The purpose of this study is to look at how patients respond to treatment with guadecitabine and pembrolizumab. The researchers will also be looking at the amount of time it takes for cancer to get worse when participants take the study drugs. All participants will be treated with guadecitabine and pembrolizumab. Guadecitabine interferes with the cancer cells' DNA and can increase the production of certain proteins, making cancer cells more recognizable by the immune system. Pembrolizumab helps your immune system to kill cancer cells. Thus the combination of guadecitabine and pembrolizumab may increase the ability of the immune system to eliminate cancer cells. Researchers want to find out whether the combination of guadecitabine and pembrolizumab is effective in treating ovarian cancer that has not responded to traditional chemotherapy. Participants will keep receiving treatment until their cancer gets worse, they have side effects, or they decide they don't want to receive the treatment anymore. After stopping treatment, the study doctor will watch participants for side effects and follow their condition every 6-12 weeks. The study aims to keep track of participants' medical conditions for the rest of their lives. This helps us look at the long-term effects of the study drugs.
PRIMARY OBJECTIVES: I. Measure objective response rate (RR) to guadecitabine and pembrolizumab in subjects with recurrent platinum resistant ovarian cancer (OC). SECONDARY OBJECTIVES: I. Measure progression free survival (PFS) for the combination of guadecitabine and pembrolizumab. II. Progression free survival (PFS). III. Measure clinical benefit rate (CBR) for the combination of guadecitabine and pembrolizumab. IV. Measure toxicity profiles to the combination of guadecitabine and pembrolizumab. TERTIARY OBJECTIVES: I. NY-ESO-1 and MAGE antigens' promoter methylation (pyrosequencing) and messenger ribonucleic acid (mRNA) expression levels (quantitative reverse transcriptase-polymerase chain reaction \[RT-PCR\]) will be measured before and after treatment in deoxyribonucleic acid (DNA) (plasma and/or tumor biopsies) and ribonucleic acid (RNA) (tumor biopsies), respectively. II. Cytokine response (IFN gamma IL2, IL6, IL10, TNF alpha) will be measured in plasma by enzyme-linked immunosorbent assay (ELISA). III. Measure LINE 1 methylation in DNA extracted from peripheral blood mononuclear cells (PBMCs) (measured on days 1 and 5 of cycles 1 and 2). IV. Expression of the PD-L1 ligand will be measured by immunohistochemistry (IHC) in archival tumors. V. Tumor infiltrating lymphocytes (TILs) will be quantified in tumor biopsies before and after treatment (IHC). OUTLINE: Patients receive guadecitabine subcutaneously (SC) on days 1-4 and pembrolizumab intravenously (IV) over 30 minutes on day 5. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 days, every 6 weeks for 1 year, and then every 9 weeks and, once a subject experiences confirmed disease progression or starts a new anticancer therapy, every 3 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Northwestern University
Chicago, Illinois, United States
The University of Chicago Medicine
Chicago, Illinois, United States
Northwestern Lake Forest Hospital
Lake Forest, Illinois, United States
Objective Response Rate (ORR) Using RECIST 1.1
Objective response rate (ORR) is defined as the number of patients who's best response is complete response plus those with partial response. Imaging scans will be assessed using RECIST 1.1 to measure ORR to guadecitabine and pembrolizumab in patients with recurrent platinum resistant Ovarian Cancer. In general the following definitions apply Complete Response - Disappearance of all lesions Partial Response - At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: Assessed from start of treatment and during treatment for up to 38 cycles where 1 cycle equals 21 days (maximum number of cycles that any patient attempted)
Objective Response Rate (ORR) Using Immune Related Response Criteria (irRC)
Objective response rate (ORR) is defined as the number of complete responders and partial responders divided by the patient population evaluable for response. Imaging scans will be assessed using the using the Immune Related Response Criteria (irRC) to measure ORR to guadecitabine and pembrolizumab in patients with recurrent platinum resistant Ovarian Cancer.
Time frame: Up to 3 years
Progression Free Survival (PFS)
Progression-Free Survival (PFS) is defined as the duration of time from treatment start to time of progression or death, whichever occurs first. The median PFS value (in months) is reported here. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions
Time frame: Up to 3 years
Clinical Benefit Rate (CBR)
CBR is defined as the number of patients who's best response is complete response, plus those with partial response plus those with stable disease as evaluated using imagining scans and assessed by RECIST 1.1 and received at least 6 cycles of treatment. Complete Response - Disappearance of all lesions Partial Response - At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. Stable Disease - Neither sufficient shrinkage to qualify for partial response nor sufficient increase to qualify for progressive disease, taking as reference the smallest sum of diameters while on study
Time frame: Assessed from start of treatment and during treatment for up to 38 cycles where 1 cycle equals 21 days (maximum number of cycles that any patient attempted)
Incidence of Adverse Events
Assess the toxicity of guadecitabine and pembrolizumab by measuring the number, type, grade, severity, and frequency of adverse events according to the National Cancer Institute Common Terminology Criteria Adverse events (AE) (CTCAE) v 4.03. Those that were determined to be at least possibly related to study drugs are reported per drug (guadecitabine and pembrolizumab). Number of related Serious Adverse Events (SAEs) is also reported
Time frame: Assessed from start of treatment and during treatment for up to 38 cycles and up to 90 days post last dose where 1 cycle equals 21 days (maximum number of cycles that any patient attempted)
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