This phase I trial identifies the best dose and side effects of CpG-STAT3 siRNA CAS3/SS3 (CAS3/SS3) in combination with localized radiation therapy in treating patients with B-cell non-Hodgkin lymphoma that has come back (relapsed) or does not respond to treatment (refractory). CAS3/SS3 simultaneously targets two molecules, TLR9 receptor and STAT3. This investigational drug combines a CpG oligonucleotide and an siRNA in one molecule that act together to interfere with the ability of the cancer cells to grow. Radiation therapy uses high energy x-rays to kill cancer cells and shrink tumors. Giving CAS3/SS3 with localized radiation therapy may kill more cancer cells.
PRIMARY OBJECTIVES: I. Determine the recommended phase 2 dose (RP2D) of CAS3/SS3 when given in combination with local fixed-dose radiation therapy (RT). II. Evaluate the safety and feasibility of intratumoral injections of CAS3/SS3 when combined with local fixed-dose RT, by evaluation of toxicities including: type, frequency, severity, attribution, time course and duration. SECONDARY OBJECTIVES: I. Characterize the clinical activity (overall and per dose level) of CAS3/SS3 through the assessment of disease response, and response duration. (Clinical) II. Characterize the biologic activity (overall and per dose level) of CAS3/SS3 when combined with local fixed-dose RT by assessing. (Biologic \[Immunologic Correlative Studies\]) IIa. Silencing of the STAT3 gene and its key downstream genes. IIb. Local and systemic immune responses, including: evidence/extent of immune cell intratumoral infiltration, immune cell activation within the tumor and in the peripheral blood, and changes in proinflammatory mediators in plasma. OUTLINE: Patients undergo radiation therapy on days 1 and 2 tumor-bearing lymph node, and receive CAS3/SS3 intratumorally on days 2, 4, 16, and 18. Patients assigned to dose level 3 also receive CAS3/SS3 intratumorally on days 9, 11, 23, and 25. After completion of study treatment, patients are followed up every 3 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Given intratumorally
Undergo radiation therapy
Incidence of adverse events
Toxicity will be graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5. Observed toxicities will be summarized in terms of type (organ affected or laboratory determination), severity, attribution, time of onset, duration, and reversibility or outcome.
Time frame: Up to 6 months
Dose Limiting Toxicity
Grade 3 or higher toxicities at least possibly related to study treatment as assessed by CTCAE, with noted exceptions.
Time frame: Up to 56 days
Overall response
Will be categorized using the 2014 Lugano response criteria for malignant lymphoma.
Time frame: From 56 days through 6 months
Response duration
Time interval from the date of first documented response (CR or PR) to documented disease relapse, progression or death whichever occurs first, assessed up to 2 years
Time frame: Up to 6 months
Suppression of STAT3 expression
Measurement of STAT3 mRNA cleavage in lymph node tissue and peripheral blood mononuclear cells using RACE
Time frame: up to 56 days
Suppression of STAT3 activation of downstream targets.
Suppression of STAT3 activation of downstream target genes and immune genes as assessed by Nanostring in lymph node tissue
Time frame: Up to 19 days
Activation of immune cells
Serum IFNs, IP-10, MCP1 levels will be evaluated as evidence for systemic effects of CAS3/SS3 injections.
Time frame: Up to 56 days
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