Clinical trial NCT03385226: A Trial Assessing the Effect of Pembrolizumab Combined with Radiotherapy in Patients with Relapsed, Refractory, Specified Stages of Cutaneous T-cell Lymphoma (CTCL) Mycosis Fungoides (MF)/Sezary Syndrome (SS)
Official title: Phase II Trial of Pembrolizumab and Radiotherapy in Cutaneous T-cell Lymphoma
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE2
Conditions: Cutaneous T Cell Lymphoma
Mycosis Fungoides/Sezary Syndrome
Keywords: Relapsed
Refractory
Lead sponsor: University College, London
Sponsor class: OTHER
Collaborators: name: Merck Sharp & Dohme LLC
First posted: 2017-12-28
Enrollment: 46
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Trial Subjects (patients), will receive single infusions of pembrolizumab every 3 weeks until disease progression or unacceptable toxicity develops. They will receive radiotherapy at week 12.

Detailed description: Trial Subjects (patients) who are deemed eligible for the trial will be administered a single infusion of pembrolizumab (200mg) every 3 weeks. At week 12, patients will be planned to start radiotherapy at a dose of 12 Gray (Gy) in 3 fractions which will be given concomitantly with pembrolizumab. Patients who progress on pembrolizumab before week 12 will start radiotherapy as soon as possible after progression. Following completion of radiotherapy, patients will continue receiving pembrolizumab at 3 weekly intervals for a maximum of 2 years until disease progression or unacceptable toxicity develops. Patients on pembrolizumab will be seen every 3 weeks until 2 years after study entry, while Patients who progressed/ stopped pembrolizumab will be seen annually for survival/disease status only. Patients completing 2 years of treatment will then be followed up annually for survival and disease status until the end of trial is declared (2 years after the last patient is registered).

Eligibility criteria: Inclusion Criteria:

* Age ≥ 18 years
* Diagnosis of Stage IB-IVB CTCL mycosis fungoides (MF)/Sézary Syndrome (SS)
* Have relapsed, are refractory or progressed after at least 1 systemic therapy
* Skin biopsy at the time of or within 6 months prior to study entry
* Patients must have a total mSWAT (modified Severity Weighted Assessment Tool) score of ≥10 OR have 2 or more measurable tumours of any size. Of this area: there should be at least 1 cutaneous lesion (MF) or a defined area of involved skin (erythrodermic MF or SS) which is an appropriate target for palliative radiotherapy. There should be an area of skin involved by measurable Mycosis Fungoides/SS that will not be irradiated (To assess the abscopal effect of radiotherapy)
* Have a minimum wash-out and adverse event (AE) recovery period from previous treatments (e.g. topical therapy, phototherapy, local radiotherapy, monoclonal antibody, systemic cytotoxic anticancer treatment or other novel agents) prior to the first dose of pembrolizumab
* Have ECOG performance status of 0 or 1
* Life expectancy of at least 6 months
* Demonstrate adequate organ function
* Female patients of childbearing potential must have a negative urine or serum pregnancy test at pre-registration. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
* Willing to comply with the contraception requirements
* Written informed consent

  •Exclusion Criteria:
* Received chemotherapy or targeted small molecule therapy within 4 weeks prior to study entry or has not recovered from adverse events due to agents administered \>4 weeks earlier (except patients with ≤ grade 2 neuropathy)
* Is currently or has participated in an IMP or device study within 4 weeks prior to the first dose of pembrolizumab
* Received any other monoclonal antibody within 15 weeks prior to the first dose of pembrolizumab or has not recovered (≤ grade 1 or to baseline level) from adverse events due to agents administered \>4 weeks earlier. The exception to this is alemtuzumab which should not have been administered in the previous 12 weeks
* Additional malignancy that is progressing or requires active treatment
* Patients with known central nervous system (CNS) involvement with lymphoma
* Hypersensitivity to pembrolizumab or its excipients
* 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 (such as thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Stable use of corticosteroids (at a dose no higher than 10mg prednisolone per day over the preceding 4 weeks) is allowed
* Diagnosis of prior immunodeficiency or organ-transplant requiring immunosuppressive therapy
* Current or prior use of immunosuppressive therapy within 7 days prior to start of treatment except the following: intranasal, inhaled, topical steroids or local steroid injections (eg. Intra-articular injection); systemic corticosteroids at physiologic doses (10mg/day or less of prednisolone or equivalent)
* Prior treatment with anti-PD-1, anti-PD-L1, anti-PD-L2 therapy
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris or cardiac arrhythmia
* Has known history of, or any evidence of active, non-infectious pneumonitis
* History of other pulmonary disease such as interstitial lung disease, emphysema or chronic obstructive pulmonary disease
* Is pregnant or breastfeeding
* Has a known history of active TB
* Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial or interfere with the subject's participation for the full duration of the trial or to participate in the trial is not in the patient's best interest, in the opinion of the treating investigator
* Has known psychiatric or substance abuse disorders that would interfere with the requirements of the trial
* Has a known history of HIV
* Has known active Hepatitis B or Hepatitis C
* Has received a live vaccine within 30 days prior to the planned start of study medication
* Patients who have previously received a solid organ transplant
* Patients who have previously received any allogeneic transplantation

