Description:
The purpose of this study is to evaluate the effectiveness and safety of the combination of
Pembrolizumab (KEYTRUDA®) and the investigational drug, Metformin.
Title
- Brief Title: A Trial of Pembrolizumab and Metformin Versus Pembrolizumab Alone in Advanced Melanoma
- Official Title: Profiling and Reversing Metabolic Insufficiency in the Tumor Microenvironment in Advanced Melanoma: A Trial of Pembrolizumab and Metformin Versus Pembrolizumab Alone in Advanced Melanoma
Clinical Trial IDs
- ORG STUDY ID:
16-196
- NCT ID:
NCT03311308
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Pembrolizumab Injection [Keytruda] | Keytruda | Pembrolizumab |
Metformin | | Pembrolizumab and Metformin Combination |
Purpose
The purpose of this study is to evaluate the effectiveness and safety of the combination of
Pembrolizumab (KEYTRUDA®) and the investigational drug, Metformin.
Detailed Description
Patients are being asked to take part in this clinical research study because they have
advanced, un-resectable stage III or IV Melanoma. If they participate they will be randomized
to receive Pembrolizumab (KEYTRUDA®) or the combination of Pembrolizumab (KEYTRUDA®) plus
Metformin.
This research study will evaluate the effectiveness and safety of the combination of
Pembrolizumab (KEYTRUDA®) and the investigational drug, Metformin.
Patients will be randomized into one of two groups - either Arm A or Arm B. In Arm A,
patients will receive pembrolizumab alone. In Arm B, patients will receive both pembrolizumab
and metformin.
If patients are randomized to Arm A, they will be administered pembrolizumab (200 mg), by IV,
every three weeks. After the first three doses, pembrolizumab dosing can be changed to 400mg
IV every 6 weeks, at the treating physician's discretion. Pembrolizumab can be administered
up to two years, if disease does not progress or have unacceptable toxicity. However, if the
disease progresses the patient may continue on the study if they are clinically stable or
clinically improved.
If patients are randomized to Arm B, they will be administered pembrolizumab (200 mg), by IV,
every three weeks, plus metformin (500 mg), twice a day for nine weeks. Metformin will be
taken in the morning and evening, 12hrs apart, with food. After the first three doses,
pembrolizumab dosing can be changed to 400mg IV every 6 weeks, at the treating physician's
discretion.
Discontinuation of treatment may be considered for patients who have attained a confirmed
complete response that have been treated for at least 24 weeks with pembrolizumab and had at
least two treatments with pembrolizumab beyond the date when the initial complete response
was declared.
Patients will be followed for 5 years after removal from study or until death, whichever
occurs first, through standard of care visits, phone call or by medical records review.
Trial Arms
Name | Type | Description | Interventions |
---|
Pembrolizumab | Active Comparator | Pembrolizumab (Keytruda), 200 mg, by IV, every three weeks, for up to 2 years; after the first three doses, dosing can be changed to 400mg IV every 6 weeks, at the treating physician's discretion. | - Pembrolizumab Injection [Keytruda]
|
Pembrolizumab and Metformin Combination | Experimental | Pembrolizumab (Keytruda), 200mg, by IV, every three weeks, for up to 2 years will be taken in combination with Metformin, 500mg, twice a day, for nine weeks; after the first three doses, pembrolizumab dosing can be changed to 400mg IV every 6 weeks, at the treating physician's discretion. | - Pembrolizumab Injection [Keytruda]
- Metformin
|
Eligibility Criteria
Inclusion Criteria:
- Be willing and able to provide written informed consent for the trial.
- Have un-resectable (stage III) or advanced (stage IV) melanoma.
- Be 18 years of age or older on day of signing informed consent
- Have measurable disease based on RECIST 1.1. Patients without measurable disease may
be included on study after discussion with the Sponsor, given that the primary
endpoint of the study is Ki-67 of TIL (flow cytometry)
- Have biopsiable disease. Be willing to provide tissue from a newly obtained biopsy of
a tumor lesion. Newly-obtained is defined as a specimen obtained up to 30 days prior
to initiation of treatment on Day 1.
- Patients may have received prior adjuvant therapy with anti-PD-1, anti-CTLA-4, or
BRAF/MEK inhibitors.
- Patients may be immunotherapy treatment naïve in the advanced setting or may be on
anti-PD-1 therapy with SD or PR for at least 12 weeks. Patients may have received
ipilimumab plus nivolumab in the metastatic setting with SD or PR for at least 12
weeks on maintenance anti-PD1.
