Description:
Background:
-Clear-cell renal cell carcinoma (ccRCC) is a kind of kidney cancer. The drug avelumab may
help direct the immune response to the tumors and can prolong the immune response. The drug
IL-15 stimulates certain kinds of white blood cells that have the potential to attack the
cancer.
Objective:
-To test whether IL-15 and avelumab administered together are safe and effective at treating
ccRCC.
Eligibility:
-People ages 18 and older with relapsed, metastatic biopsy proven clear cell renal cell
carcinoma (ccRCC) that has not responded to standard treatments
Design:
Participants will be screened with:
- Medical history
- Physical exam
- Blood, urine, heart, and lung tests
- CT and PET scans and possible MRI: Participants will lie in a machine that takes
pictures of the body. For the CT scan, they may receive an oral contrast agent by mouth
and normally receive IV contrast through a vein to improve the x-ray images.
- Tumor sample to confirm expression of avelumab target: If one is not available,
participants will require a new biopsy that is generally obtained by a needle that is
inserted into the tumor.
Participants will be get the study drugs by vein for up to four 28-day cycles. The IL-15 will
be given through a vein continuously for the first 5 days (120 hours) of each cycle. They
avelumab will be given through a vein over about 1 hour on days 8 and 22 of each cycle.
Participants will be hospitalized for their 1st week of IL-15 cycle and may be able to
receive their subsequent IL-15 treatment as an outpatient depending on their side effects.
Participants who receive the infusion as an outpatient will return to the hospital each day
for a new bag of IL-15. Participants who cannot or do not want to be treated as an outpatient
will be treated in the hospital during their 5-day IL-15 infusions.
- Participants will need a midline venous catheter which is longer than a standard venous
catheter but is still inserted into a peripheral vein in their arm.
- Participants will have repeats of blood tests to monitor the blood counts and chemistry
throughout the study.
- Participants will have follow-up visits 30 days after their last treatment, every 60
days for the first 6 months, every 90 days for 2 years, then every 6 months.
Title
- Brief Title: Avelumab (Bavencio) With IL-15 in Subjects With Clear-Cell Renal Carcinoma
- Official Title: Phase II Trial of Avelumab (Bavencio) With IL-15 in Subjects With Clear-Cell Renal Carcinoma
Clinical Trial IDs
- ORG STUDY ID:
200007
- SECONDARY ID:
20-C-0007
- NCT ID:
NCT04150562
Conditions
- Clear-Cell Renal Carcinoma
Interventions
Drug | Synonyms | Arms |
---|
rhIL-15 | | 1- Experimental Treatment: Safety Run-in |
Avelumab | | 1- Experimental Treatment: Safety Run-in |
Purpose
Background:
-Clear-cell renal cell carcinoma (ccRCC) is a kind of kidney cancer. The drug avelumab may
help direct the immune response to the tumors and can prolong the immune response. The drug
IL-15 stimulates certain kinds of white blood cells that have the potential to attack the
cancer.
Objective:
-To test whether IL-15 and avelumab administered together are safe and effective at treating
ccRCC.
Eligibility:
-People ages 18 and older with relapsed, metastatic biopsy proven clear cell renal cell
carcinoma (ccRCC) that has not responded to standard treatments
Design:
Participants will be screened with:
- Medical history
- Physical exam
- Blood, urine, heart, and lung tests
- CT and PET scans and possible MRI: Participants will lie in a machine that takes
pictures of the body. For the CT scan, they may receive an oral contrast agent by mouth
and normally receive IV contrast through a vein to improve the x-ray images.
- Tumor sample to confirm expression of avelumab target: If one is not available,
participants will require a new biopsy that is generally obtained by a needle that is
inserted into the tumor.
Participants will be get the study drugs by vein for up to four 28-day cycles. The IL-15 will
be given through a vein continuously for the first 5 days (120 hours) of each cycle. They
avelumab will be given through a vein over about 1 hour on days 8 and 22 of each cycle.
