Study of the Effects of Pembrolizumab in Patients With Advanced Solid Tumors

NCT02644369Active, Not RecruitingPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

University Health Network, Toronto

Enrollment

100

Start Date

2016-03-21

Completion Date

2026-12-01

Study Type

INTERVENTIONAL

Official Title

Investigator-initiated Phase II Study of Pembrolizumab Immunological Response Evaluation

Interventions

Pembrolizumab

Conditions

Squamous Cell Cancer of Head and NeckTriple Negative Breast CancerEpithelial Ovarian CancerMalignant MelanomaAdvanced Solid Tumors

Eligibility

Age Range

18 Years+

Sex

ALL

Inclusion Criteria:

* Be willing and able to provide written informed consent/assent for the trial.
* Be 18 years of age or older on day of signing informed consent.
* Have histologically or cytologically-documented, locally-advanced, or metastatic solid malignancy that is incurable and has either (a) failed prior standard therapy, (b) for which no standard therapy exists, or (c) standard therapy is not considered appropriate by the patient and treating physician. There is no limit to the number of prior treatment regimens.
* Have one of the following advanced (unresectable and/or metastatic) solid tumor indications:

  * Squamous cell cancer of head and neck
  * Triple negative breast cancer
  * Epithelial ovarian cancer
  * Malignant melanoma
  * Advanced solid tumors
* Have measurable disease based on Response Evaluation Criteria In Solid Tumors (RECIST) 1.1.
* Be willing to provide tissue from a newly obtained core or excisional biopsy of a tumor lesion. Patients for whom newly-obtained samples cannot be provided (e.g. inaccessible or patient safety concern) will not be eligible for this study.
* Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale.
* Demonstrate adequate organ function.
* Negative pregnancy test for female patients of childbearing potential.
* Must use approved methods of birth control during the course of the study and for 120 days after the last dose of study drug.

Exclusion Criteria:

* Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment.
* 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 trial treatment.
* Has a known history of active TB (Bacillus Tuberculosis).
* Hypersensitivity to pembrolizumab or any of its excipients.
* Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study Day 1 or who has not recovered from adverse events due to agents administered more than 4 weeks earlier.
* Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to Study Day 1 or who has not recovered from adverse events due to a previously administered agent.
* Has a known additional malignancy that is progressing or requires active treatment.
* Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
* Has active autoimmune disease that has required systemic treatment in the past 2 years
* Has known history of, or any evidence of active, non-infectious pneumonitis.
* Has an active infection requiring systemic therapy.
* Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating investigator.
* Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
* Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with screening visit through 120 days after the last dose of trial treatment.
* Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent.
* Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
* Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA \[qualitative\] is detected).
* Has received a live vaccine within 30 days of planned start of study therapy.

Outcome Measures

Primary Outcomes

Changes in genomic and immune biomarkers that will be measured in blood and tumor pre-treatment, on-treatment and at progression (progression biopsies only done for those who have complete or partial responses, or stable disease for more than 4 months)

T-test or Wilcoxon's test

Time frame: 5 years

Secondary Outcomes

Overall response rate

summary statistics

Time frame: 5 years

Changes in circulating tumor DNA genomic biomarkers

T-test or Wilcoxon's test

Time frame: 5 years

Changes in radiomic imaging parameters

T-test or Wilcoxon's test

Time frame: 5 years

Correlation between tumor genomic profiles and radiomic imaging signatures

Pearson correlation coefficients, chi-square tests, one- or two-sample t-tests or logistic regression analyses as appropriate. Non-parametric tests such as Spearman correlation coefficients, Fisher's exact tests and Wilcoxon rank sum tests may be substituted if necessary.

Time frame: 5 years

Changes in immune cell subsets in the blood and tumor microenvironment

T-test or Wilcoxon's test

Time frame: 5 years

Positive predictive value and negative predictive value of in vitro predictive assay for Pembrolizumab response

Positive predictive value and negative predictive value

Time frame: 5 years

Distribution of drug tumor penetration using a mass spectrometry assay

summary statistics

Time frame: 5 years

Baseline tumor RNA expression profile for immune inhibitory genes

summary statistics

Time frame: 5 years

Comparison of baseline tumor RNA expression profile for immune inhibitory genes with clinical outcome (response)

T-test or Wilcoxon's test

Time frame: 5 years

Locations

Princess Margaret Cancer Centre, Toronto, Canada

Linked Papers

Combined Transcriptome and Circulating Tumor DNA Longitudinal Biomarker Analysis Associates With Clinical Outcomes in Advanced Solid Tumors Treated With Pembrolizumab

