This early phase 1 trial will investigate the combination of low-dose interleukin-2 (IL-2) and pembrolizumab in patients with previously untreated stage IV non-small cell lung cancer (NSCLC). Preclinical data demonstrate reinvigoration of exhausted T cells into an effector-like phenotype with improved anti-tumor activity in response to this combination. This study will evaluate T cell function as well as clinical outcomes associated with this combination therapy.
PRIMARY OBJECTIVE: I. To assess phenotypic, transcriptional, and epigenetic profiles of PD-1+ CD8 T cells response in patients with stage IV non-small cell lung cancer (NSCLC) treated with the combination of IL-2 and pembrolizumab. SECONDARY OBJECTIVE: I. To evaluate anti-tumor activity of the combination of IL-2 and pembrolizumab by assessing the objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST 1.1). II. To evaluate the safety of the combination of IL-2 and pembrolizumab. OUTLINE: Patients will be treated with pembrolizumab 200 mg IV once every 3 weeks in combination with IL-2 given at 5 million IU subcutaneously twice daily for 3 weeks (5 days on, 2 days off each week, first dose in clinic and subsequent doses at home). IL-2 will be given only for the three weeks, after which pembrolizumab will be continued as monotherapy at either 200 mg every 3 weeks or 400 mg every 6 weeks. After completion of the study treatment, patients are followed for up for 6 weeks.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Given SC
Given IV
Emory University/Winship Cancer Institute
Atlanta, Georgia, United States
RECRUITINGImmune Response To Combination IL-2 and Pembrolizumab
Percentage of patients that express a greater than 1.5-fold increase in Ki-67 + PD-L1 + CD8 T cells in peripheral blood by week 3 of combination therapy. A 95% exact confidence interval will be estimated using the Clopper-Pearson method. Descriptive statistical analysis will be utilized to determine frequencies and percentages for categorical measurements.
Time frame: Change from Baseline at weeks 1, 2, 3, 6, 12, and 18
Objective Response Rate
Will be calculated as proportion (Yes/\[Yes + No\]) along with 95% confidence intervals using the Clopper-Pearson method. Chi-square test or Fisher's exact test will be used to compare the response rate between the different groups stratified by dose level or other factors, respectively. Logistics regression model will be further employed to test the adjusted effect of dosage on the response rate after adjusting for other clinical factors and demographic factors.
Time frame: Up 6 weeks after study completion
Progression Free Survival (PFS)
Will be estimated alone with 95% confidence interval (CI). Cox proportional hazards models will be further used in the multivariable analyses to assess adjusted effect of dose levels on the patients' PFS after adjusting for other factors.
Time frame: 6 months, 1 year, 3 year, and 5 years
Overall Survival (OS)
Will be estimated alone with 95% CI. Cox proportional hazards models will be further used in the multivariable analyses to assess adjusted effect of dose levels on the patients' OS after adjusting for other factors.
Time frame: 6 months, 1 year, 3 year, and 5 years
Dose-limiting Toxicities (DLTs)
Will be summarized descriptively, and percentage of DLTs will be reported. Tumor response, assessed using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria, will be summarized descriptively using frequencies and percentages. Paired assessments of mean expression will be compared using paired t-tests or Wilcoxon signed rank tests, where appropriate. Statistical significance will be assessed using the 0.05 level, and analysis will be performed using SAS 9.4.
Time frame: Up 6 weeks after study completion
Incidence of Adverse Events (AEs)
The number and percentage of subjects who experience AEs will be presented in tabular and/or graphical format and summarized descriptively, where appropriate. AEs will be presented with and without regard to causality based on the investigator's judgment. The frequency of overall toxicity, categorized by toxicity grades 1 through 5, will be described. Additional summaries will be provided for AEs that are observed with higher frequency.
Time frame: Up 6 weeks after study completion
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