Description:
Background:
Kaposi sarcoma (KS) tumors grow on the skin, lymph nodes, lungs, bone, and gastrointestinal
tract. KS often affects people with immune deficiencies, such as among people living with HIV
or those with prior history of transplant. Researchers want to see if 2 non-chemotherapy
drugs can help people with KS. NHS-IL12 triggers the immune system to fight tumors. M7824
blocks the pathways that cancer cells use to stop the immune system from fighting tumors.
Objective:
To learn if giving NHS-IL12 alone or with M7824 could help the immune system fight KS tumors.
Eligibility:
People 18 and older with KS that has been treated with chemotherapy or immunotherapy
Design:
Participants will be screened with some or all of the following:
medical history
physical exam
chest X-ray
computed tomography scan
blood and urine tests
electrocardiogram and echocardiogram
skin KS lesion biopsy
lung exam
gastrointestinal exam
All participants will get NHS-IL12 every 4 weeks for up to 96 weeks (or 24cycles). It is
injected under the skin.
Some participants will also get M7824 every 2 weeks for up to 96 weeks (or 24cycles). It is
given through a plastic tube that is put in an arm vein.
Participants will complete questionnaires about how KS affects their quality of life. Their
KS lesions will be measured and photographed. They will repeat some of the screening tests.
They will give saliva samples or additional tissue samples. They will have a lung function
test. Their ability to perform their normal activities will be assessed. The treatment
duration is up to 96 weeks (or 24cycles) with an option to take NHS-IL12 and/or M7824 until
the KS tumors are not responding, or you develop unacceptable side effects.
Participants will have follow-up visits 7 and 30 days after treatment ends, then every 3 to 6
months for the next 18 months, then once a year for 3 years.
Title
- Brief Title: NHS-IL12 Monotherapy and in Combination With M7824 in Advanced Kaposi Sarcoma
- Official Title: Phase I/II of NHS-IL12 Monotherapy and in Combination With M7824 in Advanced Kaposi Sarcoma
Clinical Trial IDs
- ORG STUDY ID:
200061
- SECONDARY ID:
20-C-0061
- NCT ID:
NCT04303117
Conditions
Interventions
Drug | Synonyms | Arms |
---|
NHS-IL12 | | Arm 1/Monotherapy |
NHS-IL12+M7824 | | Arm 2/Combination therapy |
Purpose
Background:
Kaposi sarcoma (KS) tumors grow on the skin, lymph nodes, lungs, bone, and gastrointestinal
tract. KS often affects people with immune deficiencies, such as among people living with HIV
or those with prior history of transplant. Researchers want to see if 2 non-chemotherapy
drugs can help people with KS. NHS-IL12 triggers the immune system to fight tumors. M7824
blocks the pathways that cancer cells use to stop the immune system from fighting tumors.
Objective:
To learn if giving NHS-IL12 alone or with M7824 could help the immune system fight KS tumors.
Eligibility:
People 18 and older with KS that has been treated with chemotherapy or immunotherapy
Design:
Participants will be screened with some or all of the following:
medical history
physical exam
chest X-ray
computed tomography scan
blood and urine tests
electrocardiogram and echocardiogram
skin KS lesion biopsy
lung exam
gastrointestinal exam
All participants will get NHS-IL12 every 4 weeks for up to 96 weeks (or 24cycles). It is
injected under the skin.
Some participants will also get M7824 every 2 weeks for up to 96 weeks (or 24cycles). It is
given through a plastic tube that is put in an arm vein.
Participants will complete questionnaires about how KS affects their quality of life. Their
KS lesions will be measured and photographed. They will repeat some of the screening tests.
They will give saliva samples or additional tissue samples. They will have a lung function
test. Their ability to perform their normal activities will be assessed. The treatment
duration is up to 96 weeks (or 24cycles) with an option to take NHS-IL12 and/or M7824 until
the KS tumors are not responding, or you develop unacceptable side effects.
