Localized Radiation Therapy or Recombinant Interferon Beta and Avelumab With or Without Cellular Adoptive Immunotherapy in Treating Patients With Metastatic Merkel Cell Carcinoma
NCT ID: NCT02584829
Last Updated: 2022-03-22
Study Results
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View full resultsBasic Information
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TERMINATED
PHASE1/PHASE2
8 participants
INTERVENTIONAL
2015-11-06
2018-12-18
Brief Summary
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Detailed Description
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I. Assess and compare the safety and potential toxicities associated with treating patients with metastatic Merkel cell carcinoma (MCC) with either major histocompatibility complex (MHC) up regulation and programmed cell death 1 (PD1)-axis blockade (Group 1), or MHC up-regulation, PD1-axis blockade and adoptive transfer of Merkel cell polyoma virus (MCPyV) T antigen (TAg)-specific polyclonal autologous cluster of differentiation (CD)8+ T cells (Group 2).
II. Assess and compare the antitumor efficacy associated with treating patients with metastatic MCC with either MHC up-regulation and PD1-axis blockade (Group 1), or MHC up-regulation, PD1-axis blockade and adoptive transfer of MCPyV TAg-specific polyclonal autologous CD8+ T cells (Group 2).
SECONDARY OBJECTIVES:
I. Examine the in vivo persistence and, where evaluable, migration to tumor sites of adoptively transferred polyclonal CD8+ T cells targeting the MCPyV TAg (Group 2).
II. Examine the in vivo functional capacity of adoptively transferred polyclonal CD8+ T cells targeting the MCPyV Tag (Group 2).
III. Examine and compare evidence of epitope spreading with either MHC up-regulation and adoptive transfer of MHC up-regulation and PD1-axis blockade (Group 1), or MHC up regulation, PD1-axis blockade and adoptive transfer of MCPyV TAg-specific polyclonal autologous CD8+ T cells (Group 2).
OUTLINE: Patients are assigned to 1 of 2 groups.
GROUP 1: Patients who do not have a human leukocyte antigen (HLA) type for which T cells can be generated or for whom T cells cannot be generated for technical issues receive avelumab intravenously (IV) over 1 hour every 2 weeks for 12 months. Within 7-10 days after completion of 1-3 doses of avelumab, patients receive MHC class I up-regulation intervention comprising either localized radiation therapy or recombinant interferon beta via intra-tumor injection.
GROUP 2: Patients who have an HLA type for which T cells can be generated receive avelumab IV over 1 hour every 2 weeks for 12 months. Patients also receive MHC class I up-regulation intervention as in Group 1 between 7-10 days after the first infusion of avelumab and 2-5 days before the first infusion of MCPyV TAg-specific polyclonal autologous CD8+ T cells. Patients receive two infusions of MCPyV TAg-specific polyclonal autologous CD8+ T cells IV over 60-120 minutes.
In both groups, MHC class I up-regulation treatment with or without T cell infusions may repeat if indicated.
After completion of study treatment, patients are followed up at 12 months and then periodically thereafter.
Conditions
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Study Design
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NON_RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Group 1 (avelumab and MHC class I up-regulation)
Patients who do not have a HLA type for which T cells can be generated or for whom T cells cannot be generated for technical issues receive avelumab intravenously (IV) over 1 hour every 2 weeks for 12 months. Within 7-10 days after completion of 1-3 doses of avelumab, patients receive MHC class I up-regulation intervention comprising either localized radiation therapy or recombinant interferon beta via intra-tumor injection.
Avelumab
Given IV
Laboratory Biomarker Analysis
Correlative studies
Radiation Therapy
Undergo radiation therapy
Recombinant Interferon Beta
Given via intra-tumor injection
Group 2 (avelumab, MHC class I up-regulation, T cells)
Patients who have an HLA type for which T cells can be generated receive avelumab IV over 1 hour every 2 weeks for 12 months. Patients also receive MHC class I up-regulation intervention as in Group 1 between 7-10 days after the first infusion of avelumab and 2-5 days before the first infusion of MCPyV TAg-specific polyclonal autologous CD8+ T cells. Patients receive two infusions of MCPyV TAg-specific polyclonal autologous CD8+ T cells IV over 60-120 minutes.
