This is an open label, multi-institutional, single arm study with a dose escalation phase Ib cohort, followed by a phase II cohort of pembrolizumab and Imprime PGG. No randomization or blinding is involved.
OUTLINE: This is a multi-center study. The phase Ib dose escalation will evaluate the combination of pembrolizumab and Imprime PGG for subjects with metastatic non-small cell lung cancer (NSCLC) after progression on first-line platinum-based chemotherapy. The phase II trial will test whether addition of Imprime PGG to pembrolizumab will increase median progression-free survival (PFS) in second line therapy setting in NSCLC. PHASE Ib DOSE ESCALATION INVESTIGATIONAL TREATMENT: Cohort 1 will consist of 3-6 patients who will receive * Imprime PGG 2 mg/kg IV on Days 1, 8, 15 for Cycles 1-4 * Imprime PGG 2 mb/kg IV on Day 1 for Cycles 5-16 * Pembrolizumab 200 mg IV on Day 1 (cycle = 21 days) Cohort 2 will consist of 3-6 patients who will receive * Imprime PGG 4 mg/kg IV on Days 1, 8, 15 for Cycles 1-4 * Imprime PGG 2 mb/kg IV on Day 1 for Cycles 5-16 * Pembrolizumab 200 mg IV on Day 1 (cycle = 21 days) If none of the 3 subjects experience a dose limiting toxicity (DLT) during the first cycle of therapy, an additional three subjects will be enrolled at dose level 2. If all subjects in dose level 2 complete the first cycle of therapy without DLT, 3 more subjects will be enrolled into dose level 2 to ensure only 0-1 of 6 subjects have a DLT. There will be no further escalation beyond dose level 2. PHASE II INVESTIGATIONAL TREATMENT: Pembrolizumab will be given on Day 1 of each 21 day cycle after Imprime PGG, and the RP2D dose of Imprime PGG will be given on Days 1, 8 and 15 of each 21 day cycle. Treatment will continue up to 16 cycles, or until disease progression, unacceptable toxicity, subject refusal, or subject death either from progression of disease, the therapy itself, or from other causes. Life expectancy: of 6 months or greater The following baseline labs must be completed within 28 days prior to registration for protocol therapy: Hepatic: * total bilirubin ≤ 1.5 × upper limit of normal (ULN) OR direct bilirubin ≤ ULN for subjects with total bilirubin levels \> 1.5 x ULN (except subject with Gilbert's Syndrome, who can have total bilirubin \< 3.0 mg/dl) * aspartate aminotransferase (AST) ≤ 2.5 × ULN or ≤ 5 × ULN for subjects with known hepatic metastases * alanine aminotransferase (ALT) ≤ 2.5 × ULN or ≤ 5 × ULN for subjects with known hepatic metastases Renal: * Serum creatinine ≤ 3 mg/dL OR * if serum creatinine \> 3mg/dL, estimated glomerular filtration rate (GFR) ≥ 20 mL/min Hematopoietic: * hemoglobin ≥ 9 g/dL, subjects requiring transfusion will not be eligible to start study * and absolute neutrophil count (ANC) ≥ 1.5 × 10\^9/L * and platelet count ≥ 100 × 10\^9/L Coagulation: * INR \< 1.5 × ULN OR * for subjects receiving anticoagulant, the subjects must, in the investigator's opinion, be clinically stable with no evidence of active bleeding while receiving anticoagulant therapy. The INR for subjects on warfarin should be in the therapeutic range. Low molecular weight heparin (LMWH) is allowed.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
35
Arm A: Phase Ib Cohort 1: 2mg/kg IV; Arm A: Phase Ib Cohort 2: 4mg/kg IV
200mg IV
Arm B: Phase II treatment: administered at the maximum safe dose of 2mg or 4 mg as established in the Phase Ib cohort study.
University of Illinois at Chicago
Chicago, Illinois, United States
Indiana Univeristy Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States
University of Iowa Hospital and Clinics
Iowa City, Iowa, United States
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, United States
Phase Ib: Maximum Tolerated Dose
Phase Ib: Maximum tolerated dose (MTD) for subjects receiving Imprime PGG with pembrolizumab without experiencing dose-limiting toxicity(s) (DLT) per Common Terminology Criteria for Adverse Events (CTCAE) v4.
Time frame: 21 days
Progression Free Survival
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST): Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD) \>= 20% increase in tumor burden relative to nadir or the appearance of one or more new lesions; Stable Disease (SD), not meet criteria for CR/PR/PD. Progression Free Survival (PFS) is defined as time from registration until disease progression met by RECIST 1.1 or death from any cause.
Time frame: Time of treatment start until the criteria for disease progression or death. Up to a maximum of 32 months.
Adverse Events (AEs)
Number of participants with treatment related adverse events regardless of dose are reported by CTCAEv4 term and grade.
Time frame: AEs have been recorded from the time of consent until 30 days after treatment discontinuation of study drugs or until a new anti-cancer treatment starts, whichever occurs first, up to a maximum of 13 months
Clinical Benefit Rate (CBR)
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST): Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD) \>= 20% increase in tumor burden relative to nadir or the appearance of one or more new lesions; Stable Disease (SD), not meet criteria for CR/PR/PD.The CBR is defined as the proportion of subjects with a confirmed complete response, partial response or stable disease based on RECIST v1.1.
Time frame: Up to maximum of 32 months
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Penn State Cancer Institute
Hershey, Pennsylvania, United States
Progression Free Survival (PFS) at 6 Months
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST): Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD) \>= 20% increase in tumor burden relative to nadir or the appearance of one or more new lesions; Stable Disease (SD), not meet criteria for CR/PR/PD. PFS is defined as time from registration until disease progression met by RECIST 1.1 or death from any cause. PFS at 6 months is defined as the percentage of patient who was progression free at 6 months from the initiation of treatment.
Time frame: 6 months
Overall Survival (OS)
Overall survival is defined as the time from treatment start until death or date of last contact.
Time frame: Time of treatment start until death or date of last contact, up to a maximum of 52 months.