Testing the Addition of the Immunotherapy Drug Pembrolizumab to the Usual Chemotherapy Treatment (Paclitaxel and Carboplatin) in Stage III-IV or Recurrent Endometrial Cancer

  • STATUS
    Recruiting
  • End date
    Jun 30, 2023
  • participants needed
    810
  • sponsor
    National Cancer Institute (NCI)
Updated on 8 April 2021
ct scan
paclitaxel
cancer
hysterectomy
absolute neutrophil count
monoclonal antibodies
serum pregnancy test
measurable disease
carcinoma
oophorectomy
MRI
replacement therapy
neutrophil count
carboplatin
hormone therapy
tumor cells
pembrolizumab
primary tumor
brachytherapy
adenocarcinoma
step 2
thyroid stimulating hormone
pelvic radiation
undifferentiated carcinoma
endometrioid adenocarcinoma
papillary serous adenocarcinoma
clear cell adenocarcinoma
recurrent endometrial cancer
serous adenocarcinoma

Summary

This phase III trial studies how well the combination of pembrolizumab, paclitaxel and carboplatin works compared with paclitaxel and carboplatin alone in treating patients with endometrial cancer that is stage III or IV, or has come back (recurrent). Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Paclitaxel and carboplatin are chemotherapy drugs used as part of the usual treatment approach for this type of cancer. This study aims to assess if adding immunotherapy to these drugs is better or worse than the usual approach for treatment of this cancer.

Description

PRIMARY OBJECTIVE:

I. To evaluate the efficacy of pembrolizumab (MK-3475) in combination with paclitaxel and carboplatin in patients with advanced stage (measurable stage III or IVA), stage IVB and recurrent endometrial cancer.

SECONDARY OBJECTIVES:

I. To determine the nature, frequency and degree of toxicity as assessed by Common Terminology Criteria for Adverse Events (CTCAE) for each treatment arm.

II. To evaluate blinded independent central review (BICR) assessed or investigator assessed objective response rate (ORR) as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 by treatment arm and by mismatch repair (MMR) status in patients who enter the study with measurable disease.

III. To evaluate BICR assessed or investigator assessed duration of response (DOR) by treatment arm and by MMR status in patients who enter the study with measurable disease.

IV. To evaluate the effect of pembrolizumab on overall survival (OS) in patients with mismatch repair protein proficient (pMMR) or mismatch repair deficiency (dMMR).

V. To determine whether the addition of pembrolizumab (MK-3475) to standard combination chemotherapy is associated with improved patient reported physical function as measured with the Patient-Reported Outcomes Measurement Information System (PROMIS)-physical function scale (short form), quality of life as measured with the Functional Assessment of Cancer Therapy (FACT) - Endometrial Trial Outcome Index (En TOI) and worsened fatigue as measured with the PROMIS-Fatigue scale (short form) in the pMMR patients.

VI. To determine concordance between institutional MMR immunohistochemistry (IHC) testing and centralized MMR IHC.

EXPLORATORY OBJECTIVES:

I. To explore the correlation between patient-reported physical function as measured with the PROMIS-physical function scale (short form) and quality of life as measure with the FACT-En TOI.

II. To explore whether the addition of pembrolizumab (MK-3475) to standard combination chemotherapy is associated with self-reported neurotoxicity as measured with the FACT/Gynecologic Oncology Group Neurotoxicity (GOG-Ntx) subscale (short) and the extent to which patients differ on their self-reported bother from side effects of cancer therapy in the pMMR patients.

III. To evaluate the efficacy of pembrolizumab (MK-3475) in combination with paclitaxel and carboplatin in patients with advanced stage (measurable stage III or IVA), stage IVB and recurrent endometrial cancer by PD-L1 IHC (positive versus [vs] negative).

IV. To assess the association between PD-L1 IHC (positive vs negative) and mismatch repair status (pMMR and dMMR).

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I:

COMBINATION PHASE: Patients receive placebo intravenously (IV) over 30 minutes on day 1, paclitaxel IV over 3 hours on day 1, and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 3 weeks for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients with stable disease (SD) or partial response (PR) who still have measurable disease may continue treatment for up to a total 10 cycles (if deemed necessary by the treating physician) in the absence of disease progression or unacceptable toxicity.

