Clinical Trials /

Nivolumab, BMS-986205, and Radiation Therapy With or Without Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma

NCT04047706

Description:

This phase I trial studies the side effects of nivolumab, BMS-986205, and standard radiation therapy with or without temozolomide in treating patients with new diagnosed glioblastoma. Immunotherapy with nivolumab, may induce changes in body?s immune system and may interfere with the ability of tumor cells to grow and spread. BMS-986205 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving nivolumab and BMS-986205 may work better compared to radiation therapy and temozolomide alone in treating patients with newly diagnosed glioblastoma.

Related Conditions:
  • Glioblastoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Nivolumab, BMS-986205, and Radiation Therapy With or Without Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma
  • Official Title: Combination of Checkpoint Inhibition and IDO1 Inhibition Together With Standard Radiotherapy or Chemoradiotherapy in Newly Diagnosed Glioblastoma. A Phase 1 Clinical and Translational Trial

Clinical Trial IDs

  • ORG STUDY ID: NU 18C02
  • SECONDARY ID: NCI-2019-04922
  • SECONDARY ID: STU00209583
  • SECONDARY ID: NU 18C02
  • SECONDARY ID: P30CA060553
  • NCT ID: NCT04047706

Conditions

  • Glioblastoma

Interventions

DrugSynonymsArms
IDO1 Inhibitor BMS-986205BMS 986205, BMS-986205, BMS986205, IDO-1 Inhibitor BMS-986205, Indoleamine-pyrrole 2,3-Dioxygenase Inhibitor BMS-986205, ONO-7701Cohort I (radiation, temozolomide, BMS-986205, nivolumab)
NivolumabBMS-936558, MDX-1106, NIVO, ONO-4538, OpdivoCohort I (radiation, temozolomide, BMS-986205, nivolumab)
TemozolomideCCRG-81045, Imidazo[5,1-d]-1,2,3,5-tetrazine-8-carboxamide, 3, 4-dihydro-3-methyl-4-oxo-, M & B 39831, M and B 39831, Methazolastone, RP-46161, SCH 52365, Temcad, Temodal, Temodar, Temomedac, TMZCohort I (radiation, temozolomide, BMS-986205, nivolumab)

Purpose

This phase I trial studies the side effects of nivolumab, BMS-986205, and standard radiation therapy with or without temozolomide in treating patients with new diagnosed glioblastoma. Immunotherapy with nivolumab, may induce changes in body?s immune system and may interfere with the ability of tumor cells to grow and spread. BMS-986205 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving nivolumab and BMS-986205 may work better compared to radiation therapy and temozolomide alone in treating patients with newly diagnosed glioblastoma.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the safety and tolerability of nivolumab in combination with IDO1 inhibitor
      BMS-986205 (BMS986205) and radiation in newly diagnosed MGMT promoter unmethylated
      glioblastoma and MGMT promoter methylated glioblastoma.

      SECONDARY OBJECTIVES:

      I. Descriptive survival analyses (overall survival [OS] and OS at 12 months [OS12]) in
      patients with MGMT unmethylated and MGMT methylated promoter.

      II. Progression free survival (PFS) and PFS at 6 months (PFS6) in patients with MGMT
      unmethylated and MGMT methylated promoter.

      III. Radiographic response rates (RR) as determined by Response Assessment in Neuro-Oncology
      (RANO) and immunotherapy (i)RANO criteria in patients with MGMT unmethylated and MGMT
      methylated promoter.

      EXPLORATORY OBJECTIVES:

      I. Determine the T-cell changes that occur in glioblastoma (GBM) treated with nivolumab in
      combination with BMS-986205 and radiation.

      II. Correlate T-cell changes and IDO1 expression with patient outcomes.

      OUTLINE: This is a dose-escalation study of IDO1 inhibitor BMS-986205. Patients are assigned
      to 1 of 2 cohorts.

      COHORT I:

      RADIATION THERAPY: Patients with MGMT methylated promoter undergo radiation therapy 5 days
      per week (Monday-Friday) for up to 6 weeks. Patients also receive temozolomide orally (PO)
      once daily (QD), IDO1 inhibitor BMS-986205 PO QD, and nivolumab intravenously (IV) over 30
      minutes every 2 weeks for up to 6 weeks in the absence of disease progression, unacceptable
      toxicity, withdrawal of consent, the study ends, or until Q4W dosing begins.

      MAINTENANCE THERAPY: Patients receive IDO1 inhibitor BMS-986205 PO QD on days 1-28 and
      nivolumab IV over 30 minutes on days 1 and 15 of cycles 1-5 and on day 1 of subsequent
      cycles. Within 4 weeks of radiation therapy completion, patients also receive temozolomide PO
      QD on days 1-5 of cycles 2-6. Cycles repeats every 28 days for up to 2 years in the absence
      of disease progression or unacceptable toxicity.

