Intrathecal Double Checkpoint Inhibition

NCT05598853 | Active Not Recruiting Phase 1 DMC FDA Drug

• 1 other identifier: IT-IO (CA209-6K7)
• Study Type: interventional
• Target: 26
• Locations: 1 country
• Sites: 3

Brief Summary

The objective of the present study is to determine the feasibility and to explore anti-tumor activity of intrathecal double immune checkpoint inhibition for patients with newly diagnosed leptomeningeal metastases from non-small cell lung cancer without driver mutation or melanoma.

Conditions

Leptomeningeal Metastasis; Non-small Cell Lung Cancer Stage IV; Melanoma Stage IV

Keywords

intrathecal; immunotherapy

Outcome Measures

Primary Outcomes (1)

• Recommended phase II dose of intrathecal (IT) nivolumab/ipilimumab followed by IT nivolumab/ipilimumab plus systemic nivolumab/ipilimumab

  Determination of the maximum tolerated dose or the recommended phase II dose for combined intrathecal immunotherapy

  3 weeks

Secondary Outcomes (5)

• steroid intake

  through study completion, an average of 1 year

• compartmental efficacy (PFS) of nivolumab/ipilimumab combined with systemic nivolumab/ipilimumab

  through study completion, an average of 1 year

• compartmental efficacy (response) of nivolumab/ipilimumab combined with systemic nivolumab/ipilimumab

  through study completion, an average of 1 year

• efficacy of nivolumab/ipilimumab combined with systemic nivolumab/ipilimumab

  through study completion, an average of 1 year

• prognostic factors

  through study completion, an average of 1 year

Study Arms (1)

Intrathecal nivolumab and intrathecal ipilimumab

EXPERIMENTAL

The experimental treatment will be combined from cycle 2 with systemic nivolumab and systemic ipilimumab

Drug: intrathecal nivolumab and intrathecal ipilimumab

Interventions

intrathecal nivolumab and intrathecal ipilimumab DRUG

Patients shall be treated with a fixed dose of intrathecal nivolumab and increasing doses of intrathecal ipilimumab. From cycle 2, patients will receive systemic nivolumab/ipilimumab in addition to intrathecal treatment. Systemic nivolumab/ipilimumab corresponds to the current standard of care for non-small cell lung cancer and for melanoma patients.

Intrathecal nivolumab and intrathecal ipilimumab

Eligibility Criteria

• Age: 18 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Newly diagnosed confirmed or probable leptomeningeal metastases according to European Association of Neuro-Oncology (EANO) - European Society for Medical oncology (ESMO) criteria (Le Rhun et al., 2017).
• Histologically confirmed (from primary tumor or from a metastatic lesion, including in the brain) non-small cell lung cancer without actionable oncogenic driver mutation or melanoma. Programmed death-ligand 1 (PD-L1) expression status (from primary tumor or from a metastatic lesion, including brain) is optional, but should be documented if available
• Requirements for patients with non-small cell lung cancer: non-small cell lung cancer without a specified targetable oncogenic driver alteration: sensitising Epidermal Growth Factor Receptor (EGFR) mutation (exon 19-del and 21-L858R), anaplastic lymphoma kinase (ALK) or ROS proto-oncogene-1 (ROS1) rearrangement.
• Clinically eligible for systemic immunotherapy with nivolumab and ipilimumab at the time of enrolment as judged by the investigator. If already initiated, the systemic treatment must be well tolerated, without common terminology criteria for adverse events (CTCAE) grade 3 or more toxicity, and there must be no evidence of systemic progression and no indication for whole brain radiotherapy. Intrathecal immunotherapy alone may be acceptable for exceptional patients after discussion with the coordinators of the study. Systemic immunotherapy can be started later in these patients based on investigator decision.
• Patients previously treated with systemic chemotherapy must have received the last dose at least 21 days prior to treatment initiation, patients who have received another investigational agent must have received the last treatment at least 14 days prior to treatment initiation.
• Age of 18 years or older on day of signing informed consent, female or male.
• Karnofsky performance status of 60 or more.
• Life expectancy \>8 weeks. Patients with rapidly progressive systemic disease are not eligible.
• Patients may receive steroids to control symptoms related to central nervous system involvement, but the dose must be stable or decreasing and \< 4 mg per 24 hours of dexamethasone (or equivalent) in the last 7 days. Patients should experience stability of neurological symptoms for at least 7 days. Physiologic replacement doses of steroids are permitted.
• Cerebrospinal MRI criteria (on the baseline MRI, performed within 14 days prior to study treatment initiation)
• MRI can be normal or can show leptomeningeal metastases, including nodules \<0.5 cm diameter largest diameter (or more if stereotactic radiosurgery is planned)
• No evidence of cerebrospinal fluid flow obstruction at the discretion of the investigator
• Co-existing asymptomatic brain metastases \<2 cm diameter are permitted. Larger asymptomatic or oligosymptomatic brain metastases are permitted if they are planned to be treated by stereotactic radiosurgery
• Central nervous system radiotherapy criteria:
• Focal brain radiotherapy by stereotactic radiotherapy is allowed for meningeal nodules \> 5 mm diameter or concomitant brain metastases. The treated lesions cannot be used as a target for the evaluation of the study treatment

