Clinical Trials /

Combination of Ipi/Nivo Plus Sacituzumab Govitecan in Metastatic Cisplatin Ineligible Urothelial Carcinoma Patients

NCT04863885

Description:

The purpose of this study is to see how well the study drugs called Ipilimumab plus Nivolumab (IPI-NIVO) work when added to another study drug called Sacituzumab Govitecan for people who have metastatic bladder cancer.

Related Conditions:
  • Urothelial Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Combination of Ipi/Nivo Plus Sacituzumab Govitecan in Metastatic Cisplatin Ineligible Urothelial Carcinoma Patients
  • Official Title: Phase I/II Study of Ipilimumab Plus Nivolumab (IPI-NIVO) Combined With Sacituzumab Govitecan (SG)as First-line Treatment for Cisplatin-ineligible Metastatic Urothelial Carcinoma

Clinical Trial IDs

  • ORG STUDY ID: MCC-20943
  • SECONDARY ID: CA209-63Y
  • NCT ID: NCT04863885

Conditions

  • Metastatic Urothelial Carcinoma

Interventions

DrugSynonymsArms
IpilimumabYervoyPhase 1 Dose Level -1
NivolumabOpdivoPhase 1 Dose Level -1
Sacituzumab govitecanTrodelvyPhase 1 Dose Level -1

Purpose

The purpose of this study is to see how well the study drugs called Ipilimumab plus Nivolumab (IPI-NIVO) work when added to another study drug called Sacituzumab Govitecan for people who have metastatic bladder cancer.

Detailed Description

      The phase I component of this study will evaluate fixed doses of ipilimumab and nivolumab (3
      mg/kg and 1 mg/kg, respectively) IV every 3 weeks x 4 cycles combined with a starting dose of
      sacituzumab govitecan Level 1 of 8 mg/kg IV days 1,8 every 3 weeks (1 cycle) x 4 cycles. One
      dose escalation to 10 mg/kg and one dose reduction to dose level minus 1 of sacituzumab
      govitecan 6 mg/kg days 1,8 every 3 weeks is allowed.

      The phase II component will be conducted as two-stage trial enrolling 34 patients with a
      futility interim analysis after stage 1 (13 patients). After 4 cycles, patients will continue
      maintenance nivolumab 360 mg IV every Q 21 days along with RP2 dose of SG D1,8 Q21 days till
      progression of disease or intolerable toxicities or patient decision. Radiographic imaging is
      performed every 12 weeks to assess response.
    

Trial Arms

NameTypeDescriptionInterventions
Phase 1 Dose Level 1ExperimentalParticipants will be treated at dose level 1: Ipilumumab 3mg/kg + Nivolumab 1mg/kg IV day 1 every 3 weeks for 4 cycles, followed by Nivolumab 360 mg every 3 weeks. Sacituzumab Govitecan 8 mg/kg IV will be administered days 1 and 8 every 3 weeks.
  • Ipilimumab
  • Nivolumab
  • Sacituzumab govitecan
Phase 1 Dose Level 2ExperimentalParticipants will be treated at dose level 2: Ipilumumab 3mg/kg + Nivolumab 1mg/kg IV day 1 every 3 weeks for 4 cycles, followed by Nivolumab 360 mg every 3 weeks. Sacituzumab Govitecan 10 mg/kg IV will be administered days 1 and 8 every 3 weeks.
  • Ipilimumab
  • Nivolumab
  • Sacituzumab govitecan
Phase 1 Dose Level -1ExperimentalIf dose reduction is indicated, participants will be treated at dose level -1: Ipilumumab 3mg/kg + Nivolumab 1mg/kg IV day 1 every 3 weeks for 4 cycles, followed by Nivolumab 360 mg every 3 weeks. Sacituzumab Govitecan 6 mg/kg IV will be administered days 1 and 8 every 3 weeks
  • Ipilimumab
  • Nivolumab
  • Sacituzumab govitecan
Phase 2: Treatment at Maximum Tolerated Dose (MTD)ExperimentalParticipants will be treated at with Ipilumumab 3mg/kg + Nivolumab 1mg/kg IV day 1 every 3 weeks for 4 cycles, followed by Nivolumab 360 mg every 3 weeks plus the maximum tolerated dose of Sacituzumab Govitecan.
  • Ipilimumab
  • Nivolumab
  • Sacituzumab govitecan

Eligibility Criteria

        Inclusion Criteria:

          -  18 years of age or older

          -  Able to understand and give written informed consent.

