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Pharmacodynamic Study of Pembrolizumab in Patients With Recurrent Glioblastoma

This study is currently recruiting participants.
Verified September 2017 by M.D. Anderson Cancer Center
Sponsor:
ClinicalTrials.gov Identifier:
NCT02337686
First Posted: January 14, 2015
Last Update Posted: October 2, 2017
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.
Collaborator:
Merck Sharp & Dohme Corp.
Information provided by (Responsible Party):
M.D. Anderson Cancer Center
  Purpose

The goal of this clinical research study is to learn if Keytruda (pembrolizumab) can help to control glioblastoma. The safety of this drug will also be studied.

This is an investigational study. Pembrolizumab is FDA approved and commercially available for the treatment of some types of melanoma. Its use against brain tumors in this study is investigational. The study doctor can explain how the study drug is designed to work.

Up to 20 participants will be enrolled in this study. All will take part at MD Anderson.


Condition Intervention Phase
Brain Tumor Glioblastoma Cancer Drug: Pembrolizumab Procedure: Surgery Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pharmacodynamic Study of Pembrolizumab in Patients With Recurrent Glioblastoma

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Progression free survival at 6 months [ Time Frame: Baseline to 6 months ]
    Progression-free survival defined as the time from study enrollment until the time of first occurrence of disease progression, relapse, or death due to disease.

  • Immune Effector:Treg ratio measured at the time of surgery [ Time Frame: Measurement taken from tissue collected at time of surgery (Day 0) following 21 days of first treatment cycle ]
    Immune effector function measured in resected glioblastoma tissue after treatment with intravenously administered pembrolizumab monotherapy in the neoadjuvant setting in participants with recurrent glioblastoma. Pembrolizumab pharmacokinetics from blood correlated with tumor pharmacodynamic markers; Tumor tissue from surgical resection and peripheral blood evaluated longitudinally for pharmacodynamic effects including an increase of polyfunctional effector T cells:Treg ratio and improvement in the anti-tumor immune response. Defined Effector:Treg ratio>=5% is a success (i.e., favorable outcome) and <5% is a failure (i.e., unfavorable outcome).


Estimated Enrollment: 20
Actual Study Start Date: April 2015
Estimated Study Completion Date: April 2019
Estimated Primary Completion Date: April 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Pembrolizumab
Pembrolizumab 200 mg, intravenously (IV) once every 3 weeks prior to surgery for two doses and then restarting 200 mg every 3 weeks following surgical resection. Cycles defined as every 42 days.
Drug: Pembrolizumab
Up to 2 doses of 200 mg IV prior to surgery (Day -21 and Day -1, prior to the surgery on Day 0); continued after recovery from surgery (approximately 2-3 weeks) every 3 weeks until disease progression or development of unacceptable toxicities.
Other Names:
  • Keytruda
  • MK-3475
Procedure: Surgery
Routine care surgery (reoperation) performed Day 0 for tumor progression.

