Clinical Trials /

Blinatumomab and Pembrolizumab for Adults With Relapsed/Refractory B-cell Acute Lymphoblastic Leukemia With High Marrow Lymphoblasts

NCT03160079

Description:

This is a Phase I/II study of blinatumomab in combination with pembrolizumab in adult patients with relapsed or refractory B-lineage ALL The primary objective of this study is to determine if the addition of pembrolizumab to blinatumomab improves the overall response rate (CR+ CRh) relative to blinatumomab alone in adult subjects with relapsed or refractory B-cell acute lymphoblastic leukemia with high bone marrow lymphoblast percentage (>50% lymphoblasts).

Related Conditions:
  • B-Cell Acute Lymphoblastic Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Blinatumomab and Pembrolizumab for Adults With Relapsed/Refractory B-cell Acute Lymphoblastic Leukemia With High Marrow Lymphoblasts
  • Official Title: A Phase I/II Study of Blinatumomab in Combination With Pembrolizumab (MK-3475) for Adults With Relapsed or Refractory B-lineage Acute Lymphoblastic Leukemia With High Bone Marrow Lymphoblast Percentage

Clinical Trial IDs

  • ORG STUDY ID: 161287/UCHMC1504
  • NCT ID: NCT03160079

Conditions

  • B-Cell Acute Lymphoblastic Leukemia, Adult

Interventions

DrugSynonymsArms
blinatumomabBlincytoBlinatumomab + Pembrolizumab
pembrolizumabKeytruda, MK-3475Blinatumomab + Pembrolizumab

Purpose

This is a Phase I/II study of blinatumomab in combination with pembrolizumab in adult patients with relapsed or refractory B-lineage ALL The primary objective of this study is to determine if the addition of pembrolizumab to blinatumomab improves the overall response rate (CR+ CRh) relative to blinatumomab alone in adult subjects with relapsed or refractory B-cell acute lymphoblastic leukemia with high bone marrow lymphoblast percentage (>50% lymphoblasts).

Detailed Description

      This is a Phase I/II study of blinatumomab in combination with pembrolizumab in adult
      patients with relapsed or refractory B-lineage ALL The primary objective of this study is to
      determine if the addition of pembrolizumab to blinatumomab improves the overall response rate
      (CR+ CRh) relative to blinatumomab alone in adult subjects with relapsed or refractory B-cell
      acute lymphoblastic leukemia with high bone marrow lymphoblast percentage.

      Mechanisms of resistance to blinatumomab are not well understood although inhibition of or
      suboptimal T-cell activation may play an important role. PD-L1 and PD-L2 expression and
      upregulation in lymphoblasts and the bone marrow microenvironment at baseline and in response
      to cytokines including those released upon blinatumomab exposure may inhibit T-cell function
      through the PD-1 receptor and lead to resistance to blinatumomab. The investigators
      hypothesize that part of the resistance to therapy with blinatumomab is mediated by the
      exuberant cytokine release seen with higher disease burden leading to increased expression of
      PD-L1 and PD-L2. Enhancing T-cell activity through use of the PD-1 inhibitor pembrolizumab is
      predicted to augment the activity of blinatumomab and convert more patients to complete
      remission and prolong remission durations. This study will also act to expand knowledge of
      PD-L1 and PD-L2 dynamics in response to blinatumomab. It will also be a paradigm for the
      addition of checkpoint inhibitors to therapy with bifunctional T-cell engaging antibodies
      currently in development for targeting other liquid and solid tumors.

      The PD-1 receptor-ligand interaction is a major pathway hijacked by tumors to suppress immune
      control. This suggests that the PD-1/PD-L1 pathway plays a critical role in tumor immune
      evasion and should be considered as an attractive target for therapeutic intervention.
      Pembrolizumab is a potent and highly selective humanized monoclonal antibody (mAb) of the
      IgG4/kappa isotype designed to directly block the interaction between PD-1 and its ligands,
      PD-L1 and PD-L2.

      The study will be conducted in 2 stages:

      Stage 1 is to ensure safety of pembrolizumab in combination with blinatumomab.

