Nivolumab Plus Axitinib in Patients With Anti-PD1 Refractory Advanced Melanoma

NCT04493203

Last updated date
Study Location
UPMC Hillman Cancer Center
Pittsburgh, Pennsylvania, 15232, United States
Contact
412-647-8587

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Eligibility Criteria
condition
The disease, disorder, syndrome, illness, or injury that is being studied.
Advanced Melanoma, Unresectable Melanoma
Sex
Females and Males
Age
Pediatric Trials: 0-17 Years
Adult Trials: 18+ Years
18 + years
Inclusion Criteria
The factors, or reasons, that allow a person to participate in a clinical study.
Show details

- Have unresectable (stage III) or advanced (stage IV) cutaneous or mucosal melanoma. Patients with uveal melanoma are not eligible.

- Progressed on prior anti-PD1 therapy with or without anti-CTLA4 therapy. Patients may have progressed in the adjuvant setting if treated within the last 6 months. Prior treatment with BRAF/MEK inhibitors permitted, however, not required. Progression must be radiographic, and progression of disease will be confirmed by a radiologist.

- Have measurable disease based on RECIST 1.1.

- Patients do not have to have biopsiable disease to be eligible. However, patients with biopsiable disease must undergo biopsy at study entry and at week 12.

- Have a performance status of 0 or 1 on the ECOG Performance Scale.

- Demonstrate adequate organ function, per protocol

- Patients with brain metastases are permitted if they are asymptomatic or previously treated with CNS directed therapy with stable CNS disease for at least 2 weeks. Stable is defined as asymptomatic or not progressing on imaging.

- Female patients of childbearing potential - negative pregnancy testing; use of birth control, surgically sterile or abstain from heterosexual activity during study and for 5 months after the last dose of study medication.

- Male subjects - agree to use an adequate contraception starting with the first dose of study therapy through 7 months after the last dose of study therapy; abstinence acceptable

Exclusion Criteria
The factors, or reasons, that prevent a person from participating in a clinical study.
Show details


- History of prior immune-related adverse event due to an anti-PD1 or anti-CTLA4 that
has not resolved to grade 1 on a steroid dose of prednisone 10 mg or less at the time
of study entry (excluding vitiligo and endocrine toxicity).


- Patients with prior myocarditis or other immune-mediated cardiac adverse events, prior
Guillain-Barre syndrome, encephalitis, meningitis, or transverse myelitis, prior
Stevens-Johnson syndrome or toxic epidermal necrolysis are excluded regardless of
grade.


- Poorly controlled hypertension defined as systolic blood pressure (SBP) > 160 and/or
diastolic blood pressure (DBP) > 100 despite antihypertensives. If subject is above
this goal, treatment with anti-hypertensives to achieve better blood pressure control
is permitted. Ambulatory blood pressure assessment is permitted if there is concern
for discrepant blood pressure readings while patients are in clinic.


- Has Class III or IV heart failure based on the New York Heart Association.


- Has had major surgery within 4 weeks of randomization. This does not include
outpatient surgeries that do not require post-operative admission.


- Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy (greater
than the equivalent of prednisone 10 mg daily, unless for prior endocrine toxicity) or
any other form of immunosuppressive therapy within 7 days prior to the first dose of
trial treatment (premedication with steroids for contrast imaging studies is
permitted).


- Has a known history of active TB (Bacillus Tuberculosis).


- Hypersensitivity to nivolumab or axitinib, or any of their excipients.


- Has had prior chemotherapy or targeted small molecule therapy within 1 week prior to
study Day 1 or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse
events due to a previously administered agent.


- Has had radiation within 2 weeks of randomization.


- Has current use or anticipated need for treatment with drugs or foods that are known
strong cytochrome P450 (CYP34A4/5) inhibitors including but not limited to atazanavir,
clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir,
ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole, and grapefruit or
grapefruit juice. NOTE: The topical use of these medications, such as 2% ketoconazole
cream is allowed.


- Has current use or anticipated need for treatment with drugs known to be strong
CYP3A4/5 inducers, including but not limited to carbamazepine, phenobarbital,
phenytoin, rifabutin, rifampin, and St. John's wort.


- Has a known additional malignancy that is progressing or requires active treatment.
Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the
skin that has undergone potentially curative therapy, in situ cervical cancer, in situ
colon cancer, or nonmetastatic prostate cancer not on systemic therapy.


- Has known active central nervous system (CNS) metastases and/or carcinomatous
meningitis. Subjects with previously treated brain metastases may participate provided
they are stable (without evidence of progression by imaging for at least 2 weeks prior
to the first dose of trial treatment and any neurologic symptoms have returned to
baseline), have no evidence of new or enlarging brain metastases, and are not using
steroids for at least 7 days prior to trial treatment. This exception does not include
carcinomatous meningitis which is excluded regardless of clinical stability.


- Has active autoimmune disease that has required systemic treatment in the past 2 years
(i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
drugs). Replacement therapy (e.g., thyroxine or physiologic corticosteroid replacement
therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of
systemic treatment.


- Has a history of (non-infectious) pneumonitis that required steroids or current
pneumonitis.


