergo radiation therapy
Other Names:
  • Cancer Radiotherapy
  • Irradiate
  • Irradiated
  • Irradiation
  • Radiation
  • Radiation Therapy, NOS
  • Radiotherapeutics
  • Radiotherapy
  • RT
  • Therapy, Radiation




Primary Outcome Measures :
  1. Frequency and severity of adverse events (AEs) and dose limiting toxicities (DLTs) [ Time Frame: Before-surgery ]
    AEs will be tabulated by type, severity, and the proportion of subject experiencing the event.


Secondary Outcome Measures :
  1. Immune-oncologic impact of the combined regimen of nivolumab and BO-112 [ Time Frame: Before-surgery ]
    Statistical analysis of immune-oncologic changes will be performed by comparing results from surgical specimens with baseline biopsy specimens. For immunohistochemical parameters, the percentage of Cluster of Differentiation 4+ or Cluster of Differentiation 8+ (CD4+ or CD8+) cells will be compared between biopsy and surgical specimens using a paired two-tailed ratio T-test comparing means.

  2. Pathologic treatment effect [ Time Frame: through study completion, an average of 1 year ]
    Will be compared to historical samples receiving preoperative radiotherapy alone. Will use a two-sample paired T-test comparing means.



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 assent where appropriate, must be obtained from the subject prior to performing any protocol-related procedures, including screening evaluations
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1
  • Resectable, biopsy proven soft tissue sarcoma of the extremity, trunk or retroperitoneum including undifferentiated pleomorphic sarcoma, myxofibrosarcoma, leiomyosarcoma, dedifferentiated liposarcoma, and synovial sarcoma. Undifferentiated pleomorphic sarcoma encompasses any of the following histologies:

    • Pleomorphic undifferentiated sarcoma
    • Unclassified spindle cell sarcoma
    • Spindle cell sarcoma not otherwise specified
    • Pleomorphic spindle cell sarcoma
    • Pleomorphic fibroblastic sarcoma
    • Undifferentiated high-grade pleomorphic sarcoma
    • Pleomorphic sarcoma with prominent inflammation
    • Pleomorphic sarcoma with giant cells
    • Malignant fibrous histiocytoma (including storiform-pleomorphic and inflammatory subtypes)
    • Fibrosarcoma
  • Tumor that is injectable
  • Hemoglobin >= 9 g/dL
  • Absolute neutrophil count >= 1,000/mm^3
  • Platelet count >= 100,000/mm^3 and transfusion independent
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x institutional upper limit of normal (ULN)
  • Bilirubin =< 1.5 x ULN; for subjects with documented/suspected Gilbert's disease, bilirubin =< 3 x ULN
  • Prothrombin time (PT)/international normalized ratio (INR) and partial thromboplastin time (PTT) =< 1.5 x institutional upper limit of normal unless the patient is on anticoagulant therapy within 28 days prior to enrollment (if the patient is receiving anticoagulant therapy, PT, and a PTT must be within therapeutic range of intended use of anticoagulants)
  • Patients must be willing to submit blood and tissue specimens for translational medicine studies
  • Patients must be offered the opportunity to participate in specimen banking for future research
  • Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 24 hours prior to the start of study drug
  • Women must not be breastfeeding
  • Women of childbearing potential (WOCBP) must be willing to use either two adequate barrier methods or a barrier method plus a hormonal method of contraception to prevent pregnancy, or to abstain from heterosexual activity (complete abstinence) throughout the study, starting with visit 1 through 5 months after the last dose of study therapy. Approved contraceptive methods include intrauterine device, diaphragm with spermicide, cervical cap with spermicide, male condoms, female condoms with spermicide, or oral contraceptives. Spermicides alone are not an acceptable method of contraception. 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 receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to highly effective contraception during active participation in study treatment and for a period of 7 months after the last dose of nivolumab
  • HIGHLY EFFECTIVE METHODS OF CONTRACEPTION

    • Highly effective methods of contraception have a failure rate of < 1% when used consistently and correctly. WOCBP and female partners of male subjects, who are WOCBP, are expected to use one of the highly effective methods of contraception listed below. Male subjects must inform their female partners who are WOCBP of the contraceptive requirements of the protocol and are expected to adhere to using contraception with their partner. Contraception methods are as follows:
    • Progestogen only hormonal contraception associated with inhibition of ovulation
    • Hormonal methods of contraception including oral contraceptive pills containing combined estrogen + progesterone, vaginal ring, injectables, implants and intrauterine devices (IUDs) such as Mirena
    • Nonhormonal IUDs, such as ParaGard
    • Bilateral tubal occlusion
    • Vasectomized partner with documented azoospermia 90 days after procedure

