This research study is evaluating a combination therapy of 3 drugs as possible treatments for recurrent primary central nervous system lymphoma (PCNSL). The three drugs being used in the study are: * Pembrolizumab (MK3475) * Ibrutinib * Rituximab (or biosimilar)
This is an open label, multi-center, phase Ib/II trial of Pembrolizumab, Ibrutinib and Rituximab in participants with refractory/relapsed Primary Central Nervous System Lymphoma. * A Phase I clinical trial tests the safety of an investigational intervention and also tries to define the appropriate dose(s) of the investigational intervention to use for further studies. * Phase II clinical trials test the safety and effectiveness of an investigational intervention to learn whether the intervention works in treating a specific disease. The dose of investigational intervention in Phase II will depend on the results from Phase Ib * "Investigational" means that the intervention is being studied. * The FDA (the U.S. Food and Drug Administration) has not approved Pembrolizumab, ibrutinib or rituximab for refractory/relapsed primary central nervous system lymphoma (PCNSL) but these have been approved for other uses including other types of non-Hodgkin's lymphoma. * Pembrolizumab (MK-3475) has been studied in lab experiments and in other types of cancer, and information from these studies suggests that Pembrolizumab may be beneficial in this type of cancer. Pembrolizumab is a humanized monoclonal antibody. An antibody is a common type of protein made in the body in response to a foreign substance. Antibodies attack foreign substances and protect against infection. Antibodies can also be produced in the laboratory for use in treating patients; an antibody that is made in the lab is also known as humanized monoclonal antibody that is designed to block the action of the receptor, PD-1. PD-1 works to help tumor cells continue to grow and multiply. There are now several approved antibodies for the therapy of cancer and other diseases. * Ibrutinib is a type of drug called a kinase inhibitor. It is believed to block a type of protein called a kinase that helps lymphoma cells live and grow. By blocking this, it is possible that the study drug will kill cancer cells or stop them from growing. * Rituximab is a type of drug called a monoclonal antibody. An antibody is a common type of protein made in the body in response to a foreign substance. Antibodies attack foreign substances and protect against infection. Rituximab works with the immune system and has shown evidence for clinical activity when administered in combinations to treat lymphoma. * The research study procedures include: screening for eligibility and study treatment including evaluations and follow up visits. * The three drugs being used in the study are: * Pembrolizumab (MK3475) * Ibrutinib * Rituximab (or biosimilar) * Participants will receive study treatment for up to 2 years as long as they do not have serious side effects and their disease does not get worse. Once off study, participants will be followed every 3 months for the rest of their life. * Phase I Enrollment: Approximately 9 to 12 participants * Phase II Enrollment :Approximately 25 patients Merck \& Co., Inc, a pharmaceutical company, is supporting this research study by providing funding for the research study and the study drug, Pembrolizumab (MK-3475)
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Capsule, taken by mouth daily
Given as an intravenous injection through a vein (IV) every 3 weeks
Given as infusion into a vein (intravenous, IV)
Dana Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITINGBeth Israel Deaconess Medical Center
Boston, Massachusetts, United States
RECRUITINGColumbia University Medical Center
New York, New York, United States
WITHDRAWNProgression-free survival rate 6 months (PFS6)
The primary endpoint of PFS6 will be estimated as a binomial response proportion. The efficacy analysis population will include all evaluable patients (subjects will be considered evaluable for efficacy as long as they have received at least 75% of the planned doses for the 1st 6 weeks of treatment). Patients missing 6 months progression evaluation (for any reason) will be counted as progressors. For the primary analysis, the proportion of progression free patients at 6 months will be evaluated and 95% exact binomial CI will be provided. The Kaplan-Meier method will be used as a secondary approach to evaluate the PFS6 based on the recorded times to progression for each patient, with patients without progression or lost to follow-up being censored at their last follow-up date.
Time frame: 6 months
Number of Participants With Treatment-Related Adverse Events CTCAE version 5.0.
All subjects receiving at least 1 dose of study treatment will be evaluated for toxicities. DLT rates will be summarized and 95% exact binomial CI will be reported.
Time frame: 24 Months
Objective response rate (ORR)
The objective response rate (ORR) is defined as the proportion of patients with a best response of CR or PR. Objective Response Rate will be reported with 95% exact binomial CI. OS, PFS and duration of response endpoints will be evaluated by the Kaplan-Meier method and medians will be provided with 95% pointwise CI based on the log-log transformation. For all time to event analysis, patients without event information will be censored at the time of last available data.
Time frame: 24 months
Duration of response rate
Duration of response will be defined as the time form initial, complete or partial response to the time of disease progression or death. If a patient does not experience disease progression or death before the end of study, duration of response will be censored at the day of the last tumor assessment. OS, PFS and duration of response endpoints will be evaluated by the Kaplan-Meier method and medians will be provided with 95% pointwise CI based on the log-log transformation. For all time to event analysis, patients without event information will be censored at the time of last available data.
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Memorial Sloan Kettering Cancer Center
New York, New York, United States
RECRUITINGTime frame: 24 Months
Progression-free survival (PFS) Rate
Progression-free survival (PFS) is defined from start date of study treatment to the date of documented progression or death by any cause, whichever comes first. OS, PFS and duration of response endpoints will be evaluated by the Kaplan-Meier method and medians will be provided with 95% pointwise CI based on the log-log transformation. For all time to event analysis, patients without event information will be censored at the time of last available data.
Time frame: 24 Months
Overall survival (OS) Rate
Overall survival (OS) is defined as the time from start date of study treatment to the date of death by any cause. Patients not known to have died will be censored at the time of last assessment or the analysis cut-off whichever comes first. OS, PFS and duration of response endpoints will be evaluated by the Kaplan-Meier method and medians will be provided with 95% pointwise CI based on the log-log transformation. For all time to event analysis, patients without event information will be censored at the time of last available data.
Time frame: 24 Months