Description:
The goals of the overall study are to evaluate a recommended phase 2 dose and the short and
long term toxicities of the combinations. This is a modified phase I trial of immune
checkpoint inhibitors in combination with mutation - specific targeted therapy (crizotinib or
erlotinib) at conventional doses stratified for presence of ALK (Anaplastic lymphoma kinase)
or EGFR (epidermal growth factor receptor) mutation.
The goals of the overall study are to evaluate a recommended phase 2 dose and the short and
long term toxicities of the combinations.
Title
- Brief Title: Combination Checkpoint Inhibitor Plus Erlotinib or Crizotinib for EGFR or ALK Mutated Stage IV Non-small Cell Lung Cancer
- Official Title: Evaluation of Combination Checkpoint Inhibitor Plus Targeted Inhibitor (Erlotinib or Crizotinib) for EGFR or ALK Mutated Stage IV Non-small Cell Lung Cancer: Phase Ib With Expansion Cohorts
Clinical Trial IDs
- ORG STUDY ID:
HCI66705
- NCT ID:
NCT01998126
Conditions
- Non-small Cell Lung Cancer
Interventions
Drug | Synonyms | Arms |
---|
Ipilimumab | Yervoy | ALK patients plus ipilimumab |
Erlotinib | | EGFR patients with ipilimumab |
Crizotinib | | ALK patients plus ipilimumab |
Nivolumab | Nivolumab 240 mg every 2 weeks | ALK patients plus nivolumab |
Purpose
The goals of the overall study are to evaluate a recommended phase 2 dose and the short and
long term toxicities of the combinations. This is a modified phase I trial of immune
checkpoint inhibitors in combination with mutation - specific targeted therapy (crizotinib or
erlotinib) at conventional doses stratified for presence of ALK (Anaplastic lymphoma kinase)
or EGFR (epidermal growth factor receptor) mutation.
The goals of the overall study are to evaluate a recommended phase 2 dose and the short and
long term toxicities of the combinations.
Trial Arms
Name | Type | Description | Interventions |
---|
EGFR patients with ipilimumab | Experimental | ipilimumab and erlotinib in EGFR mutated patients | |
ALK patients plus ipilimumab | Experimental | ipilimumab and crizotinib in ALK mutated patients | |
EGFR patients with nivolumab | Experimental | nivolumab and erlotinib in EGFR mutated patients | |
ALK patients plus nivolumab | Experimental | nivolumab and crizotinib in ALK mutated patients | |
Eligibility Criteria
Inclusion Criteria:
- Diagnosis of Stage IV Non-Small Cell Lung Cancer (NSCLC), or Stages II - III NSCLC
that cannot be treated curatively with standard techniques.
- Non-Small Cell Lung Cancer (NSCLC) that is either EGFR or ALK mutated.
- Untreated with/or actively treated with specific inhibitor for less than 6 months if
not progressing on active therapy.
- Age > 18.
- ECOG performance status 0, 1 or 2.
- Prior chemotherapy is allowed if > one month from the end of treatment. Patients must
not have received chemotherapy within 4 weeks of the start of study drug.
- Brain metastases are allowed if the patient is asymptomatic or previous steroid
treatment was discontinued > 6 weeks.
- Adequate bone marrow function as defined in the protocol
- Serum bilirubin levels < 1.5 mg/dL except for patients with Gilbert's syndrome.
- Adequate organ function as defined in the protocol
- If female and of childbearing potential, documentation of negative pregnancy test
(serum or urine) within 7 days prior to first dose.
- Able to provide informed consent and have signed an approved consent form that
conforms to federal and institutional guidelines.
Exclusion Criteria:
- Concurrent therapy with any other non-protocol anti-cancer therapy.
- History of any other malignancy requiring active treatment.
- Patients who have had a history of acute diverticulitis, intra-abdominal abscess,
Gastrointestical obstruction and abdominal carcinomatosis which are known risk factors
for bowel perforation.
- History of symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic
progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune
vasculitis [e.g., Wegener's Granulomatosis]); motor neuropathy considered of
autoimmune origin (e.g., Guillain-Barre Syndrome). History of vitiligo and adequately
controlled endocrine deficiencies such as hypothyroidism are allowed.
- Significant cardiovascular disease including:
- Active, clinically symptomatic left ventricular failure.
- Uncontrolled symptomatic hypertension that cannot be controlled with anti-hypertensive
agents.
- Myocardial infarction, severe angina, or unstable angina within 6 months prior to
administration of first dose of study drug.
- History of serious ventricular arrhythmia (i.e., ventricular tachycardia or
ventricular fibrillation)
- Cardiac arrhythmias requiring anti-arrhythmic medications (except for atrial
fibrillation that is well controlled with anti-arrhythmic medication)
- Coronary or peripheral artery bypass graft within 6 months of screening.
- Uncontrolled CNS metastases are not allowed; subjects with previously treated brain
metastases will be allowed if the brain metastases have been treated, toxicities have
resolved to grade 1 or baseline and steroids are no longer required. Leptomeningeal
metastases are not allowed.
- Serious/active infection or infection requiring parenteral antibiotics.
- Pregnant or lactating females.
- HIV infection or chronic hepatitis B or C. Negative Screening tests for HIV, Hepatitis
B, and Hepatitis C are required.
- The presence of any other medical or psychiatric disorder that, in the opinion of the
treating physician, would contraindicate the use of the drugs in this protocol or
place the subject at undue risk for treatment complications.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | toxicity of ipilimumab and erlotinib in EGFR mutated patients |
Time Frame: | 36 months |
Safety Issue: | |
Description: | The immune-related response criteria (irRC) incorporate several elements reflecting the complex tumor dynamics of ipilimumab/nivolumab treatment. Under these criteria, a measure of tumor volume is used that incorporates the contribution of new measurable lesions. Each net percentage change in tumor burden per assessment using irRC accounts for the size and growth kinetics of both old and new lesions as they appear. New lesions alone do not qualify as immune-related progressive disease. |
Secondary Outcome Measures
Measure: | Response rate |
Time Frame: | 36 months |
Safety Issue: | |
Description: | |
Measure: | Progression Free Survival (PFS) |
Time Frame: | 36 months |
Safety Issue: | |
Description: | |
Measure: | Overall Survival |
Time Frame: | 36 months |
Safety Issue: | |
Description: | |
Measure: | immune function pre and post immune therapy |
Time Frame: | 36 months |
Safety Issue: | |
Description: | The immune-related response criteria (irRC) incorporate several elements reflecting the complex tumor dynamics of ipilimumab treatment. Under these criteria, a measure of tumor volume is used that incorporates the contribution of new measurable lesions. Each net percentage change in tumor burden per assessment using irRC accounts for the size and growth kinetics of both old and new lesions as they appear. New lesions alone do not qualify as immune-related progressive disease.
In this study, immune-related response criteria (irRC) will be used to assess subject response to study treatment per investigator assessment. The secondary endpoint irPFS will be determined based on investigator assessment. In order to adequately address this secondary objective, investigators will follow the clinical practice guidelines to obtain additional tumor assessments beyond mWHO PD and follow the instructions in this section for the determination of immune-related response. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | University of Utah |
Last Updated
April 2, 2018