Clinical Trials /

Recombinant Interleukin-15 in Combination With Checkpoint Inhibitors Nivolumab and Ipilimumab in People With Refractory Cancers

NCT03388632

Description:

Background: The drug IL-15 activates the immune system. The drugs nivolumab and ipilimumab unblock immune cells. The drugs together may allow immune cells to recognize and attack cancer cells, causing tumors to shrink. Objective: To test the effects and maximum dose of IL-15, nivolumab, and ipilimumab. Eligibility: People ages 18 and older who have cancer that does not respond to treatment Design: Participants will be screened with: - Medical history - Physical exam - Heart, blood, and urine tests - Scans Tumor biopsy: A small needle removes a tumor sample. Participants will be in 1 of 3 treatment groups: - IL-15 with nivolumab - IL-15 with ipilimumab - IL-15 with nivolumab and ipilimumab Participants will take the drugs in four 6-week cycles. IL-15 is injected under the skin. The other two drugs are injected into an arm vein over 60-90 minutes. Participants may need to stay at the hospital 2-3 hours after the first dose of any drug to watch for side effects. Each cycle will include: - Weekly blood and urine tests - 5 IL-15 injections - 1 ipilimumab injection if applicable - 3 nivolumab injections if applicable - Scans and a tumor biopsy on day 42 After cycle 4, participants will stop taking IL-15. They will continue the other drugs until they can no longer tolerate the side effects or their cancer gets worse. Those cycles will include: - Blood tests on 3-4 days - Urine tests on 1 day - 1 ipilimumab injection if applicable - 3 nivolumab injections if applicable - Scans every other cycle After participants stop treatment, their doctor will monitor their side effects for 4 months or until they go away.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Recombinant Interleukin-15 in Combination With Checkpoint Inhibitors Nivolumab and Ipilimumab in People With Refractory Cancers
  • Official Title: Phase I Study of Recombinant Interleukin 15 in Combination With Checkpoint Inhibitors Nivolumab and Ipilimumab in Subjects With Refractory Cancers

Clinical Trial IDs

  • ORG STUDY ID: 180033
  • SECONDARY ID: 18-C-0033
  • NCT ID: NCT03388632

Conditions

  • Metastatic Solid Tumors
  • Treatment-Refractory Cancers

Interventions

DrugSynonymsArms
rhIL-15Lead-in doublet A
IpilimumabLead-in doublet A
NivolumabLead-in doublet B

Purpose

Background: The drug IL-15 activates the immune system. The drugs nivolumab and ipilimumab unblock immune cells. The drugs together may allow immune cells to recognize and attack cancer cells, causing tumors to shrink. Objective: To test the effects and maximum dose of IL-15, nivolumab, and ipilimumab. Eligibility: People ages 18 and older who have cancer that does not respond to treatment Design: Participants will be screened with: - Medical history - Physical exam - Heart, blood, and urine tests - Scans Tumor biopsy: A small needle removes a tumor sample. Participants will be in 1 of 3 treatment groups: - IL-15 with nivolumab - IL-15 with ipilimumab - IL-15 with nivolumab and ipilimumab Participants will take the drugs in four 6-week cycles. IL-15 is injected under the skin. The other two drugs are injected into an arm vein over 60-90 minutes. Participants may need to stay at the hospital 2-3 hours after the first dose of any drug to watch for side effects. Each cycle will include: - Weekly blood and urine tests - 5 IL-15 injections - 1 ipilimumab injection if applicable - 3 nivolumab injections if applicable - Scans and a tumor biopsy on day 42 After cycle 4, participants will stop taking IL-15. They will continue the other drugs until they can no longer tolerate the side effects or their cancer gets worse. Those cycles will include: - Blood tests on 3-4 days - Urine tests on 1 day - 1 ipilimumab injection if applicable - 3 nivolumab injections if applicable - Scans every other cycle After participants stop treatment, their doctor will monitor their side effects for 4 months or until they go away.

Detailed Description

      BACKGROUND:

        -  IL-15 is a stimulatory cytokine that activates the immune system, inducing proliferation
           of T lymphocytes and NK cells. Administration of recombinant human IL-15 (rhIL-15) has
           been shown to result in a dramatic increase of circulating CD8+T cells and NK cells;
           these changes in immune cell populations suggest potential for anti-tumor activity.

        -  Immune checkpoint inhibitors, including nivolumab (anti-PD-1) and ipilimumab
           (anti-CTLA-4), block the engagement of specific T-cell signaling pathways by tumor
           cells. These regulatory pathways typically act to downregulate T cell activity and are
           co-opted by tumors to allow the malignant cells to evade the immune response.

        -  The combination of rhIL-15 with two checkpoint inhibitor therapies has potential to lead
           to enhanced immune activation, resulting in anti-tumor T cell responses that are
           effective in refractory cancers.

      PRIMARY OBJECTIVE:

      - Determine the safety, toxicity profile, dose-limiting toxicity (DLT) and maximum tolerated
      doses (MTD) of subcutaneous administration of rhIL-15 given in combination with the anti-
      CTLA-4 antibody ipilimumab and the anti-PD-1 antibody nivolumab in patients with metastatic
      or treatment-refractory cancers.

      EXPLORATORY OBJECTIVE:

        -  Assess the clinical activity of rhIL-15, ipilimumab, and nivolumab combination therapy
           as characterized by RECIST 1.1 and immune RECIST (iRECIST) response rate of patients
           treated in this trial.

        -  Investigate the biological effects of this combination on circulating T cell subsets and
           on PD-1/PD-L1 expression and immune cell activation in tumor tissue.

      ELIGIBILITY:

      - Patients greater than or equal to 18 years of age with histologically confirmed solid tumor
      malignancy that is metastatic or treatment-refractory cancers.

      STUDY DESIGN:

        -  The first 4-6 patients enrolling in the study will be placed into lead-in doublets with
           a combination of rhIL-15 and either nivolumab OR ipilimumab; once toxicity is cleared in
           both doublets (i.e., 2 patients enrolled on each doublet remain free of DLTs for 6
           weeks) and a safety analysis is reviewed and approved by the IRB, new patients will be
           enrolled directly onto the triple agent combination.

        -  For the first four 42-day cycles on the triplet, patients will receive SC rhIL-15 on
           days 1-8 and 22-29, intravenous (IV) nivolumab on days 8, 22, and 36, and IV ipilimumab
           on day 8. Cycles 5 and onwards will not include treatment with rhIL-15.

        -  Patients will be encouraged to report any and all adverse events, given the high
           likelihood of toxicities with the triplet combination therapy.

        -  Blood for PD endpoints will be collected throughout the study and tumor biopsies will be
           collected pretreatment and on C1D42 (optional during the doublets and triplet escalation
           phase, mandatory during the triplet expansion phase)
    

Trial Arms

NameTypeDescriptionInterventions
Lead-in doublet AExperimentalLead-in doublet for initial safety evaluation: rhIL-15 given SC days 1-8 and 22- 29 + ipilimumab (anti- CTLA-4) given IV on day 8 (IL-15 doses are limited to first 4 cycles only)
  • rhIL-15
  • Ipilimumab
Lead-in doublet BExperimentalLead-in doublet for initial safety evaluation: rhIL-15 given SC days 1-8 and 22- 29 + nivolumab (anti-PD1) given IV on days 8, 22, and 36 (IL-15 doses are limited to first 4 cycles only)
  • rhIL-15
  • Nivolumab
TripletExperimentalTriplet combination
  • rhIL-15
  • Ipilimumab
  • Nivolumab

Eligibility Criteria

        -  INCLUSION CRITERIA:

        Subjects must have histologically confirmed solid tumor malignancy that is metastatic or
        treatment refractory cancers which are not curable or do not have known measures or
        treatments that are associated with a survival advantage (as defined by the subject or the
        physician investigator). Enrollment of subjects with tumors that can be safely biopsied is
        encouraged.

        Subjects must have evaluable, or measurable disease defined as greater than or equal to 1
        lesion that can be accurately measured in greater than or equal to 1 dimension (longest
        diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as greater
        than or equal to 20 mm with conventional techniques or as greater than or equal to 10 mm
        with a spiral computed tomography (CT) scan.

        Subjects must have recovered to less than or equal to grade 1 NCI Common Terminology
        Criteria for Adverse Events (CTCAE) or stabilized from toxicity of prior chemotherapy or
        biologic therapy administered more than 4 weeks or 5 half-lives earlier, whichever is
        shorter.

        Subjects on bisphosphonates/denosumab for any cancer or on hormone therapy for prostate
        cancer may continue this therapy. However, subjects with prostate cancer must have
        confirmed metastatic disease that has progressed despite hormonal therapy or refused or is
        intolerant of hormonal therapy.

        Age greater than or equal to 18 years.

        ECOG performance status less than or equal to 2 (Karnofsky or Lansky greater than or equal
        to 70%.