MAINTENANCE PHASE: Patients receive placebo IV over 30 minutes on day 1. Treatment repeats every 6 weeks for up to 14 cycles in the absence of disease progression or unacceptable toxicity.

ARM II:

COMBINATION PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1, paclitaxel IV over 3 hours on day 1, and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 3 weeks for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients with SD or PR who still have measurable disease may continue treatment for up to a total of 10 cycles (if deemed necessary by the treating physician) in the absence of disease progression or unacceptable toxicity.

MAINTENANCE PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 6 weeks for up to 14 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Details
Condition Endometrial Clear Cell Adenocarcinoma, Endometrial Serous Adenocarcinoma, Recurrent Endometrial Cancer, Endometrial Undifferentiated Carcinoma, Endometrial Endometrioid Adenocarcinoma, Recurrent Endometrial Serous Adenocarcinoma, Stage IV Uterine Corpus Cancer AJCC v8, Stage IVA Uterine Corpus Cancer AJCC v8, Stage IVB Uterine Corpus Cancer AJCC v8, Recurrent Endometrial Carcinoma, Recurrent Endometrial Endometrioid Adenocarcinoma, Endometrial Mixed Cell Adenocarcinoma, Recurrent Endometrial Adenocarcinoma, Recurrent Endometrial Clear Cell Adenocarcinoma, Recurrent Endometrial Mixed Cell Adenocarcinoma, Recurrent Endometrial Undifferentiated Carcinoma, Stage III Uterine Corpus Cancer AJCC v8, Stage IIIA Uterine Corpus Cancer AJCC v8, Stage IIIB Uterine Corpus Cancer AJCC v8, Stage IIIC Uterine Corpus Cancer AJCC v8, Stage IIIC1 Uterine Corpus Cancer AJCC v8, Stage IIIC2 Uterine Corpus Cancer AJCC v8, Endometrial Dedifferentiated Carcinoma, Recurrent Endometrial Dedifferentiated Carcinoma, endometrial adenocarcinoma recurrent, uterine papillary serous carcinoma, endometrioid adenocarcinoma of the endometrium
Treatment questionnaire administration, quality-of-life assessment, carboplatin, Placebo, Paclitaxel, Pembrolizumab, Placebo Administration
Clinical Study IdentifierNCT03914612
SponsorNational Cancer Institute (NCI)
Last Modified on8 April 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Do you have any of these conditions: Recurrent Endometrial Cancer or Recurrent Endometrial Clear Cell Adenocarcinoma or Endometrial Dedifferentiated Carcinoma or Stage IIIC1 Uterine Corpu...?
Do you have any of these conditions: Stage IVB Uterine Corpus Cancer AJCC v8 or Endometrial Mixed Cell Adenocarcinoma or Recurrent Endometrial Undifferentiated Carcinoma or Stage IIIC Ute...?
Do you have any of these conditions: Endometrial Clear Cell Adenocarcinoma or Stage IIIC1 Uterine Corpus Cancer AJCC v8 or endometrial adenocarcinoma recurrent or uterine papillary serous...?
Do you have any of these conditions: Stage IIIC Uterine Corpus Cancer AJCC v8 or Stage IIIB Uterine Corpus Cancer AJCC v8 or Recurrent Endometrial Adenocarcinoma or Stage IIIC1 Uterine Co...?
Do you have any of these conditions: Endometrial Endometrioid Adenocarcinoma or uterine papillary serous carcinoma or Recurrent Endometrial Dedifferentiated Carcinoma or Stage IIIA Uterin...?
Do you have any of these conditions: Endometrial Dedifferentiated Carcinoma or Recurrent Endometrial Dedifferentiated Carcinoma or Recurrent Endometrial Adenocarcinoma or Stage IVB Uterin...?
Do you have any of these conditions: Stage IIIC2 Uterine Corpus Cancer AJCC v8 or Endometrial Mixed Cell Adenocarcinoma or Recurrent Endometrial Undifferentiated Carcinoma or uterine papi...?
Do you have any of these conditions: Recurrent Endometrial Clear Cell Adenocarcinoma or Stage IIIC Uterine Corpus Cancer AJCC v8 or Endometrial Endometrioid Adenocarcinoma or endometrial ...?
Do you have any of these conditions: Endometrial Endometrioid Adenocarcinoma or Recurrent Endometrial Mixed Cell Adenocarcinoma or Stage IV Uterine Corpus Cancer AJCC v8 or Stage III Uter...?
Do you have any of these conditions: Stage IIIC2 Uterine Corpus Cancer AJCC v8 or Stage IIIB Uterine Corpus Cancer AJCC v8 or Endometrial Endometrioid Adenocarcinoma or endometrioid adeno...?
Do you have any of these conditions: Endometrial Serous Adenocarcinoma or Stage IIIB Uterine Corpus Cancer AJCC v8 or Stage IV Uterine Corpus Cancer AJCC v8 or Recurrent Endometrial Adeno...?
Do you have any of these conditions: Stage IVB Uterine Corpus Cancer AJCC v8 or Recurrent Endometrial Cancer or Endometrial Endometrioid Adenocarcinoma or Stage IIIC2 Uterine Corpus Cance...?
Do you have any of these conditions: Stage IIIB Uterine Corpus Cancer AJCC v8 or Recurrent Endometrial Adenocarcinoma or Stage III Uterine Corpus Cancer AJCC v8 or Recurrent Endometrial C...?
Is your age greater than or equal to 18 yrs?
Do you have any of these conditions: Recurrent Endometrial Clear Cell Adenocarcinoma or Stage IVB Uterine Corpus Cancer AJCC v8 or Endometrial Undifferentiated Carcinoma or Recurrent Endo...?
Do you have any of these conditions: Stage IIIC1 Uterine Corpus Cancer AJCC v8 or Stage IVA Uterine Corpus Cancer AJCC v8 or Endometrial Serous Adenocarcinoma or Endometrial Clear Cell Ad...?
Do you have any of these conditions: Stage IIIA Uterine Corpus Cancer AJCC v8 or Stage IVA Uterine Corpus Cancer AJCC v8 or Recurrent Endometrial Carcinoma or Stage IIIC1 Uterine Corpus C...?
