- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04305145
Infliximab for Treatment of Immune Checkpoint Inhibitor Colitis
Phase II Study of Infliximab for the Treatment of Immune Checkpoint Inhibitor Colitis
The goal of this clinical trial is to compare the safety and effectiveness of infliximab compared to steroids for the treatment of immune checkpoint inhibitor-induced colitis (ICI colitis) in patients with stage III/IV skin cancer.
The main questions this study aims to answer are:
- How many patients treated with infliximab experience steroid-free disease resolution after 7 weeks?
- How many patients treated with steroids experience steroid-free disease resolution after 7 weeks?
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a phase II, randomized, signal-detection trial to evaluate the efficacy and safety of the drugs infliximab, methylprednisolone, and prednisone to manage the side of effect of colitis caused by immune checkpoint inhibitors (ICIs) that target a protein called CTLA-4. An example of one of these ICIs is ipilimumab, which has been approved by the FDA to treat metastatic melanoma.
The names of the treatments involved in this study are:
- Infliximab
- Methylprednisolone
- Prednisone
The FDA has approved infliximab, methylprednisolone, and prednisone to treat many conditions affecting the immune system, including colitis.
Participants will receive a CTLA-4 inhibitor, like ipilimumab, and any other cancer treatments as part of their regular care for stage III/IV skin cancer at the discretion of treating oncologist.
Participants who enroll in this study will undergo one or more flexible sigmoidoscopies or colonoscopies as part of their clinical care. The first of these procedures would occur at the time of study enrollment, and the second may occur after several weeks of treatment at the discretion of the study doctor. During these procedures, biopsies will be collected for clinical purposes as well as for research purposes. Blood will also be collected for research at the time of enrollment and at the time of study completion. Any extra samples for research would only be collected if it is safe for the participant.
Participants will also complete weekly follow-ups either over the phone or in-person that may last about 10 minutes. During these visits, participants will be asked about any new symptoms or changes in their health, their medications, and their GI symptoms. Blood for research may be collected at one or more of these visits if it coincides with a scheduled clinical blood draw.
Participants are expected to be on study treatment for approximately 7 weeks. Once participants complete the study treatment, the study team will review their medical records every 6 months for any changes in their health.
It is expected that about 42 people will take part in this research study.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Michael Dougan, MD, PHD
- Phone Number: 617-726-3527
- Email: Michael_Dougan@DFCI.HARVARD.EDU
Study Contact Backup
- Name: Keri Sullivan
- Phone Number: 617-724-0195
- Email: ksullivan79@mgh.harvard.edu
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02114
- Recruiting
- Massachusetts General Hospital Cancer Center
-
Contact:
- Michael Dougan, MD, PhD
- Email: michael_dougan@dfci.harvard.edu
-
Boston, Massachusetts, United States, 02215
- Recruiting
- Dana-Farber Cancer Institute
-
Contact:
- Nicole LeBoeuf, MD, MPH
- Email: Nicole_Leboeuf@dfci.harvard.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18
- Stage III/IV skin cancer
- Treatment with CTLA-4 inhibitor alone or in combination with PD-1or PD-L1 blockade within the past 8 weeks
- Clinically significant diarrhea resulting in the decision to pause immunotherapy treatment
- Endoscopically visible colitis (Mayo 1-3) at the time of screening
Exclusion Criteria:
- Prior history of inflammatory colitis related to immune checkpoint inhibitors requiring treatment with > 10 mg/day of prednisone or equivalent, or any other immunosuppressive medication
- Concurrent immune-related Adverse Event (irAE) requiring treatment with systemic corticosteroids (dose equivalent of prednisone 10 mg/day or higher) or another systemic immune suppressing medication within the past 10 days
- Current use of any immune suppressing biologic medication, or use within the last 4 weeks; immune stimulating medications such as checkpoint blockade are explicitly permitted
- Current use of combination treatment with an investigation immunotherapy targeting a pathway other than PD-1 or PD-L1, concurrent chemotherapy, or targeted therapy
- Previous adverse reaction to infliximab or corticosteroids
- Colonic perforation or abscess present at the time of screening
- History of Hepatitis B or C with a positive viral load, untreated mycobacterium tuberculosis, or active herpes zoster infection
- Current bacterial infection requiring antibiotic treatment, or systemic fungal infection
- Prior history of inflammatory bowel disease, microscopic colitis or segmental colitis associated with diverticulosis
- Received more than 3 doses of systemic corticosteroids, or receive dsystemic corticosteroids at a dose exceeding 2mg/kg methylprednisolone or equivalent, within 72 hours prior to endoscopy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Infliximab
Patients randomized to this arm will receive IV infliximab regardless of whether they are hospitalized due to their colitis.
|
Infusion
Other Names:
|
Experimental: Corticosteroids
Patients randomized to this arm will receive IV steroids or oral steroids depending on whether the severity of their colitis requires hospitalization ("inpatient").
Crossover for inadequate response: Patients who do not respond to initial treatment within 3 days with a decrease in symptoms by one grade, or who do not improve to grade 2 or less symptoms by 5 days will add combination therapy from the other treatment arm (infliximab) at full initial dosing. |
Infusion
Other Names:
Orally
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients with Steroid-Free Colitis
Time Frame: 7 weeks
|
Proportion of Patients with Steroid-Free Colitis at seven weeks with steroid-free colitis remission defined as less than 7.5 mg a day of prednisone or equivalent and grade-1 or lower symptoms.
|
7 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of Participants with Treatment Related Adverse Events as Assessed by CTCAE 5.
Time Frame: 6 Months
|
National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
|
6 Months
|
The proportion of patients requiring secondary immune suppression-Infliximab
Time Frame: 7 Weeks
|
patients randomly assigned to infliximab, secondary immune support will be defined as requiring subsequent treatment with steroids.
The proportions of patients in each treatment arm requiring secondary immune suppression will be summarized and presented with 90% exact binomial confidence intervals
|
7 Weeks
|
The proportion of patients requiring secondary immune suppression-Steroids
Time Frame: 7 Weeks
|
patients randomly assigned to steroids, secondary immune support will be defined as requiring subsequent treatment with steroids.
The proportions of patients in each treatment arm requiring secondary immune suppression will be summarized and presented with 90% exact binomial confidence intervals
|
7 Weeks
|
Time to steroid-free remission
Time Frame: randomization to grade-1 or lower symptoms of colitis and less than 7.5 mg a day of prednisone or equivalent or up to 6 months
|
The initial analysis of steroid-free remission will be based on cumulative incidence (1-Kaplan-Meier estimates).
|
randomization to grade-1 or lower symptoms of colitis and less than 7.5 mg a day of prednisone or equivalent or up to 6 months
|
Rate of Symptom Remission at 72 hours
Time Frame: 72 hours
|
The proportion of patients in each treatment arm who have colitis symptom reduction to grade-1 or less within 72 hours of starting randomized treatment will be summarized and presented with 90% exact binomial confidence intervals.
The treatment arms will be compared using Fisher's exact tests.
|
72 hours
|
Rate of Symptom Remission at 4 Weeks
Time Frame: 4 weeks
|
The proportion of patients in each treatment arm who have colitis symptom reduction to grade-1 or less within 72 hours of starting randomized treatment will be summarized and presented with 90% exact binomial confidence intervals.
The treatment arms will be compared using Fisher's exact tests.
|
4 weeks
|
Proportion of patients with colectomy or colitis-specific mortality
Time Frame: 7 weeks
|
The proportions of patients with colectomy or colitis-specific mortality (investigator assessed) will be presented by treatment arm with 90% exact binomial confidence intervals
|
7 weeks
|
Cumulative steroid exposure
Time Frame: 7 weeks
|
Cumulative steroid exposure over time for each patient will be calculated by adding the number of doses multiplied by strength of dose over the total follow-up time. Steroid exposure will be summarized descriptively for each treatment arm, and compared using a Wilcoxon rank-sum test. With 20 patients per treatment arm, a Wilcoxon rank-sum test will have 80% power to detect a 41difference in cumulative steroid exposure that is 0.85 times the common standard deviation, assuming a one-sided, type-I error of 10 |
7 weeks
|
Progression Free Survival
Time Frame: duration of time from start of randomization to time of progression or death, whichever occurs first or up to 24 months.
|
summarized using the method of Kaplan-Meier and compared using stratified log-rank tests
|
duration of time from start of randomization to time of progression or death, whichever occurs first or up to 24 months.
|
Overall Survival
Time Frame: the duration of time from start of randomization to time of death or up to 24 months
|
summarized using the method of Kaplan-Meier and compared using stratified log-rank tests
|
the duration of time from start of randomization to time of death or up to 24 months
|
Overall Response Rate
Time Frame: proportion of evaluable patients who achieve either a (complete response) CR or (partial response) PR or up to 24 Months
|
Response rates will be summarized by treatment arm and presented with 90% exact binomial confidence intervals.
The comparison of response rates between treatment arms will use Fisher's exact test
|
proportion of evaluable patients who achieve either a (complete response) CR or (partial response) PR or up to 24 Months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Michael Dougan, MD, PHD, Massachusetts General Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Chemically-Induced Disorders
- Digestive System Diseases
- Skin Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Gastrointestinal Diseases
- Gastroenteritis
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Colonic Diseases
- Intestinal Diseases
- Neuroendocrine Tumors
- Nevi and Melanomas
- Melanoma
- Colitis
- Skin Neoplasms
- Drug-Related Side Effects and Adverse Reactions
- Physiological Effects of Drugs
- Autonomic Agents
- Peripheral Nervous System Agents
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Antiemetics
- Gastrointestinal Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Neuroprotective Agents
- Protective Agents
- Dermatologic Agents
- Tumor Necrosis Factor Inhibitors
- Prednisolone
- Methylprednisolone Acetate
- Methylprednisolone
- Methylprednisolone Hemisuccinate
- Prednisolone acetate
- Prednisolone hemisuccinate
- Prednisolone phosphate
- Prednisone
- Infliximab
Other Study ID Numbers
- 19-763
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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