The purpose of this research is to test the safety and effectiveness of the investigational combination of anti-Programmed Death (PD)-1 antibody therapy with or without LAG-3 inhibition (pembrolizumab or nivolumab+relatlimab) and infliximab in treating metastatic melanoma.
This is a randomized, double-blind, phase 2 clinical trial that combines anti-Programmed Death (PD)-1 antibody therapy with or without LAG-3 inhibition (pembrolizumab or nivolumab+relatlimab) with the anti-Tumor Necrosis Factor (TNF)-α antibody infliximab as first line treatment for the management of patients with metastatic or recurrent melanoma. The U.S. Food and Drug Administration (FDA) has not approved infliximab for metastatic melanoma but it has been approved for other uses. The FDA has approved pembrolizumab as a treatment option for metastatic melanoma. The FDA has approved nivolumab+relatlimab as a treatment option for metastatic melanoma. Pembrolizumab is a blocking antibody (a protein used in the immune system to identity and neutralize bacteria, viruses, and other foreign pathogens) that binds to PD-1 (a protein that helps regulate the immune system's response in the body) and blocks the interaction with PD-L1 and PD-L2 (proteins that inhibits the body's immune response). By blocking this interaction, it might lead to an anti-tumor immune response that may decrease tumor growth. Relatlimab is believed to work by attaching to and blocking a molecule called Lymphocyte Activation Gene-3 (LAG-3). LAG-3 is a protein that is present on different types of cells in the immune system and controls parts of the immune system by shutting it down. Scientists believe that one way cancers escape the immune system is by shutting it down. Antibodies that block LAG-3 can potentially prevent LAG-3 from shutting down the immune system, thus allowing it to recognize and help the body destroy the cancer cells. Nivolumab is believed to work by attaching to and blocking a molecule called PD-1. PD-1 is a protein that is present on different types of cells in the immune system and controls parts of the immune system by shutting it down. Antibodies that block PD-1 can potentially prevent PD-1 from shutting down the immune system, thus allowing it to recognize and help the body destroy the cancer cells. Infliximab is an anti-TNFα agent (an antibody that blocks certain inflammatory hormones) that may interact with irEC (immune related (entero)colitis - inflammation that occurs in the digestive tract) which can develop among people with advanced melanoma. Anti- TNFα agents have shown to lead to rapid symptomatic improvement. By combining anti-PD-1 antibody therapy (pembrolizumab or nivolumab+relatlimab) and infliximab we believe it may lead to reduced immune related side effects while increasing effective anti-tumor immune response. The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits. Participants will be randomized to receive either a) anti-PD-1 antibody therapy (pembrolizumab or nivolumab+relatlimab) plus infliximab or b) anti-PD-1 antibody therapy (pembrolizumab or nivolumab+relatlimab) plus placebo (an intravenous solution without medication). Participants will receive study treatment for as long as their disease does not worsen, they do not experience any unacceptable side effects, or they have completed the two years of anti-PD-1 antibody therapy. Participants will then be followed until the study doctor determines follow-up is no longer needed or until participant withdrawal. It is expected that about 36 people will take part in this research study A research grant, The Bridge Project, is supporting this research study by providing funding for the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
36
Intravenous infusion
Intravenous infusion
Intravenous infusion
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, United States
Incidence of immune-related adverse events (irAE) in patients treated with anti-PD-1 plus infliximab compared to pembrolizumab plus placebo
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: 12 weeks
Incidence of severe immune-related adverse events (irAEs) (grade 3-5) in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: 12 weeks up to 2 years
Incidence of anti-PD-1 antibody cessation due to immune-related adverse events (irAEs)
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: 12 weeks up to 2 years
Incidence of clinically apparent infections in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: 12 weeks up to 2 years
Overall survival rate of patients receiving combination anti-PD-1 antibody/infliximab compared with anti-PD-1 antibody/placebo
Analysis based on cumulative incidence, and will include competing risks of (a) steroid initiation, or (b) anti-PD-1 antibody cessation. The methods of Fine and Gray will be used for analysis.
Time frame: Time from randomization (or registration) to death due to any cause, or censored at date last known alive up to 2 years
Progression free survival rate of patients receiving combination anti-PD-1 antibody /infliximab compared with anti-PD-1 antibody/placebo
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Intravenous infusion
Intravenous infusion
Analysis based on cumulative incidence, and will include competing risks of (a) steroid initiation, or (b) anti-PD-1 antibody cessation. The methods of Fine and Gray will be used for analysis.
Time frame: Time from randomization (or registration) to the earlier of progression or death due to any cause up to 2 years.
Response rate of patients receiving combination anti-PD-1 antibody/infliximab compared with anti-PD-1 antibody/placebo
Proportion of evaluable patients who achieve either a CR or PR per RECIST criteria
Time frame: Time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented up to 2 years
Cumulative steroid exposure (dose x duration) used for management of irAEs for anti-PD-1 antibody/infliximab compared to anti-PD-1 antibody/placebo patients
Calculated by adding the number of doses multiplied by strength of dose over the total follow-up time. Steroid exposure will be summarized descriptively for each treatment arm and compared using a Wilcoxon rank-sum test
Time frame: 12 weeks up to 2 years
Incidence of diarrhea in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: 12 weeks up to 2 years
Incidence of colitis in patients treated with anti-PD-1 antibody plus infliximab compared to anti-PD-1 antibody plus placebo
Assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: 12 weeks up to 2 years