Do you have any of these conditions: Recurrent Endometrial Serous Adenocarcinoma or Stage IIIB Uterine Corpus Cancer AJCC v8 or endometrioid adenocarcinoma of the endometrium or Recurrent...?
Do you have any of these conditions: endometrioid adenocarcinoma of the endometrium or Recurrent Endometrial Endometrioid Adenocarcinoma or Recurrent Endometrial Clear Cell Adenocarcinoma...?
Do you have any of these conditions: Endometrial Mixed Cell Adenocarcinoma or Recurrent Endometrial Dedifferentiated Carcinoma or Stage IIIA Uterine Corpus Cancer AJCC v8 or Stage IIIB Ut...?
Do you have any of these conditions: Endometrial Mixed Cell Adenocarcinoma or Endometrial Serous Adenocarcinoma or uterine papillary serous carcinoma or Recurrent Endometrial Serous Adeno...?
Do you have any of these conditions: Recurrent Endometrial Serous Adenocarcinoma or Recurrent Endometrial Endometrioid Adenocarcinoma or Endometrial Undifferentiated Carcinoma or Stage II...?
Do you have any of these conditions: Endometrial Clear Cell Adenocarcinoma or endometrial adenocarcinoma recurrent or Recurrent Endometrial Cancer or Recurrent Endometrial Carcinoma or Re...?
Do you have any of these conditions: Recurrent Endometrial Adenocarcinoma or Endometrial Endometrioid Adenocarcinoma or Recurrent Endometrial Serous Adenocarcinoma or Recurrent Endometria...?
Are you female?
Measurable stage III, measurable stage IVA, stage IVB (with or without measurable disease) or recurrent (with or without measurable disease) endometrial cancer
Pathology report showing results of institutional MMR IHC testing. (This requirement does not apply to sites in Japan.)
Histologic confirmation of the original primary tumor is required (submission of pathology report(s) is required). Patients with the following histologic types are eligible: Endometrioid adenocarcinoma, serous adenocarcinoma, dedifferentiated/undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, adenocarcinoma not otherwise specified (N.O.S.)
Submission of tumor specimens for centralized MMR IHC testing is required after Step 1 and before Step 2 registration
In patients with measurable disease (stage III and IVA), lesions will be defined and monitored by RECIST version (v) 1.1. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each lesion must be >= 10 mm when measured by computed tomography (CT) or magnetic resonance imaging (MRI). Lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
Patients may have received
NO prior chemotherapy for treatment of endometrial cancer OR
Prior adjuvant chemotherapy (e.g., paclitaxel/carboplatin alone or as a component of concurrent chemotherapy and radiation therapy [with or without cisplatin]) provided adjuvant chemotherapy was completed >= 12 months prior to STEP 2 registration
Patients may have received prior radiation therapy for treatment of endometrial cancer. Prior radiation therapy may have included pelvic radiation therapy, extended field pelvic/para aortic radiation therapy, intravaginal brachytherapy and/or palliative radiation therapy. All radiation therapy must be completed at least 4 weeks prior to STEP 2 registration
Patients may have received prior hormonal therapy for treatment of endometrial cancer. All hormonal therapy must be discontinued at least three weeks prior to STEP 2 registration
Performance status of 0, 1 or 2
Platelets >= 100,000/mcl
Absolute neutrophil count (ANC) >= 1,500/mcl
Creatinine =< 1.5 x institutional/laboratory upper limit of normal (ULN)
Total serum bilirubin level =< 1.5 x upper limit of normal (ULN) (patients with known Gilbert's disease who have bilirubin level =< 3 x ULN may be enrolled)
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN
Thyroid stimulating hormone (TSH) within normal limits (TSH < ULN allowed in euthyroid patients on thyroid replacement therapy)
Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of Step 2 registration are eligible for this trial
For patients of child bearing potential: negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test is required
Administration of study drugs (pembrolizumab, paclitaxel, carboplatin) may have an adverse effect on pregnancy and poses a risk to the human fetus, including embryo-lethality. Women of childbearing potential (WOCBP) must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) from at least 14 days prior to Step 2 registration (for oral contraceptives), during treatment, and for 120 days after the last dose of study medication. Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately. Patients will be considered of nonreproductive potential if they are either
Postmenopausal (defined as at least 12 months with no menses without an alternative medical cause; in women < 45 years of age, a high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy. In the absence of 12 months of amenorrhea, a single FSH measurement is insufficient); OR
Have a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy or bilateral tubal ligation/occlusion, at least 6 weeks prior to Step 2 registration; OR
Have a congenital or acquired condition that prevents childbearing
Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information