Avelumab
Given IV
Laboratory Biomarker Analysis
Correlative studies
MCPyV TAg-specific Polyclonal Autologous CD8-positive T Cells
Given IV
Radiation Therapy
Undergo radiation therapy
Recombinant Interferon Beta
Given via intra-tumor injection
Interventions
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Avelumab
Given IV
Laboratory Biomarker Analysis
Correlative studies
MCPyV TAg-specific Polyclonal Autologous CD8-positive T Cells
Given IV
Radiation Therapy
Undergo radiation therapy
Recombinant Interferon Beta
Given via intra-tumor injection
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Confirmation of MCC by internal pathology review of initial or subsequent biopsy or other pathologic material
* If an accessible lesion is present, a biopsy will be performed within 6 weeks of the start of study intervention; the results of the biopsy must be obtained prior to initiation of study intervention
* Evidence of MCPyV TAg tumor expression by immunohistochemistry on any prior or current tumor specimen or viral oncoprotein antibody confirmation within 6 weeks of the start of study intervention
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) =\< 2 at trial entry
* Patients must have at least one bi-dimensionally measurable lesion by palpation, clinical exam, or radiographic imaging within 6 weeks of the start of study intervention (X-ray, computed tomography \[CT\] scan, positron emission tomography \[PET\] scan, magnetic resonance imaging \[MRI\], or ultrasound)
* For patients designated to be treated on Group 2: cardiac ejection fraction \>= 35%; for patients with significant risk factors for coronary artery disease (Framingham risk score \> 15%), a cardiac stress test is recommended
* At least 3 weeks must have passed since any of the following: systemic corticosteroids, immunotherapy (for example, T-cell infusions, immunomodulatory agents, interleukins, MCC vaccines, intravenous immunoglobulin, expanded polyclonal tumor infiltrating lymphocytes \[TIL\] or lymphokine-activated killer \[LAK\] therapy), pentoxifylline, other small molecule or chemotherapy cancer treatment, other investigational agents or other systemic agents that target Merkel cell carcinoma
Exclusion Criteria
* White blood cells (WBC) \< 200/mcl
* Hemoglobin (Hb) \< 8 g/dL
* Absolute neutrophil count (ANC) \< 1000/mcl
* Platelets \< 50,000/mcl
* New York Heart Association functional class III-IV heart failure, symptomatic pericardial effusion, stable or unstable angina, symptoms of coronary artery disease, congestive heart failure, clinically significant hypotension, or history of an ejection fraction of =\< 30 % (echocardiogram or multi gated acquisition scan \[MUGA\])
* Clinically significant pulmonary dysfunction, as determined by medical history and physical exam; patients so identified will undergo pulmonary functions testing and those with forced expiratory volume in 1 second (FEV1) \< 2.0 L or diffusion capacity of the lung for carbon monoxide (DLco) (corrected \[corr\] for hemoglobin \[Hgb\]) \< 50% will be excluded
* Creatinine clearance \< 30 ml/min which cannot be attributed to MCC metastasis
* Total bilirubin \> 1.5 x upper limit of normal (ULN)
* Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) \> 2.5 x ULN; for patients with liver metastases: AST/ALT \> 5 x ULN
* Active autoimmune disease (e.g. systemic lupus erythematosus, vasculitis, infiltrating lung disease, inflammatory bowel disease) whose possible progression during treatment would be considered unacceptable by the investigators
* Symptomatic and untreated central nervous system (CNS) metastasis; however, patients with 1 to 2 asymptomatic, less than 1 cm brain/CNS metastases without significant edema may be considered for treatment; if sub-centimeter CNS lesions are noted at study entry, then repeat imaging will be performed, if more than 4 weeks have elapsed from the last scan
* Any condition or organ toxicity that is deemed by the principal investigator (PI) or the attending physician to place the patient at unacceptable risk for treatment on the protocol
* Pregnant women, nursing mothers, men or women of reproductive ability who are unwilling to use effective contraception or abstinence; women of childbearing potential must have a negative pregnancy test within 2-6 weeks prior to treatment
* Clinically significant and ongoing immune suppression including, but not limited to, systemic immunosuppressive agents such as cyclosporine or corticosteroids, chronic lymphocytic leukemia (CLL), uncontrolled human immunodeficiency virus (HIV) infection, or solid organ transplantation
* Patients may not be on any other treatments for their cancer aside from those included in the protocol; patients may not undergo another form of treatment concurrently with this study
* Known severe hypersensitivity reactions to monoclonal antibodies (grade \>= 3 National Cancer Institute \[NCI\]-Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v\] 4.0), any history of anaphylaxis, or uncontrolled asthma
* Vaccination with live inactivated viral strains for the prevention of infectious diseases within 4 weeks of the start of the study treatment, inactivated influenza vaccines are permitted while on trial
* Known alcohol or drug abuse
* Legal incapacity or limited legal capacity
18 Years
ALL
No
Sponsors
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EMD Serono
INDUSTRY
National Cancer Institute (NCI)
NIH
Fred Hutchinson Cancer Center
OTHER
Responsible Party
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Aude Chapuis
Associate Professor
Principal Investigators
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Aude Chapuis
Role: PRINCIPAL_INVESTIGATOR
Fred Hutch/University of Washington Cancer Consortium
Locations
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Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Countries
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Provided Documents
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Document Type: Study Protocol and Statistical Analysis Plan
Other Identifiers
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NCI-2014-02462
Identifier Type: REGISTRY
Identifier Source: secondary_id
FHCRC 9245
Identifier Type: -
Identifier Source: secondary_id
9245
Identifier Type: OTHER
Identifier Source: secondary_id
RG1015013
Identifier Type: OTHER
Identifier Source: secondary_id
9245
Identifier Type: -
Identifier Source: org_study_id
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