This phase I trial studies the side effects and best dose of belinostat when given together with durvalumab in treating patients with urothelial cancer that has spread to other places in the body (metastatic) or cannot be removed by surgery (unresectable) and has spread to nearby tissue or lymph nodes (locally advanced). Immunotherapy with monoclonal antibodies, such as durvalumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Belinostat is a potential anti-cancer drug, known as a histone deacetylase (HDAC) inhibitor, which means that belinostat stops the activity of HDAC enzymes (an enzyme is a protein that in small amounts can speed up a biological reaction). HDAC enzymes play an important role in cell growth and cell death. Giving durvalumab and belinostat may improve the body's ability to fight cancer.
PRIMARY OBJECTIVES: I. To assess the recommended phase 2 dose of belinostat in combination with tremelimumab and durvalumab or belinostat in combination with durvalumab alone in advanced urothelial carcinoma. (Phase 1A) II. To assess the ongoing safety of belinostat in combination with durvalumab in patients with advanced urothelial carcinoma. (Phase 1B) SECONDARY OBJECTIVES: I. To assess the efficacy of belinostat in combination with tremelimumab and durvalumab or belinostat in combination with durvalumab in patients with advanced urothelial carcinoma. EXPLORATORY OBJECTIVES: I. To assess the mechanism of action of belinostat in combination with tremelimumab and durvalumab or belinostat in combination with durvalumab. II. To explore possible mechanisms of treatment resistance. III. Determine the feasibility of establishing patient-derived xenografts from tumor cells collected from enrolled subjects at baseline, and progression to better explore mechanisms of response and resistance. IIII. To explore possible biomarkers predictive of treatment benefit. OUTLINE: This is a dose-escalation study of belinostat. Patients receive durvalumab intravenously (IV) over 30 minutes on day 1. Patients also receive tremelimumab IV over 60 minutes on day 1 of cycle 1. Beginning cycle 2, patients receive belinostat IV over 30 minutes on days 1-5. Treatment repeats every 21 days for 7 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive durvalumab IV over 30 minutes on day 1. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year and then every 6 months for 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
9
Given IV
Given IV
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, United States
Incidence of dose limiting toxicities (DLTs) (Phase 1A Part 1)
Rate of DLTs during the defined DLT period for belinostat dose escalation. The number and proportion of DLTs will be reported for each dose level. An exact 95% confidence interval will be reported for each dose level with more than one patient.
Time frame: Up to 21 days
Incidence of DLTs (Phase 1A Part 2)
Rate of DLTs during the defined DLT period for confirmation of belinostat for the phased triplet regimen.
Time frame: Up to 21 days
Incidence of adverse events (AEs) (Phase 1B)
The incidence and frequency of AEs characterized by type, severity (as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0), seriousness, duration, and relationship to study treatment. Will be tabulated by dose level and cohort. Exact 95% binomial confidence intervals.
Time frame: Up to 3 years
Rate of clinical benefit
Defined as the proportion of evaluable patients achieving stable disease, a partial response, or a complete response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Will be tabulated by dose level and cohort. Exact 95% binomial confidence intervals.
Time frame: Up to 3 years
Objective response rate
Defined as the proportion of evaluable patients achieving a partial response or a complete response per RECIST 1.1 criteria. Will be tabulated by dose level and cohort. Exact 95% binomial confidence intervals.
Time frame: Up to 3 years
Duration of response
Defined as the time from documented tumor response to disease progression as defined by RECIST 1.1. Will be analyzed using Kaplan-Meier methodology and associated 95% confidence intervals.
Time frame: Up to 3 years
Progression-free survival
Will be analyzed using Kaplan-Meier methodology and associated 95% confidence intervals.
Time frame: From the initiation of study therapy to disease progression per RECIST 1.1, initiation of alternative therapy, or death from any cause, assessed up to 3 years
Overall survival
Will be analyzed using Kaplan-Meier methodology and associated 95% confidence intervals.
Time frame: From the initiation of study therapy until death from any cause, assessed up to 3 years
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