      Stage 2 of the study will include an expansion cohort of up to 21 additional subjects (for a
      total of 24 subjects) to evaluate the efficacy of the combination of blinatumomab and
      pembrolizumab in adults with relapsed/refractory B-cell ALL
    

Trial Arms

NameTypeDescriptionInterventions
Blinatumomab + PembrolizumabExperimental
  • blinatumomab
  • pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          -  Relapsed or refractory B-lineage acute lymphoblastic leukemia having received at least
             1 prior line of therapy

          -  Philadelphia chromosome/BCR-ABL1-positive B-lineage ALL must have failed at least 1
             second or third generation tyrosine kinase inhibitor (TKI) or be intolerant to TKIs

          -  Greater than 50% lymphoblasts on screening bone marrow aspirate or biopsy

          -  Adequate organ function

          -  Women of child-bearing potential and men with partners of child-bearing potential must
             agree 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.

          -  A woman of child-bearing potential is any female (regardless of sexual orientation,
             having undergone a tubal ligation, or remaining celibate by choice) who meets the
             following criteria:

               -  Has not undergone a hysterectomy or bilateral oophorectomy; or

               -  Has not been naturally postmenopausal for at least 12 consecutive months (i.e.,
                  has had menses at any time in the preceding 12 consecutive months)

          -  Male subjects must agree to use a latex condom during sexual contact with females of
             childbearing potential even if they have had a successful vasectomy starting with the
             first dose of study therapy through 120 days after the last dose of study therapy.

        Exclusion Criteria:

          -  Allogeneic hematopoietic cell transplantation within 5 years of study drug
             administration

          -  Is currently participating and receiving study therapy or has participated in a study
             of an investigational agent and received study therapy or used an investigational
             device within 4 weeks of the first dose of treatment.

          -  GM-CSF or G-CSF use within 2 weeks of study treatment and throughout the study

          -  Prior checkpoint inhibitor therapy including anti-PD1, anti-PD-L1, anti-CTLA4, anti-
             CD137, or anti-PD-L2 therapy

          -  Active CNS or testicular involvement by leukemia

          -  History of neurologic disorder

          -  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.

          -  Burkitt lymphoma/leukemia

          -  Has a diagnosis of congenital immunodeficiency

          -  Has a known history of active TB (Bacillus Tuberculosis)

          -  Known HIV infection

          -  Active hepatitis B or hepatitis C infection

          -  Has received a live vaccine within 30 days prior to first dose

          -  Is pregnant or breastfeeding, or expecting to conceive or father children within the
             projected duration of the trial, starting with the pre-screening or screening visit
             through 120 days after the last dose of trial treatment.

          -  History of autoimmune disease

          -  Known interstitial lung disease

          -  Any evidence of active, non-infectious pneumonitis or has a history of
             (non-infectious) pneumonitis that required steroids or current pneumonitis

          -  Patients who have received chemotherapy or radiotherapy within 2 weeks prior to
             entering the study or has not recovered from adverse events due to agents administered
             more than 2 weeks earlier.

          -  Patients who are less than 4 weeks from surgery or have insufficient recovery from
             surgical-related trauma or wound healing.

          -  Known impaired cardiac function
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall Response Rate (ORR)
Time Frame:28 weeks
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Complete Response Rate (CR)
Time Frame:28 weeks
Safety Issue:
Description:
Measure:Minimal residual disease (MRD) negativity rate in subjects achieving a CR or CRh
Time Frame:28 weeks
Safety Issue:
Description:
Measure:2 year relapse-free survival
Time Frame:2 years
Safety Issue:
Description:
Measure:2-year overall survival
Time Frame:2 years
Safety Issue:
Description:
Measure:Number of participants with treatment-related adverse events as assessed by NCI CTCAE v4.0
Time Frame:4 years
Safety Issue:
Description:Safety and tolerability of blinatumomab in combination with pembrolizumab

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Matthew Wieduwilt, M.D., Ph.D.

Trial Keywords

  • blinatumomab
  • pembrolizumab
  • MK-3475
  • relapsed
  • refractory
  • B-lineage acute lymphoblastic leukemia
  • ALL

Last Updated

October 19, 2020