Study of Pembrolizumab and Chemotherapy With or Without Radiation in Small Cell Lung Cancer (SCLC)
Condition: Small Cell Lung Cancer (SCLC)
MeSH terms: Lung Neoplasms; Small Cell Lung Carcinoma
Intervention: Pembrolizumab; Cisplatin; Carboplatin; Etoposide; Radiation therapy
Intervention description: 200 mg IV fixed dose every 3 weeks until progression or for up to 2 years of therapy.; 75 mg/m2; AUC 6; IV every 3 weeks for up to 6 cycles (minimum of 4 cycles, maximum of 6).; Thoracic radiotherapy will be given per institutional standards(dose and duration may vary for individual participants).
Intervention MeSH terms: Carboplatin; Pembrolizumab; Etoposide
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 5.0
Sex: All
Minimum age: 19 Years
Healthy volunteers: No
Keywords: Chemotherapy; PD-L1; Thoracic radiotherapy; PD-1; MK-3475

Summary:

      This trial is to assess the efficacy of pembrolizumab added to concurrent chemotherapy with
      or without radiation therapy in patients with small cell lung cancer (SCLC).
    

Eligibility criteria:

        Inclusion Criteria:

          -  Participants must have histologically confirmed small cell lung carcinoma not amenable
             to initial concurrent radiotherapy (extensive-stage disease).

          -  Participants may have evaluable or measurable disease, defined as at least one lesion
             that can be accurately measured in at least one dimension (longest diameter to be
             recorded for non-nodal lesions and short axis for nodal lesions) as ≥20 mm with
             conventional techniques or as ≥10 mm with spiral CT scan, MRI, or calipers by clinical
             exam.

          -  Participants in cohort B must have completed 1 cycle of systemic chemotherapy. Therapy
             with the combination must start no sooner than 3 weeks from the last dose of
             chemotherapy and no later than 5 weeks from the last dose of chemotherapy.
             Participants in cohort B must not have had progression of disease prior to the start
             of therapy.

          -  Participants in cohort C must have completed systemic therapy (4-6 cycles cisplatin or
             carboplatin + etoposides) and NOT be a candidate for consolidation thoracic
             radiotherapy or PCI. Participants in cohort C must initiate therapy with pembrolizumab
             within 6 weeks of the last dose of chemotherapy (therapy must not start within 2 weeks
             from the last dose). Participants in cohort C must not have had progression of disease
             prior to the start of therapy.

          -  Participants in cohort D must have completed systemic therapy AND have completed
             either consolidation thoracic radiotherapy or PCI or both completed either
             consolidation thoracic radiotherapy or PCI or both. Participants in cohort D must
             initiate therapy with pembrolizumab within 6 weeks of the last dose of radiation.
             Therapy must not start within 2 weeks from the last dose. Consolidation radiotherapy
             dose must NOT be more than 3000 centigray (cGy). Participants in cohort D must not
             have had progression of disease prior to the start of therapy.

          -  Age > 18 years.

          -  Eastern Cooperative Oncology Group (ECOG) performance status ≤2 (Karnofsky ≥60%)

          -  Life expectancy of greater than 3 months

          -  Participants must have normal organ and marrow function during screening and on Cycle
             1, day 1 as defined below.

             * Adequate Organ Function Laboratory Values

          -  System Laboratory Value Hematological

          -  Absolute neutrophil count (ANC) ≥1,500 /microliter (mcL)

          -  Platelets ≥100,000 / mcL

          -  Hemoglobin ≥9 g/dL or ≥5.6 mmol/L without transfusion or erythropoietin (EPO)
             dependency (within 7 days of assessment)

        Renal

          -  Serum creatinine OR Measured or ≤1.5 X upper limit of normal (ULN) OR calculated
             creatinine ≥60 mL/min for subject with creatinine clearance (GFR can also be used
             levels >1.5X institutional ULN in place of creatinine or CrCl)

        Hepatic

          -  Serum total bilirubin ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for subjects with total
             bilirubin levels > 1.5 ULN

          -  AST (SGOT) and Alanine transaminase (ALT) (SGPT) ≤ 2.5 X ULN OR ≤ 5 X ULN for subjects
             with liver metastases

          -  Albumin >2.5 mg/dL

        Coagulation

          -  International Normalized Ratio ≤1.5 X ULN unless subject is receiving (INR) or
             Prothrombin Time (PT) anticoagulant therapy as long as PT or PTT is within therapeutic
             range of intended use of anticoagulants

          -  Activated Partial Thromboplastin ≤1.5 X ULN unless subject is receiving Time (aPTT)
             anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use
             of anticoagulants.

