Nivolumab and Ipilimumab +/- UV1 Vaccination as Second Line Treatment in Patients With Malignant Mesothelioma

  • STATUS
    Recruiting
  • End date
    Mar 15, 2027
  • participants needed
    118
  • sponsor
    Åslaug Helland
Updated on 2 November 2021
ct scan
platelet count
total bilirubin
absolute neutrophil count
measurable disease
MRI
pemetrexed
neutrophil count
chemotherapy regimen
nivolumab
ipilimumab
malignant mesothelioma
pleural mesothelioma

Summary

The objective of the study is to induce a meaningful progression-free survival benefit in patients with Malign Pleural Mesothelioma (MPM) after progression on first line standard platinum doublet chemotherapy, by treating with nivolumab and ipilimumab with or without UV1 vaccine.

Description

Several studies have investigated the use of checkpoint inhibition in Malign Pleural Mesothelioma (MPM). Most of them are small studies investigating the efficacy of single-agent immunotherapy in few patients. Given that the combination of anti-PD-1 or anti-PD-L1 therapy with CTLA-4 has been shown in other cancers to enhance treatment effect, combined checkpoint inhibitor treatment has also been investigated in patients with MPM. Although these results are encouraging, the response rates seen are moderate compared to what has been documented for the combination of checkpoint inhibitors in other cancer indications. An approach to further enhance the PFS and response rate in MPM may be to use a vaccine aiming to activate an immune response directed against tumor-related antigens, and to combine the vaccine with checkpoint inhibitors. The proposed study will evaluate the use of the therapeutic cancer vaccine UV1 in combination with nivolumab and ipilimumab after progression on standard first-line chemotherapy in patients with malignant pleural mesothelioma.

The objective of the study is to induce a meaningful progression-free survival benefit in patients with MPM after progression on first line standard platinum doublet chemotherapy, by treating with nivolumab and ipilimumab with or without UV1.

The primary end-point (PFS) is expected to be analyzed in 2022.

Details
Condition Pulmonary Disease, Cancer, Lung Neoplasm, Mesothelioma, Mesothelioma, Cancer/Tumors, Malignant Pleural Mesothelioma, Malignant Mesothelioma, Ewing's Family Tumors, Pleural Mesothelioma, Cancer (Pediatric), Lung Cancer, Mesotheliomas Pleural, Lung Disease, Neoplasms, Mesothelioma; Lung, Mesothelioma; Pleura, Mesothelioma; Lung, Mesothelioma; Pleura, primary cancer, primary malignant neoplasm, malignancy, cancers, malignancies, malignant tumor, malignant tumors, carcinoma lung, lung carcinoma, Mesothelioma; Lung, Mesothelioma; Pleura, Mesothelioma; Lung, Mesothelioma; Pleura, Mesothelioma; Lung, Mesothelioma; Pleura
Treatment Ipilimumab, Nivolumab, UV1 vaccine + leukine
Clinical Study IdentifierNCT04300244
SponsorÅslaug Helland
Last Modified on2 November 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Histologically and/or cytologically confirmed malignant pleural mesothelioma
Unresectable disease
Measurable disease, defined as at least 1 lesion (measurable) that can be accurately assessed at baseline by computed tomography (CT) or magnetic resonance imaging (MRI) and is suitable for repeated assessment (modified RECIST)
Available unstained archived tumor tissue sample in sufficient quantity to allow for analyses. At least fifteen unstained slides or a tumor block (preferred). NOTE: A fine needle aspiration sample is not sufficient to make the patient eligible for enrollment. Given the complexity of mesothelioma pathological diagnosis , it is expected that they will have a core needle biopsy or surgical tumor biopsy as part of their initial diagnostic work up
Age 18 years
Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 1
Willing to provide archived tumor tissue and blood samples for research
Adequate organ function as defined below
Haemoglobin 9.0 g/dL
Absolute neutrophil count (ANC) 1.5 (or 1.0) x (> 1500 per mm3)
Platelet count 100 (or 75) x 109/L (>75,000 per mm3)
Serum bilirubin 1.5 x institutional upper limit of normal (ULN)
AST (SGOT)/ALT (SGPT) 2.5 x institutional upper limit of normal unless liver metastases are present, in which case it must be 5x ULN
Measured creatinine clearance (CL)
>40 mL/min
Calculated creatinine CL>40 mL/min (Cockcroft-Gault formula)
24-hour urinecollection for determination of CL
Males: Creatinine CL (mL/min) =Weight (kg) x (140 - Age) 72 x serum creatinine (mg/dL)
Females:Creatinine CL (mL/min)=Weight (kg) x (140 - Age)x0.85 72 x serum creatinine (mg/dL)
Previously treated with at least one line of platinum -pemetrexed

Exclusion Criteria

Disease suitable for curative surgery
Previous treatment with a PD-1 or PD-L1 inhibitor, including nivolumab or any other agent targeting immune checkpoints
Non-pleural mesothelioma e.g. mesothelioma arising in peritoneum, tunica vaginalis or any serosal surface other than the pleura
Active second malignancy other than non-melanoma skin cancer or cervical carcinoma in situ
Symptomatic or uncontrolled brain metastases requiring concurrent treatment, inclusive of but not limited to surgery, radiation and/or corticosteroids (prednisone >10 mg or equivalent). Surgery, radiation and/or corticosteroids (any dose >10 mg prednisone equivalent) must have been completed 2 weeks prior to registration
Uncontrolled seizures
Current or prior use of immunosuppressive medication within 28 days before the first dose of nivolumab, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid. Standard steroid premedication given prior to chemotherapy or as prophylaxis for imaging contrast allergy should not be counted for this criterion
Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease, diverticulitis with the exception of diverticulosis, celiac disease, irritable bowel disease; Wegner syndrome) within the past 2 years. Subjects with vitiligo, alopecia, Grave's disease, or psoriasis not requiring systemic treatment (within the past 3 years) are not excluded
History of primary immunodeficiency
History of allogeneic organ transplant
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, active bleeding diatheses including any subject known to have psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the subject to give written informed consent
Active infection including tuberculosis (clinical evaluation including: physical examination findings, radiographic findings, positive PPD test, etc.), hepatitis B (known positive HBV surface antigen [HBsAg] result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies as defined by a positive ELISA test). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA. HIV testing is not required in the absence of clinical suspicion
Known history of leptomeningeal carcinomatosis
Pregnant or lactating women
Live attenuated vaccination within 30 days prior to study entry or within 30 days of receiving nivolumab
Any condition that, in the opinion of the investigator, would interfere with the evaluation of study treatment or interpretation of patient safety or study results
History of allergy or hypersensitivity to any of the active substances or excipients in the study drug
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