Participants will be hospitalized for their 1st week of IL-15 cycle and may be able to
receive their subsequent IL-15 treatment as an outpatient depending on their side effects.
Participants who receive the infusion as an outpatient will return to the hospital each day
for a new bag of IL-15. Participants who cannot or do not want to be treated as an outpatient
will be treated in the hospital during their 5-day IL-15 infusions.
- Participants will need a midline venous catheter which is longer than a standard venous
catheter but is still inserted into a peripheral vein in their arm.
- Participants will have repeats of blood tests to monitor the blood counts and chemistry
throughout the study.
- Participants will have follow-up visits 30 days after their last treatment, every 60
days for the first 6 months, every 90 days for 2 years, then every 6 months.
Detailed Description
Background:
- Clear-cell renal cell carcinoma (ccRCC) is among the 10 most frequent diagnostic cancers
in the United States with more than an estimated 62,000 new cases in 2016. The prognosis
for patients with metastatic disease is poor with survival rates of 8%.
- The immunologic effects of recombinant human Interleukin-15 (rhIL-15), a stimulatory
cytokine that promotes the differentiation and activation of NK cells, monocytes and
longterm CD8+ memory T-cells, has been assessed in several Phase 1 trials in cancer
patients.
- Avelumab is an anti-programmed death ligand-1 (PD-L1) fully human IgG1 antibody that
inhibits PD1/PD-L1 interactions while leaving the PD1/PD-L2 pathway intact and enhances
immune activation against tumor cells. It has received U.S. FDA accelerated approval for
the treatment of patients with metastatic Merkel cell carcinoma (MCC) and urothelial
carcinoma.
- Unlike other approved anti-PD-L1/PD1 antibodies, avelumab induces lysis of tumor cells
via antibody-dependent cell-mediated cytotoxicity (ADCC), indicating an
additionalmechanism of action. However, avelumab has not shown ADCC against normal
immune cell subsets in humans.
- More than 50% of ccRCC is PD-L1+ with higher expression in unfavorable prognostic
tumors. Since the anti-PD-L1 antibody avelumab has shown ADCC activity in vitro, agents
that may enhance ADCC by increasing number and activity of Fc-binding effector cells
-such as rhIL15 - could improve efficacy of avelumab in this disease.
Objectives:
-Determine the efficacy of combined continuous intravenous infusion (CIV) rhIL-15 and
avelumab treatment in patients with anti-PD-1/PD-L1 refractory metastatic clear cell renal
carcinoma (ccRCC) by assessing the overall response rate
Eligibility:
- Age greater than or equal to 18 years of age
- ECOG performance status of less than or equal to 1
- Histologically proven metastatic clear cell renal carcinoma with greater than or equal
to 5% expression of PD-L1 in the tumor area confirmed by IHC
- Patients must have failed or relapsed and have progressive disease after at least 2
prior therapies that include multityrosine kinase inhibitor like axitinib or sunitinib
and an anti-PD1 or PD-L1 immune checkpoint inhibitor therapy like nivolumab which could
have been administered in combination with an anti-CTLA4 agent like ipilimumab
- Adequate organ and marrow function
Design:
- Open-label, single-center, non-randomized Phase II study
- Safety Run-in Cohort with 3-6 patients at dose level 2mcg/kg and 4mcg/kg CIV IL-15
(recommended phase II dose) will ensure safety of recommended phase II dose rhIL-15 with
fixed dose avelumab with Dose Expansion Cohort at 4mcg/kg dose level
- Efficacy of the combination will be assessed in a Simon two-stage phase II design with 9
or 17 patients depending on demonstration of clinical activity in the initial group of 9
patients
- Maximum 4 cycles (28-day cycle) of combination therapy
- To explore both Safety Run-in Cohort and further evaluation in a Dose Expansion
Cohort,the accrual ceiling will be set at 25 patients.
