Description:
Phase I/II trial in which participants with recurrent glioblastoma will receive a combination of tumor treating fields(portable device), nivolumab with or without ipilimumab.
Phase I/II trial in which participants with recurrent glioblastoma will receive a combination of tumor treating fields(portable device), nivolumab with or without ipilimumab.
Terminated
Phase 2
| Drug | Synonyms | Arms |
|---|---|---|
| Nivolumab 240 mg IV | Nivolumab Monotherapy | Nivolumab Monotherapy |
| Nivolumab 3 mg/kg | Nivolumab+Ipilimumab | Nivolumab+Ipilimumab |
| Ipilimumab 1 mg/kg | Nivolumab+Ipilimumab | Nivolumab+Ipilimumab |
Phase I/II trial in which participants with recurrent glioblastoma will receive a combination
of tumor treating fields(portable device), nivolumab with or without ipilimumab.
The NovoTTF200A (OptuneTM) device is worn continuously for a goal of 75% or more of the time,
ranging from at least 18 hours daily uninterrupted or 22 hours daily with 2-3 days off
monthly. Therapy is planned for approximately 24 months.
Infusions with nivolumab will start within 1 week of study start. Ipilimumab will either
start with the second nivolumab infusion or at after tumor progression. Nivolumab is infused
intravenously at 240 mg once every 2 weeks with or without ipilimumab for a maximum of 24
months. Ipilimumab is dosed at 1 mg/kg once every 6 weeks for a maximum of 4 doses (24
weeks). Infusions will continue until maximum doses are completed or there is confirmed tumor
progression, intolerable adverse effects or withdrawal of consent.
| Name | Type | Description | Interventions |
|---|---|---|---|
| Nivolumab Monotherapy | Experimental | Nivolumab 240 mg IV every 2 weeks for maximum of 24 months. TTF (Optune) for max of 24 months |
|
| Nivolumab+Ipilimumab | Experimental | Nivolumab 3 mg/kg IV with ipilimumab then 240 mg every 2 weeks for maximum of 24 months. Ipilimumab 1 mg/kg IV every 6 weeks maximum of 4 times. NovoTTF200A (Optune) TTF for maximum 24 months |
|
Inclusion Criteria:
- Histologically confirmed World Health Organization Grade IV glioblastoma with
supratentorial distribution.
- Unequivocal evidence of progressive disease on contrast-enhanced brain CT or MRI as
defined by RANO criteria, or documented recurrent glioblastoma on biopsy.
- Prior therapies including radiation and temozolomide.
- Only 1-2 prior treatments for recurrences are allowed. Resection of recurrent
glioblastoma is not considered a prior treatment.
- Must be at least 12 weeks from radiotherapy or progression outside of the high-dose
radiation target volume or unequivocal evidence of progressive tumor on biopsy.
- All adverse events Grade > 1 related to prior therapies (chemotherapy, radiotherapy,
and/or surgery) must be resolved, except for alopecia.
- Karnofsky Performance Status (KPS) ≥ 60
- Adequate organ and marrow function as defined below, all screening labs should be
performed within 14 days of treatment initiation:
- absolute neutrophil count ≥ 1,000/mcL
- platelets ≥ 100,000/mcL
- hemoglobin > 8.0 mg/dL
- total bilirubin ≤ 2.0 x upper limit of normal
- AST (SGOT)/ALT (SGPT) ≤2.5 × upper limit of normal
- creatinine or creatinine clearance ≥60 mL/min/1.73 m2 for creatinine >ULN
- Corticosteroid dose must be stable or decreasing for at least 5 days prior to
enrollment.
- Ability to understand and the willingness to provide written informed consent.
Exclusion Criteria:
- Infratentorial disease.
- Prior use of bevacizumab, ipilimumab or other CTLA-4 inhibitor, or TTFields.
- Tumors with known IDH1 or IDH2 mutations.
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to nivolumab or ipilimumab or their excipients.
- Current or planned participation in a study of an investigational agent or using an
investigational device.
- Uncontrolled intercurrent illness that would limit compliance with study requirements.
- Active or life-threatening infection requiring intravenous or >2 weeks of systemic
therapy.
- Prior stereotactic radiotherapy, convection enhanced delivery (CED) or brachytherapy
requires a biopsy to confirm radiographic progression is consistent with progressive
tumor and not treatment-related necrosis unless the recurrent lesion is outside of any
prior high-dose radiation target volume or distant from the prior CED or brachytherapy
site.
- breastfeeding must be discontinued by enrollment on study.
- Uncontrolled HIV or AIDS is not allowed. Patients with known history of HIV but with
undetectable viral load on antiretroviral therapy are allowed.
- CHF, or MI or hemorrhagic/ischemic stroke in the last 3 months.
- Active illicit drug use or diagnosis of alcoholism
- Known additional malignancy that is progressing or requires active treatment within 3
years of start of study drug.
- Any surgery (not including minor diagnostic procedures such as lymph node biopsy)
within 2 weeks of start of treatment.
- Any significant autoimmune disorders expected to impact multiple or internal organs,
excluding mild eczema or autoimmune thyroiditis treated with thyroidectomy and
requiring systemic immunosuppressive or immunomodulatory therapy.
- Any implanted programmable cranial device, including reprogrammable
ventriculoperitoneal shunt (VPS) or cochlear implants, that precludes use of TTFields
(Optune) therapy.
| Maximum Eligible Age: | N/A |
| Minimum Eligible Age: | 18 Years |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
| Measure: | Objective response rate according to modified iRANO criteria |
| Time Frame: | Analyses will occur 4 months after accrual of 15 patients for each arm. |
| Safety Issue: | |
| Description: | Overall response rate is the proportion of patients whose best overall response per modified iRANO criteria is complete (CR) or partial (PR) after at least 6 weeks from start of therapy |
| Phase: | Phase 2 |
| Primary Purpose: | Interventional |
| Overall Status: | Terminated |
| Lead Sponsor: | Baptist Health South Florida |
March 17, 2021