      COHORT II:

      RADIATION THERAPY: Patients with MGMT unmethylated promoter undergo radiation therapy 5 days
      per week (Monday-Friday) for up to 6 weeks. Patients also receive IDO1 inhibitor BMS-986205
      PO QD and nivolumab IV over 30 minutes every 2 weeks for up to 6 weeks in the absence of
      disease progression or unacceptable toxicity.

      MAINTENANCE THERAPY: Patients receive IDO1 inhibitor BMS-986205 PO QD on days 1-28 and
      nivolumab IV over 30 minutes on days 1 and 15 of cycles 1-5 and on day 1 of subsequent
      cycles. Cycles repeats every 28 days for up to 2 years in the absence of disease progression,
      unacceptable toxicity, withdrawal of consent, the study ends, or until Q4W dosing begins.

      After completion of study treatment, patients are followed up at 30 days and then every 3
      months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Cohort I (radiation, temozolomide, BMS-986205, nivolumab)ExperimentalRADIATION THERAPY: Patients with MGMT methylated promoter undergo radiation therapy 5 days per week (Monday-Friday) for up to 6 weeks. Patients also receive temozolomide PO QD, IDO1 inhibitor BMS-986205 PO QD, and nivolumab IV over 30 minutes every 2 weeks for up to 6 weeks in the absence of disease progression, unacceptable toxicity, withdrawal of consent, the study ends, or until Q4W dosing begins. MAINTENANCE THERAPY: Patients receive IDO1 inhibitor BMS-986205 PO QD on days 1-28 and nivolumab IV over 30 minutes on days 1 and 15 of cycles 1-5 and on day 1 of subsequent cycles. Within 4 weeks of radiation therapy completion, patients also receive temozolomide PO QD on days 1-5 of cycles 2-6. Cycles repeats every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
  • IDO1 Inhibitor BMS-986205
  • Nivolumab
  • Temozolomide
Cohort II (radiation, BMS-986205, nivolumab)ExperimentalRADIATION THERAPY: Patients with MGMT unmethylated promoter undergo radiation therapy 5 days per week (Monday-Friday) for up to 6 weeks. Patients also receive IDO1 inhibitor BMS-986205 PO QD and nivolumab IV over 30 minutes every 2 weeks for up to 6 weeks in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive IDO1 inhibitor BMS-986205 PO QD on days 1-28 and nivolumab IV over 30 minutes on days 1 and 15 of cycles 1-5 and on day 1 of subsequent cycles. Cycles repeats every 28 days for up to 2 years in the absence of disease progression, unacceptable toxicity, withdrawal of consent, the study ends, or until Q4W dosing begins.
  • IDO1 Inhibitor BMS-986205
  • Nivolumab

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must have a newly diagnosed histologically confirmed diagnosis of any grade
             IV glioma with documentation of MGMT methylation status. The histological diagnosis
             can be obtained either from a brain biopsy or from a neurosurgical resection of the
             tumor

               -  Note: Study enrollment is to be within 5 weeks from diagnostic surgery or biopsy

               -  Note: Pyrosequencing to determine MGMT methylation status will be performed at
                  Northwestern Memorial Hospital as standard of care (SOC)

          -  Tumor tissue specimens from the GBM surgery or biopsy for central pathology review and
             exploratory analysis of immunocorrelative studies, if available (no minimum
             requirement)

          -  For subjects who had undergone tumor resection, preoperative gadolinium (Gd)-magnetic
             resonance imaging (MRI) and immediate postoperative Gd-MRI performed within < 72 hours
             after surgery or biopsy is recommended. If computed tomography (CT) scans were
             performed perioperatively, an MRI should be performed before initiation of study
             treatment

          -  Patients must exhibit a Karnofsky performance score of >= 70%

          -  Stable or decreasing dose of steroids for >= 7 days prior to registration

               -  Note: Patients must be off of all steroids at the time of initiation of study
                  treatment (day 1 [D#1])

          -  Patients must have adequate organ and bone marrow function at registration, as defined
             below:

          -  Absolute neutrophil count >= 1500/mm^3

          -  Platelets >= 100,000/mm^3

          -  Creatinine or creatinine clearance =<1.5 times upper limit of normal or >= 60 mL/min

          -  Hemoglobin >=10 mg/dL

               -  Blood transfusion allowed

          -  Total bilirubin =< 1.5 times upper limit of normal

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
             [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SPGT]) =<
             2.5 times above upper limit of normal

          -  Alkaline phosphatase =< 2.5 times above upper limit of normal

          -  Females of child-bearing potential (FOCBP) and males must agree to use adequate
             contraception prior to study entry, for the duration of study participation, and for 5
             months following completion of therapy. Should a female patient become pregnant or
             suspect she is pregnant while participating in this study, she should inform her
             treating physician immediately. Due to the potential interaction with study drug(s),
             contraceptions that use hormones are not considered to be highly effective for FOCBP
             participants in this study.

