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Trial Title:
Immunotherapy Combined With Radiotherapy for Metastatic Sarcoma
NCT ID:
NCT05488366
Condition:
Sarcoma, Soft Tissue
Conditions: Official terms:
Sarcoma
Pembrolizumab
Conditions: Keywords:
Sarcoma
Advanced Sarcoma
Metastatic Sarcoma
Pembrolizumab
Stereotactic Ablative Radiotherapy
Study type:
Interventional
Study phase:
Early Phase 1
Overall status:
Recruiting
Study design:
Allocation:
Non-Randomized
Intervention model:
Parallel Assignment
Primary purpose:
Treatment
Masking:
None (Open Label)
Intervention:
Intervention type:
Drug
Intervention name:
Pembrolizumab
Description:
Given IV
Arm group label:
A: Pembrolizumab + Radiation Therapy
Other name:
MK-3475
Intervention type:
Radiation
Intervention name:
Radiation therapy
Description:
Single target will be selected by the treating radiation oncologist. A lesion causing
symptoms or expected to become symptomatic will be favored for target selection.
Arm group label:
A: Pembrolizumab + Radiation Therapy
Arm group label:
B: Radiation Therapy with or without standard of care checkpoint inhibitor immunotherapy
Other name:
RT
Summary:
This is a pilot study determining the feasibility of combination treatments,
pembrolizumab and stereotactic ablative radiotherapy (SBRT) in subjects with soft-tissue
sarcoma. These are subjects who have metastatic disease initially, or recurrent or
progressive disease that is not eligible for curative surgery.
Criteria for eligibility:
Criteria:
Inclusion Criteria:
- Patients must have histologically or cytologically confirmed soft-tissue sarcoma, or
a soft-tissue sarcoma with tumor mutational burden ≥10 mut/Mb.
- Patient must either have started a checkpoint inhibitor immunotherapy regimen within
60 days, or have a soft-tissue sarcoma histology amenable to pembrolizumab therapy
(inclusive of undifferentiated pleomorphic sarcoma [formerly known as malignant
fibrous histiocytoma], myxofibrosarcoma, dedifferentiated liposarcoma or
undifferentiated sarcoma [unclassified histology]).
- Patients with soft-tissue sarcoma must have advanced disease (stage IV) or
previously treated disease that has become progressive, recurrent, or metastatic,
and either previously received first-line systemic therapy or been deemed ineligible
to receive first-line systemic therapy. Staging is by AJCC 8th Edition.
- Must not have disease amenable to curative intent surgery.
- Must have at least 2 measurable lesions per RECIST v1.1 assessed by CT scan. A
measurable lesion is defined to mean 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.
- Must have at least 1 site of non-central nervous system (CNS) disease amenable to
treatment with radiation therapy. This lesion may have been previously treated with
radiation if the cumulative spinal cord dose will remain below a Biologically
Effective Dose (BED)α/β 2Gy of 112 Gy (single fraction equivalent 14 Gy) and the
radiation will be delivered at least 180 days after completion of the prior
radiation course to the same site. BED will be calculated using the linear-quadratic
formula: d * f * (1 + [d / (α/β)]), where d is the dose per fraction, f is the total
number of fractions, and α/β is the property of irradiated tissue measured in Gray.
- Must be age ≥ 18 years. Because initial and subsequent therapies for pediatric
sarcomas (<18 years of age) are different than those ≥18, children are excluded from
this study. In addition, because no adverse event data are currently available on
the use of SBRT combined with pembrolizumab in patients <18 years of age, children
are excluded from this study but will be eligible for future pediatric trials, if
applicable.
1. Both men and women and members of all races and ethnic groups are eligible for
this trial. Non-English speaking, deaf, hard of hearing and illiterate
individuals are eligible for this trial
- Performance status: ECOG performance status ≤2 (Karnofsky ≥50%).
- Life expectancy of ≥3 months.
- Adequate organ and marrow function as defined below. Labs should be performed within
14 days of treatment.
1. Leukocytes ≥2,000/mcL
2. Absolute neutrophil count ≥1,000/mcL
3. Platelets ≥75,000/mcL
4. AST(SGOT)/ALT(SPGT) ≤3 times institutional upper limit of normal (ULN), or ≤5
times ULN for patients with liver metastases
5. Total bilirubin ≤2.5 times institutional ULN
6. Serum creatinine ≤2.5 times institutional ULN, or calculated creatinine
clearance ≥30 mL/min (if serum creatinine >2.5 times institutional ULN)
7. Thyroid stimulating hormone within institutional limits, or T4 is within
institutional limits if TSH is outside of institutional limits
- Female patients of childbearing potential must have a negative urine or serum
pregnancy within 72 hours before receiving the first dose of pembrolizumab. If the
urine test is positive or cannot be confirmed as negative, a serum pregnancy test
will be required.
