This phase Ib/II trial studies the side effects and best dose of propranolol hydrochloride when given together with pembrolizumab and how well they work in treating patients with stage IIIC-IV melanoma that cannot be removed by surgery. Pembrolizumab is a monoclonal antibody that "takes the brakes off the immune system" and thus allows for anti-tumor immune responses. Propranolol hydrochloride is a beta adrenergic blocking agent that can enhance immune cell responses when under stress. Giving propranolol hydrochloride and pembrolizumab may work better in treating patients with melanoma.
PRIMARY OBJECTIVES: I. To determine dose limiting toxicities (DLT) of propranolol hydrochloride (propranolol) in combination with fixed dose pembrolizumab in the treatment of melanoma. II. To evaluate the efficacy of pembrolizumab in combination with propranolol in patients with melanoma, as determined by overall response rate (ORR) per immune-modified Response Evaluation Criteria in Solid Tumors (RECIST) (1). SECONDARY OBJECTIVES: I. To evaluate the efficacy of pembrolizumab in combination with propranolol in patients with melanoma, as determined by secondary measures of efficacy, including: progression free survival (PFS) and overall survival (OS). TERTIARY OBJECTIVES: I. To correlate baseline or changes in the levels of biomarkers, like, peripheral T-cell subsets/myeloid derived suppressor cells (MDSC)/cytokines/urinary catecholamine and perceived stress scale (PSS) with efficacy (ORR, PFS, OS) in melanoma patients treated with pembrolizumab and propranolol. OUTLINE: This is a phase Ib, dose-escalation study of propranolol hydrochloride followed by a phase II study. Patients receive propranolol hydrochloride orally (PO) twice daily (BID) and pembrolizumab intravenously (IV) over 30 minutes of day 1. Courses repeat every 3 weeks for up to 2 years in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 days, every 3 months for 6 months, and then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
47
Emory University Hospital/ Winship Cancer Institute
Atlanta, Georgia, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Cleveland Clinic Cancer Center
Cleveland, Ohio, United States
Penn State Milton S. Hershy Medical Center Cancer Institute
Hershey, Pennsylvania, United States
Dose limiting toxicities (DLT) defined as any grade 3 or higher hematological or non-hematological toxicity that is probably or definitely related to treatment according to Common Terminology Criteria for Adverse Events version 4.03 (Phase Ib)
Adverse events and toxicities will be summarized by dose level using frequencies and relative frequencies.
Time frame: Up to 12 weeks
Overall response rate (ORR) per immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) version 1.1 (Phase II)
ORR is defined as partial or complete response within 6 months of initiating combination therapy.
Time frame: Up to 6 months
Overall survival (OS) (Phase II)
Will be summarized using standard Kaplan-Meier methods and rates will be obtained with 90% confidence intervals.
Time frame: From treatment initiation until death due to any cause (event) or last follow-up, assessed up to 2 years
PFS (Phase II)
Will summarized using standard Kaplan-Meier methods and rates will be obtained with 90% confidence intervals.
Time frame: From treatment initiation until disease progression, death due to disease (events), or last follow-up, assessed up to 2 years
Progression free survival (PFS) (Phase II)
Will be summarized using standard Kaplan-Meier methods and rates will be obtained with 90% confidence intervals.
Time frame: At 1 year
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