Patient case: 64-year-old female with Lung adenocarcinoma. Genetic variant: ALK Fusion. Other conditions: Emphysema.

Clinical trial: Nimotuzumab and Nivolumab in Treating Patients With Advanced Non-small Cell Lung Cancer

Summary: This phase I/II trial studies the best dose and side effects of nimotuzumab when giving together with nivolumab and to see how well they work in treating patients with non-small cell lung cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment. Monoclonal antibodies, such as nimotuzumab and nivolumab, may block tumor growth in different ways by targeting certain cells.

Detailed description: PRIMARY OBJECTIVES:
  I. To determine the dose-limiting toxicities (DLT) and identify the maximum tolerated dose (MTD) of nimotuzumab combined with nivolumab in the therapy of advanced non-small cell lung cancer (NSCLC) in order to establish the recommended phase II dose (RP2D). (Phase I)
  II. To evaluate the efficacy of nimotuzumab in combination with nivolumab in patients with advanced NSCLC, as assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 guidelines compared to historical outcomes of nivolumab alone. (Phase II)
  SECONDARY OBJECTIVES:
  I. Characterize the safety profile of nivolumab in combination with nimotuzumab in NCSLC. (Phase I)
  II. To evaluate the safety and the tolerability of nimotuzumab in combination with nivolumab using the Cancer Therapy Evaluation Program (CTEP) National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE version 4.0). (Phase I)
  III. Determine the immune analysis profile of nivolumab in combination with nimotuzumab. (Phase I)
  IV. Determine the preliminary efficacy of the study combination utilizing RECIST 1.1 guidelines. (Phase I)
  V. Overall response rate (ORR) per the immune-related Response Evaluation Criteria in Solid Tumors (irRC) and irRECIST. (Phase I)
  VI. Progression-free survival (PFS) rate at 1 year. (Phase I)
  VII. Progression-free survival (PFS). (Phase I)
  VIII. Overall survival (OS). (Phase I)
  IX. Disease control rate (DCR) and stable disease (SD). (Phase I)
  X. To evaluate the efficacy of nimotuzumab in combination with nivolumab in patients with advanced NSCLC compared to historic outcomes of nivolumab alone, as determined by secondary measures of efficacy, including: overall response rate (ORR) per the immune-related Response Evaluation Criteria in Solid Tumors (irRC) and irRECIST. (Phase II)
  XI. To evaluate the efficacy of nimotuzumab in combination with nivolumab in patients with advanced NSCLC compared to historic outcomes of nivolumab alone, as determined by secondary measures of efficacy, including: progression-free survival (PFS) rate at 1 year. (Phase II)
  XII. To evaluate the efficacy of nimotuzumab in combination with nivolumab in patients with advanced NSCLC compared to historic outcomes of nivolumab alone, as determined by secondary measures of efficacy, including: progression-free survival (PFS). (Phase II)
  XIII. To evaluate the efficacy of nimotuzumab in combination with nivolumab in patients with advanced NSCLC compared to historic outcomes of nivolumab alone, as determined by secondary measures of efficacy, including: overall survival (OS). (Phase II)
  XIV. To evaluate the efficacy of nimotuzumab in combination with nivolumab in patients with advanced NSCLC compared to historic outcomes of nivolumab alone, as determined by secondary measures of efficacy, including: disease control rate (DCR) and stable disease (SD). (Phase II)
  TERTIARY OBJECTIVES:
  I. Examine the relationship of EGFR expression in tissue to PFS, OS, ORR and adverse events (AE). (Phase I)
  II. Examine the relationship of infiltrating CD4+ and CD8+ T cells and other immune and genetic markers, and their associated PD-1, CD45RA or CD45RO levels; PD-L1 expression within both neoplastic and non-neoplastic stromal elements of the tumor microenvironment to PFS, OS, ORR and AE. (Phase I)
  III. Comparison of response assessment criteria for a prospective analysis; irRECIST response assessment; irRC. (Phase I)
  IV. Examine the relationship of EGFR expression in tissue to PFS, OS, ORR and AE. (Phase II)
  V. Examine the relationship of infiltrating CD4+ and CD8+ T cells and other immune and genetic markers, and their associated PD-1, CD45RA or CD45RO levels. (Phase II)
  VI. Examine the relationship of PD-L1 expression within both neoplastic and non-neoplastic stromal elements of the tumor microenvironment to PFS, OS, ORR and AE. (Phase II)
  VII. Comparison of response assessment criteria for a prospective analysis; irRECIST response assessment; irRC. (Phase II)
  OUTLINE: This is a phase I, dose-escalation study of nimotuzumab followed by a phase II study.
  Patients receive nivolumab intravenously (IV) over 60 minutes and nimotuzumab IV over 60 minutes on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  After completion of study treatment, patients are followed up at 30 days and then every 12 weeks.

