Phase II Trial of the Immune Checkpoint Inhibitor Nivolumab in Patients With Select Rare CNS Cancers
Clinical Trial Information
Trial Contact: Manchola-Orozco, Carolina; Walton, Sherri
IRB No: 20.180.10
Protocol Abbrev: Nivo Rare CNS Study
Principal Investigator: Nicholas G. Avgeropoulos, MD
Phase: Drug: Phase II
Age Group: Adult
Secondary Protocol No: 17C0102 C
Treatment: Experimental: 1/Experimental Therapy Participants will receive nivolumab at standard dose of240mg IV every 2 weeks for cycles 1 through 2, then doses of 480mg every 4 weeks for a total of 14 additional doses
Therapies Involved: Chemotherapy
ClinicalTrials.gov ID: NCT03173950
To learn if stimulating the immune system using the drug nivolumab can shrink tumors in people with rare CNS (brain or spine) tumors or increase the time it takes for these tumors to grow or spread.
Adults whose rare CNS tumor has returned.
Participants will be screened:
• Heart and blood tests
• Physical and neurological exam
• Hepatitis tests
• Pregnancy test
• MRI. They will lay in a machine that takes pictures.
• Tumor tissue sample. This can be from a previous procedure.
• INCLUSION CRITERIA:
1.Histopathologically proven diagnosis of Ependymoma, Medulloblastoma, Parenchymal Pineal Region Tumors (Pineoblastoma, Pineocytoma, Pineal Tumor of Intermediate Differentiation, Papillary Tumor of the Pineal Region), Choroid Plexus Tumors (Carcinoma, Papilloma, Atypical Papilloma), Histone Mutated Gliomas, Gliomatosis Cerebri, ATRT, Malignant/Atypical Meningioma, Gliosarcoma or Primary CNS Sarcoma, Pleomorphic Xanthoastrocytoma (PXA) and Anaplastic Pleomorphic Xanthoastrocytoma (APXA), and tumors formerly known as Primitive Neuro-Ectodermal Tumors (Embryonal Tumor with Multilayered Rosettes, Medulloepithelioma, CNS Neuroblastoma, CNS Ganglioneuroblastoma, CNSEmbryonal Tumor NOS) prior to registration as confirmed by NCI Laboratory of Pathology.
2.The tumor tissue (e.g. block or 15 unstained slides) must be available to be sent for immunophenotyping.
3.Patients must have progressive tumor growth after having received established standard of care treatment for their disease. Patients will be enrolled into 2 different cohorts (cohort 1 or heavily pretreated; cohort 2 or not heavily pretreated)
4.Age greater than or equal to 18;
5.Karnofsky performance status greater than or equal to 70 within 14 days prior to Step 2 registration;
6.Adequate hematologic function based on CBC/differential within 14 days prior to Step 2 registration defined as follows:
◾Absolute neutrophil count greater than or equal to 1,500 cells/mm3;
◾Platelet count greater than or equal to 100,000 cells/mm3
◾Hemoglobin > 9.0 g/dl (may be transfused to achieve this level)
7.Adequate renal function within 14 days prior to Step 2 registration defined as follows:
◾BUN less than or equal to 30 mg/dl and
◾Serum creatinine less than or equal to 1.7 mg/dl
8.Adequate hepatic function within 14 days prior to Step 2 registration defined as follows:
◾Total bilirubin (except patients with Gilbert s Syndrome, who are eligible for the study but exempt from the total bilirubin eligibility criterion) less than or equal to 2.0 mg/dl and
◾ALT and AST less than or equal to 2.5x ULN
◾No active or chronic hepatitis infection. HCV antibody (for Hepatitis C) and Hepatitis B Surface antigen and Hepatitis B core antibody must be negative. This has been routinely incorporated into immunotherapy trials with checkpoint inhibitors because of concerns that the risk of treatment-induced hepatic injury is increased in the setting of active viral hepatitis.
9.The patient must not be on a corticosteroid dose greater than physiologic replacement dosing defined as 30 mg of cortisone per day or its equivalent.
10.The patient must provide study-specific informed consent prior to study entry. No Durable Power of Attorney or Next of Kin can provide initial consent.
11.The effects of nivolumab on the developing human fetus are unknown. For this reason, women of childbearing potential (WOCBP) must use appropriate method(s) of contraception. WOCBP should use an adequate method to avoid pregnancy for 5 months (30 days plus the time required for nivolumab to undergo five half-lives) after the last dose of investigational drug.
Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 7 months after the last dose of investigational product. Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile as well as azoospermic men do not require contraception.
1.Patients who are receiving any other investigational agents.
2.Use of an immunotherapy such as a vaccine therapy, dendritic cell vaccine or intracavitary or convectional enhanced delivery of therapy
3.Prior or concurrent malignancy unless its natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen
4.Severe, active co-morbidity defined as follows:
◦Unstable angina within the last 6 months prior to Step 2 registration
◦Transmural myocardial infarction within the last 6 months prior to Step 2 registration
◦Evidence of recent myocardial infarction or ischemia by the findings of S-T elevations of greater than or equal to 2 mm using the analysis of an EKG performed within 14 days prior to Step 2 registration
◦New York Heart Association grade II or greater congestive heart failure requiring hospitalization within 12 months prior to Step 2 registration
◦History of stroke, cerebral vascular accident (CVA) or transient ischemic attack within 6 months prior to Step 2 registration
◦Serious and inadequately controlled cardiac arrhythmia
◦Significant vascular disease (e.g., aortic aneurysm, history of aortic dissection) or clinically significant peripheral vascular disease
◦Evidence of bleeding diathesis or coagulopathy
◦Serious or non-healing wound, ulcer, or bone fracture or history of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Step 2 registration, with the exception of the craniotomy for tumor resection.
◦Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
◦Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
◦Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
◦Known acquired immune deficiency syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS is based on the lack of information regarding the safety of nivolumab in patients with active HIV infection.
◦Active connective tissue disorders, such as lupus or scleroderma, which in the opinion of the treating physician may put the patient at high risk for immunologic toxicity.
5.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, should be excluded. These include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome or CIDP, myasthenia gravis; systemic autoimmune disease such as 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 should be excluded because of the risk of recurrence or exacerbation of disease.
--Of note, patients with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible. Patients with rheumatoid arthritis and other arthropathies, Sj(SqrRoot)(Delta)gren 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. However, patients with vitiligo, diabetes mellitus, and Hashimoto thyroiditis on appropriate replacement therapy may be enrolled.
6.Any other major medical illnesses or psychiatric impairments that in the investigator's opinion will prevent administration or completion of protocol therapy.
7.Allergies and Adverse Drug Reaction: History of allergy to study drug components
8.Pregnancy or lactating females due to possible adverse effects on the developing fetus or infant due to study drug. Women of childbearing potential must have a negative serum pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to Step 2 registration.
9.History of severe hypersensitivity reaction to any monoclonal antibody.