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Trial Title: Immunotherapy in Combination With Prednisone and Sirolimus for Kidney Transplant Recipients With Unresectable or Metastatic Skin Cancer

NCT ID: NCT05896839

Condition: Clinical Stage III Cutaneous Melanoma AJCC v8
Clinical Stage III Cutaneous Merkel Cell Carcinoma AJCC v8
Clinical Stage IV Cutaneous Melanoma AJCC v8
Clinical Stage IV Cutaneous Merkel Cell Carcinoma AJCC v8
Metastatic Basal Cell Carcinoma
Metastatic Carcinoma in the Skin
Metastatic Melanoma
Metastatic Merkel Cell Carcinoma
Metastatic Skin Squamous Cell Carcinoma
Unresectable Basal Cell Carcinoma
Unresectable Melanoma
Unresectable Merkel Cell Carcinoma
Unresectable Skin Squamous Cell Carcinoma

Conditions: Official terms:
Carcinoma, Merkel Cell
Carcinoma
Melanoma
Carcinoma, Squamous Cell
Carcinoma, Basal Cell
Melanoma, Cutaneous Malignant
Skin Neoplasms
Sirolimus
Prednisone
Cortisone
Nivolumab
Ipilimumab
Temsirolimus
MTOR Inhibitors

Study type: Interventional

Study phase: Phase 1/Phase 2

Overall status: Recruiting

Study design:

Allocation: N/A

Intervention model: Single Group Assignment

Primary purpose: Treatment

Masking: None (Open Label)

Intervention:

Intervention type: Procedure
Intervention name: Biopsy
Description: Undergo tumor biopsy
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: BIOPSY_TYPE

Other name: Bx

Intervention type: Procedure
Intervention name: Biospecimen Collection
Description: Undergo blood sample collection
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: Biological Sample Collection

Other name: Biospecimen Collected

Other name: Specimen Collection

Intervention type: Procedure
Intervention name: Computed Tomography
Description: Undergo CT scan
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: CAT

Other name: CAT Scan

Other name: Computed Axial Tomography

Other name: Computerized Axial Tomography

Other name: Computerized axial tomography (procedure)

Other name: Computerized Tomography

Other name: Computerized Tomography (CT) scan

Other name: CT

Other name: CT Scan

Other name: tomography

Intervention type: Biological
Intervention name: Ipilimumab
Description: Given IV
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: Anti-Cytotoxic T-Lymphocyte-Associated Antigen-4 Monoclonal Antibody

Other name: BMS 734016

Other name: BMS-734016

Other name: BMS734016

Other name: Ipilimumab Biosimilar CS1002

Other name: MDX 010

Other name: MDX-010

Other name: MDX-CTLA4

Other name: MDX010

Other name: Yervoy

Intervention type: Procedure
Intervention name: Kidney Biopsy
Description: Undergo kidney biopsy
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: Biopsy of Kidney

Other name: Renal Biopsy

Intervention type: Procedure
Intervention name: Magnetic Resonance Imaging
Description: Undergo MRI
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: Magnetic Resonance

Other name: Magnetic Resonance Imaging (MRI)

Other name: Magnetic resonance imaging (procedure)

Other name: Magnetic Resonance Imaging Scan

Other name: Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance

Other name: MR

Other name: MR Imaging

Other name: MRI

Other name: MRI Scan

Other name: MRIs

Other name: NMR Imaging

Other name: NMRI

Other name: Nuclear Magnetic Resonance Imaging

Other name: sMRI

Other name: Structural MRI

Intervention type: Biological
Intervention name: Nivolumab
Description: Given IV
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: ABP 206

Other name: BCD-263

Other name: BMS 936558

Other name: BMS-936558

Other name: BMS936558

Other name: CMAB819

Other name: MDX 1106

Other name: MDX-1106

Other name: MDX1106

Other name: NIVO

Other name: Nivolumab Biosimilar ABP 206

Other name: Nivolumab Biosimilar BCD-263

Other name: Nivolumab Biosimilar CMAB819

Other name: ONO 4538

Other name: ONO-4538

Other name: ONO4538

Other name: Opdivo

Intervention type: Drug
Intervention name: Prednisone
Description: Given PO
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: .delta.1-Cortisone