Primary outcomes:
measure: Overall Response (Global Assessment)
timeFrame: 24 weeks after commencement of pembrolizumab
Secondary outcomes:
measure: Response
timeFrame: 12 weeks after start of pembrolizumab
measure: Change in Global Response
timeFrame: 24 weeks after start of pembrolizumab
measure: Safety and toxicity
timeFrame: 5 months after last dose of pembrolizumab (anticipated 2 years and 5 months after last patient being registered)
measure: Response Duration
timeFrame: Time from date of first confirmed response to the first date of diagnosis of progressive disease or death from any cause (anticipated by 2 years and 5 months after the last patient being registered)
measure: Progression Free Survival
timeFrame: Time from date of registration to the date of first progression or death from any cause ((anticipated by 2 years and 5 months after the last patient being registered)
measure: Overall Survival
timeFrame: Time from date of registration to the date of death from any cause ((anticipated by 2 years and 5 months after the last patient being registered)
measure: Number of patients achieving abscopal effect
timeFrame: Through study completion, 2 years post last patient being registered
Other outcomes:
measure: Assessment of changes in the immune status
timeFrame: 24 weeks after start of pembrolizumab
measure: Analysis of plasma High Mobility Group Box 1 (HMGB-1) isoform levels
timeFrame: 24 weeks after start of pembrolizumab
measure: Functional analysis of isolated cell populations
timeFrame: 24 weeks after start of pembrolizumab
measure: Assessment of diversity and clonality of T cell clones
timeFrame: 24 weeks after start of pembrolizumab
measure: Evaluation of immune signatures for responders and non-responders
timeFrame: 24 weeks after start of pembrolizumab
measure: Epitope screening for tumour infiltrating lymphocyte specific neo-antigens
timeFrame: 24 weeks after start of pembrolizumab
measure: Immunohistochemical analysis of expression of immunological checkpoints
timeFrame: At baseline
measure: Investigation of the baseline tumour immune microenvironment
timeFrame: At baseline
Locations:
city: Birmingham
country: United Kingdom
facility: University Hospital Birmingham
city: Cardiff
country: United Kingdom
facility: Velindre Cancer Centre
city: Coventry
country: United Kingdom
facility: University Hospital Coventry
city: Glasgow
country: United Kingdom
facility: Beatson West of Scotland Cancer Centre
city: London
country: United Kingdom
facility: Guy's & St Thomas'
city: Manchester
country: United Kingdom
facility: The Christie
city: Newcastle
country: United Kingdom
facility: Freeman Hospital
city: Nottingham
country: United Kingdom
facility: Nottingham City Hospital
city: Oxford
country: United Kingdom
facility: Churchill Hospital
city: Southampton
country: United Kingdom
facility: Southampton University Hospital
city: Wirral
country: United Kingdom
facility: Clatterbridge Cancer Centre
Study officials:
affiliation: University of Manchester
name: Tim Illidge
role: PRINCIPAL_INVESTIGATOR
References:
citation: Narducci MG, Tosi A, Frezzolini A, Scala E, Passarelli F, Bonmassar L, Monopoli A, Accetturi MP, Cantonetti M, Antonini Cappellini GC, De Galitiis F, Rosato A, Picozza M, Russo G, D'Atri S. Reduction of T Lymphoma Cells and Immunological Invigoration in a Patient Concurrently Affected by Melanoma and Sezary Syndrome Treated With Nivolumab. Front Immunol. 2020 Sep 25;11:579894. doi: 10.3389/fimmu.2020.579894. eCollection 2020.