Clinical Trials /

Lenvatinib and Pembrolizumab in People With Advanced Soft Tissue Sarcoma

NCT04784247

Description:

The purpose of this study is to find out whether combining the study drugs, lenvatinib and pembrolizumab, is a safe and effective treatment for metastatic soft tissue sarcomas that cannot be removed with surgery.

Related Conditions:
  • Angiosarcoma
  • Chondrosarcoma
  • Epithelioid Hemangioendothelioma
  • Leiomyosarcoma
  • Malignant Peripheral Nerve Sheath Tumor
  • Osteosarcoma
  • Synovial Sarcoma
  • Undifferentiated Pleomorphic Sarcoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Lenvatinib and Pembrolizumab in People With Advanced Soft Tissue Sarcoma
  • Official Title: A Pilot Study of Lenvatinib Plus Pembrolizumab in Patients With Advanced Sarcoma

Clinical Trial IDs

  • ORG STUDY ID: 21-047
  • NCT ID: NCT04784247

Conditions

  • Advanced Sarcoma

Interventions

DrugSynonymsArms
LenvatinibBone sarcomas (including osteosarcoma and chondrosarcoma)
PembrolizumabBone sarcomas (including osteosarcoma and chondrosarcoma)

Purpose

The purpose of this study is to find out whether combining the study drugs, lenvatinib and pembrolizumab, is a safe and effective treatment for metastatic soft tissue sarcomas that cannot be removed with surgery.

Trial Arms

NameTypeDescriptionInterventions
LeiomyosarcomaExperimentalPatients enrolled in the study will be treated initially with a 2 week run-in of lenvatinib 20 mg orally daily. Subsequently, they will start pembrolizumab 200 mg intravenously every 3 weeks (21-day cycles). Treatment will continue until progression or other indications for study withdrawal Otherwise, treatment will be discontinued after a maximum of 35 cycles of pembrolizumab (approximately 2 years) or after achieving CR. RECIST v1.1 tumor assessments will be made at baseline (CT or MRI) and approximately every 3 cycles (or every 9 weeks +/- 1 week) for the first 9 cycles (27 weeks), then every 4 cycles (or every 12 weeks +/- 1week). Patients who progress after having discontinued therapy after completing 2 years of treatment or after achieving confirmed CR may be eligible to reinitiate therapy for an additional 1 year (approximately 17 cycles).
  • Lenvatinib
  • Pembrolizumab
High grade undifferentiated pleomorphic sarcomaExperimentalPatients enrolled in the study will be treated initially with a 2 week run-in of lenvatinib 20 mg orally daily. Subsequently, they will start pembrolizumab 200 mg intravenously every 3 weeks (21-day cycles). Treatment will continue until progression or other indications for study withdrawal . Otherwise, treatment will be discontinued after a maximum of 35 cycles of pembrolizumab (approximately 2 years) or after achieving CR. RECIST v1.1 tumor assessments will be made at baseline (CT or MRI) and approximately every 3 cycles (or every 9 weeks +/- 1 week) for the first 9 cycles (27 weeks), then every 4 cycles (or every 12 weeks +/- 1week). Patients who progress after having discontinued therapy after completing 2 years of treatment or after achieving confirmed CR may be eligible to reinitiate therapy for an additional 1 year (approximately 17 cycles).
  • Lenvatinib
  • Pembrolizumab
Vascular sarcomas (including angiosarcoma and epithelioid hemangioendothelioma)ExperimentalPatients enrolled in the study will be treated initially with a 2 week run-in of lenvatinib 20 mg orally daily. Subsequently, they will start pembrolizumab 200 mg intravenously every 3 weeks (21-day cycles). Treatment will continue until progression or other indications for study withdrawal. Otherwise, treatment will be discontinued after a maximum of 35 cycles of pembrolizumab (approximately 2 years) or after achieving CR. RECIST v1.1 tumor assessments will be made at baseline (CT or MRI) and approximately every 3 cycles (or every 9 weeks +/- 1 week) for the first 9 cycles (27 weeks), then every 4 cycles (or every 12 weeks +/- 1week). Patients who progress after having discontinued therapy after completing 2 years of treatment or after achieving confirmed CR may be eligible to reinitiate therapy for an additional 1 year (approximately 17 cycles).
  • Lenvatinib
  • Pembrolizumab
Other soft tissue sarcomas (including synovial sarcoma and malignant peripheral nerve sheath tumorExperimentalPatients enrolled in the study will be treated initially with a 2 week run-in of lenvatinib 20 mg orally daily. Subsequently, they will start pembrolizumab 200 mg intravenously every 3 weeks (21-day cycles). Treatment will continue until progression or other indications for study withdrawal. Otherwise, treatment will be discontinued after a maximum of 35 cycles of pembrolizumab (approximately 2 years) or after achieving CR. RECIST v1.1 tumor assessments will be made at baseline (CT or MRI) and approximately every 3 cycles (or every 9 weeks +/- 1 week) for the first 9 cycles (27 weeks), then every 4 cycles (or every 12 weeks +/- 1week). Patients who progress after having discontinued therapy after completing 2 years of treatment or after achieving confirmed CR may be eligible to reinitiate therapy for an additional 1 year (approximately 17 cycles).
  • Lenvatinib
  • Pembrolizumab
Bone sarcomas (including osteosarcoma and chondrosarcoma)ExperimentalPatients enrolled in the study will be treated initially with a 2 week run-in of lenvatinib 20 mg orally daily. Subsequently, they will start pembrolizumab 200 mg intravenously every 3 weeks (21-day cycles). Treatment will continue until progression or other indications for study withdrawal. Otherwise, treatment will be discontinued after a maximum of 35 cycles of pembrolizumab (approximately 2 years) or after achieving CR. RECIST v1.1 tumor assessments will be made at baseline (CT or MRI) and approximately every 3 cycles (or every 9 weeks +/- 1 week) for the first 9 cycles (27 weeks), then every 4 cycles (or every 12 weeks +/- 1week). Patients who progress after having discontinued therapy after completing 2 years of treatment or after achieving confirmed CR may be eligible to reinitiate therapy for an additional 1 year (approximately 17 cycles).
  • Lenvatinib
  • Pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          -  Male or female age ≥18 years at time of informed consent

