Patient case: 38-year-old male with melanoma; genetic feature: BRAF (K601E)

Clinical trial: A Dose Escalation and Cohort Expansion Study of CD122-Biased Cytokine (NKTR-214) in Combination With Anti-PD-1 Antibody (Nivolumab) in Patients With Select Advanced or Metastatic Solid Tumors

Summary: This study is to determine first, the recommended Phase 2 dose of NKTR-214 when administered in combination with nivolumab, and then, the clinical benefit, safety, and tolerability of combining NKTR-214 with nivolumab in select patients with melanoma, renal cell carcinoma or non-small cell lung cancer. Both drugs target the immune system and may act synergistically to promote anti-cancer effects.

Detailed description: NKTR-214 is a cytokine (investigational agent) that is designed to target CD122, a protein which is found on certain immune cells (known as CD8+ T Cells and Natural Killer Cells) to expand these cells to promote their anti-tumor effects. Nivolumab is a full human monoclonal antibody that binds to a molecule called PD-1 on immune cells and promotes anti-tumor effects.
  Approximately 40 eligible patients that enroll in the dose escalation portion of the study (Phase 1) will be assigned to one of five dose regimens of NKTR-214 in combination with nivolumab (0.006 mg/kg NKTR-214 every 21 days with 240 mg nivolumab every 14 days, 0.003 mg/kg NKTR-214 every 14 days with 240 mg nivolumab every 14 days, 0.006 mg/kg NKTR-214 every 14 days with 240 mg nivolumab every 14 days, 0.006 mg/kg NKTR-214 every 21 days with 360 mg nivolumab every 21 days, 0.003 mg/kg NKTR-214 every 21 days with 360 mg nivolumab every 21 days). Based on safety, tolerability and efficacy observed in the trial, enrollment to additional dose escalation cohorts are planned. The first phase of the study will test the safety and efficacy profile of the combination and determine which dose will be studied in Phase 2 of the overall study. During Phase 2, cohorts of patients with specific cancers will be expanded and these patients will receive the recommended Phase 2 dose and schedule of NKTR-214 in combination with nivolumab.
  All patients enrolled in the study will be closely monitored to determine if there is response to the treatment as well as for any side effects that may occur. The efficacy of the combination will be assessed using objective response rate (ORR). Exploratory immunological biomarkers in plasma and tumor samples will evaluate immune activation.

Eligibility: Inclusion Criteria:
  -  Histologically confirmed diagnosis of a locally advanced or metastatic melanoma, renal cell carcinoma (RCC), or nonsmall cell lung cancer (NSCLC)
  -  Melanoma - Advanced or metastatic Melanoma who are treatment naive and are known BRAF wild-type.
  -  Renal Cell Carcinoma (RCC) - Advanced or metastatic RCC who have received only 1 prior anti-angiogenic therapy, or patient refuses standard of care. Must not have received prior immunotherapy with specified immunomodulators.
  -  Non-Small Cell Lung Cancer (NSCLC) - Advanced or metastatic NSCLC lacking EGFR-sensitizing mutation and/or ALK translocation. Must have experienced disease recurrence or progression during or after 1 prior platinum doublet-based chemotherapy regimen or patient refuses standard of care. Must not have received prior immunotherapy with specified immunomodulators.
  -  Life expectancy >12 weeks
  -  Patients must not have received prior interleukin 2 (IL 2) therapy
  -  Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1
  -  Measurable disease per RECIST 1.1
  -  Demonstrated adequate organ function within 14 days of treatment initiation
  -  Oxygen saturation ≥ 92% on room air. NSCLC patients may use supplemental oxygen
  -  Subjects must be recovered from the effects of any prior chemotherapy, immunotherapy, other prior system anticancer therapy, radiotherapy, or surgery
  -  Women of childbearing potential must agree to use highly effective methods of birth control. All participants must agree to use double barrier contraception during study participation for at least 3 months after the last dose of study drugs
  -  Patients with stable brain metastases may be enrolled if certain criteria are met
  -  Sample of archival tumor tissue and fresh baseline tumor biopsies are required
  -  Additional criteria may apply
  Exclusion Criteria:
  -  Use of an investigational agent or an investigational device within 28 days before administration of first dose of NKTR--214
  -  Females who are pregnant or breastfeeding
  -  Participants who have an active autoimmune disease requiring systemic treatment within the past 3 months or have a documented history of clinically severe autoimmune disease that requires systemic steroids or immunosuppressive agents
  -  History of organ transplant that requires use of immune suppressive agents
  -  Evidence of clinically significant interstitial lung disease or active, noninfectious pneumonitis
  -  Prior surgery or radiotherapy within 14 days of therapy
  -  Participants who have had < 28 days since the last chemotherapy, biological therapy, or < 14 days from approved tyrosine kinase inhibitor (TKI) therapy (sunitinib, sorafenib, vemurafenib, dabrafenib, cobimetinib), or systemic or inhaled steroid therapy at doses greater than 10mg of prednisone or equivalent before administration of the first dose of study medication. Participants' inability to adhere to or tolerate protocol or study procedures.
  -  Additional criteria may apply

Relevance to patient case: possibly relevant