Description:
This is an open-label, single center, one cohort, non-randomized, phase I/II study. The aim
is to evaluate the efficacy and safety of the combination of hypofractionated radiotherapy
(HRT) and pembrolizumab on local tumor control in mucosal melanoma patients. Treatment effect
will be compared with historical radiation therapy-alone control data.
Title
- Brief Title: Pembrolizumab and Hypofractionated Radiation Therapy for the Treatment of Mucosal Melanoma
- Official Title: Adjuvant Pembrolizumab and Hypofractionated Radiation Therapy for the Treatment of Mucosal Melanoma
Clinical Trial IDs
- ORG STUDY ID:
202003124
- NCT ID:
NCT04318717
Conditions
- Mucosal Melanoma of the Head and Neck
Interventions
Drug | Synonyms | Arms |
---|
Pembrolizumab | Keytruda | Pembrolizumab + Hypofractionated radiation therapy |
Purpose
This is an open-label, single center, one cohort, non-randomized, phase I/II study. The aim
is to evaluate the efficacy and safety of the combination of hypofractionated radiotherapy
(HRT) and pembrolizumab on local tumor control in mucosal melanoma patients. Treatment effect
will be compared with historical radiation therapy-alone control data.
Trial Arms
Name | Type | Description | Interventions |
---|
Pembrolizumab + Hypofractionated radiation therapy | Experimental | Pembrolizumab will be given intravenously over 30 minutes (-5/+10 minutes) at a dose of 200 mg on an outpatient basis on Day 1 of each 21-day cycle for a total of up to 12 months (17 cycles).
Hypofractionated radiation therapy may be given at any point during the first 2 cycles of pembrolizuimab. It should begin within 90 days of surgical resection. Intensity modulated radiation therapy (IMRT) or intensity modulated proton therapy (IMPT) are to be used exclusively. IMRT or IMPT will be delivered twice per week in five fractions of 6 Gy given over 2.5 weeks totaling 30 Gy. | |
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically confirmed mucosal melanoma that has undergone surgical
resection. Patient must not have received prior radiation therapy within the area of
interest.
- At least 16 years of age.
- Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (Karnofsky ≥ 70%)
- Normal bone marrow and organ function as defined below:
- Absolute neutrophil count ≥ 1,200/mcL
- Platelets ≥ 100,000/mcL
- Total bilirubin ≤ 1.5 x institutional upper limit of normal (IULN)
- AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
- Creatinine clearance > 30 mL/min by Cockcroft-Gault
- The effects of pembrolizumab on the developing human fetus are unknown. For this
reason, women of childbearing 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 6 months after last dose of
pembrolizumab. Should a woman become pregnant or suspect she is pregnant while
participating in this study, she must inform her treating physician immediately. Men
treated or enrolled on this protocol must also agree to use adequate contraception
prior to the study, for the duration of the study, and 6 months after last dose of
pembrolizumab.
- Ability to understand and willingness to sign an IRB approved written informed consent
document (or that of legally authorized representative, if applicable).
Exclusion Criteria:
- A history of other malignancy with the exception of malignancies for which all
treatment was completed at least 2 years before registration and the patient has no
evidence of disease.
- Received radiation therapy within the area of interest.
- Currently receiving any other investigational agents.
- Metastatic disease.
- A history of allergic reactions attributed to compounds of similar chemical or
biologic composition to pembrolizumab or other agents used in the study.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac
arrhythmia.
- Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any
other form of immunosuppressive therapy within 7 days prior to the first dose of study
treatment. The use of up to 10 mg/day of prednisone or equivalent is approved and does
not exclude the patient from the trial.
- Active autoimmune disease that has required systemic treatment in past 2 years (i.e.,
with use of disease modifying agents, > 10 mg of prednisone per day, or
immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or
physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency,
etc.) is not considered a form of systemic treatment. The use of up to 10 mg/day of
prednisone or equivalent is approved and does not exclude the patient from the trial.
- Has a history of (non-infectious) pneumonitis/Interstitial lung disease that required
maintenance steroids (>10 mg of prednisone) or current pneumonitis/interstitial lung
disease.
- Has received a live vaccine or live-attenuated vaccination within 30 days of planned
treatment start. Administration of killed vaccines is allowed.
- Pregnant and/or breastfeeding. Women of childbearing potential must have a negative
pregnancy test within 14 days of study entry.
- Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or
they have a history of AIDS-defining opportunistic infection within the 12 months
prior to registration. Concurrent treatment with effective ART according to DHHS
treatment guidelines is recommended.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 16 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Local tumor control rate |
Time Frame: | 1 year |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | Number of treatment-related grade 3 or greater adverse events |
Time Frame: | Baseline through 30 days after end of treatment (estimated to be 13 months) |
Safety Issue: | |
Description: | |
Measure: | Number of treatment discontinuations due to treatment-related adverse events |
Time Frame: | Through end of treatment (estimated to be 12 months) |
Safety Issue: | |
Description: | |
Measure: | Relapse-free survival (RFS) |
Time Frame: | Through completion of follow-up (estimated to be 48 months) |
Safety Issue: | |
Description: | -defined as the duration of time from the start date of study treatment to the date of earliest disease relapse or death, whichever occurs first. Patients who neither relapse nor die by the data cutoff date will be censored at the last follow up date. |
Measure: | Distant metastasis-free survival |
Time Frame: | Through completion of follow-up (estimated to be 48 months) |
Safety Issue: | |
Description: | -defined as the duration of time from the start date of study treatment to the date of appearance of a distant metastasis or death, whichever occurs first. Patients who neither develop distant metastasis nor die by the data cutoff date will be censored at the last follow up date. |
Measure: | Overall survival |
Time Frame: | Through completion of follow-up (estimated to be 48 months) |
Safety Issue: | |
Description: | -defined as the duration of time from the start date of study treatment to death from any cause. Patients who are alive by the data cutoff date will be censored at the last follow up date. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Washington University School of Medicine |
Last Updated
July 6, 2021