          -  Be willing and able to provide written informed consent/assent for the trial

          -  Be willing to comply with treatment protocol

          -  Availability of archival tissue for correlative studies; either a paraffin block or at
             least 20 unstained slides are acceptable

          -  Patients must have a metastatic and/or unresectable soft tissue sarcoma as below:

               -  Cohort A: Leiomyosarcoma

               -  Cohort B: High grade undifferentiated pleomorphic sarcoma

               -  Cohort C: Vascular sarcomas (including angiosarcoma and epithelioid
                  hemangioendothelioma)

               -  Cohort D: Other soft tissue sarcomas (including synovial sarcoma and malignant
                  peripheral nerve sheath tumor

               -  Cohort E: Bone sarcomas (including osteosarcoma and chondrosarcoma)

          -  Subjects must have had at least 1 but not more than 3 prior lines of systemic therapy
             (e.g. chemotherapy, immunotherapy, targeted or biological therapy); patients who
             decline the standard of care first-line systemic therapy will be eligible for this
             trial. Prior adjuvant therapy will not count provided it was completed more than
             6-month previously.

          -  Presence of measurable disease per RECIST v1.1. Target lesions must not be chosen from
             a previously irradiated field unless there has been radiographically and/or
             pathologically documented tumor progression in that lesion prior to enrollment.Where
             and when possible, target lesions will not be chosen as the biopsy lesion.

          -  Must have a performance status ECOG 0-1.