               -  NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a
                  tubal ligation, or remaining celibate by choice) who meets the following
                  criteria:

                    -  Has not undergone a hysterectomy or bilateral oophorectomy. Has had menses
                       at any time in the preceding 12 consecutive months (and therefore has not
                       been naturally postmenopausal for > 12 months)

          -  Males who are sexually active with FOCBP must agree to follow instructions for
             method(s) of contraception for the duration of treatment with study treatment plus 7
             months after the last dose of the study treatment (i.e., 90 days [duration of sperm
             turnover] plus the time required for nivolumab to undergo approximately 5 half-lives).
             In addition, male participants must be willing to refrain from sperm donation during
             this time. Male participants with partners who are FOCBP are required to use a condom
             for study duration and until end of relevant systemic exposure defined as 7 months
             after the end of study treatment. This criteria applies to azoospermic males as well

          -  FOCBP must have a negative serum pregnancy test within 14 days of registration on
             study and within 24 hours of beginning study treatment

          -  Clinically normal cardiac function without history of ischemic heart disease in the
             past 6 months and normal 12 lead electrocardiogram (ECG)

          -  Patients must have recovered from the effects of surgery, postoperative infection, and
             other complications before study registration

          -  Patients must have the ability to understand and the willingness to sign a written
             informed consent prior to registration on study

        Exclusion Criteria:

          -  Patients who have had chemotherapy within 2 years prior to entering the study are not
             eligible

          -  Patients who have received brain radiation therapy (RT) are not eligible

          -  Patients may not be receiving any other investigational agents. Patients may not have
             received an investigational agent within the past 30 days prior to the initiation of
             study treatment

          -  Patients with a condition requiring systemic treatment with either corticosteroids or
             other immunosuppressive medications are not eligible

               -  Note: Inhaled or topical steroids, and adrenal replacement steroid doses >= 10 mg
                  daily prednisone equivalent, are permitted in the absence of active autoimmune
                  disease

          -  Patients with an active, known or suspected autoimmune disease are not eligible.
             Patients with type I diabetes mellitus, hypothyroidism only requiring hormone
             replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring
             systemic treatment, or conditions not expected to recur in the absence of an external
             trigger are permitted to enroll

          -  Participants with a personal or family (i.e., in a first-degree relative) history or
             presence of cytochrome b5 reductase deficiency (previously called methemoglobin
             reductase deficiency) or other diseases that puts them at risk of methemoglobinemia
             are not eligible. All participants will be screened for methemoglobin levels prior to
             registration

          -  Participants with a history of G6PD deficiency or other congenital or autoimmune
             hemolytic disorders are not eligible. All participants will be screened for G6PD
             levels prior to registration

          -  Participants with active interstitial lung disease (ILD)/pneumonitis or with a history
             of ILD/pneumonitis requiring steroids are not eligible

          -  Patients with a history of recent prior malignancy are not eligible. Subjects with
             curatively treated cervical carcinoma in situ or non-melanoma basal cell carcinoma of
             the skin, or subjects who have been free of other malignancies for >= 2 years are
             eligible for this study

          -  Patients who have a history of allergic reactions attributed to compounds of similar
             chemical or biologic composition to nivolumab, temozolomide or BMS-986205 are not
             eligible

          -  Patients who have had prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2,
             anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell
             co-stimulation or checkpoint pathways are not eligible

          -  Patients who have had prior treatment with BMS-986205 or any other IDO1 inhibitors are
             not eligible

          -  Patients who have received treatment with botanical preparations (e.g., herbal
             supplements or traditional Chinese medicines) intended for general health support or
             to treat the disease under study within 14 days prior to registration are not eligible

          -  Patients who have an uncontrolled intercurrent illness including, but not limited to
             any of the following, are not eligible:

               -  Hypertension that is not controlled on medication

               -  Ongoing or active infection requiring systemic treatment

               -  Symptomatic congestive heart failure

               -  Unstable angina pectoris

               -  Cardiac arrhythmia

               -  Psychiatric illness/social situations that would limit compliance with study
                  requirements

               -  Any other illness or condition that the treating investigator feels would
                  interfere with study compliance or would compromise the patient?s safety or study
                  endpoints

          -  Female patients who are pregnant or nursing are not eligible

          -  Patients who have quantitative or qualitative G6PD assay results suggesting underlying
             G6PD deficiency are not eligible

          -  Patients who have blood methemoglobin > upper limit of normal (ULN), assessed in an
             arterial or venous blood sample or by co-oximetry are not eligible