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

          -  Participants with histologically documented locally advanced or metastatic urothelial
             carcinoma. Upper and lower tract tumors are permitted and mixed histologies are
             permitted if urothelial carcinoma is the predominant histology (≥50%).

          -  Ineligiblity for cisplatin-based chemotherapy, defined by any of the following: (a)
             Creatinine clearance (CL) <60 mL/min. GFR should be calculated from serum/plasma
             creatinine using the Cockcroft-Gault formula. (b) CTCAE v5.0 Grade > 1 hearing loss
             (c) CTCAE v5.0 Grade > 1 neuropathy (d) NYHA Class > II cardiac dysfunction

          -  Adequate organ function laboratory values as defined per protocol

          -  Have measurable disease by CT or MRI as per RECIST 1.1 criteria. Tumor lesions
             situated in a previously irradiated area are considered measurable if progression has
             been demonstrated in such lesions.

          -  Evidence of post-menopausal status or negative urinary or serum pregnancy test for
             female pre- menopausal patients. Women will be considered post-menopausal if they have
             been amenorrheic for 12 months without an alternative medical cause. The following
             age-specific requirements apply: (a) Women <50 years of age would be considered
             post-menopausal if they have been amenorrheic for 12 months or more following
             cessation of exogenous hormonal treatments and if they have luteinizing hormone and
             follicle-stimulating hormone levels in the post-menopausal range for the institution
             or underwent surgical sterilization (bilateral oophorectomy or hysterectomy). (b)
             Women ≥50 years of age would be considered post-menopausal if they have been
             amenorrheic for 12 months or more following cessation of all exogenous hormonal
             treatments, had radiation-induced menopause with last menses >1 year ago, had
             chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical
             sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).

          -  Male participants must agree to use an adequate method of contraception starting with
             the first dose of study therapy through 7 months after the last dose of study therapy.
             Female participants if sexually active must agree to use dual methods of contraception
             during the study and for a minimum period of 5 months after the last dose of study
             drug.

        Exclusion Criteria:

          -  Women who are pregnant or lactating.

          -  Currently participating in or has participated in a study of an investigational agent
             or using an investigational device within 4 weeks prior to the first dose of trial
             treatment.

          -  Prior chemotherapy for metastatic urothelial carcinoma at any time in the patient's
             medical history.

          -  Small-cell carcinoma component

          -  Prior chemotherapy for localized urothelial carcinoma completed within 12 months
             before registration. Has received anti-PD-1/PD-L1 therapy previously, except if used
             in earlier stage urothelial carcinoma such as non-muscle invasive bladder cancer
             (NMIBC) or muscle invasive bladder cancer (MIBC) as neoadjuvant or adjuvant therapy
             and completed >3 months prior to registration.

          -  Prior therapy with sacituzumab govitecan, irinotecan, or any topoisomerase
             I-containing regimen or antibody-drug conjugate

          -  Received radiation therapy for bone metastasis ≤2 weeks, any other radiation therapy
             within 4 weeks before first dose of study treatment. Systemic treatment with
             radionuclides within 6 weeks before the first dose of study treatment. Note: If
             subject received major surgery, they must have recovered adequately from the toxicity
             and/or complications from the intervention prior to starting therapy.

          -  Requires concomitant medication interfering with ABCA1 transporter or UGT1A1

          -  Participants with Gilbert's disease.

          -  An active second malignancy. Note: Participants with a history of malignancy that has
             been completely treated, with no evidence of active cancer for 3 years prior to
             enrollment, or subjects with surgically cured tumors with low risk of recurrence are
             allowed to- enroll.

