This phase Ib/II trial studies the best dose and side effects of siltuximab and how well it
works in combination with spartalizumab in treating patients with pancreatic cancer that has
spread to other places in the body. Monoclonal antibodies, such as siltuximab and
spartalizumab, interfere with the ability of tumors cells to grow and spread.
I. Determine the recommended phase II dose for the combination of spartalizumab and
I. Define the toxicity profile of the combination of the recommended phase II dose of
spartalizumab and siltuximab.
II. Evaluate the activity of the combination of spartalizumab and siltuximab in previously
treated patients with pancreatic cancer.
I. Evaluate the effect of the combination on the immune profile in the serum and in tumor
OUTLINE: This is a dose-escalation study of siltuximab.
Participants receive spartalizumab intravenously (IV) over 30 minutes on day 1 and siltuximab
IV over 1 hour on day 1. Cycles repeat every 3 weeks in the absence of disease progression or
After completion of study treatment, participants are followed up at 30, 60, 90, 120, and 150
days, then every 12 weeks thereafter.
- Cytological or histologic diagnosis and metastatic pancreatic adenocarcinoma disease
that has failed at least one standard regimen such as gemcitabine nab-paclitaxel or
folinic acid, fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX).
- Patient must meet the following laboratory values at the screening visit:
- Absolute neutrophil count ≥ 1.5 x 109/L
- Platelets ≥ 75 x 109/L
- Hemoglobin (Hgb) ≥ 9 g/dL
- Serum creatinine < 1.5 mg/dL OR Creatinine Clearance ≥ 45 mL/min using
- Total bilirubin ≤ 1.5 x ULN
- Aspartate transaminase (AST) ≤ 2.5 x ULN, except for patients with liver
metastasis, who may only be included if AST ≤ 5.0 x upper limit of normal (ULN)
- Alanine transaminase (ALT) ≤ 2.5 x ULN, except for patients with liver
metastasis, who may only be included if ALT ≤ 5.0 x ULN
- Presence of measurable disease by RECIST criteria
- Patient has an Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
- Written informed consent must be obtained prior to any screening procedures.
- Normal ECG defined as the following:
- Resting heart rate 50-90 bpm
- QT corrected for HR using Fridericia's method (QTcF) at screening < 450 ms (male
patients), < 460 ms (female patients)
- Before enrollment, a woman must be either:
- Not of childbearing potential: postmenopausal (> 45 years of age with amenorrhea
for at least 12 months or any age with amenorrhea for at least 6 months and a
serum follicle stimulating hormone (FSH) level > 40 IU/mL); permanently
sterilized (eg, tubal occlusion, hysterectomy, bilateral salpingectomy); or
otherwise be incapable of pregnancy
- Of childbearing potential and practicing (during the study and for 150 days after
receiving the last dose of study agent) a highly effective method of birth
control consistent with local regulations regarding the use of birth control
methods for subjects participating in clinical studies: eg, established use of
oral, injected or implanted hormonal methods of contraception; placement of an
intrauterine device (IUD) or intrauterine system (IUS); barrier methods: condom
with spermicidal foam/gel/film/cream/suppository or occlusive cap (diaphragm or
cervical/vault caps) with spermicidal foam/gel/film/cream/suppository; male
partner sterilization (the vasectomized partner should be the sole partner for
that subject); true abstinence (when this is in line with the preferred and usual
lifestyle of the subject)
- Note: If the childbearing potential changes after start of the study (eg, woman
who is not heterosexually active becomes active) a woman must begin a highly
effective method of birth control, as described above.
- A woman of childbearing potential must have a negative serum (β-human chorionic
gonadotropin [β-hCG]) or urine pregnancy test at screening.
- During the study and for 150 days after receiving the last dose of study agent, a
woman must agree not to donate eggs (ova, oocytes) for the purposes of assisted
- A man who is sexually active with a woman of childbearing potential and has not had a
vasectomy must agree to use a barrier method of birth control eg, either condom with
spermicidal foam/gel/film/cream/suppository or partner with occlusive cap (diaphragm
or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository, and all men
must also not donate sperm during the study and for 3 months after receiving the last
dose of study drug.
- Sign an informed consent document indicating that they understand the purpose of and
procedures required for the study, are willing to participate in the study, and are
willing and able to adhere to the prohibitions and restrictions specified in this
protocol. Informed consent must be obtained before performing any study specific
- Prior exposure to agents targeting programmed cell death protein-1 (PD-1), PD-L1, IL-6
or the IL-6 receptor. Prior chemotherapy is allowed as long as adequate washout period
of ≥ 4 weeks.
- Any untreated central nervous system (CNS) lesion. However, patients are eligible if:
a) all known CNS lesions have been treated with radiotherapy or surgery and b) patient
remained without evidence of CNS disease progression ≥ 4 weeks after treatment and c)
patients must be off corticosteroid therapy for ≥ 2 weeks.
- Use of any live vaccines against infectious diseases within 4 weeks of initiation of
- Systemic chronic steroid therapy (≥ 10mg/day prednisone or equivalent) or any
immunosuppressive therapy 7 days prior to planned date of first dose of study
treatment. Note: Topical, inhaled, nasal and ophthalmic steroids are allowed.
- Active, known or suspected autoimmune disease or a documented history of autoimmune
disease Note: Patients with vitiligo, controlled type I diabetes mellitus on stable
insulin dose, residual autoimmune-related hypothyroidism only requiring hormone
replacement or psoriasis not requiring systemic treatment are permitted).
- Allogenic bone marrow or solid organ transplant.
- History of severe hypersensitivity reactions to other monoclonal antibodies, which in
the opinion of the investigator may pose an increased risk of serious infusion
- Known history or current interstitial lung disease or non-infectious pneumonitis.
- Malignant disease, other than that being treated in this study. Exceptions to this
exclusion include the following: malignancies that were treated curatively and have
not recurred within 2 years prior to study treatment; completely resected basal cell
and squamous cell skin cancers and any completely resected carcinoma in situ.
- Clinically significant infection, including known HIV or hepatitis C infection, or
known hepatitis B surface antigen positivity.
- Clinically significant ongoing infection.
- Received an investigational drug (including investigational vaccines) or used an
invasive investigational medical device within 14 days or 5 half-lives before
enrollment (whichever is longer) or is currently enrolled in the treatment stage of an
- A woman who is pregnant or breast-feeding, or a woman who is planning to become
pregnant or a man who plans to father a child while enrolled in this study or within
150 days after the last dose of study agent.
- Had hospitalization for infection or major surgery (eg, requiring general anesthesia)
within 2 weeks before enrollment or have not fully recovered from surgery. Note:
subjects with surgical procedures conducted under local anesthesia may participate.
- History or current diagnosis of cardiac disease indicating significant risk of safety
for patients participating in the study such as uncontrolled or significant cardiac
disease, including any of the following:
- Recent myocardial infarction (within last 6 months)
- Uncontrolled congestive heart failure
- Unstable angina (within last 6 months)
- Clinically significant (symptomatic) cardiac arrhythmias (e.g., sustained
ventricular tachycardia, and clinically significant second or third degree
atrioventricular block (AV) block without a pacemaker)