Eligibility: Inclusion Criteria:
  -  Eastern Cooperative Oncology Group (ECOG) performance status of =< 2
  -  Patients with histologically proven non-small cell lung cancer
  -  Patients must have had progressive NSCLC after first-line platinum-based chemotherapy for advanced disease
  -  Have at least 3 months life expectancy
  -  Have measurable disease per RECIST 1.1 criteria present
  -  Patients with adenocarcinoma known to have anaplastic lymphoma kinase (ALK) rearrangements and/or epidermal growth factor receptor (EGFR) mutations that have had prior EGFR or ALK tyrosine kinase inhibitor therapy and have progressed, will also be eligible, regardless of line of therapy
  -  Phase I optional archival tissue/phase II mandatory archival tissue: able to provide enough biopsy tissue samples including primary diagnostic biopsy (archival), re-biopsy tissues (archival from time of disease progression/recurrence following first-line treatment failure) at disease progression to determine PD-L1 and EGFR expression and other biomarkers
  -  Absolute neutrophil count (ANC) >= 1.5 x 10^9/L
  -  Platelets >= 100 x 10^9/L
  -  Hemoglobin >= 9 g/dL
  -  Serum creatinine =< 1.5 x institution upper limit of normal (ULN)
  -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 1.5 x ULN or =< 5 x ULN if liver metastases are present
  -  Total serum bilirubin =< ULN; or total bilirubin =< 3.0 x ULN with direct bilirubin within normal range in patients with well documented Gilbert's syndrome
  -  Participants of child-bearing potential must agree to use adequate contraceptive methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study entry; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
  -  Participant or legal representative must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure
  Exclusion Criteria:
  -  Active autoimmune disease that has required systemic treatment in past 2 years; use of inhaled corticosteroids is allowed
  -  Phase II only: history of other malignancies are allowed as long as the current disease stage that did not require active treatment with concomitant systemic cytotoxic chemotherapy, targeted therapy, investigational or biologic therapy (e.g., anti-CTLA4 or HER2 monoclonal antibodies) within 12 months prior to study registration and, is not likely to require systemic therapy in the next 12 months; hormone-related therapies (e.g., somatostatin analogues, etc.) are allowed on a case-to-case basis upon discussion with principal investigator
  -  Active clinically serious infections requiring antibiotics, antiviral or antifungal agents; participants must be off these agents for at least 28 days prior to the first dose of the study drug
  -  Symptomatic brain metastases; uncontrolled pleural effusion, seroperitoneum, or pericardial effusion
  -  Has had any major surgery, chemotherapy, or radiotherapy within the previous 4 weeks; gamma knife radiosurgery for brain metastases within less than 2 weeks
  -  Receiving other anti-cancer medical treatment during the study outside of the nimotuzumab or nivolumab
  -  Clinically significant interstitial pulmonary disease or known diagnosis of interstitial lung disease (ILD)
  -  Has known immunosuppressive disease (e.g. human immunodeficiency virus [HIV], acquired immune deficiency syndrome [AIDS])
  -  Patient has known hypersensitivity to the components of the study drugs or their analogs
  -  Patient with uncontrolled cardiac disease or cardiac dysfunction, including any of the following:
  -  History of uncontrolled angina pectoris that does not respond to medical intervention
  -  Symptomatic pericarditis or myocardial infarction within 12 months prior to study entry that did not respond to treatment
  -  History of documented congestive heart failure (New York Heart Association functional classification III or IV)
  -  Documented cardiomyopathy
  -  Uncontrolled hypertension defined by: systolic blood pressure (SBP) >= 160 mmHg and/or diastolic blood pressure (DBP) >= 100 mmHg
  -  Pregnant or nursing female participants
  -  Unwilling or unable to follow protocol requirements
  -  Any condition which in the investigator's opinion deems the participant an unsuitable candidate to receive study drug

Relevance to patient case: possibly relevant