Description:
This early phase I trial investigates how well radiation therapy, plasma exchange, and
pembrolizumab or nivolumab work in treating patients with melanoma. Radiation therapy uses
high energy x-rays to kill tumor cells and shrink tumors. Plasma exchange (also known as
"plasmapheresis") is a way to "clean" or "flush out" the blood. Immunotherapy with monoclonal
antibodies, such as pembrolizumab and nivolumab, may help the body's immune system attack the
cancer, and may interfere with the ability of tumor cells to grow and spread. Plasma exchange
may help to improve the effect of standard radiation therapy and immunotherapy treatment on
tumor cells of patients with melanoma.
Title
- Brief Title: Radiation Therapy, Plasma Exchange, and Immunotherapy (Pembrolizumab or Nivolumab) for the Treatment of Melanoma
- Official Title: Radiation Therapy, Plasma Exchange, and Immunotherapy in Melanoma
Clinical Trial IDs
- ORG STUDY ID:
MC200703
- SECONDARY ID:
NCI-2020-06970
- SECONDARY ID:
MC200703
- SECONDARY ID:
P30CA015083
- NCT ID:
NCT04581382
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Nivolumab | BMS-936558, CMAB819, MDX-1106, NIVO, Nivolumab Biosimilar CMAB819, ONO-4538, Opdivo | Treatment (radiation therapy, plasma exchange, immunotherapy) |
Pembrolizumab | Keytruda, Lambrolizumab, MK-3475, SCH 900475 | Treatment (radiation therapy, plasma exchange, immunotherapy) |
Therapeutic Exchange Plasma | TEP | Treatment (radiation therapy, plasma exchange, immunotherapy) |
Purpose
This early phase I trial investigates how well radiation therapy, plasma exchange, and
pembrolizumab or nivolumab work in treating patients with melanoma. Radiation therapy uses
high energy x-rays to kill tumor cells and shrink tumors. Plasma exchange (also known as
"plasmapheresis") is a way to "clean" or "flush out" the blood. Immunotherapy with monoclonal
antibodies, such as pembrolizumab and nivolumab, may help the body's immune system attack the
cancer, and may interfere with the ability of tumor cells to grow and spread. Plasma exchange
may help to improve the effect of standard radiation therapy and immunotherapy treatment on
tumor cells of patients with melanoma.
Detailed Description
PRIMARY OBJECTIVE:
I. To determine the kinetics of soluble (s)PD-L1 removal and regeneration by plasma exchange
in patients with melanoma.
SECONDARY OBJECTIVES:
I. To observe response at 3 months after plasma exchange plus immunotherapy. II. To observe
ongoing response at approximate 3 month intervals after plasma exchange plus immunotherapy.
CORRELATIVE RESEARCH OBJECTIVES:
I. To determine the effects of plasma exchange on immune cell function. II. To observe the
kinetics of extracellular vesicles (EVs) after plasma exchange in patients with melanoma.
OUTLINE:
Patients undergo radiation therapy daily on days 1-5 (weekdays). Patients then undergo
therapeutic plasma exchange over 1-2 hours on days 4-6 or 5-7. Beginning on day 7, patients
receive pembrolizumab intravenously (IV) or nivolumab IV. Treatment with pembrolizumab
continues every 3 weeks or treatment with nivolumab continues every 2 weeks in the absence of
disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 3 weeks and then for up to 2
years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (radiation therapy, plasma exchange, immunotherapy) | Experimental | Patients undergo radiation therapy daily on days 1-5 (weekdays). Patients then undergo therapeutic plasma exchange over 1-2 hours on days 4-6 or 5-7. Beginning on day 7, patients receive pembrolizumab IV or nivolumab IV. Treatment with pembrolizumab continues every 3 weeks or treatment with nivolumab continues every 2 weeks in the absence of disease progression or unacceptable toxicity. | - Nivolumab
- Pembrolizumab
- Therapeutic Exchange Plasma
|
Eligibility Criteria
Inclusion Criteria:
- Histological confirmation of melanoma. Patients may have completed biopsy outside of
Mayo Clinic, but there must be an internal review done to confirm diagnosis prior to
confirming eligibility
- Measurable or non-measurable disease
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) =< 3
- sPD-L1 levels > 1.7 ng/ml by enzyme-linked immunosorbent assay (ELISA)
- Feasible vascular access as determined by study apheresis technician
- Negative pregnancy test done =< 7 days prior to radiation therapy, for women of
childbearing potential only
- Provide written informed consent
- Willing to return to enrolling institution for follow-up (during the Active Monitoring
Phase of the study)
- Willing to provide blood samples for correlative research purposes
Exclusion Criteria:
- Persons taking a biotin supplement
- sPD-L1 level < 1.7 ng/ml by ELISA
- Pregnant or nursing women
- Men or women of childbearing potential who are unwilling to employ adequate
contraception
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Feasibility of treatment approach |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Feasibility will be assessed tracking of the accrual and accrual rate. This will be tracked by spreadsheet and being able to complete the study accrual in a reasonable time period. |
Secondary Outcome Measures
Measure: | Overall response rate |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Overall response rate is the proportion of patients with a tumor response (partial response or complete response at least 4 weeks apart). |
Measure: | Progression-free survival (PFS) |
Time Frame: | From registration to the first of either disease progression or death from any cause, assessed up to 2 years |
Safety Issue: | |
Description: | PFS will be estimated using the method of Kaplan-Meier. |
Measure: | Overall survival (OS) |
Time Frame: | From registration to death from any cause, assessed up to 2 years |
Safety Issue: | |
Description: | OS will be estimated using the method of Kaplan-Meier. |
Measure: | Incidence of adverse events (AEs) |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | The descriptions and grading scales found in the revised National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 will be utilized for AE reporting. The maximum grade for each type of AE will be recorded for each patient, and frequency tables will be reviewed to determine AE patterns. |
Details
Phase: | Early Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Mayo Clinic |
Last Updated
June 21, 2021