Exclusion Criteria

Patients with prior treatment with anti-PD-1, anti-PD-L1 or anti-CTLA-4 therapeutic antibody or other similar agents
Patients who have a history of a severe hypersensitivity reaction to monoclonal antibody or pembrolizumab and/or its excipients
Patients who are currently participating and receiving cancer-directed study therapy or have participated in a study of an investigational agent and received cancer-directed study therapy within 4 weeks prior to Step 2 registration
Patients who have a diagnosis of immunodeficiency or are receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to Step 2 registration
Patients who have received steroids as CT scan contrast premedication may be enrolled
The use of inhaled or topical corticosteroids is allowed
The use of mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed
The use of physiologic doses of corticosteroids may be approved after consultation with the study chair
Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression, and they have been off steroids for at least 4 weeks prior to Step 2 registration and remain clinically stable
Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids. This includes, but is not limited to, patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome because of the risk of recurrence or exacerbation of disease
Patients with vitiligo, endocrine deficiencies including type I diabetes mellitus, thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible
Patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible
Patients who have a history of (non-infectious) pneumonitis that required steroids, or current pneumonitis
Uncontrolled intercurrent illness including, but not limited to: ongoing or active infection (except for uncomplicated urinary tract infection), interstitial lung disease or active, non-infectious pneumonitis, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis; and cirrhosis
For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
Pregnant or lactating patients
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