Clinical Trials /

Apatinib With Pembrolizumab in Previously Treated Advanced Malignancies

NCT03407976

Description:

This is an open label nonrandomized Phase I/ IIA trial designed to assess the safety, tolerability, and efficacy of apatinib in combination with pembrolizumab. Phase I will assess the safety of combining increasing oral daily doses of apatinib with a fixed dose of IV pembrolizumab every three weeks and will determine the RP2D (Recommended Phase 2 Dose). Phase II will assess the efficacy of the RP2D of apatinib in combination with pembrolizumab and provide additional safety and tolerability data in three disease-specific cohorts

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Gastric Adenocarcinoma
  • Malignant Solid Tumor
  • Urothelial Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Apatinib With Pembrolizumab in Previously Treated Advanced Malignancies
  • Official Title: A Phase I/II Open Label Study of the Safety and Efficacy of Apatinib Administered to Patients With Advanced Malignancies to Improve Sensitivity to Pembrolizumab in the Second- or Later-line Setting (APPEASE)

Clinical Trial IDs

  • ORG STUDY ID: HCI108884
  • NCT ID: NCT03407976

Conditions

  • Advanced Malignancies
  • Urothelial Carcinoma
  • MSI-H or dMMR Solid Tumors
  • Gastric or Gastroesophageal Junction (GEJ) Adenocarcinoma

Interventions

DrugSynonymsArms
ApatinibYN968D1Apatinib and Pembrolizumab, all patients
PembrolizumabApatinib and Pembrolizumab, all patients

Purpose

This is an open label nonrandomized Phase I/ IIA trial designed to assess the safety, tolerability, and efficacy of apatinib in combination with pembrolizumab. Phase I will assess the safety of combining increasing oral daily doses of apatinib with a fixed dose of IV pembrolizumab every three weeks and will determine the RP2D (Recommended Phase 2 Dose). Phase II will assess the efficacy of the RP2D of apatinib in combination with pembrolizumab and provide additional safety and tolerability data in three disease-specific cohorts

Trial Arms

NameTypeDescriptionInterventions
Apatinib and Pembrolizumab, all patientsExperimental
  • Apatinib
  • Pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          -  Male or female subject aged ≥ 18 years.

          -  One of the following advanced solid malignancies which qualifies for standard of care
             pembrolizumab treatment per FDA approval:

               -  Locally advanced or metastatic urothelial carcinoma that has progressed during or
                  following platinum-based chemotherapy or within 12 months of neoadjuvant/adjuvant
                  platinum-based therapy, ONLY in the second- or later-line setting.

               -  Unresectable or metastatic MSI-H or dMMR solid tumors that have progressed during
                  or following prior treatment and have no satisfactory alternative treatment
                  options (including MSI-H or dMMR colorectal cancer that has progressed following
                  treatment with a fluoropyrimidine, oxaliplatin, and irinotecan).

               -  Recurrent locally advanced or metastatic, gastric or gastroesophageal junction
                  (GEJ) adenocarcinoma expressing PD-L1 (as determined by an FDA-approved test)
                  that have progressed on or after two or more systemic therapies, including
                  fluoropyrimidine- and platinum-containing chemotherapy and, if appropriate,
                  HER2/neu-targeted therapy.

          -  Patients must have available and be willing to provide formalin fixed paraffin
             embedded tissue sample from archival tissue (patients who can't provide archival
             tissue will be offered an optional biopsy; lack of tissue will not be exclusionary).

          -  Have measurable disease based on RECIST 1.1.

          -  Female subject of childbearing potential should have a negative urine or serum
             pregnancy test within 72 hours prior to receiving the first dose of study drug. If the
             urine test is positive, 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 at least 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 drug.

          -  ECOG Performance Status ≤ 1.

          -  Adequate organ function as defined in the protocol

          -  Recovery to baseline or Grade ≤ 1 CTCAE v4 from toxicities related to any prior
             treatments, unless AE(s) are clinically nonsignificant and/or stable on supportive
             therapy.

          -  Patients must be able to provide informed consent and be willing to sign an approved
             consent form that conforms to federal and institutional guidelines

        Exclusion Criteria:

          -  Previous treatment with and disease progression on a combination of a VEGF inhibitor
             and an immune checkpoint inhibitor. Patients who have been treated with and have
             progressed on a single agent VEGF inhibitor OR an immune checkpoint inhibitor will not
             be excluded.

          -  Current use of immunosuppressive medication, EXCEPT for the following:

               -  Topical, ocular, intra-articular, intranasal, and inhaled corticosteroids.

               -  Systemic corticosteroids at physiologic doses ≤ 10 mg/day of prednisone
                  equivalent.

               -  Steroids as premedication for hypersensitivity reactions.

          -  Active autoimmune disease that might deteriorate when receiving an immune-stimulatory
             agent per treating physician's clinical judgment. Subjects with type 1 diabetes,
             vitiligo, psoriasis, hypothyroidism, or hyperthyroidism not requiring
             immunosuppressive medications are eligible.

          -  Prior organ transplant including allogenic hematopoietic stem cell transplant.

          -  Active infection requiring intravenous antibiotics (must be completed prior to
             registration).

          -  Known brain metastases or cranial epidural disease unless adequately treated with
             radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks
             before first dose of study treatment. Eligible subjects must be neurologically
             asymptomatic and without corticosteroid treatment at the time of first dose of study
             treatment.

          -  Uncontrolled, significant intercurrent or recent illness including, but not limited
             to, the following conditions:

               -  Cardiovascular disorders:

                    -  Uncontrolled hypertension defined as sustained blood pressure (BP) > 140 mm
                       Hg systolic or > 90 mm Hg diastolic despite optimal antihypertensive
                       treatment.

                    -  Congestive heart failure New York Heart Association Class 3 or 4, unstable
                       angina pectoris, serious cardiac arrhythmias.

                    -  Stroke (including transient ischemic attack [TIA]), myocardial infarction
                       (MI), or other ischemic event, or thromboembolic event (eg, deep venous
                       thrombosis, pulmonary embolism) within 6 months before first dose.

               -  Any history of congenital long QT syndrome.

               -  Presence of a non-healing wound.

               -  Other clinically significant disorders that would preclude safe study
                  participation including colitis, inflammatory bowel disease, pneumonitis,
                  pulmonary fibrosis, psychiatric conditions with active suicidal ideation within
                  the past year; or laboratory abnormalities that may increase the risk associated
                  with study participation or study treatment administration and, in the judgment
                  of the investigator, would make the patient inappropriate for entry into this
                  study.

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to apatinib or pembrolizumab.

          -  History of severe hypersensitivity reaction to any monoclonal antibody.

          -  Known history of testing positive for HIV or known acquired immunodeficiency syndrome.

          -  Known history of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at
             screening (positive HBV surface antigen or detectable HCV RNA if anti-HCV antibody
             screening test positive).

          -  Live vaccine within 4 weeks of the first dose of pembrolizumab and while on trial is
             prohibited.

          -  Packed red blood cell transfusions or erythropoietin therapy within 14 days prior to
             the study enrollment unless erythropoietin therapy has been used to maintain a stable
             condition for at least 1 month prior to the enrollment.

          -  Major surgery within 4 weeks of first dose of study medications. Minor procedures
             (e.g. port placement, endoscopy with intervention) within 2 weeks of first dose of
             study medications are allowed.

          -  Known prior severe hypersensitivity to investigational product or any component in its
             formulations, including known severe hypersensitivity reactions to monoclonal
             antibodies (NCI CTCAE v4 Grade ≥ 3).

          -  Subjects taking prohibited medications as described in the protocol with the exception
             of systemic corticosteroids as defined in the protocol. A washout period of at least 5
             elimination half-lives (or as clinically indicated) should occur for prohibited
             medications prior to the start of treatment.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of dose limiting toxicities (DLTs) of Apatinib in combination with pembrolizumab
Time Frame:21 days, one cycle
Safety Issue:
Description:Safety and tolerability of apatinib in combination with pembrolizumab in subject with select advanced malignancies (urothelial carcinoma, MSI-H/dMMR solid tumors including colorectal cancer, and gastric or gastroesophageal junction GEJ adenocarcinoma) and determine the recommended Phase II dose (RP2D) for apatinib. Adverse events (AEs), serious adverse events (SAEs), dose-limiting toxicities (DLTs)

Secondary Outcome Measures

Measure:Progression Free Survival (PFS)
Time Frame:5 years (Patients are expected to stay on treatment for approximately 12 months)
Safety Issue:
Description:
Measure:Occurrence of Adverse Events and Serious Adverse Events
Time Frame:12 months
Safety Issue:
Description:Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v4.0

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:University of Utah

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