Clinical Trials /

Nivolumab and Tocilizumab for Relapsed Hematological Malignancy Post-allogeneic Transplant

NCT03588936

Description:

This is a phase 1, interventional single arm, open label, treatment study designed to evaluate the safety combination programmed cell death protein 1 (PD-1) and interleukin 6 (IL-6) inhibition in participants with relapsed disease post-allogeneic transplant.

Related Conditions:
  • Acute Leukemia
  • Chronic Leukemia
  • Lymphoma
  • Myelodysplastic Syndromes
  • Myelodysplastic/Myeloproliferative Neoplasm
  • Myeloproliferative Neoplasm
  • T-Cell and NK-Cell Neoplasm
Recruiting Status:

Terminated

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Nivolumab and Tocilizumab for Relapsed Hematological Malignancy Post-allogeneic Transplant
  • Official Title: Phase 1 Study of Nivolumab in Combination With Tocilizumab for Treatment of Patients With Relapsed Hematological Malignancies Post-allogeneic Transplant

Clinical Trial IDs

  • ORG STUDY ID: PRO32525
  • NCT ID: NCT03588936

Conditions

  • Acute Leukemia
  • Chronic Leukemia
  • Lymphoma
  • Myelodysplastic Syndromes

Interventions

DrugSynonymsArms
Nivolumab (.25 mg/kg)OPDIVONivolumab (0.25 mg/kg) and Tocilizumab
TocilizumabACTEMRANivolumab (0.25 mg/kg) and Tocilizumab
Nivolumab (.5 mg/kg)OPDIVONivolumab (0.5 mg/kg) and Tocilizumab

Purpose

This is a phase 1, interventional single arm, open label, treatment study designed to evaluate the safety combination programmed cell death protein 1 (PD-1) and interleukin 6 (IL-6) inhibition in participants with relapsed disease post-allogeneic transplant.

Detailed Description

      Study disease: Hematologic malignancies including, but not exclusive to,acute/chronic
      leukemia, lymphoma, and myelodysplastic syndrome that has relapsed after allogeneic
      transplant.

      Study Rationale: Phase 1 Safety/Dose Finding Study: To determine the safety and maximum
      tolerated dose of Nivolumab in combination with Tocilizumab.

      Study Agent Description:

      Tocilizumab is a monoclonal antibody and immunosuppressant; specifically, tocilizumab is an
      IL-6 receptor antagonist.

      Nivolumab is a human immunoglobulin G4 (IgG4) monoclonal antibody that binds to the PD-1
      receptor of T cells blocking its interaction with PD-L1 and PD-L2, thereby enhancing T-cell
      proliferation and allowing the immune system to attack the tumor.

      Number of Subjects: A maximum of 12 participants will be enrolled on this Phase 1 study.

      Duration of Follow-up: Participants will be followed for up to one year post-treatment for
      survival and response.

      Study Design: This is a 3 + 3 design. In a "3 + 3 design," three participants are initially
      enrolled into a given dose cohort. If there is no dose limiting toxicity (DLT) observed in
      any of these subjects, the trial proceeds to enroll additional subjects into the next higher
      dose cohort. If one subject develops a DLT at a specific dose, an additional three subjects
      are enrolled into that same dose cohort. Development of DLTs in more than one of six subjects
      in a specific dose cohort suggests that the maximum tolerated dose (MTD) has been exceeded,
      and further dose escalation is not pursued.
    

Trial Arms

NameTypeDescriptionInterventions
Nivolumab (0.25 mg/kg) and TocilizumabExperimentalParticipant will receive tocilizumab 8 mg/kg IV (max dose 800 mg) on Day 0. On Day 1 participants will receive nivolumab IV (0.25 mg/kg based on dose escalation design). Nivolumab will be given every ~2 weeks for up to 4 doses and a second dose of Tocilizumab will be given on ~Day 29 on the same day as Dose # 3 of Nivolumab.
  • Nivolumab (.25 mg/kg)
  • Tocilizumab
Nivolumab (0.5 mg/kg) and TocilizumabExperimentalParticipant will receive tocilizumab 8 mg/kg IV (max dose 800 mg) on Day 0. On Day 1 participants will receive nivolumab IV (0.5 mg/kg based on dose escalation design). Nivolumab will be given every ~2 weeks for up to 4 doses and a second dose of Tocilizumab will be given on ~Day 29 on the same day as Dose # 3 of Nivolumab.
  • Tocilizumab
  • Nivolumab (.5 mg/kg)

Eligibility Criteria

        Inclusion Criteria

          1. Age≥18 years with hematological malignancies who have undergone allogeneic transplant
             for hematological malignancy and are ≥180 days post-transplant.

