This phase II trial studies how well talimogene laherparepvec and pembrolizumab work in treating patients with stage III-IV melanoma. Biological therapies, such as talimogene laherparepvec, use substances made from living organisms that may stimulate or suppress the immune system in different ways and stop tumor cells from growing. 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. Giving talimogene laherparepvec and pembrolizumab may work better in treating patients with melanoma by shrinking the tumor.
PRIMARY OBJECTIVE: I. To evaluate the objective response rate (confirmed complete and partial responses) of treatment with talimogene laherparepvec (T-VEC) in combination with pembrolizumab (MK-3475) following progression on prior anti-PD-1 or anti-PD-L1 therapy alone or in combination with other agents different from talimogene laherparepvec (T-VEC). SECONDARY OBJECTIVES: I. To estimate the durable response rate. II. To estimate the objective response rate (ORR) defined as confirmed and unconfirmed, complete and partial responses in the injected lesions. III. To estimate the ORR in the non-visceral, non-injected lesions. IV. To estimate the ORR in the visceral lesions (Cohort A). V. To estimate the median progression-free survival (PFS). VI. To estimate the median overall survival (OS). VII. To evaluate the toxicity of the regimen. TRANSLATIONAL OBJECTIVES: I. To evaluate whether adding talimogene laherparepvec (T-VEC) to PD1 blockade can increase T-cell infiltration into tumors and whether change in T-cell infiltration is associated with response. II. To evaluate whether adding talimogene laherparepvec (T-VEC) to PD1 blockade can increase T-cell receptor (TCR) clonality in tumors and in peripheral blood and whether increased TCR clonality is associated with response. III. To evaluate whether intra-tumoral injection of talimogene laherparepvec (T-VEC) can improve the tumor immune microenvironment. IV. To evaluate whether tumor mutational load, mutations in the IFN pathway, and circulating tumor deoxyribonucleic acid (DNA) profile are is associated with response to talimogene laherparepvec (T-VEC) plus pembrolizumab (MK-3475) therapy in the anti-PD1/L1 therapy refractory melanoma patients. OUTLINE: Patients receive talimogene laherparepvec intralesionally (IL) and pembrolizumab intravenously (IV) over 30 minutes on day 1. Treatment repeats every 21 days for up to 36 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months for up to 1 year and then annually for a total of 5 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
43
Given IV
Given IL
University of South Alabama Mitchell Cancer Institute
Mobile, Alabama, United States
CTCA at Western Regional Medical Center
Goodyear, Arizona, United States
Los Angeles General Medical Center
Los Angeles, California, United States
USC / Norris Comprehensive Cancer Center
Los Angeles, California, United States
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, United States
Keck Medical Center of USC Pasadena
Pasadena, California, United States
Loyola University Medical Center
Maywood, Illinois, United States
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas, United States
Henry Ford Cancer Institute-Downriver
Brownstown, Michigan, United States
...and 10 more locations
Objective Response Rate (ORR)
Number of participants with a complete response, defined as the disappearance of all target and non-target lesions, or partial response, defined as a greater than or equal to 30% decrease under baseline of the sum of appropriate diameters of all target measurable legions. ORR is measured using RECIST 1.1 guidelines.
Time frame: Up to 5 years post registration or until death
Durable Response Rate
Number of participants with complete or partial response per RECIST 1.1 with no evidence of disease progression for at least 180 days from the initial documentation of CR/PR.
Time frame: Up to 5 years post registration or until death
Objective Response Rate (ORR) in Injected Lesions
Number of participants with confirmed and unconfirmed complete and partial responses in injected lesions. A confirmed complete response (CR) is defined as 2 or more consecutive objective statuses of CR a minimum of 4 weeks apart, a confirmed partial response is defined as 2 or more consecutive objective statuses of PR or better a minimum of 4 weeks apart but no qualifying as a CR. A unconfirmed CR is defined as 1 objective status of CR but not qualifying as a CR or PR, a unconfirmed PR is defined as 1 objective status of PR but not qualifying as CR, PR, or unconfirmed CR. ORR is measured per RECIST 1.1 guidelines.
Time frame: Up to 5 years post registration or until death
Objective Response Rate (ORR) in Non-Visceral, Non-Injected Lesions
Number of participants with confirmed and unconfirmed complete and partial responses in non-visceral, non-injected lesions. A confirmed complete response (CR) is defined as 2 or more consecutive objective statuses of CR a minimum of 4 weeks apart, a confirmed partial response is defined as 2 or more consecutive objective statuses of PR or better a minimum of 4 weeks apart but no qualifying as a CR. A unconfirmed CR is defined as 1 objective status of CR but not qualifying as a CR or PR, a unconfirmed PR is defined as 1 objective status of PR but not qualifying as CR, PR, or unconfirmed CR. ORR is measured per RECIST 1.1 guidelines.
Time frame: Up to 5 years post registration or until death
Objective Response Rate (ORR) in Visceral Lesions (Cohort A)
Number of participants with confirmed and unconfirmed complete and partial responses in visceral lesions. A confirmed complete response (CR) is defined as 2 or more consecutive objective statuses of CR a minimum of 4 weeks apart, a confirmed partial response is defined as 2 or more consecutive objective statuses of PR or better a minimum of 4 weeks apart but no qualifying as a CR. A unconfirmed CR is defined as 1 objective status of CR but not qualifying as a CR or PR, a unconfirmed PR is defined as 1 objective status of PR but not qualifying as CR, PR, or unconfirmed CR. ORR is measured per RECIST 1.1 guidelines.
Time frame: Up to 5 years post registration or until death
Progression-Free Survival (PFS)
Time from date of first registration to date of first documentation of progression or death due to any cause. Patients last known to be alive without report of progression are censored at date of last contact. For a patient to have "progressed", one or more of the following must occur: 20% increase in the sum of appropriate diameters of target measurable lesions over smallest sum observed (over baseline if no decrease during therapy) using the same techniques as baseline, as well as an absolute increase of at least 0.5 cm. Unequivocal progression of non-measurable disease in the opinion of the treating physician (an explanation must be provided). Appearance of any new lesion/site. Death due to disease without prior documentation of progression and without symptomatic deterioration.
Time frame: Up to 5 years post registration or until death
Overall Survival (OS)
Time from date of registration to date of death due to any cause. Participants last known to be alive are censored at date of last contact.
Time frame: Up to 5 years post registration or until death
Number of Participants With Gr 1 Through 5 Adverse Events That Are Related to Study Drugs
Only adverse events that are possibly, probably or definitely related to study drug are reported. CTCAE Version 4.0 was used for AE reporting.
Time frame: Duration of treatment and 5 years follow-up or death, whichever occurs first.
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