Participants will have follow-up visits 7 and 30 days after treatment ends, then every 3 to 6
months for the next 18 months, then once a year for 3 years.
Detailed Description
Background:
- Kaposi Sarcoma (KS) is a multicentric angioproliferative tumor, caused by Kaposi
sarcoma-associated herpesvirus, that most frequently involves the skin, but may also
involve lymph nodes, lungs, bone and gastrointestinal tract. It is most common in people
with HIV but may also occur in patients without a diagnosis of HIV. Patients with
HIVassociated KS have worse survival than HIV-infected patients without KS.
- As it is a relapsing and remitting condition, patients with KS often require prolonged
courses of cytotoxic chemotherapy.
- KS is an immune responsive tumor as interferon-alpha, pomalidomide, and restoring Tcell
function in HIV + patients treated with antiretroviral drugs can result in clinical
benefit and remission of KS.
- Published Phase I/II studies by our group demonstrated that IL-12 alone and in
combination with liposomal doxorubicin led to clinical responses in patients with
advanced KS.
- NHS-IL12 (M9241) is an immunocytokine with affinity to both single and double stranded
DNA allowing for targeting of exposed DNA, which is commonly seen in necrotic tumors.
This agent is able to deliver IL-12 to the tumor microenvironment promoting local
immunomodulation, that results in less systemic toxicity than IL-12 systemic
administration.
- M7824 is a novel bifunctional fusion protein composed of a monoclonal antibody against
human PD-L1 (avelumab) fused with the extracellular domain of human TGF-beta receptor II
(TGF- RII), which functions as a TGF-beta trap .
- Anti-PD-L1 and anti-PD-1 agents have been found to be active in certain virus-induced
cancers, including Kaposi sarcoma, and to be safe and active in patients with HIV
infection.
- Currently, no clinical data exists for the combination of NHS-IL12 and M7824.
Preclinical data suggest synergy between these agents from existing ongoing studies and
the available clinical data both in KS and other tumor subtypes suggest that the
combination of NHSIL12 with M7824 is likely to be well-tolerated and has scientific
rationale. This combination offers a new treatment approach for patients with advanced
KS who have received prior therapies.
Objectives:
-Evaluate the safety and tolerability of single agent NHS-IL12 and the combination of NHSIL12
with M7824 in patients with advanced KS.
Eligibility:
- Age >18 years
- Histologically confirmed Kaposi sarcoma (KS)
- KS requiring systemic therapy, with a history of prior systemic therapy:
- 2 weeks from last chemotherapy
- 4 weeks from last immunotherapy
- At least five measurable cutaneous KS lesions with no previous local radiation, surgical
or intralesional cytotoxic therapy to these measurable lesions.
- ECOG Performance Status (PS) less than or equal to 2
- Patient must be willing to give informed consent.
- Patients can be HIV positive or negative.
- Antiretroviral therapy (ART) for HIV+ patients for 8 or more weeks prior to entry with
an HIV viral load of <400 copies/ml and CD4+ T-cell count >50 cells/microliter.
- Patients with bleeding from visceral sites of KS or requiring blood transfusions in the
2 weeks prior to study entry will not be eligible.
Design:
- This is a Phase I/II study assessing the safety and efficacy of NHS-IL12 alone or in
combination with M7824 in patients with advanced KS. Patients will receive therapy until
optimal tumor response, unacceptable toxicity, the patient s request to discontinue
therapy, PI decision, up to a total of 96 weeks, or 24 cycles.
- Monotherapy: Patients will receive NHS-IL12 alone with a 3+3 design applicable to the
first 3-6 patients at a starting dose of 16.8 microgram/kg on day 1 of a 28-day cycle.
Two dose de-escalation levels (Dose Level -1: 12 microgram/kg or Dose Level -2: 8
microgram/kg) will be permitted if there is evidence of 2 or more dose limiting
toxicities within the first 6 weeks of therapy.
