Radiation Therapy, Plasma Exchange, and Immunotherapy (Pembrolizumab or Nivolumab) for the Treatment of Melanoma

NCT ID: NCT04581382

Last Updated: 2025-07-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

EARLY_PHASE1

Total Enrollment

18 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-12-14

Study Completion Date

2024-10-06

Brief Summary

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This early phase I trial investigates how well radiation therapy, plasma exchange, and pembrolizumab or nivolumab work in treating patients with melanoma. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Plasma exchange (also known as "plasmapheresis") is a way to "clean" or "flush out" the blood. Immunotherapy with monoclonal antibodies, such as pembrolizumab and nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Plasma exchange may help to improve the effect of standard radiation therapy and immunotherapy treatment on tumor cells of patients with melanoma.

Detailed Description

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PRIMARY OBJECTIVE:

I. To determine the kinetics of soluble (s)PD-L1 removal and regeneration by plasma exchange in patients with melanoma.

SECONDARY OBJECTIVES:

I. To observe response at 3 months after plasma exchange plus immunotherapy. II. To observe ongoing response at approximate 3 month intervals after plasma exchange plus immunotherapy.

CORRELATIVE RESEARCH OBJECTIVES:

I. To determine the effects of plasma exchange on immune cell function. II. To observe the kinetics of extracellular vesicles (EVs) after plasma exchange in patients with melanoma.

OUTLINE:

Patients undergo radiation therapy daily on days 1-5 (weekdays). Patients then undergo therapeutic plasma exchange over 1-2 hours on the first session starting on the last day of radiation therapy and the last session ending prior to immunotherapy. Beginning day 5, patients receive pembrolizumab intravenously (IV) or nivolumab IV. Treatment with pembrolizumab continues every 3 weeks or treatment with nivolumab continues every 2 weeks in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection throughout the study and standard of care (SOC) computed tomography (CT), positron emission tomography (PET), and/or magnetic resonance imaging (MRI) scans as clinically indicated during follow-up.

After completion of study treatment, patients are followed up at 3 weeks and then for up to 2 years.

Conditions

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Melanoma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Treatment (radiation therapy, plasma exchange, immunotherapy)

Patients undergo radiation therapy daily on days 1-5 (weekdays). Patients then undergo therapeutic plasma exchange over 1-2 hours on the first session starting on the last day of radiation therapy and the last session ending prior to immunotherapy. Beginning day 5, patients receive pembrolizumab IV or nivolumab IV. Treatment with pembrolizumab continues every 3 weeks or treatment with nivolumab continues every 2 weeks in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection throughout the study and SOC CT, PET, and/or MRI scans as clinically indicated during follow-up.

Group Type EXPERIMENTAL

Nivolumab

Intervention Type BIOLOGICAL

Given IV

Pembrolizumab

Intervention Type BIOLOGICAL

Given IV

Radiation Therapy

Intervention Type RADIATION

Undergo radiation therapy

Therapeutic Exchange Plasma

Intervention Type BIOLOGICAL

Undergo therapeutic plasma exchange

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Computed Tomography

Intervention Type PROCEDURE

Undergo CT

Positron Emission Tomography

Intervention Type PROCEDURE

Undergo PET

Magnetic Resonance Imaging

Intervention Type PROCEDURE

Undergo MRI

Interventions

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Nivolumab

Given IV

Intervention Type BIOLOGICAL

Pembrolizumab

Given IV

Intervention Type BIOLOGICAL

Radiation Therapy

Undergo radiation therapy

Intervention Type RADIATION

Therapeutic Exchange Plasma

Undergo therapeutic plasma exchange

Intervention Type BIOLOGICAL

Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Computed Tomography

Undergo CT

Intervention Type PROCEDURE

Positron Emission Tomography

Undergo PET

Intervention Type PROCEDURE

Magnetic Resonance Imaging

Undergo MRI

Intervention Type PROCEDURE

Other Intervention Names

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BMS-936558 CMAB819 MDX-1106 NIVO Nivolumab Biosimilar ABP 206 Nivolumab Biosimilar BCD-263 Nivolumab Biosimilar CMAB819 ONO-4538 Opdivo Keytruda Lambrolizumab MK-3475 SCH 900475 Cancer Radiotherapy ENERGY_TYPE Irradiate Irradiated Irradiation Radiation Radiation Therapy, NOS Radiotherapeutics Radiotherapy RT Therapy, Radiation TEP Biological Sample Collection Biospecimen Collected Specimen Collection CAT CAT Scan Computed Axial Tomography computerized axial tomography Computerized axial tomography (procedure) Computerized Tomography Computerized Tomography (CT) scan CT CT SCAN tomography Medical Imaging, Positron Emission Tomography PET PET Scan Positron emission tomography (procedure) positron emission tomography scan Positron-Emission Tomography proton magnetic resonance spectroscopic imaging PT Magnetic Resonance Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (procedure) Magnetic Resonance Imaging Scan Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance MR MR Imaging MRI MRS Scan MRIs NMR Imaging NMRI nuclear magnetic resonance imaging sMRI Structural MRI

Eligibility Criteria

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Inclusion Criteria

* Histological confirmation of melanoma. Patients may have completed biopsy outside of Mayo Clinic, but there must be an internal review done to confirm diagnosis prior to confirming eligibility
* Measurable or non-measurable disease
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) =\< 3
* sPD-L1 levels \> 1.7 ng/ml by enzyme-linked immunosorbent assay (ELISA)
* Negative pregnancy test done =\< 7 days prior to radiation therapy, for women of childbearing potential only
* Provide written informed consent
* Willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study)
* Willing to provide blood samples for correlative research purposes

Exclusion Criteria

* Persons taking a biotin supplement
* sPD-L1 level \< 1.7 ng/ml by ELISA
* Pregnant or nursing women
* Men or women of childbearing potential who are unwilling to employ adequate contraception
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sean S. Park, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic in Rochester

Jacob J. Orme, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic in Rochester

Locations

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Mayo Clinic in Rochester

Rochester, Minnesota, United States

Site Status

Countries

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United States

References

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Davidson TM, Foster N, Lucien F, Markovic S, Dong H, Winters JL, Park SS, Orme JJ. Rescuing Cancer Immunity by Plasma Exchange in Metastatic Melanoma (ReCIPE-M1): protocol for a single-institution, open-label safety trial of plasma exchange to clear sPD-L1 for immunotherapy. BMJ Open. 2022 May 12;12(5):e050112. doi: 10.1136/bmjopen-2021-050112.

Reference Type DERIVED
PMID: 35551087 (View on PubMed)

Provided Documents

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Document Type: Informed Consent Form

View Document

Related Links

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Other Identifiers

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NCI-2020-06970

Identifier Type: REGISTRY

Identifier Source: secondary_id

MC200703

Identifier Type: OTHER

Identifier Source: secondary_id

R21CA259236

Identifier Type: NIH

Identifier Source: secondary_id

View Link

20-003367

Identifier Type: OTHER

Identifier Source: secondary_id

MC200703

Identifier Type: -

Identifier Source: org_study_id

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