This phase I trial studies the side effects of pembrolizumab in treating patients with human immunodeficiency virus (HIV) and malignant neoplasms that have come back (relapsed), do not respond to treatment (refractory), or have distributed over a large area in the body (disseminated). Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.
PRIMARY OBJECTIVES: I. To assess the safety and tolerability of MK-3475 (pembrolizumab) in HIV-infected patients on effective antiretroviral therapy and with relapsed/refractory or disseminated acquired immune deficiency syndrome (AIDS)-defining or non-AIDS defining malignancy. II. To assess the safety and feasibility of MK-3475 (pembrolizumab) administration as first systemic therapy for HIV associated Kaposi sarcoma in patients on effective antiretroviral therapy. SECONDARY OBJECTIVES: I. To obtain preliminary insights into clinical benefit (e.g., tumor shrinkage or stabilization \>= 24 weeks) across a variety of tumors in patients infected with HIV and on effective antiretroviral therapy. II. To evaluate the response rate in Kaposi sarcoma impacting physical and/or psychological wellbeing and not amenable to local therapy. EXPLORATORY OBJECTIVES: I. To assess the correlation of pre-therapy tumor PD-L1 expression and T-cell infiltration on clinical benefit. II. To assess the effect of MK-3475 (pembrolizumab) on circulating HIV and the HIV viral reservoir in patients on effective combination anti-retroviral therapy (cART), as measured by plasma HIV single copy ribonucleic acid (RNA), CD4+ T-cell associated HIV unspliced RNA, CD4+ T-cell associated integrated HIV deoxyribonucleic acid (DNA) provirus, ratio of HIV unspliced RNA/DNA, "Tat/Rev induced limiting dilution assay" (TILDA), and phylogenetic analysis of HIV-1 molecular evolution. III. To evaluate the effect of MK-3475 (pembrolizumab) on host gene expression in circulating blood cells. IV. To evaluate the effect of MK-3475 (pembrolizumab) on circulating HIV-specific CD8+ T-cell cytotoxicity against autologous HIV infected CD4+ T-cells in patients on effective antiretroviral therapy. V. To evaluate the effect of MK-3475 (pembrolizumab) on circulating lymphocyte and monocyte numbers and phenotypes. VI. To assess biopsied tumors from participants that progress by immunohistochemistry arrays and gene expression analysis to evaluate potential reasons for the lack of response to MK-3475 (pembrolizumab) or progression such as a lack of T cells within or around tumor. VII. To evaluate the effect of pembrolizumab on human herpesvirus 8 (KSHV) viral load in the blood, KSHV seroreactivity and KSHV specific CD8+ T-cell activity. OUTLINE: Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1. Patients continue receiving their recommended combination antiretroviral therapy orally (PO) once daily (QD). Cycles repeat every 21 days for up to 2 years or 35 doses in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT) or positron emission tomography (PET)/CT and blood sample collection throughout the trial. Patients may also undergo biopsies during screening and on study. After completion of study treatment, patients are followed up 30 days and then every 12 weeks up to 1 year.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
58
Given PO
Undergo biopsy
Undergo blood sample collection
Undergo CT or PET/CT
Given IV
Undergo PET/CT
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, United States
Zuckerberg San Francisco General Hospital
San Francisco, California, United States
UCSF Medical Center-Parnassus
San Francisco, California, United States
Yale University
New Haven, Connecticut, United States
Louisiana State University Health Science Center
New Orleans, Louisiana, United States
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, United States
National Institutes of Health Clinical Center
Bethesda, Maryland, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, United States
...and 2 more locations
Frequency of Observed Adverse Events (AEs)
Will be graded using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (version 5.0 beginning April 1, 2018). Safety and tolerability will be assessed by summarizing all relevant parameters including AEs, serious AEs, laboratory tests, vital signs, and electrocardiogram measurements. All summaries will be presented for each cohort and overall. If the numbers are sufficient, the results may additionally be stratified by tumor type.
Time frame: Up to 90 days after the last dose of trial treatment, up to 2 years or 35 cycles of trial treatment.
Incidence of Immune-related Events of Clinical Interest (irECI)
This includes the occurrence of grade 2 or higher AEs. Will be graded using CTCAE version 4.0 (version 5.0 beginning April 1, 2018). Any AE of unknown etiology associated with study therapy will be evaluated to determine if it is possibly an ECI of a potentially immunologic etiology or related to combination antiretroviral therapy (cART). All summaries will be presented for each cohort and overall. If the numbers are sufficient, the results may additionally be stratified by tumor type.
Time frame: Up to 90 days after the last dose of trial treatment, up to 2 years or 35 cycles of trial treatment.
Incidence of cART-related ECIs of Grade 2 or Higher AEs
Will be graded using CTCAE version 4.0 (version 5.0 beginning April 1, 2018). Any AE of unknown etiology associated with study therapy will be evaluated to determine if it is possibly an ECI of a potentially immunologic etiology or related to cART. All summaries will be presented for each cohort and overall. If the numbers are sufficient, the results may additionally be stratified by tumor type.
Time frame: Up to 90 days after the last dose of trial treatment, up to 2 years or 35 cycles of trial treatment.
Objective Response Rate (Cohorts 1-3)
Defined as the proportion of participants who achieved complete response (CR) or partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, "Lugano Criteria" for Malignant Lymphoma or other tumor-specific criteria. Analyzed using Clopper-Pearson 95% confidence intervals.
Time frame: Up to 2 years
Progression-free Survival (Cohorts 1-3)
Assessed using RECIST 1.1, "Lugano Criteria" for Malignant Lymphoma or other tumor-specific criteria. Summarized statistically using Kaplan-Meier method.
Time frame: From the first dose of study drug to progressive disease or death, whichever occurs earlier, assessed up to 25 months
Duration of Response (Cohorts 1-3)
Defined in participants experiencing CR or PR using RECIST 1.1, "Lugano Criteria" for malignant lymphoma or other tumor-specific criteria. Summarized statistically using Kaplan-Meier method.
Time frame: Interval between the date of first response (CR/PR) and the date of progression, assessed up to 2 years
Overall Survival (Cohorts 1-3)
Summarized statistically using Kaplan-Meier method.
Time frame: From the first dose of study drug to death due to any cause, assessed up to 3 years
Objective Response Rate (Partial Response + Completion Response)(Kaposi Sarcoma Cohort)
Defined as the proportion of participants who achieved the best objective response rate (complete response (CR) + partial response (PR)) as determined by modified Acquired Immunodeficiency Syndrome Clinical Trials Group (ACTG) criteria Analyzed using Clopper-Pearson 95% confidence intervals.
Time frame: Up to 2 years
Progression-free Survival (Kaposi Sarcoma Cohort)
Assessed using ACTG criteria. Summarized statistically using Kaplan-Meier method.
Time frame: From the first dose of study drug to progressive disease or death, whichever occurs earlier, assessed up to 3 years
Duration of Response (Kaposi Sarcoma Cohort)
Assessed using ACTG criteria. Summarized statistically using Kaplan-Meier method.
Time frame: Interval between the date of first response (CR/PR) and the date of progression, assessed up to 2 years
Overall Survival (Kaposi Sarcoma Cohort)
Summarized statistically using Kaplan-Meier method.
Time frame: From the first dose of study drug to death due to any cause, assessed up to 3 years
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