- The effects of pembrolizumab and ionizing radiation on the developing human fetus
are known to have the potential for congenital abnormalities and fetal harm. Women
of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry, for
the duration of study participation, and for 120 days following completion of
therapy. Should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately.
1. A female of child-bearing potential is any woman (regardless of sexual
orientation, having undergone a tubal ligation, or remaining celibate by
choice) who meets the following criteria:
1. Has not undergone a hysterectomy or bilateral oophorectomy; or
2. Has not been naturally postmenopausal for at least 12 consecutive months (i.e.,
has had menses at any time in the preceding 12 consecutive months).
- Patients who are HIV-positive with undetectable HIV viral load are eligible provided
they meet all other protocol criteria for participation.
- Patients with HBV or HCV infection are eligible provided viral loads are
undetectable. Patients on suppressive therapy are eligible.
- Patients must not be on active immunosuppression within 7 days prior to the first
dose of treatment.
- Patients must not have a history of (non-infectious) pneumonitis that required
steroids or has current pneumonitis.
- Ability to understand and willingness to sign a written informed consent document
Exclusion Criteria:
- Patients who have had chemotherapy or radiotherapy within 2 weeks prior to
initiation of study therapy.
- Patients who have not recovered from adverse events due to prior anti-cancer therapy
administered.
- Patients must not be receiving any other investigational agents.
- Patients with a history of allergic reactions attributed to compounds of similar
chemical or biologic composition to pembrolizumab.
- Patients with 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.
- Patients must not be pregnant or nursing due to the potential for congenital
abnormalities and the potential of this regimen to harm nursing infants.
1. Pembrolizumab can cause fetal harm when administered to a pregnant woman based
on the biological mechanism that PD-1/PD-L1 signaling is an important pathway
in the maintenance of pregnancy through induction of maternal immune tolerance
to fetal tissue.1 Human IgG4 is known to cross the placenta. Animal models have
found that blocking PD-L1 signaling increases the risk of fetal loss, and
immune-mediated disorders occurred in PD-1 knockout mice.
2. Although there are not data on the presence of pembrolizumab in either animal
or human milk or its effects on breastfed children or on milk production, there
is a potential for serious adverse reactions in breastfed children. Thus, women
are advised not to breastfeed during treatment with pembrolizumab and for 120
days after the final dose.
- Patients with disease amenable to curative intent surgery.
- Patient has had a prior monoclonal antibody for treatment of sarcoma, unless the
current regimen is checkpoint inhibitor immunotherapy.
- Patient has a known additional malignancy that is progressing or requires active
treatment; exceptions include basal cell carcinoma of the skin, squamous cell
carcinoma of the skin.
- Patient has an active autoimmune disease requiring systemic treatment within the
past 3 months or a documented history of clinically severe autoimmune disease, or a
syndrome that requires systemic steroids or immunosuppressive agents. Patients with
resolved childhood asthma, hypothyroidism stable on hormone replacement, Sjogren's
syndrome, or with vitiligo would not be excluded. Patients requiring intermittent
bronchodilators, inhaled steroids, or local steroid injections would not be
excluded. Patients requiring physiologic doses of corticosteroids may be approved
after consultation with the protocol principal investigator.
Gender:
All
Minimum age:
18 Years
Maximum age:
N/A
Healthy volunteers:
No
Locations:
Facility:
Name:
Chao Family Comprehensive Cancer Center, University of California, Irvine
Address:
City:
Orange
Zip:
92868
Country:
United States
Status:
Recruiting
Contact:
Last name:
Jeremy Harris, MD, MPhil
Phone:
877-827-8839
Email:
ucstudy@uci.edu
Start date:
August 3, 2022
Completion date:
August 2025
Lead sponsor:
Agency:
University of California, Irvine
Agency class:
Other
Source:
University of California, Irvine
Record processing date:
ClinicalTrials.gov processed this data on November 12, 2024
Source: ClinicalTrials.gov page:
https://clinicaltrials.gov/ct2/show/NCT05488366