This phase II trial studies how well pembrolizumab and dasatinib, imatinib mesylate, or nilotinib work in treating patients with chronic myeloid leukemia and persistent detection of minimal residual disease, defined as the levels of a gene product called bcr-abl in the blood. Monoclonal antibodies, such as pembrolizumab, may interfere with the ability of cancer cells to grow and spread. Dasatinib, imatinib mesylate, and nilotinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving pembrolizumab and dasatinib, imatinib mesylate, or nilotinib may work better in treating patients with chronic myeloid leukemia.
PRIMARY OBJECTIVES: I. Assess the proportion of chronic myelogenous leukemia (CML) patients on stable-dose tyrosine kinase inhibitor (TKI) who convert to undetectable minimal residual disease (UMRD) (molecular response \[MR\]\^4.5) during or within 2 years of initiating pembrolizumab therapy. SECONDARY OBJECTIVES: I. Among patients who have converted to UMRD (MR\^4.5), assess the proportion of CML patients who maintain UMRD for 6 months and 12 months. II. Among patients who have converted to UMRD (MR\^4.5), assess the proportion of CML patients who discontinue their TKI. III. Among patients who have converted to UMRD (MR\^4.5), assess the proportion of CML patients who are UMRD and TKI-free at 2 years from first determined UMRD. IV. Assess the proportion of CML patients who develop grade 3 or 4 immune related adverse events related to pembrolizumab treatment during the first 2 years after registration (not including grade 3 events that respond to corticosteroids and improve to grade 1 or less within 4 weeks). OUTLINE: Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1 and dasatinib, imatinib mesylate, or nilotinib orally (PO) as clinically indicated per the treating physician. Treatment repeats every 21 days for up to 18 courses in the absence of disease progression or unacceptable toxicity. Patients with detectable MRD after course 18 continue pembrolizumab and dasatinib, imatinib mesylate, or nilotinib every 21 days for up to an additional 18 courses in the absence of disease progression or unacceptable toxicity. Patients with UMRD at any time before course 18 discontinue pembrolizumab after course 18 and continue dasatinib, imatinib mesylate, or nilotinib every 21 days for up to an additional 18 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months for 6 years from the date of registration.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Given PO
Given PO
Correlative studies
Given PO
Given IV
Fairbanks Memorial Hospital
Fairbanks, Alaska, United States
CTCA at Western Regional Medical Center
Goodyear, Arizona, United States
Cancer Center at Saint Joseph's
Phoenix, Arizona, United States
Mercy Hospital Fort Smith
Fort Smith, Arkansas, United States
CHI Saint Vincent Cancer Center Hot Springs
Hot Springs, Arkansas, United States
Proportion of patients on tyrosine kinase inhibitor (TKI) who convert to undetectable minimal residual disease (UMRD)
Will be reported with exact confidence intervals. The binomial test will be used to test the null hypothesis that this proportion is 0.2 with the alternative hypothesis being that this proportion is greater than 0.2.
Time frame: Up to 2 years of initiating pembrolizumab
Proportion of patients who maintain UMRD for 6 months
Will be assessed among patients who achieve UMRD within two years of initiating pembrolizumab. The proportions will be reported with exact confidence intervals.
Time frame: Up to 6 years
Proportion of patients who maintain UMRD for 6 and 12 months
Will be assessed among patients who achieve UMRD within two years of initiating pembrolizumab. The proportions will be reported with exact confidence intervals.
Time frame: Up to 6 years
Proportion of patients who meet the criteria for discontinuing TKI
Will be assessed among patients who achieve and maintain UMRD within two years of initiating pembrolizumab. The proportions will be reported with exact confidence intervals.
Time frame: Up to 6 years
Proportion of patients who maintain UMRD for 2 years after first achieving UMRD
Will be assessed among patients who have converted to UMRD (molecular response \[MR\]\^4.5) and discontinued TKI. The proportions will be reported with exact confidence intervals.
Time frame: Up to 6 years
Proportion of patients who develop grade 3 or 4 immune related adverse events (not including grade 3 events that respond to corticosteroids and improve to grade 1 or less within 4 weeks)
Will be tabulated based on grade Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
Time frame: Up to 6 years
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