This pilot phase I trial compares administration schedules of anti-programmed cell death-1
ligand 1 (PD-L1) monoclonal antibody MPDL3280A and stereotactic ablative radiotherapy in
treating patients with stage IV non-small cell lung cancer. Monoclonal antibodies, such as
anti-PD-L1 monoclonal antibody MPDL3280A, may block tumor growth in different ways by
targeting certain cells. Stereotactic ablative radiotherapy, also known as stereotactic body
radiation therapy, is a specialized radiation therapy that delivers a single, high dose of
radiation directly to the tumor and may kill more tumor cells and cause less damage to normal
tissue. Giving anti-PD-L1 monoclonal antibody MPDL3280A with stereotactic ablative
radiotherapy may be a better treatment for non-small cell lung cancer. However, it is not yet
known what the best administration schedule is for these treatments.
PRIMARY OBJECTIVES:
I. To determine which administration schedule of MPDL3280A (anti-PD-L1 monoclonal antibody
MPDL3280A) and stereotactic ablative radiotherapy (SAR) will be most promising to move
forward to a phase II trial based on safety and objective response rate.
SECONDARY OBJECTIVES:
I. To define the safety and toxicity profile of MPDL3280A plus SAR using Common Terminology
Criteria for Adverse Events (CTCAE) version 4 (v4).
II. Radiographic response rates by immure-related Response Evaluation Criteria in Solid
Tumors (irRECIST).
III. Progression free survival using Response Evaluation Criteria in Solid Tumors (RECIST)
1.1 and irRECIST.
TERTIARY OBJECTIVES:
I. Conduct correlative immunologic endpoints.
OUTLINE: Patients are assigned to 1 of 3 arms.
ARM I (CONCURRENT COHORT): Patients receive anti-PD-L1 monoclonal antibody MPDL3280A
intravenously (IV) over 30-60 minutes on day 1. Courses repeat every 3 weeks in the absence
of disease progression or unacceptable toxicity. Beginning on day 1 of course 1, patients
also undergo SAR 2-3 times per week (with a minimum of 40 hours and a maximum of 96 hours
between fractions) over 1.5-2 weeks for a total of 5 fractions.
ARM II (INDUCTION COHORT): Patients receive anti-PD-L1 monoclonal antibody MPDL3280A IV over
30-60 minutes on day 1. Courses repeat every 3 weeks in the absence of disease progression or
unacceptable toxicity. Beginning on day 1 of course 3, patients also undergo SAR 2-3 times
per week (with a minimum of 40 hours and a maximum of 96 hours between fractions) over 1.5-2
weeks for a total of 5 fractions.
ARM III (SEQUENTIAL COHORT): Patients undergo SAR 2-3 times per week (with a minimum of 40
hours and a maximum of 96 hours between fractions) over 1.5-2 weeks for a total of 5
fractions beginning on day 1 of course 1. After completion of SAR (beginning on day 1 of
course 2), patients receive anti-PD-L1 monoclonal antibody MPDL3280A IV over 30-60 minutes on
day 1. Courses repeat every 3 weeks in the absence of disease progression or unacceptable
toxicity.
After completion of study treatment, patients are followed up for 30 days.
Inclusion Criteria:
- Signed informed consent
- Ability to comply with the protocol
- Adults with histologically proven stage IV non-small cell lung cancer
- At least two sites of measurable disease as defined by RECIST 1.1; one of which must
be amenable to treatment with SAR and accessible for optional pre- and post- treatment
biopsy; if a pulmonary nodule is being considered for SAR it must range in size from
1-3 cm
- Have provided written consent for mandatory pre- and post-treatment biopsy (expansion
cohort only)
- Patients with treated supratentorial metastases are allowed if stable, the patient is
off steroids and no evidence of intracranial hemorrhage
- Archival tumor sample available; a minimum of 10 unstained slides; no fine needle
aspiration (FNAs) allowed or tumor tissue from bone
- Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1
- Life expectancy >= 3 months
- Absolute neutrophil count (ANC) >= 1500 cells/ul
- White blood cell (WBC) count > 2500/uL
- Lymphocyte count >= 500/uL
- Platelet count >= 100,000/uL
- Hemoglobin >= 9 g/dL
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 x upper
limit of normal (ULN) with alkaline phosphatase =< 2.5 x ULN OR AST and ALT =< 1.5 x
ULN, with alkaline phosphatase > 2.5 x ULN
- Serum bilirubin =< 1.0 x ULN
- International normalized ratio (INR) and activated partial thromboplastin time (aPTT)
=< 1.5 x ULN (for patients on anticoagulation they must be receiving a stable dose for
at least 1 week prior to randomization)
- Creatinine clearance >= 30 mL/min by Cockcroft-Gault formula
- No history of severe hypersensitivity reactions to other monoclonal antibodies (mAbs)