          -  Screening laboratory values must meet the following criteria:

               -  Neutrophils ≥ 1000/μL

               -  Platelets ≥ 100x10^3/μL

               -  Hemoglobin > 9.0 g/dL (without packed red blood cell [pRBC] transfusion within
                  the last 2 weeks)

               -  AST and ALT ≤ 2.5 x ULN (if liver metastases are present, AST and ALT≤ 5x ULN)

               -  Total Bilirubin ≤ 1.5 x ULN OR direct bilirubin < ULN for participants with total
                  bilirubin levels >1.5 x ULN (except participants with Gilbert syndrome, who can
                  have a total bilirubin < 3.0 mg/dL)

               -  Serum creatinine ≤ 1.5 x ULN OR creatinine clearance (CrCl) ≥ 40 mL/min per the
                  Cockcroft-Gault formula if creatinine is >1.5 x ULN

               -  INR OR prothrombin time (PT) < 1.5, unless participant is receiving anticoagulant
                  therapy as long as PT or aPTT is within therapeutic range of intended use of
                  anticoagulants

          -  Male participants must agree to use adequate contraception (complete abstinence, male
             condom) of this protocol during the treatment period and for at least 120 days after
             the last dose of study therapy and refrain from donating sperm during this period.

          -  A female participant is eligible to participate if she is not pregnant (for women of
             childbearing potential, serum pregnancy test must be negative within 72 hours prior to
             initiation; not breast feeding, and at least one of the following conditions applies:

               -  Not a woman of child bearing potential including:

               -  Premenopausal with one of the following: documented hysterectomy, documented
                  bilateral salpingectomy, documented bilateral oophorectomy

               -  Postmenopausal females defined as no menses for 12 months without an alternative
                  medical cause (a high follicle stimulating hormone level in the postmenopausal
                  range may be used to confirm a post-menopausal state in women not using hormonal
                  contraception or hormonal replacement therapy (HRT). However, in the absence of
                  12 months of amenorrhea, confirmation with two FSH measurements in the
                  postmenopausal range is required.

               -  A woman of child bearing potential who agrees to highly effective contraception
                  from the start of therapy through 120 days after the last dose of study
                  medication

          -  Participants must be able to swallow and retain oral medication or have a functioning
             G-tube in place.

        Exclusion Criteria:

          -  Untreated metastatic brain (subjects with treated brain metastases will be eligible,
             provided that they are radiographically stable, i.e. without evidence of progression
             for at least 4 weeks by repeat imaging performed during study screening, clinically
             stable and without requirement of steroid treatment for at least 14 days prior to the
             first dose of study treatment).

          -  Concurrent anti-cancer therapy (chemotherapy, definitive radiation therapy, surgery,
             immunotherapy, biologic therapy or tumor embolization) other than study treatment.
             Concurrent therapy with bisphosphonates or denosumab for bone metastases is allowed,
             provided they are started prior to study entry. Palliative radiation to non-target
             lesions is also allowed as screened by the Principal Investigator.

          -  Presence of any other concurrent malignancy requiring active therapy or thought to
             potentially interfere with the safe conduct or assessment of outcomes on this trial.

          -  History of allergy or intolerance to lenvatinib or study drug components (or any of
             their excipients) or severe (> Grade 3) hypersensitivity reaction to pembrolizumab
             and/or any of its excipients or any monoclonal antibody.

          -  Prior use of lenvatinib or pazopanib or any PD-1/PD-L1 or anti-PD-L2 targeted
             therapies or with an agent directed at another stimulatory or co-inhibitory T-cell
             receptor (CTLA-4, OX-40, CD137).

          -  Uncontrolled hypertension (systolic pressure >140mm Hg or diastolic pressure >90mm Hg,
             despite optimal medical management.

          -  Prior systemic anti-cancer therapy including use of another investigation drug or
             device (i.e., outside study treatment) during, or within 3 weeks of trial entry (time
             of initiation of experimental drug).

          -  Prior radiotherapy within 2 weeks of the start of study treatment. Participants must
             have recovered from all radiation-related toxicities, not require corticosteroids, and
             not have had radiation pneumonitis.

          -  Participants must have recovered all AEs due to previous therapies to ≤ Grade 1 or
             baseline. Participants with ≤ Grade 2 neuropathy or alopecia may be eligible. If
             participant received major surgery, they must have recovered adequately from the
             toxicity and/or complications from the intervention prior to starting study treatment.