- Has an active infection requiring systemic IV antibiotic therapy.


- Has had any of the following within the past 6 months


- Myocardial infarction or unstable angina


- Ventricular arrythmia


- Acute decompensated heart failure


- Cerebrovascular accident


- Hypertensive emergency requiring ICU admission


- Presence of a disorder that may impact absorption of axitinib, such as inability to
take oral medication, requirement for IV alimentation, prior gastric resection,
treatment for active peptic ulcer confirmed by endoscopy within the past 3 months,
active GI bleed, malabsorption syndrome.


- Has a history or current evidence of any condition, therapy, or laboratory abnormality
that might confound the results of the trial, interfere with the subject's
participation for the full duration of the trial, or is not in the best interest of
the subject 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 the pre-screening or screening visit
through 5 months after the last dose of trial treatment for females and 7 months after
the last dose of trial treatment for males.


- Has a known history of HIV (HIV 1/2 antibodies) if the CD4 count is less than 350 mm3
or serum HIV viral load is < 25,000 IU/mL.


- Has a known history of or is positive for hepatitis B (hepatitis B surface antigen
[HBsAg] reactive) or hepatitis C (hepatitis C virus [HCV] RNA [qualitative] is
detected). Note: Without known history, testing only needs to be performed if there is
clinical suspicion for Hepatitis B or C.


- Is currently incarcerated or otherwise detained.


- Has received a live vaccine within 30 days of planned start of study therapy.
(intranasal iNinfluenza vaccines (e.g., Flu-Mist®) are live attenuated vaccines, and
are not allowed)


Note: Subjects with ≤ Grade 2 neuropathy are an exception to this criterion and may qualify
for the study.


Note: If subject received major surgery, they must have recovered adequately from the
toxicity and/or complications from the intervention prior to starting therapy.

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Advanced Melanoma, Unresectable MelanomaNivolumab Plus Axitinib in Patients With Anti-PD1 Refractory Advanced Melanoma
NCT04493203
  1. Pittsburgh, Pennsylvania
ALL GENDERS
18 Years+
years
MULTIPLE SITES
Advanced Information
Descriptive Information
Brief Title  ICMJE Nivolumab Plus Axitinib in Patients With Anti-PD1 Refractory Advanced Melanoma
Official Title  ICMJE A Phase II Trial of Nivolumab Plus Axitinib in Patients With Anti-PD1 Refractory Advanced Melanoma
Brief Summary This is Phase II trial of nivolumab plus axitinib for patients with unresectable stage III or IV melanoma who have progressed on prior anti-PD1 therapy with or without concomitant anti-CTLA4 therapy. Patients will receive treatment with nivolumab 480 mg intravenously every 4 weeks and axitinib 5 mg twice daily by mouth. Patients may continue both agents for up to two years if they do not experience disease progression or dose-limiting toxicities.
Detailed Description This trial hypothesizes that decreasing hypoxia in the TME will re-sensitize melanoma tumors to anti-PD1 therapy. Axitinib has already been safely combined with anti-PD1 therapy and was overall well-tolerated. With nivolumab plus axitinib taken together, based on previously published work and data from our laboratories, it is hypothesized that axitinib can metabolically remodel the TME to render it more sensitive to ICB, specifically by reducing intra-tumoral hypoxia, increasing T cell infiltration, and increasing polyfunctional T cells. It will determined if treatment with nivolumab plus axitinib will prolong both progression-free and overall survival.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • Advanced Melanoma
  • Unresectable Melanoma
Intervention  ICMJE
  • Drug: Nivolumab
    Nivolumab is a human IgG4 monoclonal antibody that blocks PD-1. It is a type of Immunotherapy and works as a checkpoint inhibitor, blocking a signal that prevents activation of T cells from attacking the cancer.
    Other Names:
    • Opdivo
    • AG013736
  • Drug: Axitinib
    Axitinib (AG013736; trade name Inlyta) is a small molecule tyrosine kinase inhibitor.Its primary mechanism of action is thought to be vascular endothelial growth factor receptor 1-3, c-KIT and PDGFR inhibition, this, in turn, enables it to inhibit angiogenesis (the formation of new blood vessels by tumours)
    Other Name: INLYTA
Study Arms  ICMJE Experimental: Nivolumab plus Axitinib

Nivolumab 480mg, IV, every 4 weeks, for up to two years.

Axitinib 5mg, PO, BID, for up to two years.

