Patient case: 60-year-old male with melanoma; genetic feature: NTRK1 rearrangement

Clinical trial: A Study to Assess the Safety and Tolerability of MPDL3280A in Combination With Other Immune-modulating Therapies in Patients With Locally Advanced or Metastatic Solid Tumors

Summary: This global, multicenter, open-label study will evaluate the safety and tolerability of MPDL3280A in combination with other immune-modulating therapies in the treatment of selected advanced or metastatic malignancies. The MPDL3280A plus ipilimumab arm (Arm A) will focus primarily on patients with advanced or metastatic NSCLC. The MPDL3280A plus interferon alfa-2b arm (Arm B) will enroll patients with advanced or metastatic RCC and melanoma. MPDL3280A will be administered intravenously every 3 weeks (q3w).


Eligibility: Inclusion Criteria:
  -  Age >/= 18 years
  -  Histologically or cytologically documented locally advanced or metastatic solid tumors meeting the following study drug-specific criteria:
  Inclusion criteria specific to Arm A: MPDL3280A + ipilimumab
  -  Escalation stage: NSCLC patients
  -  Expansion stage: NSCLC patients
  -  Mandatory biopsy cohort: NSCLC or melanoma patients
  -  Prior MPDL3280A-treated cohort: NSCLC or melanoma patients
  Inclusion criteria specific to Arm B: MPDL3280A + interferon alfa-2b
  -  Escalation stage: RCC or melanoma patients
  -  Expansion stage: RCC or melanoma patients
  -  Mandatory biopsy cohort: RCC or melanoma patients
  -  Prior MPDL3280A-treated cohort: RCC or melanoma patients
  Inclusion criteria specific to prior MPDL3280A-treated cohorts
  Patients who have previously received MPDL3280A as monotherapy or in combination with other agents (except those outlined as exclusions) are eligible if they meet the following criteria:
  -  Radiologic evidence of progression after having derived stable disease, partial response, or complete response; patients without evidence of clinical benefit may be enrolled only after approval by the Medical Monitor.
  -  Minimum of 21 days from the last dose of MPDL3280A
  -  No permanent discontinuation of MPDL3280A due to a treatment-related adverse event
  -  Recovery from all MPDL3280A-related adverse events to Grade </= 1 or baseline at the time of consent
  -  No history of Grade >/= 3 immune-related adverse events from MPDL3280A, of Grade >/= 3 elevated total bilirubin, of usage of additional immunosuppression or ongoing use of > 10 mg prednisone or corticosteroid dose-equivalent.
  -  Disease progression during or after at least one previous systemic, anti-cancer treatment for locally advanced or metastatic NSCLC and RCC
  -  Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1
  -  Life expectancy >/= 12 weeks
  -  Measurable disease, as defined by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1
  -  Adequate hematologic and end organ function as confirmed by laboratory results within 14 days prior to the first study treatment
  -  For women who are not postmenopausal or surgically sterile and for men with partners of childbearing potential, the agreement to remain abstinent or to use single or combined contraceptive methods that result in a failure rate of <1% per year during the treatment period and for at least 6 months after the last dose of study drug.
  Exclusion Criteria:
  General Medical Exclusions:
  -  Pregnant and lactating women
  -  Any approved anti-cancer therapy, including chemotherapy or hormonal therapy, within 3 weeks prior to initiation of study treatment, with the following exception: (1) hormone-replacement therapy or oral contraceptives; (2) tyrosine kinase inhibitors (TKIs) that have been discontinued > 7 days prior to Cycle 1, Day 1, baseline scans must be obtained after discontinuation of prior TKIs
  -  Investigational therapy within 28 days prior to initiation of study treatment
  -  History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
  -  Known hypersensitivity or allergy to Chinese hamster ovary cell products or any component of the MPDL3280A formulation
  -  History of or active autoimmune disease
  -  History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia, risk of pulmonary toxicity, or evidence of active pneumonitis on screening chest computed tomography (CT) scan
  -  Prior allogeneic bone marrow transplantation or prior solid organ transplantation
  -  History of human immunodeficiency virus (HIV)
  -  Patients with active hepatitis B
  -  Patients with active hepatitis C
  -  Patients with active tuberculosis
  -  Any serious medical condition, physical examination finding, or abnormality in clinical laboratory tests that, in the investigator's judgment, precludes the patient's safe participation in and completion of the study
  Cancer-Specific Exclusions:
  -  NSCLC with sensitizing mutations in EGFR or ALK rearrangements
  -  Melanoma with BRAF mutations
  -  Active or untreated central nervous system (CNS) metastases, as determined by CT or MRI evaluation during screening and prior radiographic assessments
  -  Spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for >/= 2 weeks prior to screening
  -  Leptomeningeal disease
  -  Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently); patients with indwelling catheters are allowed.
  -  Uncontrolled/unstable tumor-related pain
  -  Uncontrolled hypercalcemia or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab
  -  History of other malignancy within 2 years prior to screening, except for appropriately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, Stage I uterine cancer, localized prostate cancer treated with curative intent, ductal carcinoma in situ treated surgically with curative intent, or other cancers with a similar outcome
  Exclusion Criteria Related to Medications:
  -  Prior treatment with CD137 agonists or immune checkpoint blockade therapies (Note: Patients who enroll in the prior MPDL3280A-treated cohorts will have previously received MPDL3280A)
  -  Treatment with systemic immunostimulatory agents within four weeks or five half-lives of the drug, whichever is shorter, prior to Cycle 1, Day 1
  -  Treatment with systemic immunosuppressive medications within 2 weeks prior to Cycle 1, Day 1 (the use of inhaled corticosteroids and mineralocorticoids is allowed)
  Exclusion Criteria Specific to Arm B (MPDL3280A + Interferon Alfa-2b):
  -  History of depression, suicidal ideation or behavior, bipolar disorder, or psychosis
  -  Hypersensitivity to interferon alpha or any component of the product

Relevance to patient case: not relevant