Trial Subjects (patients), will receive single infusions of pembrolizumab in combination with CXD101 every 3 weeks for two years or until disease progression or unacceptable toxicity develops.
Trial Subjects (patients) who are deemed eligible for the trial will initially be entered into the safety run-in stage of the trial. Up to 12 patients will be registered into the safety run-in stage, in cohorts of 3 patients at a time. 3 patients will be registered initially and will be administered a single infusion of pembrolizumab (200mg, day 1) in combination with CXD101 (20mg twice daily days 1 to 5). This is dose level 0. If 0 to 1 dose limiting toxicity (DLT) is observed, 3 more patients will be entered into the trial and treated at dose level 0. If 0 to 1 DLT is observed across all 6 patients, the maximum tolerated dose (MTD) will be declared and the expansion stage of the trial will be opened. If more than 1 DLT is observed at dose level 0, 3 patients will be recruited and treated at dose level -1. The CXD101 dose will be reduced by 25% (20mg in the morning and 10mg in the evening, days 1 to 5), while the pembrolizumab dose will remain the same (200mg, day 1). If 0 or 1 DLT is observed, 3 more patients will be recruited and treated at dose level -1. If 0 or 1 DLT is observed across all 6 patients the maximum tolerated dose will be declared and the expansion stage of the trial will be opened. If more than 1 DLT is observed at dose level -1 the combination will be deemed excessively toxic and no further patients enrolled. Once the MTD is declared, the cohort will be expanded and a further 33 patients will be treated at this dose level. Patients will continue to receive pembrolizumab and CXD101 at 3 weekly intervals for a maximum of 2 years or until disease progression or unacceptable toxicity develops. Patients on pembrolizumab will be seen every 3 weeks during trial treatment. Patients who progress will be seen annually for disease status. Patients completing treating or who stop treatment early for reasons other than disease progression will be followed every 3 months for up to one year after the end of treatment, and annually thereafter until end of trial is declared (when the last patient has completed 1 year follow up).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Pembrolizumab is a humanised monoclonal antibody which targets the programmed cell death 1 (PD-1) receptor. It blocks a protective mechanism on cancer cells, and allow the immune system to destroy these cancer cells. CXD101 is a histone deacetylase (HDAC) inhibitor which kills cancer cells by blocking the vital functions of HDAC enzymes.
Safety run in: Determine the maximum tolerated dose of CXD101 given in combination with pembrolizumab
MTD to be defined as the highest dose level where 0 or 1 Dose limiting toxicity is observed in 6 patients
Time frame: During first cycle of CXD101 + pembrolizumab (each cycle lasts 21 days; assessment will take into account dose limiting toxicities reported at any time during the first 21 days of treatment)
Best Objective Response Rate
Proportion of patients achieving CR or PR during the first 6 cycles of CXD101 in combination with pembrolizumab using the RECIL criteria
Time frame: From baseline to end of cycle 6 of treatment (approximately 18 weeks; each cycle lasts 21 days)
Overall Response Rate at the end of 4 cycles
Overall Response of the combination of CXD101 and Pembrolizumab
Time frame: From baseline to end of cycle 4 of treatment (approximately 12 weeks; each cycle lasts 21 days)
Response Duration
Time from date of first response confirmation to the first date of progressive disease confirmation
Time frame: From start of treatment to time of disease progression (any time during study participation, minimum 3 years)
Best Overall Response at any time point
Best Overall Response of CXD101 in combination with Pembrolizumab
Time frame: From baseline to end of treatment (up to 2 years)
Best response at end of cycle 6 of treatment
CR, PR, MR, Stable Disease, Progressive Disease rates over 6 weeks of treatment
Time frame: From baseline to end of cycle 6 of treatment (approximately 18 weeks; each cycle lasts 21 days)
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Progression Free Survival
Progression Free Survival at 1 year
Time frame: 52 weeks after commencement of CXD101 and Pembrolizumab
Overall Survival
Overall survival at 1 year
Time frame: 52 weeks after commencement of CXD101 and Pembrolizumab
Incidence of treatment-emergent adverse events (safety and tolerability)
Adverse events to be reported during and after treatment, coded using CTCAE v5.0
Time frame: From start of CXD101 and Pembrolizumab until 5 months post-treatment