I. Evaluate the safety of pembrolizumab in combination with romidepsin. II. Estimate the
response rate of the combination therapy in refractory or recurrent peripheral T-cell
I. Estimate progression free survival (PFS). II. Estimate overall survival (OS). III.
Estimate complete response (CR) and duration of response (DOR).
I. Assess activation of T-cells after treatment in peripheral blood and tumor
II. Correlate features of peripheral blood T-cell activation with toxicities, clinical
response, and PFS.
Participants receive romidepsin intravenously (IV) over 4 hours on days 1 and 8 or day 8 of
cycle 1 and days 1 and 8 of subsequent cycles and pembrolizumab IV over 30 minutes on day 1.
Cycles repeat every 21 days for up to 36 cycles in the absence of disease progression or
After completion of study treatment, participants are followed up at 30 days and then every
- Patients with peripheral T-cell lymphoma (including but not limited to peripheral
T-cell lymphoma, not otherwise specified [PTCL-NOS], angioimmunoblastic T-cell
lymphoma, anaplastic large T-cell lymphoma). Patients with mycosis fungoides with
large cell transformation with measurable disease is eligible.
- Disease status defined as refractory to or relapsed after >=1 prior treatment lines.
- Subjects with ALK+, anaplastic large cell lymphoma (ALCL) should have been treated
with, be ineligible for, or have refuse chemotherapy and brentuximab prior to
enrollment on the current study.
- Patients with a measurable disease, defined by a node or mass with the longest
diameter >= 1.5 cm.
- Be willing and able to provide written informed consent/assent for the trial.
- Patients with PTCL should have radiographically measurable disease >= 1.5 cm.
- Be willing to provide tissue from a newly obtained core or excisional biopsy of a
tumor lesion. Newly-obtained is defined as a specimen obtained up to 6 weeks (42 days)
prior to initiation of treatment on day 1. Subjects for whom newly-obtained samples
cannot be provided (e.g. inaccessible or subject safety concern) may submit an
- Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG)
- Absolute neutrophil count (ANC) >= 1,500 /mcL.
- Platelets >= 100,000 / mcL.
- Hemoglobin >= 9 g/dL or >= 5.6 mmol/L without transfusion or erythropoietin (EPO)
dependency (within 7 days of assessment).
- Serum creatinine OR measured or calculated creatinine clearance glomerular filtration
rate (GFR) can also be used in place of creatinine or creatinine clearance (CrCl) =<
1.5 x upper limit of normal (ULN) OR =< 60 mL/min for subject with creatinine levels >
1.5 x institutional ULN.
- Creatinine clearance should be calculated per institutional standard.
- Serum total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for subjects with total
bilirubin levels > 1.5 ULN.
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and
alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x
ULN OR =< 5 x ULN for subjects with liver metastases.
- Albumin >= 2.5 mg/dL.
- International normalized ratio (INR) or prothrombin time (PT) =< 1.5 x ULN unless
subject is receiving anticoagulant therapy as long as PT or partial thromboplastin
time (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.
- Thromboplastin time (aPTT)anticoagulant therapy, as long as PT or PTT is within
therapeutic range of intended use of anticoagulants.
- Female subject of childbearing potential should have a negative urine or serum
pregnancy within 72 hours prior to receiving the first dose of study medication. If
the urine test is positive or cannot be confirmed as negative, a serum pregnancy test
will be required.
- Female subjects of childbearing potential must be willing to use an adequate method of
contraception, for the course of the study through 120 days after the last dose of
study medication. Note: Abstinence is acceptable if this is the usual lifestyle and
preferred contraception for the subject.
- Male subjects of childbearing potential must 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. Note: Abstinence is acceptable if this is the usual
lifestyle and preferred contraception for the subject.
- 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.
- Has a diagnosis of immunodeficiency, is receiving systemic steroids above physiologic
dose (> 10 mg/day prednisone or equivalent) within 7 days of start of therapy or is
receiving any other form of immunosuppressive therapy.
- Has a known history of active TB (Bacillus tuberculosis).
- Hypersensitivity to pembrolizumab or any of its excipients.
- Has had a prior anti-cancer monoclonal antibody (mAb) 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.
- 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 =< grade 2 neuropathy are an exception to this criterion and may qualify for the
study. Note: If subject received major surgery, they must have recovered adequately
from the toxicity and/or complications from the intervention prior to starting
- Has a known additional malignancy that is progressing or requires active treatment.
Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the
skin that has undergone potentially curative therapy or in situ cervical cancer.
- Has known active central nervous system (CNS) metastases and/or carcinomatous
meningitis. Subjects with previously treated brain metastases may participate provided
they are stable (without evidence of progression by imaging for at least four weeks
prior to the first dose of trial treatment and any neurologic symptoms have returned
to baseline), have no evidence of new or enlarging brain metastases, and are not using
steroids for at least 7 days prior to trial treatment. This exception does not include
carcinomatous meningitis which is excluded regardless of clinical stability.
- Has active autoimmune disease that has required systemic treatment in the past 2 years
(i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid
replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
form of systemic treatment.
- Has known history of non-infectious pneumonitis that required systemic steroid use, or
has active pneumonitis.
- Has an active infection requiring systemic therapy.
- 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.
- Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.
- 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.
- Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent.
- Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
- Has known active hepatitis B (e.g., hepatitis b surface antigen [HBsAg] reactive) or
hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is
- Baseline electrocardiogram (EKG) shows corrected QT interval by Fridericia (QTcF) >
- Concomitant use of strong CYP3A4 inhibitors and inducers.
- Has received a live vaccine within 30 days of planned start of study therapy. Note:
Seasonal influenza vaccines for injection are generally inactivated flu vaccines and
are allowed; however intranasal influenza vaccines (e.g., Flu-Mist) are live
attenuated vaccines, and are not allowed.
- Has undergone prior allogeneic hematopoietic stem cell transplantation within the last
5 years. (Subjects who have had a transplant greater than 5 years ago are eligible as
long as there are no symptoms of graft versus host disease (GVHD).