OUTLINE:
Patients receive pembrolizumab IV on day 1. Treatment repeats every 21 for up to 16 cycles in
the absence of disease progression or unacceptable toxicity. Patients also receive umbralisib
orally (PO) daily on days 1-21 days. Cycles repeat every 21 days in the absence of disease
progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 28 days, then up to 1 year.
Inclusion Criteria:
- Relapsed or refractory CHL that has received at least 1 prior lines of therapy
- Measurable fludeoxyglucose F-18 (FDG)-avid disease defined by standard criteria
(Lugano 2014) and a minimum of 1.0 cm in diameter
- Prior treatment with anti-PD1 or anti-PDL1 therapy is allowed.
* Patients who are currently on anti-PD1 or anti-PDL1 therapy who have failed to
achieve a CR after at least 18 weeks of treatment may enroll on study. For these
patients, anti-PD1 or anti-PDL1 therapy may be delayed for screening and to align
pembrolizumab dosing with the expected cycle 1 day 1. Patients with progressive
disease after prior anti-PD1 or anti-PDL1 therapy do not have to be treated for 18
weeks
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
- Ability to swallow and retain oral medication
- Willingness and ability to comply with study and follow-up procedures, and give
written informed consent
- Female subjects of childbearing potential must be surgically sterile, be
post-menopausal (for at least 1 year prior to screening visit), or must have a
negative pregnancy test within 3 days prior to cycle 1 day 1 and agree to use
medically acceptable contraception throughout the study period and for 4 months after
the last dose of either study drug. Men of reproductive potential may not participate
unless they agree to use medically acceptable contraception throughout the study
period and for 4 months after the last dose of either study drug
- Patients must be expected to receive at least 2 cycles of therapy
- Patients should have a life expectancy if untreated of >= 90 days in the opinion of
the investigator
- Patients must have a FDG-positron emission tomography (PET)-computed tomography (CT)
of chest, abdomen, and pelvis within 42 days of enrollment
- Absolute neutrophil count (ANC) > 750
- Platelet count > 40,000
- Total bilirubin =< 1.5 times the upper limit of normal (ULN)
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN (if
known liver involvement then =< 5 x ULN is allowed)
- Calculated creatinine clearance > 30 mL/min (as calculated by the Cockcroft-Gault
formula)
Exclusion Criteria:
- Patients receiving cancer therapy (i.e., chemotherapy, immunotherapy, biologic
therapy, hormonal therapy, surgery and/or tumor embolization, prednisone > 10 mg or
equivalent) or any investigational drug within 21 days of cycle 1 day 1. Patients
receiving radiation therapy within 14 days from cycle 1 day 1. Anti-PD1 or anti-PDL1
therapy in patients with less than a CR after 18 weeks of such therapy is permitted to
continue on schedule
- Discontinuation from prior anti-PD1 or anti-PDL1 therapy due to immune-related adverse
event or any other treatment-related adverse event
- Autologous transplantation within 100 days
- Prior allogeneic transplant within 12 months of initiation on study
- Active graft versus host disease (GVHD) within 90 days prior to cycle 1 day 1
- Evidence of active central nervous system lymphoma
- Pregnant or nursing women
- Evidence of chronic active hepatitis B or chronic active hepatitis C infection
(hepatitis C virus [HCV]), active cytomegalovirus (CMV), or known history of human
immunodeficiency virus (HIV). If hepatitis B core (HBc) antibody, HCV antibody or CMV
immunoglobulin (Ig)M is positive, the patient should be correspondingly evaluated for
the presence of HBV, HCV or CMV by deoxyribonucleic acid (DNA) (polymerase chain
reaction [PCR]) to determine presence or absence of active infection. If HBc antibody
is positive, the subject must be evaluated for the presence of hepatitis B virus (HBV)
DNA by polymerase chain reaction (PCR). If HCV antibody is positive, the subject must
be evaluated for the presence of HCV ribonucleic acid (RNA) by PCR. Subjects with
positive HBc antibody and negative HBV DNA by PCR are eligible. Subjects with positive
HCV antibody and negative HCV RNA by PCR are eligible. Subjects who are
cytomegalovirus (CMV) IgG or CMV IgM positive but who are CMV DNA negative by PCR are
eligible
- Prior exposure to idelalisib (CAL-101), duvelisib (IPI-145), or any drug that
specifically inhibits phosphoinositide-3-kinase (PI3K)
- Evidence of ongoing active systemic bacterial, fungal or viral infection
- Any severe and/or uncontrolled medical conditions or other conditions that could
affect their participation in the study such as:
- Symptomatic, or history of documented congestive heart failure (New York [NY]
Heart Association functional classification III-IV)
- Significant cardiovascular disease such as uncontrolled or symptomatic
arrhythmias, congestive heart failure, or myocardial infarction within 6 months
of randomization
- Concomitant use of medication known to cause QT prolongation or torsades de
pointes. Poorly controlled or clinically significant atherosclerotic vascular
disease including cerebrovascular accident (CVA), transient ischemic attack
(TIA), angioplasty, cardiac/vascular stenting within 3 months of randomization
- Patients with other prior malignancies except for adequately treated basal cell
carcinoma, squamous cell carcinoma of the skin, breast or cervical cancer in situ, or
other cancer from which the patient has been disease-free for 5 years or greater,
unless approved by the protocol principal investigator
- Patients with an active autoimmune disorder (with the exception of autoimmune
hemolytic anemia, idiopathic thrombocytopenic purpura [ITP] or vitiligo)
- History of non-infectious pneumonitis related to prior line of therapy
