This is an international, multicenter, multi-arm, phase Ib, model-based dose-escalation study. The primary objectives of the study in each arm is to determine the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), dose limiting toxicities (DLTs) and to evaluate the clinical efficacy at the MTD of various combinations of pembrolizumab, pralatrexate and decitabine.
The peripheral T-cell lymphomas (PTCLs) are rare subtypes of Non-Hodgkin lymphoma (NHL) with unique clinicopathologic features and very unfavorable prognosis. Recently it has been demonstrated that PTCLs are characterized by recurrent mutations in epigenetic operators (e.g. TET2, DNMT3A, and IDH2) and escape from immune surveillance. The safety and toxicity of these combinations will be evaluated throughout the entire study. Dose allocation in Arms A and C will be based upon a continual reassessment method (CRM), and combination allocation in Arm B will be conducted using a DLT-adapted partial order continual reassessment method (POCRM) for dose-finding with combinations of agents. Study Hypothesis: If pralatrexate and/or decitabine functions in an immunomodulatory fashion then priming and modulating the malignant cells and the microenvironment will enhance the antitumor activity of pembrolizumab in patients with PTCLs and CTCLs.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Pembrolizumab 200 mg IV
Pralatrexate 20 or 30 mg/m2 IV push
Decitabine 10 mg/m2
Allegheny Health Network
Pittsburgh, Pennsylvania, United States
University of Virginia
Charlottesville, Virginia, United States
Maximum Tolerated Dose (MTD)
The study dose level that is recommended after the maximum target sample size of 10 participants are accrued to each arm
Time frame: 1-2 years
Dose Limiting Toxicity (DLT)
Only DLT's that occur prior to the initiation of cycle 2 will be used to determine dose escalation/de-escalation decisions. DLT criteria are defined as any non-hematologic toxicity greater and/or equal to grade 3 except for exceptions outlined in the protocol.
Time frame: 1-2 years
Overall Response Rate (ORR)
Evaluate the efficacy, as determined by the ORR (complete + partial response) for each Arm
Time frame: 1-2 years
Anti-tumor activity
Describe the anti-tumor activity of the combinations in each Arm.
Time frame: 1-2 years
ORR, PFS, DOR
Evaluate the efficacy, as determined by the overall response rate (ORR), progression free survival (PFS), and duration of response (DOR) for each Arm.
Time frame: 1-2 years
Pharmacodynamic markers
Evaluate pharmacodynamic markers of drug effect in paired tissue biopsies (pre- and post-treatment).
Time frame: 1-2 years
Pharmacokinetic Profile
Establish pharmacokinetic profile for pembrolizumab when administered with pralatrexate (Arm A), with decitabine (Arm C) and when given as a combination (Arm B) during cycle 1 only.
Time frame: 1-2 years
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