This is a multicenter, Phase II, open-label, 42-patient single-arm trial of intratumoral pIL-12 electroporation (EP) in combination with pembrolizumab in patients with melanoma. Patients will be evaluated in 2 parts. Part A patients will be selected using a flow cytometric assay that quantifies intratumoral PD-1hiCD8+CTLA4+ "exhausted" lymphocytes in the tumor. Part B will enroll patients who have or are failing pembrolizumab at least 12 weeks after starting Programmed cell death protein 1 (PD-1) antibody alone or in combination, or, who have been selected using a flow cytometric assay that quantifies intratumoral PD-1hiCD8+CTLA4+ "exhausted" lymphocytes in the tumor.
Closed to enrollment earlier than expected due to high response rate in order to advance to phase 2b in proven PD-1-refractory patients. A total of 24 patients were consented instead of the planned enrollment of 42 patients.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
24
University of San Francisco, California
San Francisco, California, United States
Huntsman Cancer Institute, University of Utah
Salt Lake City, Utah, United States
Best Overall Objective Response Rate (ORR) Within 24 Weeks Using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1
Best overall ORR within 24 weeks of first treatment with pIL-12 electroporation (EP) and pembrolizumab will be determined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by CT or MRI. The ORR is the proportion of participants with either a Complete Response (CR) defined as a disappearance of all target lesions determined by 2 separate scans conducted not \< 4 weeks apart and any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm (the sum may not be "0" if there are target nodes) and no appearance of new lesions or a Partial Response (PR) defined as a \>=30% decrease in the sum of the longest diameter of target lesions with no appearance of new lesions. ORR = CR + PR.
Time frame: Up to week 24
Best Overall ORR Determined by Immune Related-Response Criteria (irRC)
Best overall objective response rate is defined as the proportion of participants with a demonstrated complete or partial response according to irRC. In the irRC, an immune-related Complete Response (irCR) is the disappearance of all lesions, measured or unmeasured, and no new lesions; an immune-related Partial Response (irPR) is a 50% drop in tumour burden from baseline as defined by the irRC.
Time frame: Up to 5 years
Twenty-Four Week Landmark Progression Free Survival (PFS)
Twenty-four week landmark PFS (PFS at 24) is defined as the percentage of patients, who have progressed at the 24 week time point (+ / - 2 days visit tolerance). Tumor response determinations were assessed by RECIST v1.1.
Time frame: At 24 weeks after treatment initiation
Number of Participants With Treatment-related Adverse Events
The study will use the NCI Common Terminology Criteria for Adverse Events (CTCAE) v4.0 with an adverse or serious adverse event determination of possible, probable, or definite attribution. Analyses will be performed for all patients having received at least one dose of study drug.
Time frame: Up to 2 years
Median PFS
PFS is defined as the duration between the date of treatment initiation to the first date of either disease progression where progression is assessed by RECIST v1.1, or death.
Time frame: Up to 5 years
Duration of Response (DOR) Estimate
DOR is defined as the number of days from the initial documentation of an objective response (CR or PR) per RECIST v1.1 criteria to the final evaluation of that response (censored duration), or to documentation of progression using Kaplan-Meier (KM) estimates .
Time frame: Up to 5 years
Overall Survival (OS) Estimate
OS is defined as the duration between the date of treatment initiation to the date of death, regardless of the cause of death using KM estimates.
Time frame: Up to 5 years
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