Trial Arms
Name | Type | Description | Interventions |
---|
1- Experimental Treatment: Safety Run-in | Experimental | IL-15 by CIV infusion at escalating doses of 2 and 4 mcg/kg/day on days 1-5 of each 28-day cycle (max 4 cycles) with avelumab by IV infusion at a dose of 800mg on Day 8 and 22 of each cycle | |
2-Experimental Treatment: Doe Expansion | Experimental | IL-15 by CIV infusion at 4 mcg/kg/day on days 1-5 of each 28- day cycle (max 4 cycles) with avelumab by IV infusion at a dose of 800mg on Day 8 and 22 of each cycle | |
Eligibility Criteria
- INCLUSION CRITERIA:
- Patients must have histologically proven metastatic clear cell renal carcinoma with
greater than or equal to 5% expression of PD-L1 on the tumor cells confirmed by IHC in
the NCI Lab of Pathology.Archival tumor sample may be used but if archival tissue is
not available or is not adequate, tissue biopsy will be required.
- Patients must have failed or relapsed and have progressive disease after at least 2
prior therapies that include multityrosine kinase inhibitor (mTKI) like axitinib or
sunitinib and an anti-PD1 or PD-L1 (ICI) therapy like nivolumab which could have been
administered in combination with an anti-CTLA4 agent like ipilimumab. Patients who
received an ICI in combination with a mTKI would be eligible for the trial if they
received another appropriate treatment. Adjuvant or neoadjuvant with either type of
agent would not fulfill this requirement only treatment for metastatic disease will be
considered to satisfy this criterion.
- Disease must be measurable with at least one measurable lesion by Recist v1.1 criteria
that is different from the lesion biopsied.
- Age >=18 years
NOTE: Because no dosing or adverse event data are currently available on the use of rhIL-15
in combination with avelumab in patients <18 years of age, children are excluded from this
study, but may be eligible for future pediatric trials
- ECOG performance status <= 1 (Karnofsky >=80%)
- Adequate organ and marrow function as defined below:
- absolute neutrophil count greater than or equal to 1,500/mcL
- absolute lymphocyte count greater than or equal to 500/mcL
- Hemoglobin greater than or equal to 10 g/dL
- Platelets greater than or equal to 100,000/mcL
- total bilirubin less than or equal to 1.5 X institutional upper limit of normal
(ULN)
- AST(SGOT)/ALT(SGPT) less than or equal to 2.5 X institutional ULN
- Serum creatinine less than or equal to 1.5 X institutional ULN
OR
- Creatinine clearance greater than or equal to 50 mL/min/1.73 m^2 for patients with
creatinine levels >1.5 institutional ULN
- Negative serum or urine pregnancy test at screening for women of childbearing
potential (WOCBP).
NOTE: WOCBP is defined as any female who has experienced menarche and who has not undergone
successful surgical sterilization or who is not postmenopausal. WOCBP must have a negative
pregnancy test (HCG blood or urine) during screening.
- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry, for
the duration of study participation, and 1 month after completion of rhIL-15 and
avelumab administration. Should a woman become pregnant or suspect she is pregnant
while she or her partner is participating in this study, she should inform her
treating physician immediately.
- Ability of subject to understand and the willingness to sign a written informed
consent document.
EXCLUSION CRITERIA:
- Chemotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C).
- Persisting toxicity related to prior therapy of grade > 1, with the exception of the
following: alopecia, sensory neuropathy grade <= 2, or other grade <= 2 not
constituting a safety risk based on investigator's judgement.
- Patients who are receiving any other investigational agents
- Current use of immunosuppressive medication, EXCEPT for the following:
- Intranasal, inhaled, topical steroids, or local steroid injection (e.g.,
intra-articular injection)
- Systemic corticosteroids at physiologic doses <= 10 mg/day of prednisone or
equivalent; or,
- Steroids as premedication for hypersensitivity reactions (e.g., CT scan
premedication).
