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.
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
Drug | Synonyms | Arms |
---|
Nivolumab (.25 mg/kg) | OPDIVO | Nivolumab (0.25 mg/kg) and Tocilizumab |
Tocilizumab | ACTEMRA | Nivolumab (0.25 mg/kg) and Tocilizumab |
Nivolumab (.5 mg/kg) | OPDIVO | Nivolumab (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
Name | Type | Description | Interventions |
---|
Nivolumab (0.25 mg/kg) and Tocilizumab | Experimental | Participant 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 Tocilizumab | Experimental | Participant 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