A Pilot Window-Of-Opportunity Study of the Anti-PD-1 Antibody Pembrolizumab in Patients With Resectable Malignant Pleural Mesothelioma

NCT02707666 | Terminated Phase 1 FDA Drug

• 1 other identifier: IRB15-1149
• Study Type: interventional
• Target: 7
• Locations: 1 country
• Sites: 1

Brief Summary

This is a single institution, single-arm, window of opportunity pilot trial of pembrolizumab in patients with resectable malignant pleural mesothelioma. All patients will undergo a pretreatment PET/CT scan for clinical staging and a VATS procedure to acquire pretreatment tissue. Three cycles of pembrolizumab will then be administered (200 mg IV every 21 days). A PET/CT scan will then be repeated to assess response to pembrolizumab and then surgical resection will be performed at least 4 weeks after the third dose of pembrolizumab. Standard adjuvant chemotherapy consisting of cisplatin and pemetrexed for 4 cycles (every 21 days) will be given following surgery. After the completion of standard chemotherapy, optional adjuvant treatment with pembrolizumab will be given to eligible patients for 1 year post-surgery.

Conditions

Pleural Mesothelioma

Keywords

resectable malignant pleural mesothelioma; Pembrolizumab

Outcome Measures

Primary Outcomes (2)

• Gamma-Interferon Gene Expression profile (GEP) response rate defined as an increase beyond the median value of the sum of individual genes

  Determined using a CLIA Nanostring nCounter based profiling assay

  12 months after completion of treatment

• Number of participants with adverse events related to pembrolizumab administered prior to surgery as measured by Common Terminology Criteria for Adverse Events (CTCAE) v4.0

  Adverse events will be summarized by type, grade, and relationship to the study drug.

  12 months after completion of treatment

Secondary Outcomes (5)

• Progression Free Survival

  1 year

• Overall Survival

  12 months after completion of treatment

• Objective Response Rate

  12 months after completion of treatment

• Number of participants with adverse events related to pembrolizumab administered post surgery as measured by Common Terminology Criteria for Adverse Events (CTCAE) v4.0

  12 months after completion of treatment

• Pathologic Complete Response Rate

  12 months after completion of treatment

Study Arms (1)

Pembrolizumab+Surgery+Chemotherapy

EXPERIMENTAL

Neoadjuvant pembrolizumab, followed by surgery, followed by adjuvant pemetrexed and cisplatin

Drug: Pembrolizumab; Drug: Cisplatin and Pemetrexed

Interventions

Pembrolizumab DRUG

Neoadjuvant pembrolizumab every 21 days for three cycles

Pembrolizumab+Surgery+Chemotherapy

Cisplatin and Pemetrexed DRUG

Adjuvant chemotherapy with cisplatin and pemetrexed every 21 days for 4 cycles

Pembrolizumab+Surgery+Chemotherapy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histologically or cytologically confirmed pleural malignant mesothelioma, epithelial or biphasic subtypes.
• Disease amenable to maximal surgical debulking via extended pleurectomy/decortication as determined by a surgeon specializing in mesothelioma.
• No prior chemotherapy, targeted therapy, or immunotherapy for mesothelioma.
• Be willing and able to provide written informed consent for the trial.
• Be \> or = to 18 years of age on day of signing informed consent.
• Have measurable or evaluable disease based on modified RECIST for mesothelioma (Byrne, 2004).
• Be willing to undergo a video assisted thoracoscopy surgery (VATS) to provide diagnostic tissue (if not previously done and patient has adequate free pleural space to allow for procedures).
• If VATS procedures has been previously done or patient does not have a free pleural space to allow for a VATS procedure, then they must be able to undergo a CT or ultrasound guided needle biopsy to obtain baseline tissue if it is feasible. If this is not anatomically feasible, then they must be able to provide at least 15 unstained slides or a tumor block from their prior biopsy.
• Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale
• Have adequate cardiac function as assessed by echocardiogram, with an ejection fraction \> 45%
• Have adequate pulmonary function to tolerate surgery.Patients must have a predicted postoperative diffusing capacity of the lung for carbon monoxide (ppoDLCO) \> 35% of predicted, and a predicted postoperative FEV1 (ppoFEV1) \> 35% of predicted.
• Arterial blood gas predicted postoperative pCO2 \< 50 mmHg
• Demonstrate adequate organ function as defined below.
• Absolute neutrophil count (ANC) ≥ 1,500 /mcL
• Platelets ≥ 100,000 / mcL

You may not qualify if:

• Is currently participating in a study of an investigational agent and received an investigational agent within 4 weeks of the first dose of treatment.
• Has received any prior anticancer therapy for mesothelioma (no prior chemotherapy, immunotherapy, or targeted therapy).
• Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment during the neoadjuvant pembrolizumab and optional adjuvant pembrolizumab stages.
• Has a known history of active TB (Bacillus Tuberculosis)
• Hypersensitivity to pembrolizumab or any of its excipients.
• Has a known additional malignancy that is progressing or requires active treatment within the past 3 years. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer or other tumors that will not affect life expectancy.
• Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
• Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids (with higher than physiologic doses) or immunosuppressive drugs). Replacement therapy (e.g.: thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
• Has known history of, or any evidence of active, non-infectious pneumonitis that required steroids or active pneumonitis
• Has evidence of interstitial lung disease
• Has an active infection requiring systemic therapy.
• Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
• Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
• Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment.
• Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).

Sponsors & Collaborators

• University of Chicago: lead

Study Sites (1)

University of Chicago

Chicago, Illinois, 60637, United States

Location

MeSH Terms

Conditions

Mesothelioma, Malignant

Interventions

pembrolizumab; Cisplatin; Pemetrexed

Condition Hierarchy (Ancestors)

Mesothelioma; Adenoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Mesothelial; Lung Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Pleural Neoplasms; Lung Diseases; Respiratory Tract Diseases

Intervention Hierarchy (Ancestors)

Chlorine Compounds; Inorganic Chemicals; Nitrogen Compounds; Platinum Compounds; Guanine; Hypoxanthines; Purinones; Purines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Glutamates; Amino Acids, Acidic; Amino Acids; Amino Acids, Peptides, and Proteins; Amino Acids, Dicarboxylic

Study Officials

• Hedy Kindler, MD

  University of Chicago

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 29, 2016
• First Posted: March 14, 2016
• Study Start: February 25, 2016
• Primary Completion: April 24, 2023
• Study Completion: April 24, 2023
• Last Updated: July 31, 2024

Record last verified: 2024-07

Locations

US (1)