You may not qualify if:

• Leptomeningeal metastases related to primary tumors other than non-small cell lung cancer without driver mutation or melanoma.
• Inability to undergo craniospinal MRI evaluation.
• Progressive parenchymal brain metastases thought to require whole brain radiotherapy.
• Contra-indication to lumbar puncture or to implantation of a ventricular device.
• Prior intrathecal chemotherapy, intrathecal immunotherapy or intrathecal targeted therapy.
• Ventriculo-peritoneal shunt (except if intrathecal therapy is administered via a ventricular device with an ON/OFF option).
• Condition requiring systemic treatment with either corticosteroids (\> 4 mg daily dexamethasone equivalents) or other immunosuppressive medications within 7 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses \< 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
• Patients with a history of pneumonitis or previous non-hematological grade \>2 toxicity under previous immunotherapy treatment.
• Active infection (systemic or central nervous system) within 7 days prior to initiation of the study drug.
• Active autoimmune disease that has required systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids 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.
• Known positive test for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV antibody) indicating acute or active chronic infection.
• Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) even if fully immunocompetent on antiretroviral therapy due to the unknown effects of HIV on the immune response to combined nivolumab plus ipilimumab or the unique toxicity spectrum of these drugs in patients with HIV infection.
• Use of vaccines containing live virus for prevention of infectious disease within 12 weeks prior to study drug.
• History of allergy to study drug components and history of severe hypersensitivity reaction to any monoclonal antibody.
• Concurrent treatment with other systemic cancer-derived pharmacotherapies is not allowed. No other concomitant intrathecal therapy is allowed.

Sponsors & Collaborators

• University of Zurich: lead

Study Sites (3)

University Hospital Zurich

Zurich, Canton of Zurich, Switzerland

Location

University Hospital Basel

Basel, Switzerland

Location

University Hospital Geneva

Geneva, Switzerland

Location

MeSH Terms

Conditions

Meningeal Carcinomatosis; Carcinoma, Non-Small-Cell Lung; Melanoma

Condition Hierarchy (Ancestors)

Meningeal Neoplasms; Central Nervous System Neoplasms; Nervous System Neoplasms; Neoplasms by Site; Neoplasms; Nervous System Diseases; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Diseases; Respiratory Tract Diseases; Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms, Nerve Tissue; Nevi and Melanomas; Skin Neoplasms; Skin Diseases; Skin and Connective Tissue Diseases

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: October 11, 2022
• First Posted: October 28, 2022
• Study Start: November 25, 2022
• Primary Completion: December 1, 2025
• Study Completion: December 1, 2025
• Last Updated: October 2, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

CH (3)