          2. Relapsed disease post-allogeneic transplant defined as follows i. Acute or Chronic
             Leukemia or myelodysplastic or myeloproliferative disorders or natural killer (NK)
             cell neoplasms: Bone marrow (BM) with ≥5% disease involvement or peripheral blood
             evidence of overt relapse ii. Lymphoma: BM evidence of relapsed/persistent disease or
             PET/CT or CT evidence of persistent/progressive lymphadenopathy consistent with active
             lymphoma. Active disease defined as nodal lesions ≥ 20 mm in the long axis or
             extranodal lesions≥10 mm in long and short axis or bone marrow involvement that is
             biopsy proven

          3. Karnofsky performance status ≥70 (See Appendix A for details)

          4. Creatinine Clearance≥60 ml/min

          5. Adequate hepatic function, defined as aspartate aminotransferase (AST) and alanine
             aminotransferase (ALT) ≤3 x upper limit of normal (ULN). Serum bilirubin and alkaline
             phosphatase ≤3x x ULN, or considered not clinically significant (e.g. Gilbert's or
             indirect hyperbilirubinemia) or felt to be due to underlying disease.

          6. Without evidence of active acute or chronic graft versus host disease (GVHD)

          7. Off all immunosuppression and corticosteroids (other than replacement dose steroids
             defined as equivalent to a maximum of 10 mg Prednisone daily) for ≥28 days from first
             treatment.

          8. Off all disease targeted treatments for ≥10 days to first treatment day

          9. Able to provide written informed consent

         10. Women of child-bearing potential and men must agree to use adequate contraception for
             the duration of study participation and for 120 days after the last treatment with
             nivolumab.

         11. No FDA approved, more appropriate therapies available for disease control as
             determined by the treating physician

        Exclusion Criteria

          1. Positive beta-human chorionic gonadotropin (HCG) in female of child-bearing potential

          2. Cluster of differentiation 3 (CD3) donor chimerism <5% within 4 weeks of starting
             study treatment

          3. Prior administration of donor lymphocyte infusion post-allogeneic transplant within
             the last 6 months of study treatment

          4. History of or active autoimmune disease, or other syndrome that requires systemic
             steroids.

          5. History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to nivolumab.

          6. Uncontrolled or active infections on treatment

          7. Confirmed active human immunodeficiency virus (HIV), Hepatitis B or C infection.

          8. Presence of ≥grade 3 non-hematologic toxicities as per CTCAE version 5 from any
             previous treatment unless it is felt to be due to underlying disease.

          9. Concurrent use of investigational therapeutic agents or enrollment on another
             therapeutic clinical trial at any institution.

             a. Minimum of 4 weeks from last dose of investigational agent

         10. Prior exposure to PD-1 or CTLA4 antibodies in the post-allogeneic transplant setting.
             Participants who received such agents pre-allogeneic transplant will NOT be excluded.

         11. Prior exposure to daratumumab in the post-allogeneic transplant setting within two
             months of start date of treatment with this investigational protocol. Participants who
             received this agent pre-allogeneic transplant will NOT be excluded

         12. Concurrent therapies targeted at disease relapse. However, previous treatments for
             relapsed disease are allowed.

         13. Concurrent active malignancy (exceptions: treated solid malignancy in >2 years'
             remission, treated basal or squamous cell carcinomas of the skin)

         14. History of Crohn's disease or ulcerative colitis

         15. History of demyelinating disorder

         16. Prior intolerance or allergy to tocilizumab
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum-tolerated Dose
Time Frame:Up to 4 weeks after last dose of study treatment (approximately 3 months)
Safety Issue:
Description:Determine the safety and the maximum tolerated dose among two candidate doses of nivolumab in combination with tocilizumab for treatment of relapsed hematological malignancy post-allogeneic transplant. Maximum-tolerated dose is based on the determination of dose-limiting toxicities.

Secondary Outcome Measures

Measure:Response Rates Based on Imaging
Time Frame:End of study treatment (approximately 2 months)
Safety Issue:
Description:The number of subjects with stable disease as evidenced by imaging (Diagnostic positron emission tomography (PET)-CT scans or CT of the neck, chest, abdomen, and pelvis).
Measure:Response Rates Based on Pathologic Response
Time Frame:End of study treatment (approximately 2 months)
Safety Issue:
Description:The number of subjects with bone marrow response (achievement of complete response; <5% blasts; stable disease; progressive disease).
Measure:Overall Survival
Time Frame:Up to 1 year from beginning of treatment
Safety Issue:
Description:The number of participants alive.
Measure:Progression-Free Survival
Time Frame:Up to 1 year from beginning of treatment
Safety Issue:
Description:Determine the number of subjects alive and in remission after treatment.
Measure:Duration of response in responding participants
Time Frame:Up to 1 year from the beginning of treatment
Safety Issue:
Description:Number of subjects with complete response or stable disease.
Measure:Dose-limiting toxicities
Time Frame:Up to 4 weeks after last dose of study treatment (approximately 3 months)
Safety Issue:
Description:The number of subjects with dose-limiting toxicities. This will be measured by the number of adverse events as defined by the NCI CTCAE version 4.03 non-hematologic ≥ grade 3-5 signs/symptoms or by the development of steroid refractory grade 2-4 graft-versus-host disease or severe chronic graft-versus-host disease.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Terminated
Lead Sponsor:Medical College of Wisconsin

Last Updated

July 22, 2020