          -  Clinically significant proteinuria:

             °Subjects having >1+ proteinuria on urinalysis will undergo 24-hour urine collection
             for quantitative assessment of proteinuria. Subjects with proteinuria ≥/24-hour will
             be ineligible.

          -  Gastrointestinal malabsorption, gastrointestinal anastomosis, or any other condition
             that might affect the absorption of lenvatinib.

          -  ≥ Grade 3 gastrointestinal or non-gastrointestinal fistula

          -  New York Heart Association congestive heart failure of grade II or above, unstable
             angina, myocardial infarction within the past 6 months, serious cardiac arrhythmia
             associated with significant cardiovascular impairment within the past 6 months
             (baseline echocardiogram is not required unless clinically indicated) or left
             ventricular ejection fraction <55% as determined by echocardiogram.

          -  Subjects with thrombotic, embolic, venous or arterial events, such as cerebrovascular
             accidents (including transient ischemic attacks), deep venous thrombosis or pulmonary
             embolism within 6 months of study treatment start.

          -  Therapeutic anticoagulation with Vitamin-K antagonists (e.g., warfarin) is not allowed
             if the medication dose and/or INR is not considered stable by the treating physician.
             If the dose and/or INR is stable, therapeutic anticoagulation with Vitamin-K
             antagonists is allowed with close monitoring. Anticoagulation with heparin or low
             molecular weight heparin is allowed.

          -  Prolongation of QTc >480 msec

          -  Any hemorrhage or bleeding event ≥ NCI CTCAE v5.0 Grade ≥3 within 4 weeks prior to
             start of study medication.

          -  Active infection (any infection requiring systemic treatment)

          -  Subject is known to be positive for Human Immunodeficiency Virus (HIV) or active
             Hepatitis C Virus (HCV) or active hepatitis B (HBV) infection (positive viral load).
             Testing for HIV, HCV, or HBV prior to initiation of the study drug is not required. If
             patient's have a known history of treated HCV, then a viral load is required to
             confirm clearance of infection.

          -  Serious non-healing wound, ulcer or bone fracture, that is not tumor related.

          -  History of organ allograft (including corneal transplant).

          -  Has a history or current evidence of any medical or other condition, therapy or
             laboratory abnormality which, in the opinion of the investigator, might confound the
             results of the study, or preclude participation in a clinical study.

          -  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 physiologic doses of corticosteroids (up to 10 mg/d of
             prednisone or equivalent) may be approved after consultation with the Primary
             Investigator.

          -  Active autoimmune disease that has required systemic treatment in the past 2 years
             (i.e., with the use of disease modifying agents, corticosteroids or immunosuppressive
             drugs), with the exception of autoimmune thyroid disease, vitiligo, type 1 diabetes
             mellitus, or psoriasis. 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.

          -  Has a history of (non-infectious) pneumonitis that required steroids or current
             pneumonitis.

          -  Renal failure requiring active hemo- or peritoneal dialysis.

          -  Has received a live-virus vaccination within 30 days of planned treatment start.
             Examples of live vaccines include, but are not limited to, the following: measles,
             mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus
             Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection
             are generally killed virus vaccines and are allowed; however, intranasal influenza
             vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed.

          -  Has known psychiatric or substance abuse disorders that would interfere with the
             cooperation with the requirements of the trial.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:best overall response rate
Time Frame:at 27 weeks
Safety Issue:
Description:Response and progression will be evaluated in this study using the new international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1)

Secondary Outcome Measures

Measure:progression-free survival (PFS)
Time Frame:27 weeks
Safety Issue:
Description:Response and progression will be evaluated in this study using the new international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1)

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Memorial Sloan Kettering Cancer Center

Trial Keywords

  • Lenvatinib
  • Pembrolizumab
  • Metastatic and/or unresectable soft tissue sarcomas
  • 21-047

Last Updated

March 5, 2021