- Have a performance status of 0, 1 or 2 on the ECOG Performance Scale.
- Have a baseline HbA1c ≤ 6.4.
- Demonstrate adequate organ function. All screening labs should be performed within 14
days of treatment initiation.
1. Absolute neutrophil count (ANC) ≥1,500 /mcL
2. Platelets ≥100,000 / mcL
3. Hemoglobin ≥9 g/dL or ≥5.6 mmol/L without transfusion or EPO dependency (within 7
days of assessment)
4. Serum creatinine OR Measured or calculateda creatinine clearance ≤1.5 X upper
limit of normal (ULN) (GFR can also be used in place of creatinine or CrCl ≥60
mL/min for subject with creatinine levels > 1.5 X institutional ULN)
5. Serum total bilirubin ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for subjects with
total bilirubin levels > 1.5 ULN
6. AST (SGOT) and ALT (SGPT) ≤ 2.5 X ULN OR ≤ 5 X ULN for subjects with liver
metastases
7. Albumin >2.5 mg/dL
8. International Normalized Ratio (INR) or Prothrombin Time (PT) ≤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; 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
- Patients must be free of active brain metastases by contrast-enhanced CT/MRI scans
within 2 weeks prior to starting the study drugs. If known to have prior brain
metastases, must not have evidence of active (enlarging and/or symptomatic lesions)
brain disease on MRI evaluation within 4 weeks from SRS or WBRT treatment.
- Patients who have received radiation may be enrolled if the treating physician
determines that they have recovered from radiation and are not experiencing radiation
related clinically significant adverse events.
- Female patients of child bearing potential must have a negative urine or serum
pregnancy test within 7 days from the time of registration.
- 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 should be willing 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. Subjects of
childbearing potential are those who have not been surgically sterilized or have not
been free from menses for > 1 year.
- Male subjects should 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.
Exclusion Criteria:
- Has a current confirmed diagnosis of type 1 diabetes or type 2 diabetes that has been
diagnosed by an HbA1c ≥6.5, or is on any hypoglycemic medications (insulin, metformin,
etc). Patients with a screening HbA1c 6.5-7.0 may be included after discussion with
the principal investigator. Patients currently on metformin will be excluded.
- Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any
other form of immunosuppressive therapy within 7 days prior to the first dose of trial
treatment.
- 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 (this excludes patients on anti-PD1) 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. If subject received major surgery, they must have recovered adequately from the
toxicity and/or complications from the intervention prior to starting therapy.
- 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 two 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 (eg., thyroxineor physiologic corticosteroid replacement
therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of
systemic treatment.
- Has a history of (non-infectious) pneumonitis that required steroids or current
pneumonitis.
- Has an active infection requiring systemic IV antibiotic 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 a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
- Has a known history of or is positive for hepatitis B (hepatitis B surface antigen
[HBsAg] reactive) or hepatitis C (hepatitis C virus [HCV] RNA [qualitative] is
detected). Note: Without known history, testing only needs to be performed if there is
clinical suspicion for Hepatitis B or C.
- 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.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Ki-67 proliferation index in T cell |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | determine the cell cycle status |
Secondary Outcome Measures
Measure: | Number of participants experiencing adverse events |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | Number of participants that received a combination of Pembrolizumab and Metformin who experience treatment-related adverse events as assessed by CTCAE v4.0 |
Measure: | Hypoxia in the primary tumor by IHC Staining |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | |
Measure: | Mitochondrial functional restoration in Tumor Infiltrating Lymphocytes by mitochondrial mass |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | patients treated with metformin and pembrolizumab compared to pembrolizumab alone |
Measure: | Cell cycle status of peripheral blood T lymphocytes by Flow Cytometry |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | patients treated with pembrolizumab and metformin compared to patients treated with pembrolizumab alone |
Measure: | overall tumor response rate |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | patients treated with metformin and pembrolizumab compared to pembrolizumab alone, as measured by clinical tumor measurement and radiological tumor measurement on PET/CT scans. |
Measure: | Mitochondrial functional restoration in Tumor Infiltrating Lymphocytes by Seahorse metabolic profiling |
Time Frame: | up to 4 years |
Safety Issue: | |
Description: | patients treated with metformin and pembrolizumab compared to pembrolizumab alone |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Yana Najjar |
Trial Keywords
- Melanoma
- Unresectable
- Stage III
- Stage IV
Last Updated
November 27, 2020