      • Vasectomized partner is a highly effective birth control method provided that partner is the sole sexual partner of the WOCBP trial participant and that the vasectomized partner has received medical assessment of the surgical success
    • Intrauterine hormone-releasing system (IUS)
    • Complete abstinence

      • Complete abstinence is defined as the complete avoidance of heterosexual intercourse
      • Complete abstinence is an acceptable form of contraception for all study drugs and must be used throughout the duration of the study treatment (plus 5 half-lives of the investigational drug plus 30 days)
      • It is not necessary to use any other method of contraception when complete abstinence is elected
      • Subjects who choose complete abstinence must continue to have pregnancy tests, as specified
      • Acceptable alternate methods of highly effective contraception must be discussed in the event that the subject chooses to forego complete abstinence
      • The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the subject
  • LESS EFFECTIVE METHODS OF CONTRACEPTION

    • Diaphragm with spermicide
    • Cervical cap with spermicide
    • Vaginal sponge with spermicide
    • Male or female condom with or without spermicide

      • A male and a female condom must not be used together
    • Progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action
  • UNACCEPTABLE METHODS OF CONTRACEPTION

    • Periodic abstinence (calendar, symptothermal, post-ovulation methods)
    • Withdrawal (coitus interruptus)
    • Spermicide only
    • Lactation amenorrhea method (LAM)

Exclusion Criteria:

  • Contraindications to tumor biopsy and injections (coagulopathy, known history of keloid formation, etc.)
  • Women who are pregnant or breastfeeding
  • Inability to give informed consent
  • History of other malignancy that can interfere with interpretation of the results
  • Prior irradiation in the area to be treated with preoperative radiation
  • Any condition that might interfere with the subject's participation in the study, safety, or in the evaluation of the study results
  • Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) clinical study or the follow-up period of an interventional study
  • Prior exposure to any Programmed death-ligand 1 (anti-PD-1 or anti-PD-L1 antibody), or any Cytotoxic T lymphocyte-associated antigen (anti-CTLA 4) antibodies
  • Patients must not have received any live vaccine within 30 days prior to registration. Seasonal flu vaccines and other vaccines that do not contain live virus are permitted
  • Any concurrent chemotherapy, immunotherapy, or biologic therapy for cancer treatment. Concurrent use of hormones is acceptable
  • Patient must not have evidence of any clinically significant immunosuppression such as the following: primary immunodeficiency state such as severe combined immunodeficiency disease; concurrent opportunistic infection; receiving systemic immunosuppressive therapy within 28 days before enrollment with the exceptions of intranasal, topical, and inhaled corticosteroids or oral corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or equivalent
  • Active or prior documented autoimmune disease within the past 3 years

    • NOTE: Subjects with active, known or suspected autoimmune disease such as vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll
  • Active or prior documented inflammatory bowel disease
  • History of (non-infectious) interstitial lung disease (ILD)/pneumonitis that required steroids or has current ILD/pneumonitis or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening
  • Exposure to any investigational drug within 7 days prior to screening visit or for which 5 half-lives have not elapsed
  • Prisoners or subjects who are involuntarily incarcerated

    • Note: under certain specific circumstances a person who has been imprisoned may be included or permitted to continue as a subject
  • Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g., infectious disease) illness

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): NCT04420975


Locations
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United States, California
UCLA / Jonsson Comprehensive Cancer Center Recruiting
Los Angeles, California, United States, 90095
Contact: Anusha Kalbasi    310-267-4871    anushakalbasi@mednet.ucla.edu   
Principal Investigator: Anusha Kalbasi         
Sponsors and Collaborators
Jonsson Comprehensive Cancer Center
Highlight Therapeutics
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Anusha Kalbasi UCLA / Jonsson Comprehensive Cancer Center
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Responsible Party: Jonsson Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT04420975    
Other Study ID Numbers: 19-000419
NCI-2019-08556 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
1K08CA245181 ( U.S. NIH Grant/Contract )
First Posted: June 9, 2020    Key Record Dates
Last Update Posted: June 21, 2021
Last Verified: June 2021

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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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Sarcoma
Leiomyosarcoma
Liposarcoma
Sarcoma, Synovial
Fibrosarcoma
Histiocytoma
Histiocytoma, Benign Fibrous
Histiocytoma, Malignant Fibrous
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Muscle Tissue
Neoplasms, Adipose Tissue
Neoplasms, Connective Tissue
Neoplasms, Fibrous Tissue
Nivolumab
Immunologic Factors
Adjuvants, Immunologic
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immune Checkpoint Inhibitors
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs