Ramucirumab + Pembrolizumab hos patienter med tilbagevendende/metastaserende hoved- og halspladecellecarcinom
Et prospektivt fase I og II forsøg med Ramucirumab + Pembrolizumab hos patienter med recidiverende/metastatisk hoved- og halspladecellekræft
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 2
- Fase 1
Kontakter og lokationer
Studiesteder
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Missouri
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St Louis, Missouri, Forenede Stater, 63110
- Washington University School of Medicine
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
Uhelbredelig HNSCC, defineret som RM-sygdom, der ikke kan helbredes ved kirurgi og/eller strålebehandling, eller patient med HNSCC falder eller er ikke egnet til helbredende terapi
- I fase I, mundhulen, oropharynx, strubehovedet, hypopharynx, nasopharynx, paranasal sinus eller spytkirtel
- I fase II, mundhule, oropharynx, larynx eller hypopharynx
Sygdomsvurdering:
- I fase I, evaluerbar eller målbar sygdom.
- I fase II, målbar sygdom pr. RECIST 1.1
Forudgående behandling:
- For fase I, et hvilket som helst antal linjer af tidligere behandling for RM-HNSCC.
- For fase II, ingen tidligere systemisk behandling for RM-HNSCC.
- Mindst 18 år.
- Ydelsesstatus 0-2 (ECOG).
Tilstrækkelig blod- og organfunktion som defineret:
- Absolut neutrofiltal ≥ 1.500/mcL
- Blodplader ≥ 100.000/mcL
- Hæmoglobin ≥ 9,0 g/dL
- Total bilirubin ≤ 1,5 mg/dL
- AST(SGOT) ≤ 3 x institutionel øvre normalgrænse (IULN) og ALT(SGPT) ≤ 3 x IULN. Ved levermetastaser er ASAT < 5 x IULN og ALT < 5 x IULN.
- Kreatinin ≤ 2 x ULN ELLER kreatininclearance ≥ 40 ml/min/1,73 m2
- Urinprotein til kreatinin-forhold (UPC) ≤ 1; hvis UPC ≥ 1, så skal et 24-timers urinprotein vurderes; patienter skal have en 24-timers urinproteinværdi < 1 g for at være berettiget
- INR ≤ 1,5 x ULN (≤ 3,0 x ULN hvis på antikoagulering) og PTT ≤ 1,5 x ULN (
- Kvinder i den fødedygtige alder og mænd skal acceptere at bruge passende prævention (hormonel prævention eller barrieremetode til prævention, abstinens) begyndende 14 dage før første dosis ramucirumab, gennem doseringsperioden og i mindst 28 dage efter.
- Underskrevet IRB godkendt skriftligt informeret samtykke dokument.
Ekskluderingskriterier:
- Fase II: tidligere PD-1-hæmmer til behandling af uhelbredelig HNSCC. For fase I er forudgående behandling med PD-1-hæmmere i uhelbredelige omgivelser tilladt.
- Stråling, kemoterapi, målrettet eller forsøgsbehandling inden for 14 dage efter behandlingsstart.
- Større operation, tilstedeværelse af et ikke-helende, ikke-malignt sår inden for 14 dage efter behandlingsstart; Anamnese med betydelig blødning fra tumorstedet inden for 14 dage efter studiesamtykke.
- Anamnese med anden malignitet ≤ 1 år tidligere med undtagelse af fuldstændigt resekeret hudkarcinom eller andre kræftformer med lav risiko for tilbagefald.
- Cirrhose på et niveau af Child-Pugh B (eller værre), skrumpelever af enhver grad med en historie med hepatisk encefalopati eller klinisk betydningsfuld ascites (fra skrumpelever, der kræver diuretika eller paracentese).
- Modtagelse af andre undersøgelsesmidler.
- Vedvarende toksicitet tilskrevet tidligere anti-cancerbehandling, der er > grad 1, undtagen alopeci, anæmi, træthed eller udslæt.
- Aktive metastaser i centralnervesystemet: defineret som aktuelt modtagende strålebehandling til metastatisk CNS-sygdom. Når strålebehandlingen er afsluttet, er patienter med CNS-sygdom kvalificerede, hvis de opfylder alle andre kriterier for tilmelding.
- Anamnese med alvorlige allergiske reaktioner tilskrevet midler anvendt i undersøgelsen.
- Alvorlig ukontrolleret interaktuel sygdom inden for de 3 måneder forud for studiestart eller psykiatrisk sygdom/sociale situationer, der ville begrænse overholdelse af studiekrav.
- Modtager systemisk steroidbehandling (i en dosis på over 20 mg dagligt prednisonækvivalent) eller enhver anden form for immunsuppressiv terapi inden for 7 dage før den første dosis af pembrolizumab.
- Har en aktiv autoimmun sygdom (dvs. rheumatoid arthritis, lupus, Sjogrens syndrom), som har krævet IV eller subkutan systemisk behandling inden for de seneste 6 måneder (undtagen rituxin). Erstatningsterapi (dvs. thyroxin, insulin eller fysiologisk kortikosteroiderstatningsterapi for binyre- eller hypofyseinsufficiens osv.) betragtes ikke som en form for systembehandling.
- GI-perforation eller fistel inden for 6 måneder efter første dosis af protokolbehandling
- Anamnese med GI-problemer såsom inflammatorisk tarmsygdom, colitis ulcerosa eller Crohns sygdom.
- Dårligt kontrolleret hypertension (defineret som målinger af højt blodtryk [systolisk blodtryk på ≥ 160 mmHg eller diastolisk blodtryk på > 100 mmHg] dokumenteret i løbet af 2-ugers intervallet før tilmelding). Påbegyndelse eller justering af antihypertensiv medicin for at kontrollere blodtrykket er tilladt før studiestart.
- Arterielle tromboemboliske hændelser (herunder, men ikke begrænset til, myokardieinfarkt, forbigående iskæmisk anfald, cerebrovaskulær ulykke eller ustabil angina) inden for 3 måneder før første dosis af behandlingen.
- GI-blødning (grad 3 eller 4) inden for 3 måneder før første dosis.
- Gravid og/eller ammende. Patienten skal have en negativ serumgraviditetstest inden for 7 dage efter første dosis af behandlingen.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomiseret
- Interventionel model: Sekventiel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Eksperimentel: Phase I Dose Level 1 : Ramucirumab (10 mg/kg) + Pembrolizumab
Participants enrolled in Phase I Dose Level 1 received 10 mg/kg ramucirumab administered intravenously (IV) on Day 1. Pembrolizumab was administered as per standard of care (SOC) IV at a dose of 200 mg on Day 1.
Each cycle was 21 days.
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Pembrolizumab er kommercielt tilgængeligt
Andre navne:
Ramucirumab er et forsøgsmiddel til dette forsøg og vil blive leveret af Lilly Oncology, gratis til patienten
Andre navne:
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Eksperimentel: Phase II: Ramucirumab (10 mg/kg) + Pembrolizumab
Participants enrolled in the Phase II portion received 10 mg/kg intravenous ramucirumab which was the recommended phase 2 dose (RP2D) determined during the Phase I portion on Day 1. Pembrolizumab was administered as per standard of care (SOC) IV at a dose of 200 mg on Day 1.
Each cycle was 21 days.
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Pembrolizumab er kommercielt tilgængeligt
Andre navne:
Ramucirumab er et forsøgsmiddel til dette forsøg og vil blive leveret af Lilly Oncology, gratis til patienten
Andre navne:
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Recommended Phase 2 Dose (RP2D) of Ramucirumab Combined With Fixed Dose Pembrolizumab (Phase I Participants Only)
Tidsramme: Completion of first cycle of treatment (each cycle is 21 days) for all participants enrolled in Phase I portion of study (estimated to be 2.5 months)
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-The RP2D of ramucirumab is defined as the highest dose level at which fewer than 2 participants of a cohort of three participants experience a dose-limiting toxicity (DLT) during the first cycle.
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Completion of first cycle of treatment (each cycle is 21 days) for all participants enrolled in Phase I portion of study (estimated to be 2.5 months)
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Objective Response Rate of Ramucirumab and Pembrolizumab (Phase II Participants Only)
Tidsramme: Through completion of treatment (median length of follow-up 162 days, full range 1-2240 days)
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Through completion of treatment (median length of follow-up 162 days, full range 1-2240 days)
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Adverse Event Profile of the Combination of Ramucirumab and Pembrolizumab (Phase I and II Participants) as Measured by the Frequency of Adverse Events
Tidsramme: Through 28 days after completion of treatment (median length of follow-up 183 days, full range 14-2240 days)
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-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.
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Through 28 days after completion of treatment (median length of follow-up 183 days, full range 14-2240 days)
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Duration of Response (Phase II Participants Only)
Tidsramme: Through completion of follow-up (median length of follow-up of 445 days, full range 14-2240 days)
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-Duration of response: The duration of response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
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Through completion of follow-up (median length of follow-up of 445 days, full range 14-2240 days)
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Kaplan-Meier Estimate of Median Progression-free Survival (PFS) (Phase II Participants Only)
Tidsramme: Through completion of follow-up (median length of follow-up of 445 days, full range 14-2240 days)
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Through completion of follow-up (median length of follow-up of 445 days, full range 14-2240 days)
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Kaplan-Meier Estimate of Median Overall Survival (OS) (Phase II Participants Only)
Tidsramme: Through completion of follow-up (median length of follow-up of 445 days, full range 14-2240 days)
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OS is defined as the duration of time from start of treatment to time of death (or last follow-up alive).
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Through completion of follow-up (median length of follow-up of 445 days, full range 14-2240 days)
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Changes in Quality of Life as Measured by Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) (Phase II Participants Only)
Tidsramme: Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Changes in Quality of Life as Measured by Functional Assessment of Cancer Therapy-Head and Neck Trial Outcome Index (FACT-H&N TOI) (Phase II Participants Only)
Tidsramme: Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Changes in Quality of Life as Measured by Functional Assessment of Cancer Therapy-General (FACT-G) (Phase II Participants Only)
Tidsramme: Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Changes in Quality of Life as Measured by The European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-30) - Global Health Status (Phase II Participants Only)
Tidsramme: Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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EORTC QLQ-C30: this has a total score, one general quality of life (QoL), and one "within the last week" subscale, as well as a general health item and a single overall QoL item.
This study does not use current empirical guidelines for the EORTC-QLQ-30 global score with the understanding that both the magnitude and variance of scores vary considerably from patient to patient, from one time point to another and by such factors as disease condition, age, and comorbidity.
The participants can choose from 1-4 with 1 being Not At All and 4 being Very Much.
A high scale score represents a higher response level but these differ based on the type of sub-scale.
Per the QLQ-C30 scoring manual, a high score for the global health status / QoL represents a high QoL, The total score range was 0-100.
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Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Changes in Quality of Life as Measured by The European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-30) - Functional Scale (Phase II Participants Only)
Tidsramme: Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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EORTC QLQ-C30: this has a total score, one general quality of life (QoL), and one "within the last week" subscale, as well as a general health item and a single overall QoL item.
This study does not use current empirical guidelines for the EORTC-QLQ-30 global score with the understanding that both the magnitude and variance of scores vary considerably from patient to patient, from one time point to another and by such factors as disease condition, age, and comorbidity.
The participants can choose from 1-4 with 1 being Not At All and 4 being Very Much.
A high scale score represents a higher response level but these differ based on the type of sub-scale.
Per the QLQ-C30 scoring manual, high score for a functional scale represents a high / healthy level of functioning.
The total score range was 0-100.
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Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Changes in Quality of Life as Measured by The European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-30) - Symptom Scale (Phase II Participants Only)
Tidsramme: Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
|
EORTC QLQ-C30: this has a total score, one general quality of life (QoL), and one "within the last week" subscale, as well as a general health item and a single overall QoL item.
This study does not use current empirical guidelines for the EORTC-QLQ-30 global score with the understanding that both the magnitude and variance of scores vary considerably from patient to patient, from one time point to another and by such factors as disease condition, age, and comorbidity.
The participants can choose from 1-4 with 1 being Not At All and 4 being Very Much.
A high scale score represents a higher response level but these differ based on the type of sub-scale.
Per the QLQ-C30 scoring manual, a high score for a symptom scale / item represents a high level of symptomatology / problems.
The total score range was 0-100.
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Baseline, start of cycle 2 (each cycle is 21 days), and start of cycle 5 (estimated to be 12 weeks)
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Douglas R Adkins, M.D., Washington University School of Medicine
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Neoplasmer efter sted
- Neoplasmer
- Neoplasmer efter histologisk type
- Neoplasmer i hoved og hals
- Neoplasmer, kirtel og epitel
- Karcinom
- Karcinom, pladecelle
- Planocellulært karcinom i hoved og hals
- Aminosyrer, peptider og proteiner
- Proteiner
- Antistoffer, monoklonal, humaniseret
- Antistoffer, monoklonal
- Antistoffer
- Immunoglobuliner
- Immunoproteiner
- Blodproteiner
- Serum globuliner
- Globuliner
- Ramucirumab
- pembrolizumab
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 201809094
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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