Clinical Trials /

Combination Checkpoint Inhibitor Plus Erlotinib or Crizotinib for EGFR or ALK Mutated Stage IV Non-small Cell Lung Cancer

NCT01998126

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.

Related Conditions:
  • Non-Small Cell Lung Carcinoma
Recruiting Status:

Completed

Phase:

Phase 1

Trial Eligibility

Document

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

DrugSynonymsArms
IpilimumabYervoyALK patients plus ipilimumab
ErlotinibEGFR patients with ipilimumab
CrizotinibALK patients plus ipilimumab
NivolumabNivolumab 240 mg every 2 weeksALK 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

NameTypeDescriptionInterventions
EGFR patients with ipilimumabExperimentalipilimumab and erlotinib in EGFR mutated patients
  • Ipilimumab
  • Erlotinib
ALK patients plus ipilimumabExperimentalipilimumab and crizotinib in ALK mutated patients
  • Ipilimumab
  • Crizotinib
EGFR patients with nivolumabExperimentalnivolumab and erlotinib in EGFR mutated patients
  • Erlotinib
  • Nivolumab
ALK patients plus nivolumabExperimentalnivolumab and crizotinib in ALK mutated patients
  • Crizotinib
  • Nivolumab

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