        Subjects must have normal organ and marrow function as defined below:

          -  leukocytes greater than or equal to 2,000/mm^3

          -  absolute neutrophil count (ANC) greater than or equal 1,500/mm^3

          -  platelets greater than or equal to 100,000/mm^3

          -  total bilirubin less than or equal to 1.5 times institutional upper limit of normal
             (ULN)

          -  AST/ALT less than or equal to 1.5 times institutional upper limit of normal (ULN) or
             if liver metastasis, less than or equal to 2.5 times ULN

          -  Serum creatinine less than or equal to 1.5 times institutional ULN, OR Creatinine
             clearance greater than or equal to 50 mL/min/1.73 m2 for subjects with serum
             creatinine levels greater than 1.5 times higher than institutional normal

        DLCO/VA and FEV1 greater than or equal to 50% of predicted on pulmonary function tests
        (subjects must have pulmonary function tests performed to be eligible)

        Subjects with inactive central nervous system (CNS) metastasis are eligible. Inactive CNS
        metastasis is defined as: no symptoms of brain metastases after successful definitive
        treatment of brain metastases (surgical resection, whole brain irradiation, stereotactic
        radiation therapy, or a combination of these) with stable or improved radiographic
        appearance on magnetic resonance imaging (MRI) scan at least 1 month after completion of
        treatment.

        Subjects may have previously progressed on treatment with one of the 3 agents being used in
        this trial or treatment with other checkpoint inhibitors, as long as they have recovered
        from previous toxicity. Subjects that previously progressed on treatment with a combination
        of any 2 of the 3 agents being used in this trial are eligible for the triplet cohort only.

        The effects of ipilimumab, nivolumab, and rhIL-15 on the developing human fetus are
        unknown. For this reason, women of child-bearing potential and men must agree to use
        adequate contraception (hormonal or barrier method of birth control; abstinence) prior to
        study entry, during the treatment portion of the study, and for a minimum for 5 months
        (women) and 7 months (men) after the last dose of study drug. Should a woman become
        pregnant or suspect she is pregnant while she or her partner is participating in this
        study, she should inform her treating physician immediately.

        Ability to understand and the willingness to sign a written informed consent document.

        Willingness to provide blood and biopsy samples for research purposes if on the expansion
        phase of the study.

        EXCLUSION CRITERIA:

        Subjects who have received any prior cytotoxic therapy, immunotherapy, major surgery,
        antitumor vaccines or monoclonal antibodies in the 4 weeks or 5 halflives, whichever is
        shorter, prior to C1D1 (6 weeks prior for checkpoint inhibitors such as anti-CTLA-4 or
        anti-PD1/PD-L1 and for nitrosoureas or mitomycin C). Subjects must not have received
        radiotherapy in the 2 weeks prior to C1D1. Subjects who had grade greater than or equal to3
        irAE during previous treatment with one of the checkpoint inhibitors are excluded from the
        trial; subjects who had grade 1 or 2 irAE that have resolved to grade 1 are eligible.

        Subjects with primary brain cancers or active CNS metastases should be 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 allergic reactions attributed to compounds of similar chemical or biologic
        composition to any of the agents on this trial.

        Concurrent anticancer therapy (including other investigational agents) with the exception
        of hormone therapy for breast or prostate cancer. Patients that have received treatment for
        a different cancer previously and have been disease-free for less than one year are
        excluded.

        Uncontrolled intercurrent illness including, but not limited to, ongoing or active
        infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
        arrhythmia, cognitive impairment, active substance abuse, or psychiatric illness/social
        situations that, in the view of the Investigator, would preclude safe treatment or the
        ability to give informed consent and limit compliance with study requirements.

        Inability or refusal to practice effective contraception during therapy or the presence of
        pregnancy or active breastfeeding. Because there is no significant preclinical information
        regarding the risk to a fetus or newborn infant, pregnant or breastfeeding women will be
        excluded from participation in this trial.

        Documented HIV infection or positive serology, active bacterial infections, serologic or
        PCR evidence for active or chronic hepatitis B or hepatitis C. Since rhIL-15 treatment
        stimulates the subjects immune system to attack their tumor, the defective immune systems
        of subjects with HIV or hepatitis B or hepatitis C makes responses to this treatment much
        less likely to provide benefit and these subjects are not eligible for this trial.

        History of severe asthma (subjects with a history of mild asthma that are on or can be
        switched to non-corticosteroid

        bronchodilator regimens are eligible).

        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. The use of inhaled corticosteroids is
        allowed.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Safety, toxicity profile, dose-limiting toxicity (DLT), and maximum tolerated doses (MTD)
Time Frame:Cycle 1
Safety Issue:
Description:Determine the safety, toxicity profile, DLTs, and MTD of rhIL-15 administered subcutaneously for 8 consecutive days in combination with anti-CTLA-4 and anti-PD1 monoclonal antibodies, in patients with metastatic or treatment-refractory cancers which are not curable or do not have known measures or treatments that are associated with a survival advantage.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Immunotherapy
  • T Cells
  • Checkpoint Inhibitor
  • IL-15
  • Combination Therapy

Last Updated

June 18, 2021