Carboplatin/Nab-Paclitaxel and Pembrolizumab in NSCLC



Status:Recruiting
Conditions:Lung Cancer, Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:18 - Any
Updated:2/10/2018
Start Date:June 2015
End Date:May 2019
Contact:Nisha Mohindra, M.D.
Email:n-mohindra@northwestern.edu
Phone:312.695.6180

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A Phase I/II Study of Carboplatin/Nab-Paclitaxel and Pembrolizumab for Patients With Advanced Non-Small Cell Lung Cancer (NSCLC)

This is a phase I/II study for previously untreated subjects with advanced NSCLC. The study
will take place in two phases. First, a cohort of twelve participants will be enrolled in
phase I part and will be treated with carboplatin, nab-paclitaxel and pembrolizumab. A cohort
of twelve subjects will be evaluated for safety and tolerability after 2 cycles of therapy.
All subjects who receive either nab-paclitaxel or pembrolizumab will be evaluable. If 33% of
subjects or less have unacceptable toxicity in the first cohort or any subsequent cohort (if
necessary), the study will proceed to the Phase II part. If more than 33% have unacceptable
toxicity, 12 additional subjects will be enrolled in a second cohort, if necessary. If
unacceptable toxicity is seen in more than 33% in Cohort 2, the study will end due to
unacceptable toxicity of this drug combination.

The phase II part of the study is a single arm study. All subjects will be treated with
carboplatin, nab-paclitaxel, and pembrolizumab in 21-day cycles for up to 4 cycles.

Mandatory pre-treatment tumor biopsies will be obtained prior to initiating treatment for all
subjects (only if adequate archived samples are unavailable). Mandatory tumor biopsies will
be obtained in the Phase II part of the study after 4 cycles of study treatment or at the
time of progression, whichever comes first.

For subjects without progression of disease after Cycle 4, pembrolizumab will continue every
3 weeks for up to 2 years or until unacceptable toxicity.

OUTLINE: This is a multi-center study.

INVESTIGATIONAL TREATMENT:

Phase I, Cohort 1 Induction Therapy:

- Carboplatin AUC 6 IV, Day 1

- Nab-paclitaxel 100 mg/m^2 IV, Days 1, 8, 15

- pembrolizumab 2 mg/kg IV, Day 1

- Cycle length: 21 days; number of cycles: 4

Phase I, Cohort 1 Maintenance Therapy:

For subjects who have confirmed CR, PR, or SD (non-progression) after 4 cycles of induction
therapy, maintenance therapy with pembrolizumab 2* mg/kg will continue on Day 1 of each
21-day cycle. Treatment will continue until progression of disease, unacceptable toxicity, or
for a maximum of 2 years from Cycle 1, Day 1 (C1D1). Subjects who complete 24 months of
treatment with pembrolizumab may be eligible for up to one year of additional study treatment
if they progress after stopping study treatment provided they continue to meet inclusion
criteria requirements.

If unacceptable toxicity is seen in Phase I, Cohort 1, 12 additional participants will be
enrolled.

Phase I, Cohort 2 Induction Therapy (if necessary):

- Carboplatin AUC 6 IV, Day 1

- Nab-paclitaxel 100 mg/m^2 IV, Days 1, 8, 15

- pembrolizumab 2 mg/kg IV, Day 1 (cycle 2-4 only)

- Cycle length: 21 days; Number of cycles: 4

Phase I, Cohort 2 Maintenance Therapy:

For subjects who have confirmed CR, PR, or SD (non-progression) after 4 cycles of induction
therapy, maintenance therapy with pembrolizumab 2* mg/kg will continue on Day 1 of each
21-day cycle. Treatment will continue until progression of disease, unacceptable toxicity, or
for a maximum of 2 years from Cycle 2, Day 1 (C2D1). Subjects who complete 24 months of
treatment with pembrolizumab may be eligible for up to one year of additional study treatment
if they progress after stopping study treatment provided they continue to meet inclusion
criteria requirements.