- Combination Therapy: The combination arm will open following accrual and completion of
the the DLT period for patients in the monotherapy arm. Up to 28 patients will be
treated with M7824 (1200 mg IV, every 2 weeks) and NHS-IL12 (MTD dose from the
monotherapy arm). The DLT period for this arm will be 6 weeks.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm 1/Monotherapy | Experimental | Treatment with NHS-IL12 at de-escalating doses if necessary | |
Arm 2/Combination therapy | Experimental | Treatment with NHS-IL12 at MTD and M7824 at a fixed dose | |
Eligibility Criteria
- INCLUSION CRITERIA:
- Patients with biopsy proven (confirmed in the Laboratory of Pathology, CCR) Kaposi
sarcoma (KS)
- KS requiring systemic therapy, with a history of prior therapy:
- T1 KS or T0 KS sufficiently widespread that systemic therapy is advisable, or KS
affecting quality-of-life due to local symptoms or psychological distress OR
- KS patients with an inadequate response to liposomal doxorubicin, paclitaxel,
other systemic chemotherapy (either progressive disease or stable disease after 3
or more cycles) or immunotherapy (progressive disease)
- A wash-out period off treatment of 2 weeks from last chemotherapy and 4 weeks from
last immunotherapy, other systemic treatment with a biologic agent, or monoclonal
antibody therapy will be required.
- Resolution of toxicity from prior therapy to less than or equal to Grade 1.
- At least five measurable cutaneous KS lesions with no previous local radiation,
surgical or intralesional cytotoxic therapy that would prevent response assessment for
that lesion.
- Measurable disease by the criteria proposed by the AIDS Clinical Trials Group (ACTG)
Oncology Committee for KS
- Patients can be HIV positive or negative.
- ART for HIV+ patients for 8 or more weeks prior to entry with an HIV viral load of
<400 copies/ml at screening and CD4+ T cell count of >50 cells/ (NotEqual)L as this
may be expected if patients have received several courses of chemotherapy.
- Age greater than or equal to18 years.
- ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to
60%).
- Patients must have adequate organ and marrow function as defined below:
- absolute neutrophil count greater than or equal to 1,500/mcL
- platelets greater than or equal to 100,000/mcL
- total bilirubin within normal institutional limits; OR <3x institutional ULN for
Gilbert s syndrome or HIV protease inhibitors; OR <5x ULN and direct bilirubin <
0.7mg/dL for patients on atazanavir-containing HIV regimen
- AST(SGOT)/ALT(SGPT) less than or equal to 1.5 X institutional upper limit of
normal
- hemoglobin greater than or equal to 9g/dL
- Creatinine within normal institutional limits OR creatinine clearance >30
mL/min/1.73m^2 as estimated by either Cockroft-Gault of 24- hour urine collection
for patients with creatinine levels above institutional normal
- Normal international normaoized ration (INR), PT less than or equal to 1.5 x ULN and
activated partial thromboplastin time (aPTT) less than or equal to 1.5 x ULN
- The effects of NHS-IL12 and M7824 on the developing human fetus are unknown. For this
reason, 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, during treatment and for at least 4 months after the last dose of treatment and
agree to inform the treating physician immediately if they become pregnant. Also,
there is unknown but potential risk for adverse events in nursing infants secondary to
treatment of the mother with M7824 and/or NHS-IL12, therefore female patients must
agree to discontinue breastfeeding if treated with these agents.
- Ability of subject to understand and the willingness to sign a written informed
consent document.
EXCLUSION CRITERIA:
- Patients who are receiving any other investigational agents.
- Pregnant women are excluded from this study as the effects of NHS-IL12 and M7824 have
potential teratogenic or abortifacient effects.
- Severe KS (such as symptomatic pulmonary KS) that could be life threatening if it
progressed over 2-4 weeks
- Actively bleeding sites caused by visceral KS.
- Subjects unwilling to accept blood products as medically indicated
- Patients who are actively bleeding and/or requiring transfusions in the 2 weeks
preceding study entry.
- Patients with history of bleeding, diathesis, or recent major bleeding events within a
period of 4 weeks considered by the investigator as high risk for investigational drug
treatment.