- Patients with known brain metastases should be excluded from this clinical trial
because of their poor prognosis and because they often develop progressive neurologic
dysfunction that would confound the evaluation of neurologic and other adverse events.
- Patients with previous malignant disease other than the target malignancy within the
last 5 years with the exception of basal or squamous cell carcinoma of the skin or
cervical carcinoma in situ.
- Patients with history of any organ transplantation
- Vaccination within 4 weeks of the first dose of avelumab. Vaccination with a live
vaccine while on trial is prohibited.
NOTE: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and
are allowed; however intranasal influenza vaccines (e.g., Flu-Mist ) are live attenuated
vaccines, and are not allowed.
- Patients with history of allergic reactions attributed to compounds of similar
chemical or biologic composition to rhIL-15 or avelumab.
- Patients with uncontrolled intercurrent illness including, but not limited to, ongoing
or active infection requiring systemic therapy, or psychiatric illness/social
situations that would limit compliance with study requirements.
- Inability or refusal to practice effective contraception during therapy or the
presence of pregnancy or active breastfeeding. Based on its mechanism of action,
avelumab can cause fetal harm when administered to a pregnant woman. Animal studies
have demonstrated that inhibition of the PD-1/PD-L1 pathway can lead to increased risk
of immune-mediated rejection of the developing fetus resulting in fetal death. These
potential risks may also apply to other agents used in this study.
- Patients with active bacterial infections, documented HIV infection or positive
screening serology, PCR evidence for active or chronic hepatitis B or hepatitis C, or
positive screening HBV/HCV serology without documentation of successful curative
treatment
- Patients with active or history of any autoimmune disease, including asthma requiring
chronic inhaled or oral corticosteroids, or with history of asthma requiring
mechanical ventilation; patients with a history of mild asthma that are on or can be
switched to noncorticosteroid bronchodilator regimens are eligible
- Cardiovascular disease: Clinically significant (i.e., active) cardiovascular disease:
cerebral vascular accident/stroke (< 6 months prior to enrollment), myocardial
infarction (< 6 months prior to enrollment), unstable angina, congestive heart failure
(greater than or equal to New York Heart Association Classification Class II), or
serious cardiac arrhythmia requiring medication
- Other severe acute or chronic medical conditions including immune colitis,
inflammatory bowel disease, immune pneumonitis, pulmonary fibrosis or psychiatric
conditions including recent (within the past year) or active suicidal ideation or
behavior; or laboratory abnormalities that may increase the risk associated with study
participation or study treatment administration or may interfere with the
interpretation of study results and, in the judgment of the investigator, would make
the patient inappropriate for entry into this study.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Efficacy of rhIL-15 + avelumab |
Time Frame: | one month after completion of treatment |
Safety Issue: | |
Description: | Overall response rate |
Secondary Outcome Measures
Measure: | Duration of response |
Time Frame: | date clinical response is 1st identified until progression assessed - every 2 months for 6 months, every 3 months for 2 years, every 6 months for 2 years, then annually |
Safety Issue: | |
Description: | The response rate will be determined and reported along with a 95% confidence interval. |
Measure: | Progression-free survival |
Time Frame: | every 2 months for 6 months, every 3 months for 2 years, every 6 months for 2 years, then annually |
Safety Issue: | |
Description: | The response rate will be determined and reported along with a 95% confidence interval. |
Measure: | Overall response rate |
Time Frame: | 4 cycles |
Safety Issue: | |
Description: | The response rate will be determined and reported along with a 95% confidence interval. |
Measure: | safety and tolerability of rhIL-15 + avelumab |
Time Frame: | 4 cycles |
Safety Issue: | |
Description: | rate and severity of AEs will be summarized by grade and type of toxicity |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- Antibody Dependent Cellular Cytotoxicity (ADCC)
- Anti-PD-L1 monoclonal antibody
Last Updated
June 16, 2021