This phase II trial studies how well low dose, reduced frequency nivolumab works in treating patients with cancer that cannot be removed by surgery (unresectable) or that has spread from where it first started (primary site) to other places in the body (metastatic). 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. Nivolumab is a type of immune checkpoint inhibitor (ICI). ICIs have revolutionized the treatment of numerous cancers with remarkable improvement in participant outcomes. However, accessibility of ICIs is extremely poor on a global scale, mainly due to high costs. Previous research has suggested that these drugs can be given at lower doses and reduced frequency than their approved dosing regimens, with similar results. Giving nivolumab at a lower dose and less often may help reduce the cost of therapy, improve immunotherapy accessibility, and therefore improve survival outcomes globally.
OUTLINE: INDUCTION PHASE: Patients receive nivolumab intravenously (IV) over approximately 30 minutes on days 1 and 45 in the absence of disease progression or unacceptable toxicity. Patients who are benefitting after 45 days proceed to Maintenance Phase. MAINTENANCE PHASE: Patients receive nivolumab IV over approximately 30 minutes every 90 days (days 90, 180, 270 and 360) in the absence of disease progression or unacceptable toxicity. All patients also undergo computed tomography (CT)/magnetic resonance imaging (MRI) and blood sample collection throughout the study. Patients may also undergo urine sample collection throughout the study. After completion of study treatment, patients are followed up at 90 days and then every 12 months for up to 4 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Undergo collection of urine and/or blood samples
Undergo CT
Undergo MRI
Given IV
Uganda Cancer Institute
Kampala, Uganda
Objective response
Defined as the best objective response of complete response (CR) or partial response (PR), as determined by investigator assessment per Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1.
Time frame: Up to 4 years after completion of study treatment
Duration of response (DOR)
Will be assessed per RECIST 1.1. The Kaplan-Meier (KM) technique will be used to obtain estimates of DOR. For event-based survival analyses in participants without documentation of the event, survival will be censored on the last date the participant was known to be event free. The standard error of the KM estimates will be computed using the Greenwood formula (Kalbfleisch \& Prentice, 2002), and standard errors from the matrix form of Greenwood's formula for cumulative incidence estimates. Median time to event, if reached, will be presented with a 90% confidence interval based on the Brookmeyer and Crowley method (Kalbfleisch \& Prentice, 2002).
Time frame: From the earliest date of disease response (CR or PR) until the earliest date of disease progression, or the date of death from any cause, assessed up to 4 years after completion of study treatment
Disease control
Defined as achievement of CR, PR, or stable disease as a patient's best objective response to the study treatment, per RECIST v1.1. For event-based survival analyses in participants without documentation of the event, survival will be censored on the last date the participant was known to be event free. The standard error of the KM estimates will be computed using the Greenwood formula (Kalbfleisch \& Prentice, 2002), and standard errors from the matrix form of Greenwood's formula for cumulative incidence estimates. Median time to event, if reached, will be presented with a 90% confidence interval based on the Brookmeyer and Crowley method (Kalbfleisch \& Prentice, 2002).
Time frame: Up to 4 years after completion of study treatment
Progression free survival (PFS)
The KM technique will be used to obtain estimates of PFS. For event-based survival analyses in participants without documentation of the event, survival will be censored on the last date the participant was known to be event free. The standard error of the KM estimates will be computed using the Greenwood formula (Kalbfleisch \& Prentice, 2002), and standard errors from the matrix form of Greenwood's formula for cumulative incidence estimates. Median time to event, if reached, will be presented with a 90% confidence interval based on the Brookmeyer and Crowley method (Kalbfleisch \& Prentice, 2002).
Time frame: From date of first dose of study treatment until the earliest date of disease progression, or the date of death from any cause, assessed up to 4 years after completion of study treatment
Overall survival (OS)
The KM technique will be used to obtain estimates of OS. For event-based survival analyses in participants without documentation of the event, survival will be censored on the last date the participant was known to be event free. The standard error of the KM estimates will be computed using the Greenwood formula (Kalbfleisch \& Prentice, 2002), and standard errors from the matrix form of Greenwood's formula for cumulative incidence estimates. Median time to event, if reached, will be presented with a 90% confidence interval based on the Brookmeyer and Crowley method (Kalbfleisch \& Prentice, 2002).
Time frame: From date of first dose of study treatment until the date of death from any cause, assessed up to 4 years after completion of study treatment
Disease specific survival
For event-based survival analyses in participants without documentation of the event, survival will be censored on the last date the participant was known to be event free. The standard error of the KM estimates will be computed using the Greenwood formula (Kalbfleisch \& Prentice, 2002), and standard errors from the matrix form of Greenwood's formula for cumulative incidence estimates. Median time to event, if reached, will be presented with a 90% confidence interval based on the Brookmeyer and Crowley method (Kalbfleisch \& Prentice, 2002).
Time frame: From date of first dose of study treatment until the date of death, assessed up to 4 years after completion of study treatment
Incidence of adverse events
Will include immune-related adverse events, treatment interruption and treatment discontinuation, and the use of immunosuppressive medications for toxicities.
Time frame: Up to 90 days years after completion of study treatment
Accrual and by compliance with treatment timepoints
Feasibility defined by accrual and by compliance with treatment timepoints in this unique setting.
Time frame: Up to 4 years after completion of study treatment
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