- No other active malignancy
- No active autoimmune disease or a history of known or suspected autoimmune disease
- No chemotherapy or radiotherapy within the past 28 days and patients must have
recovered any acute toxicity associated with their most recent previous treatment
- Any number of prior treatments is allowed; must have failed at least 1 treatment
regimen for metastatic disease
- Female patients of childbearing potential and male patients with partners of
childbearing potential, agreement (by patient and/or partner) to use highly effective
form(s) of contraception
Exclusion Criteria:
- Patients whose tumors contain activating epidermal growth factor receptor (EGFR)
mutations or anaplastic lymphoma receptor tyrosine kinase (ALK) rearrangement should
be excluded from this study, unless disease has progressed on all available, approved
therapies targeting the EGFR mutation or ALK rearrangement
- Active or untreated central nervous system (CNS) metastases
- Leptomeningeal disease
- Uncontrolled pleural or pericardial effusion or ascites that would require recurrent
drainage
- Uncontrolled tumor related pain
- Uncontrolled hypercalcemia
- Pregnant and lactating women
- Uncontrolled concomitant disease
- Significant cardiovascular disease (New York Heart Association class II or greater);
myocardial infarction within 3 months prior to enrollment, unstable arrhythmias,
unstable angina or a patient with a known left ventricular ejection fraction (LVEF) <
40%
- Severe infection within 4 weeks prior to enrollment
- Oral or IV antibiotics within 2 weeks prior to enrollment
- History of severe allergic, anaphylactic or other hypersensitivity reactions to
chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity or allergy to Chinese hamster ovary cell products or any
component of the MDPL3280A formulation
- History of autoimmune disease including but not limited to myasthenia gravis,
myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis,
inflammatory bowel disease, vascular thrombosis associated with antiphospholipid
syndrome, Wegener's granulomatosis, Sjogren's syndrome, Guillain-Barre syndrome,
multiple sclerosis, vasculitis, or glomerulonephritis
- Patients with a history of autoimmune-related hypothyroidism on a stable dose of
thyroid replacement hormone may be eligible
- Patients with controlled Type 1 diabetes mellitus on a stable insulin regimen may
be eligible
- Patients with a prior allogeneic bone marrow transplantation or prior solid organ
transplantation
- History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced
pneumonitis, organizing pneumonia (i.e. bronchiolitis obliterans, cryptogenic
organizing pneumonia), or evidence of active pneumonitis on screening chest computed
tomography (CT) scan
- A history of radiation pneumonitis in the radiation field (fibrosis) is permitted
- Positive test for human immunodeficiency virus (HIV)
- Patients with active hepatitis B (defined as a positive hepatitis B surface antigen
[HBsAg] test at screening) or hepatitis C
- Patients with past hepatitis B virus infection or resolved hepatitis B virus
(HBV) infection (defined as a negative HBSAg test and a positive antibody to
hepatitis B core antigen antibody test) are eligible
- Patients with a hepatitis C virus (HCV) antibody are eligible only if polymerase
chain reaction is negative for HCV ribonucleic acid (RNA)
- Active tuberculosis
- Administration of a live, attenuated vaccine within 4 weeks prior to enrollment or
anticipation that such a live attenuated vaccine will be required during the study
- Prior treatment with a cluster of differentiation (CD)137 agonists, anti-cytotoxic
T-lymphocyte-associated protein 4 (CTLA4), anti-programmed cell death 1 (PD-1), or
anti-PD-L1 therapeutic antibody or pathway targeting agents
- Treatment with systemic immunostimulatory agents (including but not limited to
interferons or interleukin-2) within 4 weeks or five half-lives of the drug, whichever
is shorter, prior to enrollment
- Treatment with systemic corticosteroids or other systemic immunosuppressive
medications (including but not limited to prednisone, dexamethasone, cyclophosphamide,
azathioprine, methotrexate, thalidomide, anti-tumor necrosis factor agents) within 2
weeks prior to enrollment or anticipated requirement for systemic immunosuppressive
medications during the trial
- Patients who have received acute, low dose, systemic immunosuppressant medication
(e.g., a one-time dose of dexamethasone for nausea) may be enrolled after a
discussion and approval by the principal investigator
- The use of inhaled corticosteroids and mineralocorticoids (eg, fludrocortisone)
is allowed
