This phase Ib trial test effects of aldesleukin in combination with nivolumab and standard chemotherapy in treating patients with gastric cancer that has spread to the tissue lining of the abdomen (peritoneal metastasis). Aldesleukin is similar to a protein that naturally exists in the body that stimulates the immune system to fight infections. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as leucovorin calcium, fluorouracil, and oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving aldesleukin in combination with nivolumab and standard chemotherapy may work better in treating patients with gastric cancer with peritoneal metastasis.
PRIMARY OBJECTIVE: I. To evaluate the reduction in the peritoneal carcinomatosis index (PCI) after completion of the study treatment. SECONDARY OBJECTIVES: I. Evaluate histological response of the peritoneal metastasis to study treatment using the peritoneal regression grading score (PRGS). II. Assess overall survival (OS). III. Assess progression-free survival (PFS). IV. Assess safety and tolerability of the study regimen. TERTIARY AND CORRELATIVE RESEARCH OBJECTIVES: I. Assess the number and percentage of patients that successfully undergo complete cytoreductive surgery after treatment. II. Evaluate for helper T cell, cytotoxic T cell, natural killer (NK) cells as well as T-reg cells in blood and peritoneal fluid. III. Evaluate the neutrophilic, lymphocytic, and eosinophilic infiltration of tumor using a standardized classification. OUTLINE: Patients receive aldesleukin intraperitoneally (IP) over at least 40 minutes on days 1 and 8 of each cycle. Patients also receive standard of care nivolumab intravenously (IV) over 30 minutes on day 1, leucovorin calcium IV over 2 hours on day 1, oxaliplatin IV over 2 hours on day 1, and flurouracil IV continuously over 46 hours on days 1-3 for each cycle. Cycles repeat every 14 days for up to 8 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo diagnostic laparoscopy with biopsy, positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance imaging (MRI), and collection of blood and tissue samples throughout the trial. After completion of study treatment, patients follow up at 30 days, 90 days then every 3 months for up to 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Given IP
Undergo biopsy
Undergo collection of blood and tissue samples
Undergo PET/CT
Undergo diagnostic laparoscopy
Given IV
Given IV
Undergo PET/MRI
Given IV
Given IV
Undergo PET/CT or PET/MRI
Mayo Clinic in Rochester
Rochester, Minnesota, United States
RECRUITINGChange of reduction in the peritoneal carcinomatosis index
Time frame: About 90 days after last dose of aldesleukin (IL-2)
Incidence of adverse events
Time frame: About 90 days after last dose of aldesleukin (IL-2)
Histological response of the peritoneal metastasis
Will be assessed using the peritoneal regression grading score. Will be reported descriptively, including reporting of frequencies, percentages and 95% confidence intervals.
Time frame: About 90 days after last dose of aldesleukin (IL-2)
Progression free survival
Summary statistics, including the median and other various timepoints will be reported as well as 95% confidence intervals.
Time frame: From study entry to the first of either disease progression or death, assessed up to 3 years
Overall survival
Summary statistics, including the median and other various timepoints will be reported as well as 95% confidence intervals.
Time frame: From date of study entry to date of death or last follow up, assessed up to 3 years
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