          -  Known active CNS metastases and/or carcinomatous meningitis. Participants with
             previously treated brain metastases may participate provided they have stable CNS
             disease for at least 4 weeks prior to the first dose of study drug and all neurologic
             symptoms have returned to baseline), have no evidence of new or enlarging brain
             metastases, and are not using steroids greater than 20 mg of prednisone daily for
             brain metastases (or the equivalent) for at least 7 days prior to trial treatment. All
             participants with carcinomatous meningitis are excluded regardless of clinical
             stability.

          -  Active cardiac disease as defined in protocol.

          -  Active chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) and
             participants with a history of bowel obstruction.

          -  Prior history of clinically significant bleeding, intestinal obstruction, or GI
             perforation within 6 months of enrollment.

          -  Must be at least 2 weeks beyond high dose systemic corticosteroids (however, low dose
             corticosteroids ≤10 mg prednisone or equivalent daily are permitted for reasons
             outside of CNS disease provided the dose is stable for 4 weeks).

          -  Active infection requiring systemic treatment with therapeutic oral or IV antibiotics
             within 2 weeks prior to initiation of study treatment. Patients receiving prophylactic
             antibiotics (e.g., to prevent a urinary tract infection or chronic obstructive
             pulmonary disease exacerbation) are eligible for the study

          -  Active autoimmune disease requiring systemic treatment with steroids or other
             immunosuppressive agent or any condition that in the Investigator's judgment precludes
             treatment with IPI-NIVO

          -  Received a live vaccine within 30 days prior to the first dose of study drug(s)

          -  History or evidence of interstitial lung disease (ILD) or non-infectious pneumonitis

          -  Known history of HIV-1/2 with uncontrolled viral load and on medications that may
             interfere with SN-38 metabolism.

          -  Known active Hepatitis B or Hepatitis C (In subjects with a history of HBV, hepatitis
             B core antibody (HBcAb) testing is required and if positive, then HB DNA testing will
             be performed and if positive the patient will be excluded).

          -  Other concurrent medical or psychiatric conditions that, in the Investigator's
             opinion, may be likely to confound study interpretation or prevent completion of study
             procedure and follow-up examinations.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase 1: Maximum Tolerated Dose
Time Frame:Up to 12 months
Safety Issue:
Description:Determine the Maximum Tolerated Dose (MTD)/ Recommended Phase 2 dose (RP2D) of Sacituzumab Govitecan when combined with Ipilimumab and Nivolumab

Secondary Outcome Measures

Measure:Phase 1: Overall Response Rate
Time Frame:Up to 12 months
Safety Issue:
Description:Overall Response Rate is defined as the rate of the best overall response as complete response (CR) or partial response (PR)
Measure:Phase 1: Duration of Response (DOR)
Time Frame:Up to 12 months
Safety Issue:
Description:Duration of Response will be calculated as the date of the first evaluation showing documented response, partial response (PR) or complete response (CR), to the date of the first progressive disease (PD) or death.
Measure:Phase 1: Progression Free Survival (PFS)
Time Frame:Up to 12 months
Safety Issue:
Description:Progression Free Survival defined as the time from start of treatment to the first event of death or progressive disease (PD) per RECIST 1.1.
Measure:Phase 2: Progression Free Survival (PFS)
Time Frame:Up to 12 months
Safety Issue:
Description:Progression Free Survival defined as the time from start of treatment to the first event of death or progressive disease (PD) per RECIST 1.1.
Measure:Phase 2: Duration of Response (DOR)
Time Frame:Up to 12 months
Safety Issue:
Description:Duration of Response will be calculated as the date of the first evaluation showing documented response, partial response (PR) or complete response (CR), to the date of the first progressive disease (PD) or death.
Measure:Phase 2: Overall Survival (OS)
Time Frame:Up to 12 months
Safety Issue:
Description:Overall Survival defined as the length of time from start of treatment until death by any cause. Participants will be evaluated using Kaplan- Meier estimation for survival for up to 6 months after discontinuation of study treatment; patients surviving longer than 6 months will be censored.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:H. Lee Moffitt Cancer Center and Research Institute

Trial Keywords

  • mUC
  • Bladder cancer

Last Updated

May 10, 2021