Radiation Therapy With Combination Immunotherapy for Relapsed/Refractory Metastatic Melanoma

A Phase 1b/2 Study of Hypofractionated Radiation and Combination Immunotherapy for Relapsed/Refractory Metastatic Melanoma

This is a Phase 1b/2 study designed to evaluate combination of the human T-cell cytokine Interleukin-2 (IL-2) and a checkpoint inhibitor Ipilimumab immediately following a course of hypofractionated palliative radiation therapy in the management of unresectable, relapsed/refractory metastatic melanoma.

Study Overview

• Status: Withdrawn
• Conditions: Pulmonary Metastases; Metastatic Melanoma; Brain Metastases; Hepatic Metastases
• Intervention / Treatment: Drug: Interleukin-2 & Ipilimumab (P-Ib); Drug: Interleukin-2 & Ipilimumab (P-II)

Detailed Description

The sequential administration of Interleukin-2 (IL-2) following radiation therapy offers a rational immunologic priming strategy to expand antigen primed T cells under the growth promoting effects of Interleukin-2 therapy.

This clinical trial is designed to evaluate the combination of the T cell cytokine Interleukin-2 and the checkpoint inhibitor Ipilimumab in sequential combination following a course of hypofractionated palliative radiation therapy. The addition of single dose Ipilimumab offers rational timing of CTLA-4 checkpoint blockade to decrease activity of regulatory and suppressor T cell subsets following IL-2 based immunotherapy.

• Study Type: Interventional
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
      • Masonic Cancer Center - University of Minnesota

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Biopsy-proven unresectable, metastatic melanoma refractory to standard immunotherapy drugs or regimens, including prior treatment with Aldesleukin (IL-2), GM-CSF, Ipilimumab, Nivolumab, Pembrolizumab, and/or Imlygic (T-VEC).
• Prior clinical trial participation or treatment with molecularly targeted agents (i.e. Vemurafenib/Cobimetinib, Dabrafenib/Trametinib) or chemotherapy (i.e. Temozolomide, Dacarbazine, Platinum, or Taxanes) is permitted.

• Must have a minimum of 3 radiographically distinct (>1.5 cm) lesions measurable by RECIST 1.1 at time of study enrollment (>5 preferred).

  • A maximum of 2 metastases per treated organ may be targeted for HD-XRT, but must be separated by more than 5 cm of normal tissue
  • At least 2 non-irradiated lesions are required for systemic response assessments
• Pulmonary metastases: Pulmonary metastasis permissible. Appropriate candidates with lung lesions may be considered for ablative hypofractionation using SBRT.
• Hepatic metastases: Hepatic metastasis permissible. Appropriate candidates with metastasis to liver may be considered for ablative hypofractionation using SBRT.
• Brain metastases: Brain metastases may be treated using Gamma Knife Radiosurgery (GKR) or whole brain radiation therapy (WBRT) per the treating radiation oncologist. Total radiation dose and number of fractions will be determined by the treating radiation oncologist based on anatomic and dosing constraints. MRI of the vertebral column is required for all patients with suspected epidural tumor extension.
• Must have sufficient archival tissue block material (1.5 x 1.5 x 1.5 cm) and/or newly obtained core or excisional biopsy of tumor tissue; minimum of 2 cores.
• ECOG performance status 0 or 1 (appendix 2)
• Age 18 to 85 years of age; > 85 years of age must be approved by Principal Investigator.

• Adequate organ function within 14 days of registration (30 days for pulmonary and cardiac assessments) defined as:

  • Hematologic: Leukocytes ≥ 3,000/mcL, ANC ≥ 1,000/mcL, Hemoglobin ≥ 9.0 g/dL, Platelets ≥ 120,000/mcL
  • Renal: Serum creatinine ≤ 1.8 mg/dL; for patients with a creatinine > 1.5 mg/dL or a history of renal dysfunction, an estimated glomerular filtration rate ≥ 35 mL/min/1.73 m2 is required
  • Hepatic: AST, ALT, and alkaline phosphatase ≤ 10 x upper limit of normal and total bilirubin ≤ 2.0 mg/dL Pulmonary: oxygen saturation ≥90% on room air; corrected DLCO and FEV1, ≥ 50% predicted
  • Cardiac: Absence of clinical decompensated congestive heart failure or uncontrolled arrhythmia; left ventricular ejection fraction (echocardiogram within 6 months permitted) ≥ 40%. QTc must be < 450 ms in males and < 470 ms in females.
• Time from last anti-tumor treatment to first radiation treatment at least 1 week.
• Recovery from previous cancer treatment (≤ Grade 1 by CTCAE 4.0 criteria) prior to first radiation treatment
• Women of childbearing potential and males with partners of childbearing potential must agree to the use of barrier methods of contraception, hormonal contraceptives, or to abstain from heterosexual activity for the duration of study participation.
• Ability to understand and provide voluntary written informed consent

Exclusion Criteria:

• Pregnant or breast feeding. The agents used in this study have the potential to harm a fetus. Radiation is a known teratogen. There is insufficient information regarding potential for fetal harm during immunotherapy at this time. Biological females of childbearing potential must have a negative serum pregnancy test within 14 days of registration.
• Diagnosis of immunodeficiency
• Concurrent use of high dose steroids; chronic steroid use of < 2 mg dexamethasone or equivalent per day is permissible
• Concurrent malignancy requiring active treatment, except basal cell carcinoma of the skin, squamous cell carcinoma of the skin or carcinoma in situ
• Prior organ allograft or allogeneic transplantation
• Autoimmune disease
• Uncontrolled intercurrent or psychiatric illness or social situation that would limit compliance with study requirements
• Live vaccines within 30 days prior to the first dose of IL-2 and while participating in the trial. Examples of live vaccines include, but are not limited to, measles, mumps, rubella, chicken pox, yellow fever, rabies, BCG, and typhoid (oral) vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed. However, intranasal influenza vaccines (eg, Flu - Mist®) are live attenuated vaccines, and are not allowed.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Phase Ib (Dose Escalation)	Drug: Interleukin-2 & Ipilimumab (P-Ib); Phase Ib: - Ipilimumab will be administered in a 3 + 3 dose escalation design.; The starting dose will be 0.3 mg/kg administered within 7 days of day 1 cycle 2 ALdesleukin (IL-2).; If dose limiting autoimmune toxicities (DLTs) are not observed, the next cohort will receive 1.5 mg/kg.; The final cohort will receive 3 mg/kg, in the event that cohort 2 does not exhibit DLTs.; In the event of excessive toxicity in cohort 1, then a -1 dose level of 0.1 mg/kg may be evaluated in subsequent cohorts. Cohort sizes will increase to 6 patients if 1 of 3 patients in a cohort experience a DLT.; Once the maximum tolerated dose/recommended phase 2 dose (MTD/RP2D) is declared, no staggering of enrollment is required for accrual.; Other Names: IL-2; Yervoy
Experimental: Phase II (Dose Expansion)	Drug: Interleukin-2 & Ipilimumab (P-II); Phase II: - Interleukin-2 & Ipilimumab will be administered at the maximum tolerated dose/recommended phase 2 dose (MTD/RP2D).; Other Names: IL-2; Yervoy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phase 1: Maximum Tolerated Dose (MTD)	Incidence of Adverse Events	Cycle 2 Day 1
Phase 1: Maximum Tolerated Dose (MTD)	Incidence of Adverse Events	Cycle 2 Day 15
Phase 1: Maximum Tolerated Dose (MTD)	Incidence of Adverse Events	30 days after last IL-2
Phase 2: Objective Response Rate (ORR)	Disease re-assessment includes physical examination, as well as radiographic response assessment (RECIST v1.1) of non-irradiated target lesions using CT (or PET/CT) and/or at MRI.	Day 35
Phase 2: Objective Response Rate (ORR)	Disease re-assessment includes physical examination, as well as radiographic response assessment (RECIST v1.1) of non-irradiated target lesions using CT (or PET/CT) and/or at MRI.	30 days after last IL-2

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-free survival (PFS)	Incidence of PFS	Every 3 Months until 2 Years from 1st IL-2 Dose
Overall survival (OS)	Incidence of OS	Every 3 Months until 2 Years from 1st IL-2 Dose

Collaborators and Investigators

• Sponsor: Masonic Cancer Center, University of Minnesota
• Investigators: Principal Investigator: Domingo-Musibay Evidio, MD, Masonic Cancer Center, University of Minnesota

Study record dates

Study Major Dates

• Study Start (Actual): January 31, 2018
• Primary Completion (Anticipated): February 1, 2020
• Study Completion (Anticipated): February 1, 2020

Study Registration Dates

• First Submitted: September 26, 2017
• First Submitted That Met QC Criteria: September 26, 2017
• First Posted (Actual): September 29, 2017

Study Record Updates

• Last Update Posted (Actual): August 1, 2018
• Last Update Submitted That Met QC Criteria: July 30, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Neoplastic Processes; Central Nervous System Neoplasms; Nervous System Neoplasms; Neuroendocrine Tumors; Nevi and Melanomas; Neoplasm Metastasis; Brain Neoplasms; Melanoma; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Analgesics, Non-Narcotic; Antineoplastic Agents; Antineoplastic Agents, Immunological; Immune Checkpoint Inhibitors; Ipilimumab; Interleukin-2
• Other Study ID Numbers: 2016LS172

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No