          -  Availability of a diagnostic or pre-chemotherapy tissue biopsy is required (cytologic
             specimens or bone biopsies not accepted). This biopsy must be within 6 weeks of
             starting initial therapy. A minimum of 205 μm slides or block is required.

          -  Participants in cohorts B-D must be willing to provide tissue from a newly obtained
             core or excisional biopsy of a tumor lesion. Newly-obtained is defined as a specimen
             within 4 weeks to initiation of treatment and AFTER the last dose of any prior
             therapy.

          -  Participants with treated brain metastases are allowed. Radiation must be completed at
             least 2 weeks prior to pembrolizumab dosing and participants must not require ongoing
             steroids. Participants with untreated brain metastases that are all <5 mm with no
             clinical symptoms or vasogenic edema may be allowed on study on a case-by-case basis
             on discussion with sponsor. These participants will require MRI monitoring every 6
             weeks to ensure stability.

          -  The effects of pembrolizumab on the developing human fetus are unknown. For this
             reason and because the chemotherapy and radiation also used in this trial are known to
             be teratogenic, women of child-bearing potential and men must agree to use adequate
             contraception (hormonal or barrier method of birth control; abstinence) or be
             surgically sterile prior to study entry and for the duration of study participation.
             Subjects of childbearing potential are those who have not been surgically sterilized
             or have not been free from menses for > 1 year. 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.

          -  Men treated or enrolled on this protocol must also agree to use adequate contraception
             prior to the study, for the duration of study participation, and 4 months after
             completion of chemotherapy, radiation, and pembrolizumab administration.

          -  Ability to understand and the willingness to sign a written informed consent document.

        Exclusion Criteria:

          -  Participants in cohort A may not have had prior therapy for their disease.
             Participants in cohort B may not have had more than 1 cycle of systemic therapy
             (cisplatin or carboplatin + etoposide). Participants in cohort C and D should not have
             had more than one prior regimen of chemotherapy.

          -  For participants entering cohorts C or D, prior treatment-related toxicities should
             have resolved to grade 1 or baseline (with the exception of anemia (as per inclusion
             criteria, alopecia, and neuropathy (< grade 2 allowed).

          -  Participants who have had a CR after pre-study therapy are not eligible for study.

          -  No thoracic radiation > 3000 cGy allowed.

          -  Prior radiation or surgery must have completed at least 2 weeks prior to initiation of
             therapy and all toxicities or complications from these must have resolved to baseline
             or grade 1 prior to starting therapy (with the exception of anemia (as per inclusion
             criteria, alopecia, and neuropathy (< grade 2 allowed).

          -  No stroke, myocardial infarction, or major surgery within 3 months of starting on
             therapy

          -  Participants who are receiving any other investigational agents or have received
             investigational therapy or any anti-cancer monoclonal antibody (mAB) within 4 weeks
             prior to the 1st dose of pembrolizumab.

          -  Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent

          -  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 (eg., thyroxine, insulin, or physiologic corticosteroid
             replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
             form of systemic treatment.

          -  Has known history of non-infectious pneumonitis which required steroids, or any
             evidence of current, non-infectious pneumonitis.

          -  Has an active infection requiring systemic therapy.

          -  Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any
             other form of immunosuppressive therapy within 7 days prior to the first dose of trial
             treatment.

          -  Has a known history of active Bacillus Tuberculosis (TB)

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to pembrolizumab, cisplatin, carboplatin, or etoposide.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, or psychiatric illness/social situations that would limit compliance with
             study requirements.

          -  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 120 days after the last dose of trial treatment.

          -  Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C Virus (HCV) (e.g.,
             HCV RNA [qualitative] is detected).

          -  Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).

          -  Has received a live vaccine within 30 days of planned start of study therapy Note:
             Seasonal influenza vaccines for injection are generally inactivated flu vaccines and
             are allowed; however intranasal influenza vaccines (e.g., Flu-Mist are live attenuated
             vaccines, and are not allowed.

          -  Has a known additional malignancy that is progressing or requires active treatment or
             has required active treatment within the last 2 years. Exceptions include basal cell
             carcinoma of the skin or squamous cell carcinoma of the skin that has undergone
             potentially curative therapy or in situ cervical cancer or in situ bladder cancer.

          -  Has a paraneoplastic syndrome other than SIADH (hyponatremia).

          -  Evidence of interstitial lung disease.