Other name: 1, 2-Dehydrocortisone

Other name: Adasone

Other name: Cortancyl

Other name: Dacortin

Other name: DeCortin

Other name: Decortisyl

Other name: Decorton

Other name: Delta 1-Cortisone

Other name: Delta-Dome

Other name: Deltacortene

Other name: Deltacortisone

Other name: Deltadehydrocortisone

Other name: Deltasone

Other name: Deltison

Other name: Deltra

Other name: Econosone

Other name: Lisacort

Other name: Meprosona-F

Other name: Metacortandracin

Other name: Meticorten

Other name: Ofisolona

Other name: Orasone

Other name: Panafcort

Other name: Panasol-S

Other name: Paracort

Other name: Perrigo Prednisone

Other name: PRED

Other name: Predicor

Other name: Predicorten

Other name: Prednicen-M

Other name: Prednicort

Other name: Prednidib

Other name: Prednilonga

Other name: Predniment

Other name: Prednisone Intensol

Other name: Prednisonum

Other name: Prednitone

Other name: Promifen

Other name: Rayos

Other name: Servisone

Other name: SK-Prednisone

Intervention type: Drug
Intervention name: Sirolimus
Description: Given PO
Arm group label: Treatment (nivolumab and ipilimumab)

Other name: AY 22989

Other name: AY-22989

Other name: AY22989

Other name: RAPA

Other name: Rapamune

Other name: Rapamycin

Other name: SILA 9268A

Other name: SILA-9268A

Other name: SILA9268A

Other name: WY 090217

Other name: WY-090217

Other name: WY090217

Summary: This phase II trial tests the combination of nivolumab and ipilimumab with sirolimus and prednisone for the treatment of skin (cutaneous) cancer that cannot be removed by surgery (unresectable) or that has spread from where it first started to other places in the body (metastatic) in kidney transplant recipients. Immunotherapy with nivolumab and ipilimumab, may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. Sirolimus and prednisone are immunosuppressants that are given to keep the body from rejecting the transplanted kidney. Giving nivolumab and ipilimumab in combination with sirolimus and prednisone may kill more cancer cells, while also keeping the transplanted kidney healthy, in patients with unresectable or metastatic cutaneous cancer who have received a kidney transplant.