PURPOSE Immune gene expression signatures are emerging as potential biomarkers for immunotherapy (IO). VIGex is a 12-gene expression classifier developed in both nCounter (Nanostring) and RNA sequencing (RNA-seq) assays and analytically validated across laboratories. VIGex classifies tumor samples into hot, intermediate-cold (I-Cold), and cold subgroups. VIGex-Hot has been associated with better IO treatment outcomes. Here, we investigated the performance of VIGex and other IO biomarkers in an independent data set of patients treated with pembrolizumab in the INSPIRE phase II clinical trial (ClinicalTrials.gov identifier: NCT02644369 ). MATERIALS AND METHODS Patients with advanced solid tumors were treated with pembrolizumab 200 mg IV once every 3 weeks. Tumor RNA-seq data from baseline tumor samples were classified by the VIGex algorithm. Circulating tumor DNA (ctDNA) was measured at baseline and start of cycle 3 using the bespoke Signatera assay. VIGex-Hot was compared with VIGex I-Cold + Cold and four groups were defined on the basis of the combination of VIGex subgroups and the change in ctDNA at cycle 3 from baseline (ΔctDNA). RESULTS Seventy-six patients were enrolled, including 16 ovarian, 12 breast, 12 head and neck cancers, 10 melanoma, and 26 other tumor types. Objective response rate was 24% in VIGex-Hot and 10% in I-Cold/Cold. VIGex-Hot subgroup was associated with higher overall survival (OS) and progression-free survival (PFS) when included in a multivariable model adjusted for tumor type, tumor mutation burden, and PD-L1 immunohistochemistry. The addition of ΔctDNA improved the predictive performance of the baseline VIGex classification for both OS and PFS. CONCLUSION Our data indicate that the addition of ΔctDNA to baseline VIGex may refine prediction for IO.

Linked Investigators

Elena Garralda

Dr Elena Garralda has developed an internationally recognized career in early drug development, leading transformative initiatives in precision oncology and next-generation cell therapies. She is Director of the Molecular Cancer Therapy Research Unit (UITM) CaixaResearch at Vall dHebron Institute of Oncology (VHIO), Co-Director of VHIOs Clinical Research Program, and Head of the Early Drug Development Group. Her work has directly impacted the approval of novel therapies and the implementation of innovative clinical trial designs. SCIENTIFIC CONTRIBUTIONS 1. Leadership in Early Drug Development: director of the UITMCaixaResearch, one of Europes top early-phase clinical trial units. Under her leadership, over 2,800 clinical trials (including 1,600 Phase I) have been conducted, contributing to 61 regulatory approvals (EMA/FDA), significantly shaping the development of new anticancer therapies. N Engl J Med. 2023; doi:10.1056/NEJMoa2303810; Nat Med. 2022; doi:10.1038/s41591-022-01931-y; Nat Med. 2022; doi:10.1038/s41591-022-01717-2 2. Pioneering Next-Generation Cell Therapy: Principal Investigator of projects developing TIL-based therapies targeting neoantigens in tumours resistant to immune checkpoint inhibitors. Her research advances cell therapy beyond melanoma to broader solid tumours. Dr. Garralda leads innovative trials in TIL therapy such as NEXTGENTIL, TILTS and ARES-TIL. 3. Advances in Immunotherapy with Bispecific Antibodies: led early clinical studies of bispecific antibodies, such as FS222, demonstrating clinical efficacy in solid tumours. Her contributions provide new therapeutic strategies in immuno-oncology. Cancer Discov. 2023; doi:10.1158/2159-8290.CD-22 -0523 4. Major Contributions to Precision Oncology in Europe: As Project coordinator in EU-funded projects like CCE-DART, and PI of PCM4EU and CanSERV, she has driven the integration of molecular profiling and biomarker-driven therapies across European cancer centers. Nat Cancer. 2022; doi:10.1038/s43018-022-00332-x 5. Invited Speaker and Congress Contributions: presented at leading conferences including ASCO, ESMO GI, and ESMO TAT, discussing the impact of KRAS inhibitors, long-term survival in Phase I trials, neoadjuvant immunotherapy, and advances in TIL therapies. These presentations have helped disseminate critical advancements in early drug development globally. STRATEGIC ROLES 6. Scientific Committee Memberships and International Recognition: Member of key committees such as the RECIST Working Group (current chair), ESMO Scientific Committees and the AACR/NCI/EORTC Scientific Committee, influencing international standards in cancer clinical research. 7. Leadership in Cancer Research Consortia: Clinical Trials Task Force Group Leader at Cancer Core Europe, a leading consortium aiming to advance collaborative precision oncology across Europe. FUNDING AND PROJECTS 8. Principal Investigator in Competitive Grants: Coordinates multiple national and European projects, including CCE-DART (Horizon 2020), SMART Trials (AECC), and next-generation TIL therapies (Instituto de Salud Carlos III), securing competitive funding and fostering translational innovation. 9. Project Cordinator for The Pragmatic approach to Adoptive Cell Therapy (ACT) using Tumor Infiltrating Lymphocytes (TIL) in selected solid tumors (PragmaTIL), a project that received funding from the EUs Horizon Europe RECOGNITIONS 10. Awards and Accreditations: Recipient of the Texas Society of Clinical Oncology Fellows Abstract Award (2013) and Certification by the Educational Commission for Foreign Medical Graduates (ECFMG, 2012). Faculty member at the prestigious MCCR Workshop (EORTC-ESMO-AACR) since 2022, recognizing her educational leadership in clinical cancer research.