  Show Detailed Description

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Be willing and able to provide written informed consent/assent for the trial.
  2. Be >/= 18 years of age on day of signing informed consent.
  3. Have histologically confirmed World Health Organization Grade IV malignant glioma (glioblastoma or gliosarcoma). Participants will be eligible if the original histology was low-grade glioma and a subsequent histological diagnosis of glioblastoma or variants is made.
  4. Patients must be at first or second relapse and clinically require reoperation for tumor progression within 4 to 6 weeks. Note: Relapse is defined as progression following initial therapy (i.e., radiation, chemotherapy, or radiation+ chemotherapy). If the participant had a surgical resection for relapsed disease and no antitumor therapy instituted for up to 12 weeks, this is considered one relapse. For participants who had prior therapy for a low grade glioma, the surgical diagnosis of a high grade glioma will be considered first relapse.
  5. Have measurable disease consisting of a minimal volume of 1 cm3.
  6. Have provided tissue from an archival tissue sample or newly obtained core or excisional biopsy of a tumor lesion.
  7. Have a performance status of >/= 60 on the KPS.
  8. Stable dose of steroids for 5 days, no more than 2 mg dexamethasone (or equivalent) total per day
  9. Demonstrate adequate organ function as defined in Table 1, all screening labs should be performed within 14 days prior to registration. 1) Hematological : Absolute neutrophil count (ANC) >/=1,500 /mcL; Platelets >/=100,000 / mcL; Hemoglobin >/= 9 g/dL or >/= 5.6 mmol/L. 2) Renal: Serum creatinine </= 1.5 X upper limit of normal (ULN) OR Measured or calculated creatinine clearance (GFR can also be used in place of creatinine or CrCl) >/= 60 mL/min for subject with creatinine levels > 1.5 X institutional ULN.
  10. (9. continued) 3) Hepatic: Serum total bilirubin </= 1.5 X ULN OR Direct bilirubin </= ULN for subjects with total bilirubin levels > 1.5 ULN; AST (SGOT) and ALT (SGPT) </= 2.5 X ULN OR </= 5 X ULN for subjects with liver metastases. 4) Coagulation: International Normalized Ratio (INR) or Prothrombin Time (PT) </= 1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants; Activated Partial Thromboplastin Time (aPTT) </= 1.5 X ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants.
  11. Female subject of childbearing potential should have a negative serum pregnancy test.
  12. Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication. Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year.
  13. Male subjects should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy.

Exclusion Criteria:

  1. Has been treated previously with bevacizumab
  2. Has tumor localized primarily to the brainstem or spinal cord.
  3. Has received prior interstitial brachytherapy, implanted chemotherapy, or therapeutics delivered by local injection or convection enhanced delivery.
  4. Is currently participating in or has participated in a study of an investigational agent or using an investigational device 4 weeks since last dose of agent administration.
  5. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy > 2 mg of dexamethasone total per day or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
  6. Has had a prior monoclonal antibody within 4 weeks prior to study Day 1 or who has not recovered (i.e., </= Grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier.
  7. Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 or who has not recovered (i.e., </= Grade 1 or at baseline) from adverse events due to a previously administered agent. - Note: Subjects with alopecia, </= Grade 2 neuropathy are an exception to this criterion and may qualify for the study.
  8. Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy.
  9. Has known carcinomatous meningitis, extracranial disease, or multifocal disease.
  10. Has an active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. Subjects with vitiligo or resolved childhood asthma/atopy would be an exception to this rule. Subjects that require intermittent use of bronchodilators or local steroid injections would not be excluded from the study. Subjects with hypothyroidism stable on hormone replacement or Sjorgen's syndrome will not be excluded from the study.
  11. Has evidence of interstitial lung disease or active, non-infectious pneumonitis.
  12. Has an active infection requiring systemic therapy.
  13. Has a 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.
  14. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  15. Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment.
  16. Has received prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137 antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways).
  17. Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies). Testing not required.
  18. Has known history of Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected). Testing not required.
  19. Has received a live vaccine within 30 days prior to the first dose of trial treatment.
  Contacts and Locations
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): NCT02337686


Contacts
Contact: John DeGroot, MD 713-792-2883

Locations
United States, Texas
University of Texas MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Merck Sharp & Dohme Corp.
Investigators
Study Chair: John DeGroot, MD M.D. Anderson Cancer Center
  More Information

Additional Information:
Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT02337686     History of Changes
Other Study ID Numbers: 2014-0820
NCI-2015-00174 ( Registry Identifier: NCI CTRP )
First Submitted: January 8, 2015
First Posted: January 14, 2015
Last Update Posted: October 2, 2017
Last Verified: September 2017

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

Keywords provided by M.D. Anderson Cancer Center:
Keytruda
pembrolizumab
immune effector function
pembrolizumab monotherapy
ex vivo T-cell-specific cytokines profiling
immune effector Tcell:Treg ratio
immunological changes
immune response

Additional relevant MeSH terms:
Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Pembrolizumab
Antineoplastic Agents