Detailed description: PRIMARY OBJECTIVE: I. To evaluate the proportion of kidney transplant recipients with selected advanced cutaneous cancers who at 14 weeks after administration of prednisone, sirolimus, nivolumab, and ipilimumab experience complete response (CR), partial response (PR), or stable disease (SD) without allograft loss. SECONDARY OBJECTIVE: I. To estimate the objective response rate (ORR), rate of allograft loss, and durations of progression-free survival (PFS) and overall survival (OS) in the study population. EXPLORATORY OBJECTIVES: I. To characterize correlates of the host immune response including, but not limited to: Ia. Histopathological characteristics of allograft rejection/loss; Ib. Immunological changes in the tumor microenvironment (e.g., changes in T-cell subset populations or expression of immune checkpoint molecules) in paired biopsies obtained pre-treatment and on-treatment; Ic. Characteristics of anti-programmed death-1 (PD-1)-associated immune-mediated adverse reactions (IMARs) in this patient population treated with immunosuppression; Id. To identify upregulated immune-related genes using multiplex quantitative reverse transcription polymerase chain reaction (qRT-PCR). II. To observe whether changes in donor-derived cell-free deoxyribonucleic acid (DNA) (dd-cfDNA) as a marker for allograft rejection. III. To compare baseline patient allograft/donor characteristics, to include human leukocyte antigen (HLA) status, date of transplant, presence of donor specific antibodies, history of prior rejection, and Calculated Panel Reactive Antibodies score, in patients who experience and do not experience rejection while on this study. IV. To observe the objective response rate (ORR) of patients who achieve PR/CR or stable disease for >= 6 months with eventual progressive disease requiring re-induction with nivolumab + ipilimumab (receive > 4 doses of nivolumab + ipilimumab). OUTLINE: Patients receive sirolimus orally (PO) and prednisone PO daily, starting 7 days prior to cycle 1 day 1 of immunotherapy. Patients also receive nivolumab intravenously (IV) over 30 minutes and ipilimumab IV over 30 minutes on day 8 of cycle 1 and day 1 of cycle 2. Six weeks after the first dose of nivolumab and ipilimumab, patients undergo tumor response assessment. Patients who achieve stable disease (SD), partial response (PR), or complete response (CR) receive nivolumab IV on day 1 of each cycle. Cycles repeat every 4 weeks for a total of 24 cycles in the absence of disease progression or unacceptable toxicity. Patients who had disease progression at this time or any time on trial may receive nivolumab IV and ipilimumab IV on day 1 of each cycle. Cycles repeat every 3 weeks for 2 cycles, in the absence of unacceptable toxicity. Patients are then assessed for tumor response again after 6 weeks and receive nivolumab monotherapy if they achieve SD, PR, or CR. If patients have progressive disease, they may receive nivolumab monotherapy or discontinue study treatment. Patients may undergo magnetic resonance imaging (MRI) during screening, undergo tumor biopsy on study and undergo computed tomography (CT) scan and blood sample collection throughout the study. Patients may undergo kidney biopsy if rejection is suspected. Patients follow up every 12 weeks for 1 year after stopping therapy, then every 16 weeks for the second year after stopping and then every 20 weeks for up to 5 years.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Patients must be kidney transplant recipients with a functioning allograft who do not currently require dialysis - Patient's age must be >= 18 years. Because no dosing or adverse event (AE) data are currently available on the use of nivolumab and ipilimumab in kidney transplant recipients <18 years of age, children are excluded from this study, but may be eligible for future pediatric trials - Patients must have histologically or cytologically confirmed non-uveal melanoma, basal cell carcinoma, Merkel cell carcinoma, or cutaneous squamous cell carcinoma for which standard non-immunological medical, surgical, or radiation therapy would be insufficient (i.e., patients who are not surgical candidates). Patients with cutaneous squamous cell carcinoma or Merkel cell carcinoma may enroll without prior medical therapy (e.g., cetuximab or chemotherapy respectively). Non-immunologic standard therapies that patients must have received, refused or for which patients were ineligible include: - For patients with BRAF-mutant melanoma, prior therapies include BRAF/MEK inhibitors - For patients with Basal cell carcinoma, prior therapies include hedgehog pathway inhibitors - Patients must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria, i.e., 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 by chest x-ray or as >= 10 mm with CT scan, magnetic resonance imaging (MRI), or calipers by clinical exam is preferred, but not required - Patients must have Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%) performance status criteria - Leukocytes >= 2,000/mcL - Absolute neutrophil count >= 1,500/mcL - Platelets >= 50,000/mcL - Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) - Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 x institutional ULN - Serum creatinine =< 3 x ULN - dd-cfDNA =< 1.0% and =< 61% increase - The effects of nivolumab and ipilimumab on the developing human fetus are unknown. For this reason, and because other therapeutic agents used in this trial are known to be teratogenic, women of childbearing potential (WOCBP) receiving nivolumab must continue contraception for a period of 5 months after the last dose of nivolumab. Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile) as well as azoospermic men do not require contraception. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of beta-human chorionic gonadotropin [B-HCG]) during the screening period. Follow-up evaluations will include interval sexual/menstrual histories as needed. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she (or the participating partner) should inform the treating physician immediately. WOCBP is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. Women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level less than 40 mIU/mL to be considered postmenopausal. - Human immunodeficiency virus (HIV)-infected patients will be eligible for this trial if they are on effective antiretroviral regimens utilizing non-CYP-interactive agents and have an undetectable viral load. If there is evidence of chronic hepatitis B virus (HBV) infection, HBV viral load must be undetectable on suppressive therapy, if indicated. If there is history of hepatitis C virus (HCV) infection, the patient must have been treated and have undetectable HCV viral load. - Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants Exclusion Criteria: - Patients who have received a liver, lung, heart, or pancreas transplant; or allogeneic stem cell transplant; or any kind of bone marrow transplant - Patients unwilling or unable to undergo dialysis in the event of allograft failure - Patients with prior evidence of human leukocyte antigen (HLA) or non-HLA donor-specific antibodies (DSA) - Patients with a history of antibody- or cell-mediated allograft rejection within 3 months of study entry - Potential trial participants should have recovered from clinically significant adverse events of their most recent therapy/intervention prior to enrollment - Patients must not have had prior treatment for their current cancer with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-LAG-3 or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways within 1 year of study enrollment. Prior history of adjuvant therapy is allowed if received over 1 year prior to enrollment - Patients must not be receiving any other investigational agents - Patients with leptomeningeal metastases, more than 3 untreated central nervous system (CNS) metastases, untreated brain metastases measuring >1cm, or requiring treatment-dose steroids (> 10 mg/day prednisone equivalents) for CNS-related symptoms. Exclusions are due to concerns regarding progressive neurologic dysfunction that would confound the evaluation of neurologic and other AEs. Patients with brain metastases meeting the above requirements are permitted to enroll - Patients must not have a history of severe hypersensitivity reaction to any monoclonal antibody - Patients must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to other agents used in the study - Patients must not have uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or any other significant condition(s) that would make this protocol unreasonably hazardous - Pregnant women are excluded from this study because nivolumab and ipilimumab have the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for AEs in nursing infants secondary to treatment of the mother, breastfeeding should be discontinued if the mother is treated with nivolumab or ipilimumab. These potential risks may also apply to other agents used in this study - Patients with autoimmune disease that is active or might recur and affect vital organ function will be eligible only after consultation with the study PI. Guillain-Barre (GB) syndrome, bullous skin disease, Stevens Johnson syndrome, or toxic epidermal necrolysis will be excluded - Patients must not have had evidence of active or acute diverticulitis, intra-abdominal abscess, GI obstruction and abdominal carcinomatosis which are known risk factors for bowel perforation should be evaluated for the potential need for additional treatment before coming on study. In addition, patients with a history of cardiac disease including coronary artery disease (CAD), myocardial infarction (MI), cardiomyopathy, arrhythmia, heart block, should have an evaluation by history pulmonary embolism (PE) and appropriate testing to allow evaluation of any events that may occur on study. These may include troponin, electrocardiogram (EKG), echocardiogram (ECHO) as clinically indicated and may include results already in the medical record if available

