This phase I/II trial studies the best dose and effect of pimasertib in combination with bintrafusp alfa in treating patients with cancer that has spread to the brain (brain metastases). Immunotherapy with bintrafusp alfa, a bifunctional fusion protein composed of the monoclonal antibody anti-PD-L1 and TGF-beta, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Pimasertib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving pimasertib and bintrafusp alfa may help to prevent or delay the cancer from progressing (getting worse) and/or coming back.
PRIMARY OBJECTIVES: I. Establish safety profile and recommended phase II dose for combining pimasertib with bintrafusp alfa (M7824) in patients with brain metastases. (Phase I) II. Time to intracranial progression (defined as progression of existing lesions and development of new lesions by modified Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1). (Phase II) III. Overall survival. (Phase II) SECONDARY OBJECTIVES: I. Intracranial progression 6, 12 and 18 months. II. Intracranial objective response rate as measured by Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM), immunotherapy (i)RANO, and RECIST 1.1. III. Time to second intracranial progression after salvage stereotactic radiosurgery (SRS). IV. Overall survival rate at 6, 12 and 18 months. V. Frequency of grade 3+ intracranial toxicities at 4 weeks, and 3, 6, 9, 12 and 18 months. VI. Frequency of extracranial progression and response rate at 8 weeks, and 3, 6, 9, 12 and 18 months. VII. Frequency of neurocognitive decline at 6, 12 and 18 months (optional). VIII. Changes in neurocognitive function and health-related quality of life. IX. Dose, duration and frequency of steroid use for symptomatic management. EXPLORATORY OBJECTIVES: I. Identify molecular and/or immunological markers from biospecimens (tissue, blood, and cerebrospinal fluid \[CSF\]) that are associated with treatment response and toxicity. II. Identify imaging biomarkers of response and toxicity (acute radiation effect/radionecrosis and neurocognitive changes) from multiparametric magnetic resonance imaging (MRI) and/or delayed positron emission tomography (PET) that predict treatment response and toxicity. III. Identify correlative or surrogative relationship between systemic (blood) and imaging markers and treatment outcomes. OUTLINE: This is a phase I, dose-escalation study of followed by a phase II dose-expansion study. Patients receive bintrafusp alfa intravenously (IV) over 1 hour every 2 weeks and pimasertib orally (PO) twice daily (BID) on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 and 90 days, every 6 weeks during year 1, and then every 12 weeks for up to 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
8
M D Anderson Cancer Center
Houston, Texas, United States
Clinical benefit rate
Time frame: Up to 2 years
Incidence of intracranial and extracranial toxicities and dose-limiting toxicities (Phase I)
Will be summarized by grade, relationship, time during the treatment, etc., for each dose in each group.
Time frame: Up to 90 days
Recommended phase II dose (Phase I)
The recommended phase II dose is defined as the highest dose level with no more than 1 patient with dose-limiting toxicity out of 6 patients that are treated.
Time frame: At 4 weeks after first administration of treatment
Time to intracranial progression (Phase II)
Will be determined by modified Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and estimated using Kaplan-Meier method with 95% confidence interval.
Time frame: From the time of study enrollment to intracranial progression (event) or the last follow-up date if the patient has not developed the intracranial progression yet, assessed up to 2 years
Overall survival (Phase II)
Will be estimated using Kaplan-Meier method, both with 95% confidence interval.
Time frame: From treatment start date to death, assessed up to 2 years
Intracranial progression
Will be determined by modified RECIST 1.1 and estimated and reported with 95% confidence interval utilizing the method of Kaplan and Meier. Will be performed overall and within each treatment group. Completing risk analysis may be considered by treating events outside of intracranial disease progression (e.g. events such as extracranial disease progression, early dropout due to toxicity, or death) as competing risks.
Time frame: From the time of study enrollment to intracranial progression (event) or the last follow-up date if the patient has not developed the intracranial progression yet, assessed up to 18 months
Time to extracranial progression
Will be determined by modified RECIST 1.1. The cumulative incidence rate may be estimated by competing risk analysis treating events outside of extracranial disease progression (e.g. events such as intracranial disease progression, early dropout due to toxicity, or death) as competing risks.
Time frame: From the time of study enrollment to extracranial progression (event) or thelast follow-up date if the patient has not developed the extracranial progression yet, assessed up to 18 months
Best achieved extracranial objective response rate
Will be reported for each patient. The frequency of extracranial objective response will be reported overall and within each treatment group.
Time frame: Up to 2 years
Duration of response
Will be assessed in patients who achieve extracranial, PR or CR via RECIST 1.1 criteria and calculated utilizing the Kaplan-Meier method with reporting of the median and range overall and within each treatment group.
Time frame: From date of first imaging identifying partial response (PR) or complete response (CR) until the date of first imaging identifying progressive disease is noted, assessed up to 2 years
Dose, duration and frequency of steroid use for symptomatic management
Will record and report steroid requirements for symptom management overall and within each treatment group. Patients who require at least 4 mg of dexamethasone/day for symptom management will be considered as requiring high dose steroids.
Time frame: Up to 2 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.