          -  Patients with a concurrent illness, including severe infection, which may jeopardize
             the ability of the subject to receive the procedures outlined in this protocol with
             reasonable safety are not eligible. Concomitant use of strong inhibitors of CYP3A4/1A2
             within 1 week or 5 half-lives (whichever is longer) or strong inducers of CYP3A4/1A2
             within 2 weeks or 5 halflives (whichever is longer) is not permitted

          -  Patients with a placement of Gliadel wafer at surgery are not eligible

          -  Patients receiving Optune therapy are not eligible

          -  Patients who are unable to undergo Gd-MRI are not eligible

          -  Patients with current known alcohol dependence or drug abuse are not eligible

          -  Patients with a history or presence of hypersensitivity or idiosyncratic reaction to
             methylene blue are not eligible

          -  Patients with a prior history of serotonin syndrome are not eligible

          -  Known history of positive test for human immunodeficiency virus (HIV) or known
             acquired immunodeficiency syndrome (AIDS).

               -  Note: Testing for HIV must be performed at sites where mandated locally

          -  Patients who have any positive test result for hepatitis B virus or hepatitis C virus
             indicating presence of virus, e.g., hepatitis B surface antigen (HBsAg, Australia
             antigen) positive, or hepatitis C antibody (anti-HCV) positive (except if hepatitis c
             virus [HCV] ribonucleic acid [RNA] negative) are not eligible

          -  Patients with the presence of any familial, sociological or geographical condition
             potentially hampering compliance with the study protocol and follow-up schedule are
             not eligible; those conditions should be assessed with the patient before registration
             in the trial

          -  Patients with major medical illnesses or psychiatric impairments that in the
             investigator's opinion will prevent administration or completion of protocol therapy
             are not eligible
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of adverse events (AEs)
Time Frame:Up to 30 days after last dose
Safety Issue:
Description:Drug safety and tolerability will be evaluated by descriptively summarizing AEs, laboratory assessments, vital signs, and electrocardiogram assessments using tables of frequencies and counts for categorical variables and means (sds) or medians (ranges, interquartile ranges) for continuous variables.

Secondary Outcome Measures

Measure:Overall survival
Time Frame:Up to 1 year
Safety Issue:
Description:The survival curve will be plotted using the Kaplan-Meier method. Median survival time and the 95% confidence interval will be presented for each study group and 1-year overall survival will be estimated. The 95% confidence intervals will be obtained by Greenwood?s formula.
Measure:Median survival
Time Frame:Up to 1 year
Safety Issue:
Description:The survival curve will be plotted using the Kaplan-Meier method. Median survival time and the 95% confidence interval will be presented for each study group and 1-year overall survival will be estimated. The 95% confidence intervals will be obtained by Greenwood?s formula.
Measure:Progression free survival at 6 months
Time Frame:Up to 6 months
Safety Issue:
Description:The Kaplan Meier curve will be plotted and median time to disease progression and the 95% confidence interval will be calculated. 6-month progression free survival will also be estimated. Since tumor assessment will only be performed periodically (every 8 weeks), the Kaplan-Meier estimate (estimated probability that a subject is progression-free at a specific time) and its 95% confidence interval will be provided at the end of each 8-week period.
Measure:Median time to disease progression
Time Frame:Up to 1 year
Safety Issue:
Description:The Kaplan Meier curve will be plotted and median time to disease progression and the 95% confidence interval will be calculated. 6-month progression free survival will also be estimated. Since tumor assessment will only be performed periodically (every 8 weeks), the Kaplan-Meier estimate (estimated probability that a subject is progression-free at a specific time) and its 95% confidence interval will be provided at the end of each 8-week period.
Measure:Radiographic response rates (RR)
Time Frame:Up to 3 years
Safety Issue:
Description:Response rate is the percentage of subjects who achieve partial response (PR) or complete response (CR) according to the immunotherapy Response Assessment in Neuro-Oncology (iRANO) criteria. Radiographic RR will be determined by iRANO criteria. The response rate will be calculated as the percentage of responders, and similarly, the 95% confidence interval will be calculated using the exact binomial method, if data allows.
Measure:Response rate
Time Frame:Up to 3 years
Safety Issue:
Description:Defined as percentage of subjects who achieve PR or CR according to the iRANO criteria. The response rate will be calculated as the percentage of responders, and similarly, the 95% confidence interval will be calculated using the exact binomial method, if data allows.
Measure:Median duration of response
Time Frame:Up to 1 year
Safety Issue:
Description:Tumor response will be reported as CR, PR, stable disease (SD), PD, or unknown according to the iRANO criteria. The response rate will be calculated as the percentage of responders, and similarly, the 95% confidence interval will be calculated using the exact binomial method, if data allows.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Northwestern University

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