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: Keck Medicine of USC Koreatown

Address:
City: Los Angeles
Zip: 90020
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 213-388-0908

Investigator:
Last name: Gino K. In
Email: Principal Investigator

Facility:
Name: Los Angeles General Medical Center

Address:
City: Los Angeles
Zip: 90033
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 323-865-0451
Email: uscnorrisinfo@med.usc.edu

Investigator:
Last name: Gino K. In
Email: Principal Investigator

Facility:
Name: USC / Norris Comprehensive Cancer Center

Address:
City: Los Angeles
Zip: 90033
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 323-865-0451

Investigator:
Last name: Gino K. In
Email: Principal Investigator

Facility:
Name: UM Sylvester Comprehensive Cancer Center at Aventura

Address:
City: Aventura
Zip: 33180
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 954-461-2180

Investigator:
Last name: Jose Lutzky
Email: Principal Investigator

Facility:
Name: UM Sylvester Comprehensive Cancer Center at Coral Gables

Address:
City: Coral Gables
Zip: 33146
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 305-243-2647

Investigator:
Last name: Jose Lutzky
Email: Principal Investigator

Facility:
Name: UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Address:
City: Deerfield Beach
Zip: 33442
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 305-243-2647

Investigator:
Last name: Jose Lutzky
Email: Principal Investigator

Facility:
Name: University of Miami Miller School of Medicine-Sylvester Cancer Center

Address:
City: Miami
Zip: 33136
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 305-243-2647

Investigator:
Last name: Jose Lutzky
Email: Principal Investigator

Facility:
Name: UM Sylvester Comprehensive Cancer Center at Kendall

Address:
City: Miami
Zip: 33176
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 305-243-2647