Interventions:
  • Drug: Nivolumab
  • Drug: Axitinib
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: July 27, 2020)
31
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE August 2025
Estimated Primary Completion Date November 2022   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Have unresectable (stage III) or advanced (stage IV) cutaneous or mucosal melanoma. Patients with uveal melanoma are not eligible.
  • Progressed on prior anti-PD1 therapy with or without anti-CTLA4 therapy. Patients may have progressed in the adjuvant setting if treated within the last 6 months. Prior treatment with BRAF/MEK inhibitors permitted, however, not required. Progression must be radiographic, and progression of disease will be confirmed by a radiologist.
  • Have measurable disease based on RECIST 1.1.
  • Patients do not have to have biopsiable disease to be eligible. However, patients with biopsiable disease must undergo biopsy at study entry and at week 12.
  • Have a performance status of 0 or 1 on the ECOG Performance Scale.
  • Demonstrate adequate organ function, per protocol
  • Patients with brain metastases are permitted if they are asymptomatic or previously treated with CNS directed therapy with stable CNS disease for at least 2 weeks. Stable is defined as asymptomatic or not progressing on imaging.
  • Female patients of childbearing potential - negative pregnancy testing; use of birth control, surgically sterile or abstain from heterosexual activity during study and for 5 months after the last dose of study medication.
  • Male subjects - agree to use an adequate contraception starting with the first dose of study therapy through 7 months after the last dose of study therapy; abstinence acceptable

Exclusion Criteria:

  • History of prior immune-related adverse event due to an anti-PD1 or anti-CTLA4 that has not resolved to grade 1 on a steroid dose of prednisone 10 mg or less at the time of study entry (excluding vitiligo and endocrine toxicity).
  • Patients with prior myocarditis or other immune-mediated cardiac adverse events, prior Guillain-Barre syndrome, encephalitis, meningitis, or transverse myelitis, prior Stevens-Johnson syndrome or toxic epidermal necrolysis are excluded regardless of grade.
  • Poorly controlled hypertension defined as systolic blood pressure (SBP) > 160 and/or diastolic blood pressure (DBP) > 100 despite antihypertensives. If subject is above this goal, treatment with anti-hypertensives to achieve better blood pressure control is permitted. Ambulatory blood pressure assessment is permitted if there is concern for discrepant blood pressure readings while patients are in clinic.
  • Has Class III or IV heart failure based on the New York Heart Association.
  • Has had major surgery within 4 weeks of randomization. This does not include outpatient surgeries that do not require post-operative admission.
  • Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy (greater than the equivalent of prednisone 10 mg daily, unless for prior endocrine toxicity) or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment (premedication with steroids for contrast imaging studies is permitted).
  • Has a known history of active TB (Bacillus Tuberculosis).
  • Hypersensitivity to nivolumab or axitinib, or any of their excipients.
  • Has had prior chemotherapy or targeted small molecule therapy within 1 week prior to study Day 1 or who has not recovered (i.e., ? Grade 1 or at baseline) from adverse events due to a previously administered agent.
  • Has had radiation within 2 weeks of randomization.
  • Has current use or anticipated need for treatment with drugs or foods that are known strong cytochrome P450 (CYP34A4/5) inhibitors including but not limited to atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole, and grapefruit or grapefruit juice. NOTE: The topical use of these medications, such as 2% ketoconazole cream is allowed.
  • Has current use or anticipated need for treatment with drugs known to be strong CYP3A4/5 inducers, including but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, and St. John's wort.
  • Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy, in situ cervical cancer, in situ colon cancer, or nonmetastatic prostate cancer not on systemic therapy.
  • Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least 2 weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.
  • Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  • Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis.
  • Has an active infection requiring systemic IV antibiotic therapy.
  • Has had any of the following within the past 6 months
  • Myocardial infarction or unstable angina
  • Ventricular arrythmia
  • Acute decompensated heart failure
  • Cerebrovascular accident
  • Hypertensive emergency requiring ICU admission
  • Presence of a disorder that may impact absorption of axitinib, such as inability to take oral medication, requirement for IV alimentation, prior gastric resection, treatment for active peptic ulcer confirmed by endoscopy within the past 3 months, active GI bleed, malabsorption syndrome.
  • Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject 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 the pre-screening or screening visit through 5 months after the last dose of trial treatment for females and 7 months after the last dose of trial treatment for males.
  • Has a known history of HIV (HIV 1/2 antibodies) if the CD4 count is less than 350 mm3 or serum HIV viral load is < 25,000 IU/mL.
  • Has a known history of or is positive for hepatitis B (hepatitis B surface antigen [HBsAg] reactive) or hepatitis C (hepatitis C virus [HCV] RNA [qualitative] is detected). Note: Without known history, testing only needs to be performed if there is clinical suspicion for Hepatitis B or C.
  • Is currently incarcerated or otherwise detained.
  • Has received a live vaccine within 30 days of planned start of study therapy. (intranasal iNinfluenza vaccines (e.g., Flu-Mist®) are live attenuated vaccines, and are not allowed)

Note: Subjects with ? Grade 2 neuropathy are an exception to this criterion and may qualify for the study.

Note: If subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy.

Sex/Gender  ICMJE
Sexes Eligible for Study:All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Amy Rose, RN412-647-8587[email protected]
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04493203
Other Study ID Numbers  ICMJE 20-101
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
IPD Sharing Statement  ICMJE
Plan to Share IPD:No
Responsible Party Yana Najjar, University of Pittsburgh
Study Sponsor  ICMJE Yana Najjar
Collaborators  ICMJE
  • Pfizer
  • Bristol-Myers Squibb
Investigators  ICMJE
Principal Investigator:Yana Najjar, MDUPMC Hillman Cancer Center
PRS Account University of Pittsburgh
Verification Date October 2020

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP