Preclinical and early-phase clinical data suggest that immune modulation represents a
treatment strategy that is worthy of further investigation in relapsed epithelial ovarian
cancer. One method by which tumor cells may evade immune surveillance is by activation of the
programmed cell death (PD-1) pathway, mediated by expression of PD-1 on the surface of T
lymphocytes, which conveys an inhibitory signal after binding to its ligand PD-L1 on the
surface of tumor cells. Nivolumab and Ipilimumab have shown activity as monotherapies in
solid tumors and very early data suggest that nivolumab may be particularly active for
ovarian clear cell carcinoma.(Hamanishi et al., 2015). Given the uniformly poor prognosis for
patients with clear cell carcinoma in general, we are interested in formally evaluating this
agent in all extra-renal clear cell carcinomas.
- Patients must have a recurrent, advanced, or metastatic pure clear cell carcinoma of
ovarian, fallopian tube, primary peritoneal, or extra-renal origin.
- All patients must submit representative tissue from their malignancy.
- Participants must have measurable disease, defined as at least one lesion that can be
accurately measured in at least one dimension (longest diameter to be recorded for
non-nodal lesions and short axis for nodal lesions) as ≥20 mm with conventional
techniques or as ≥10 mm with spiral CT scan, MRI, or calipers by clinical exam.
- Patients with a clear cell carcinoma of ovarian, fallopian or primary peritoneal
origin must have progressed after at least one prior platinum and taxane based
chemotherapy regimen. Patients with extra-renal clear cell cancer (including other
GYN) cancers must have progressed after at least one prior regimen for
advanced/metastatic disease. Radiation therapy (including the use of chemotherapy as a
radiosensitizer) will not count as a prior systemic regimen.
- No prior anti-PD-1, PD-L1 or CTLA-4 antibody.
- Age ≥ 18
- ECOG performance status 0 to 1
- Participants must have normal organ and marrow function as defined below:
leukocytes ≥3,000/mcL absolute neutrophil count ≥1,500/mcL platelets ≥100,000/mcL total
bilirubin within normal institutional limits EXCEPTIONS: conjugated hyperbilirubinemia;
Gilbert's syndrome, both of which will allow a total bilirubin <3.0mg/dL <5xULN is liver
metastases are present A value below the LLN is acceptable if confirmed appropriate by the
treating MD AST(SGOT)/ALT(SGPT) ≤2.5 × institutional upper limit of normal creatinine ≤ 1.5
X ULN (upper limit of normal) OR creatinine clearance ≥50 mL/min
- Adequate thyroid function within 28 days prior to registration defined as serum TSH in
normal range. Patients on thyroid hormone supplementation are allowed provided the
serum TSH is within normal limits.
- Subjects must have a resting baseline O2 saturation by pulse oximetry of ≥92% at rest.
This should be documented within two weeks of registration.
- Reproductive status:
- Women of childbearing potential (WOCBP) must use method(s) of contraception. Given
there is insufficient information to assess teratogenicity (preclinical studies have
not been done), a highly effective method(s) of contraception (failure rate of less
than 1% per year) is required as determined by the treating investigator. WOCBP must
follow instructions for birth control. For all women who discontinue protocol
treatment, contraception should be continued for five months following the last dose
- WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L
or equivalent units of HCG) within 7 days prior to the start of registration.
- Women who are not of childbearing potential (ie, who are postmenopausal (lack of
menses > 24 months) or surgically sterile) and azospermic men do not require
- Women must not be breastfeeding (document for all).
- Men who are sexually active with WOCBP must use any contraceptive method with a
failure rate of less than 1 % per year. The investigator shall review contraception
methods and the time period that contraception must be followed.
- Men that are sexually active with WOCBP must follow instructions for birth control
when the half life of the investigational drug is greater than 24 hours, contraception
should be continued for a period of 7 months after discontinuation of treatment.
- Ability to understand and the willingness to sign a written informed consent document.
- Participants who have had prior therapy with nivolumab or with an anti-PD-1,
anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug
specifically targeting T-cell co-stimulation or immune check point pathways.
- Participants who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study. Patients using endocrine
therapy as treatment for their index cancer must be off of treatment for one week (7
days) prior to entering the study.
- Participants who have not recovered from clinically significant adverse events to
<grade 2 and which are related to prior treatment agents administered.
- Participants who are receiving any other investigational agents.
- Participants with known brain metastases are excluded from this clinical trial because
of their poor prognosis and because they often develop progressive neurologic
dysfunction that would confound the evaluation of neurologic and other adverse events.
- History of severe hypersensitivity reaction to any monoclonal antibody.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection requiring antibiotics, symptomatic congestive heart failure, unstable angina
pectoris, serious cardiac arrhythmia, or psychiatric illness/social situations that
would limit compliance with study requirements.
- Pregnant women are excluded from this study
- Patients with a history of other invasive malignancies, with the exception of
non-melanoma skin cancer are excluded if there is any evidence of other malignancy
being present within the last three years. However, patients with a malignancy that is
not-likely to require treatment in the next 2 years, such as a completely resected,
early stage breast cancer, are eligible.
- Patients who have received prior chemotherapy within the last three years for any
other cancer other than for clear cell cancer.
- In order for patients with known history of testing positive for human
immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) to be
eligible, they must be on a stable highly active antiretroviral therapy (HAART)
regimen, have CD4 counts > 350, with no detectable viral load on quantitative PCR
within 4 weeks of registration.
- Patients with treated hepatitis virus infections (Hepatitis B or Hepatitis C) are
eligible if they have been definitively treated for 6 months, have no detectable viral
load on quantitative PCR, and LFTs meet eligibility requirements within 4 weeks of
- Patients with active autoimmune disease or history of autoimmune disease that might
recur, which may affect vital organ function or require immune suppressive treatment
including systemic corticosteroids, should be excluded.
- Patients should be excluded if they have a condition requiring systemic treatment with
either corticosteroids (>10 mg daily prednisone equivalents) or other
immunosuppressive medications within 14 days of day 1 study drug administration.
- Any other medical condition that will prevent the safe administration of study drugs
in the opinion of the treating physician.
- Planned concomitant, non-protocol directed anti-cancer therapy during the trial.
- Grade ≥2 peripheral neuropathy