Investigator:
Last name: Jose Lutzky
Email: Principal Investigator

Facility:
Name: UM Sylvester Comprehensive Cancer Center at Plantation

Address:
City: Plantation
Zip: 33324
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 305-243-2647

Investigator:
Last name: Jose Lutzky
Email: Principal Investigator

Facility:
Name: Emory University Hospital/Winship Cancer Institute

Address:
City: Atlanta
Zip: 30322
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 404-778-1868

Investigator:
Last name: Michael Lowe
Email: Principal Investigator

Facility:
Name: Northwestern University

Address:
City: Chicago
Zip: 60611
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 312-695-1301
Email: cancer@northwestern.edu

Investigator:
Last name: Sunandana Chandra
Email: Principal Investigator

Facility:
Name: Memorial Hospital East

Address:
City: Shiloh
Zip: 62269
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 314-747-9912
Email: dschwab@wustl.edu

Investigator:
Last name: George Ansstas
Email: Principal Investigator

Facility:
Name: JHU Sidney Kimmel Comprehensive Cancer Center LAO

Address:
City: Baltimore
Zip: 21231
Country: United States

Status: Recruiting

Contact:
Last name: Evan J. Lipson

Phone: 410-502-5977
Email: evanlipson@jhmi.edu

Investigator:
Last name: Evan J. Lipson
Email: Principal Investigator

Facility:
Name: Johns Hopkins University/Sidney Kimmel Cancer Center

Address:
City: Baltimore
Zip: 21287
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 410-955-8804
Email: jhcccro@jhmi.edu

Investigator:
Last name: Evan J. Lipson
Email: Principal Investigator

Facility:
Name: Siteman Cancer Center at West County Hospital

Address:
City: Creve Coeur
Zip: 63141
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 800-600-3606
Email: info@siteman.wustl.edu

Investigator:
Last name: George Ansstas
Email: Principal Investigator

Facility:
Name: Washington University School of Medicine

Address:
City: Saint Louis
Zip: 63110
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 800-600-3606
Email: info@siteman.wustl.edu

Investigator:
Last name: George Ansstas
Email: Principal Investigator

Facility:
Name: Siteman Cancer Center-South County

Address:
City: Saint Louis
Zip: 63129
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 800-600-3606
Email: info@siteman.wustl.edu

Investigator:
Last name: George Ansstas
Email: Principal Investigator

Facility:
Name: Siteman Cancer Center at Christian Hospital

Address:
City: Saint Louis
Zip: 63136
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 800-600-3606
Email: info@siteman.wustl.edu

Investigator:
Last name: George Ansstas
Email: Principal Investigator

Facility:
Name: Siteman Cancer Center at Saint Peters Hospital

Address:
City: Saint Peters
Zip: 63376
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 800-600-3606
Email: info@siteman.wustl.edu

Investigator:
Last name: George Ansstas
Email: Principal Investigator

Facility:
Name: NYU Langone Hospital - Long Island

Address:
City: Mineola
Zip: 11501
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 212-263-4432
Email: cancertrials@nyulangone.org

Investigator:
Last name: Maya Dimitrova
Email: Principal Investigator

Facility:
Name: Laura and Isaac Perlmutter Cancer Center at NYU Langone

Address:
City: New York
Zip: 10016
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact
Email: CancerTrials@nyulangone.org

Investigator:
Last name: Maya Dimitrova
Email: Principal Investigator

Facility:
Name: University of Pittsburgh Cancer Institute (UPCI)

Address:
City: Pittsburgh
Zip: 15232
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 412-647-8073

Investigator:
Last name: Diwakar Davar
Email: Principal Investigator

Facility:
Name: Huntsman Cancer Institute/University of Utah

Address:
City: Salt Lake City
Zip: 84112
Country: United States

Status: Recruiting

Contact:
Last name: Site Public Contact

Phone: 888-424-2100
Email: cancerinfo@hci.utah.edu

Investigator:
Last name: Kathleen C. Kerrigan
Email: Principal Investigator

Start date: July 24, 2024

Completion date: January 31, 2027

Lead sponsor:
Agency: National Cancer Institute (NCI)
Agency class: NIH

Source: National Cancer Institute (NCI)

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05896839

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