This research study is studying This research study is studying the efficacy and safety of the following study drugs as a possible treatment for recurrent central nervous system (CNS) metastases: * Palbociclib alone (Cohort 1) * The combination of palbociclib and pembrolizumab (Cohort 2) Pfizer and Merck, pharmaceutical companies, are supporting this research study by providing the study drugs as well as funding for research activities.
This is a non-randomized, parallel cohort, Phase II study. Phase II clinical trials test the safety and effectiveness of an investigational intervention to learn whether the intervention works in treating a specific disease. "Investigational" means that the intervention is being studied. The study will be conducted in two independent cohorts. The first cohort (Cohort 1) is comprised of participants with measurable CNS metastases from solid tumors (including patients whose primary cancers are from lung, breast or melanoma) harboring specific alterations, and participants receive the study drug palbociclib. The second cohort (Cohort 2) will evaluate the efficacy and safety of the combination of pembrolizumab and palbociclib in recurrent brain metastases from breast cancer. Palbociclib is being studied for use in the treatment of a broad range of cancers. This type of drug inhibits cell growth in the cells called cyclin-dependent kinases which promote tumor cell proliferation. The U.S. Food and Drug Administration (FDA) has not approved palbociclib for participants with central nervous system metastases, but it has been approved for other uses. Researchers hope to study the effects of pembrolizumab. The U.S. Food and Drug Administration (FDA) has approved pembrolizumab for some diseases, but not central nervous system metastases. Many cancers use specific pathways (such as PD-1/PD-L1 and CTLA-4) to evade the body's immune system. Pembrolizumab works by blocking the PD-1/PD-L1 pathways and thus releasing the brakes on the immune system so it can stop or slow cancer. In some tumor diagnoses, there may be a correlation between a specific marker (PD-L1 status) and activity of types of immunotherapies. Participants in any cohort will receive study treatment as long as they do not experience intolerable side effects and their disease does not worsen, and will be followed for 2 years after their study treatment ends.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Administered orally once per day on days 1-21 of 28-day cycles.
Pembrolizumab is administered via intravenous (IV) infusion at a dose of 200 mg over 30 minutes once every 21 days. Pembrolizumab cycles are 3 weeks (21 days) long in this study, and participants in Cohort 2 can receive pembrolizumab as long as they are receiving study drug palbociclib.
Massachusetts General Hospital
Boston, Massachusetts, United States
RECRUITINGDana Farber Cancer Institute
Boston, Massachusetts, United States
NOT_YET_RECRUITINGIntracranial Clinical Benefit Rate (Cohort 1)
Intracranial Clinical Benefit is defined by complete response (CR), partial response (PR) or stable disease (SD) in the central nervous system (CNS). The proportion of patients in Cohort 1 with response in the CNS will be presented with a two-sided, 90% confidence interval based on the method of Atkinson and Brown, which allows for the two-stage design.
Time frame: 8 weeks (Screening through 8 weeks)
Intracranial Clinical Benefit Rate (Cohort 2)
Intracranial clinical benefit is defined by CR, PR, or SD in the CNS. The proportion of Cohort 2 participants with response in the CNS will be presented with a two-sided, 90% exact binomial confidence interval.
Time frame: 8 weeks (Screening through 8 weeks)
Extracranial Overall Response Rate
RECIST 1.1 will be used to determine extracranial response rate (CR, PR, SD). Rate will be calculated for each cohort. A two-sided, 90% exact binomial confidence interval will be estimated for the extracranial response rate. For a sample of size 30 (Cohort 1), the confidence interval will be no wider than 0.32. For Cohort 2 (N=15), the confidence interval will be no wider than 0.46.
Time frame: 8 weeks (Screening through 8 weeks)
Intracranial disease progression rate of Cohort 1
Defined as time to the first occurrence of intracranial disease progression, or death from any cause, in Cohort 1 participants; extracranial disease progression is a competing risk. The cumulative incidence of intracranial progression/death will be estimated, making adjustment for the competing risk of extracranial progression using the methods of Pepe.
Time frame: Time from registration to the earlier of progression or death due to any cause, up to 2 years post End of Treatment (EoT) visit.
Extracranial disease progression rate of Cohort 1
Time to the first occurrence of extracranial disease progression (or death from any cause) defined by RECIST 1.1; intracranial disease progression is a competing risk. The cumulative incidence of extracranial progression/death will be estimated, making adjustment for the competing risk of intracranial progression using the methods of Pepe.
Time frame: Time from registration to the earlier of progression or death due to any cause, for up to 2 years post EoT visit.
Overall Survival (OS) Rate
OS is defined as the time from registration to death due to any cause, or censored at date last known alive. Kaplan-Meier estimates of overall survival will be presented with 90% confidence intervals estimated using log(-log(survival)) methodology. Survival estimates will be presented for all patients and also according to histology. Overall survival rate will be calculated for each cohort.
Time frame: Registration to death due to any cause, or censored at date last known alive. Patients will be followed for a maximum of 2 years after End-of-Treatment visit.
Incidence of Drug Related Toxicities
Toxicity categorized and graded per NCI Common Terminology Criteria for Adverse Events (CTCAE) criteria (grade 3 or more hematologic toxicity; grade 3 or more neurologic toxicity). Descriptive tabulations of toxicity according to the worst grade of each toxicity reported for each patient will be presented, displayed by Cohort. Exact binomial 90% CI will be presented for the proportions of patients with toxicities of interest and for rates of grade 3-5 events.
Time frame: Day 1 of study treatment through 30 days post last dose, an average of 1.5 years.
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