- Patients with any active or recent history (symptomatic in the last 3 months) of a
known or suspected autoimmune disease (with the exception of diabetes type I,
vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive
treatment) or recent history of a syndrome that required systemic corticosteroids
(10mg daily prednisone or equivalent) or immunosuppressive medications except inhaled
steroids and adrenal replacement steroids doses up to 10mg daily prednisone
equivalents are permitted in the absence of active autoimmune disease.Uncontrolled
opportunistic infections
- Active multicentric Castleman disease
- Patients with primary effusion lymphoma
- History of malignant tumors other than KS, unless:
- In complete remission for greater than or equal to 3 years from the time complete
remission was first documented or
- Resected basal cell or squamous cell carcinoma of the skin or
- In situ cervical or anal dysplasia
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to NHS-IL12 and/or M7824 investigational agents used in study.
- Active tuberculosis (TB):
- Patients who are undergoing first month of therapy (RIPE or equivalent) for
active TB or
- Patients with TB immune reconstitution syndrome (IRIS) requiring corticosteroids
- Patients who have received or will receive a live vaccine within 30 days prior to the
first administration of study intervention. Seasonal flu vaccines that do not contain
a live virus are permitted. Locally approved COVID vaccines are permitted.
- Uncontrolled substantial intercurrent illness including, but not limited to, ongoing
or active severe infection, symptomatic congestive heart failure, unstable angina
pectoris, cardiac arrhythmia, that would limit compliance with study requirements.
- Medical or psychiatric illness or social situation that would, in the opinion of the
investigator, preclude participation in the study or the ability of patients to
provide informed consent for themselves.
- Uncontrolled HBV infection, defined as plasma HBV DNA detectable by PCR
Note: the following will NOT be exclusionary:
- A positive hepatitis B serology indicative of previous immunization (i.e. HBsAb
positive and HBcAb negative), or a fully resolved acute HBV infection
- Patients with chronic HBV suppressed by appropriate antiretroviral therapy with
activity against HBV, as outlined in DHHS guidelines.
- Uncontrolled HCV infection, defined as plasma HCV DNA detectable by PCR
Note: the following will NOT be exclusionary:
- Positive HCV serology but no detectable HCV RNA, indicative of spontaneously cleared
HCV infection
- Patients who have been successfully treated for HCV as long as therapy for HCV has
been completed.
-Patients will be excluded from the combination therapy arm if:
- they have discontinued prior PD1/L1 blocking agent due to immune mediated adverse
event(s) OR
- they have active non-infectious pneumonitis or a history of steroid requiring
non-infectious pneumonitis.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | safety and tolerability of NHS-IL12 alone or in combination with M7824 |
Time Frame: | 24 cycles of treatment, until confirmed progression, unacceptable toxicity or trial withdrawal |
Safety Issue: | |
Description: | The fraction of patients with toxicity noted at each dose level will be reported by grade and type of toxicity identified. Maximum tolerated dose will also be reported. |
Secondary Outcome Measures
Measure: | objective response rates |
Time Frame: | every 3 months for the first 6 months after completion of therapy, then every six months for the next 18 months, and then annually for a total of 3 years |
Safety Issue: | |
Description: | Percentage of patients with the best overall response of CR or PR to therapy |
Measure: | duration of response |
Time Frame: | every 3 months for the first 6 months after completion of therapy, then every six months for the next 18 months, and then annually for a total of 3 years |
Safety Issue: | |
Description: | the time criteria are met for CR or PR (whichever is recorded first) until the first date that patient no longer qualifies as a PR |
Measure: | progression free survival |
Time Frame: | every 3 months for the first 6 months after completion of therapy, then every six months for the next 18 months, and then annually for a total of 3 years |
Safety Issue: | |
Description: | duration of time from the start of the treatment until time of disease relapse from PR, disease progression, or death, whichever occurs first |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- Immune Therapy
- AIDS
- HIV
- Immunocytokine
Last Updated
July 28, 2021