Phase II Induction Therapy:

- Carboplatin AUC 6 IV, Day 1

- Nab-paclitaxel 100 mg/m^2 IV, Days 1, 8, 15

- pembrolizumab 200mg IV, Day 1 of each cycle

- Cycle length: 21 days; number of cycles: 4

Phase II Maintenance Therapy:

For subjects who have confirmed CR, PR, or SD (non-progression) after 4 cycles of induction
therapy, maintenance therapy with pembrolizumab 200 mg will continue on Day 1 of each 21-day
cycle. Treatment will continue until progression of disease, unacceptable toxicity, or for a
maximum of 2 years from Cycle 1, Day 1 (C1D1). Subjects who complete 24 months of treatment
with pembrolizumab may be eligible for up to one year of additional study treatment if they
progress after stopping study treatment provided they meet the requirements.

*As additional data from ongoing trials becomes available, the dose of pembrolizumab may be
adjusted.

Inclusion Criteria:

- Subjects must be willing and able to provide written informed consent for the trial
and HIPAA authorization for release of personal health information. NOTE: HIPAA
authorization may be included in the informed consent or obtained separately.

- Subjects must be ≥ 18 years of age.

- Individuals with stage IIIB or IV, unresectable non-small cell lung cancer (NSCLC) who
have not received prior chemotherapy for Stage IIIB or IV disease, and who are not
candidates for curative surgery or radiation therapy.

- ECOG performance status (PS) 0-1

- Measurable disease by RECIST v1.1 criteria

- Prior to registration, all subjects must have archival tissue available. For subjects
who have no archival tissue, but have PD-L1 testing results using the Dako 22C3
antibody, subjects will be permitted to enroll without submitting tissue. If the
patient has not had prior testing and no acceptable archival tissue is available,
subjects must be willing to consent to providing a pre-treatment biopsy for PD-L1
testing. Regardless of PD-L1 testing status, archival tissue will be requested for
research testing if available.

- Phase II subjects must be willing to consent to providing a mandatory post-treatment
core biopsy for research if clinical feasible.

- Women are eligible to participate if they are of non-childbearing potential or have
documentation of a negative pregnancy test (serum or urine β-hCG) within 3 days of
registration. Sexually active pre-menopausal women of childbearing potential must
agree to use adequate, highly effective contraceptive measures, starting with the
first dose of study drug and for 120 days after the last dose of last study drug.
Effective birth control includes (a) intrauterine device (IUD) plus one barrier
method; (b) oral, implantable, or injectable contraceptives plus one barrier method;
or (c) 2 barrier methods. Effective barrier methods are male or female condoms,
diaphragms, and spermicides (creams or gels that contain a chemical to kill sperm).
Women of childbearing potential are those who have not been surgically sterilized or
have not been free from menses for ≥ 1 year.

- Male participants should agree to use an adequate method of contraception starting
with the first dose of study drug through 120 days after the last dose of last study
drug.

Exclusion Criteria:

- Individuals with the presence of symptomatic CNS metastases requiring radiation
treatment, surgery, or ongoing use of corticosteroids.

- Untreated or brain metastasis causing any symptoms, such as neurologic deficits or
headache. Individuals with previously treated brain metastases may participate
provided they are stable (without evidence of progression by imaging for at least four
weeks prior to the first dose of study drug and any neurologic symptoms have returned
to baseline and whole brain radiation or stereotactic radiosurgery completed over 4
weeks prior to registration), have no evidence of new or enlarging brain metastases,
and are not using steroids for at least 7 days prior to study treatment.

- History of solid organ or stem cell transplant requiring immunosuppressive
medications.

- Any prior adjuvant cytotoxic chemotherapy within 12 months of registration. Subjects
who received chemotherapy for earlier stage disease more than 12 months prior to study
registration are eligible for this trial.

- Has received prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or
anti-Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) antibody (including
ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation
or checkpoint pathways).

- Any radiotherapy within 2 weeks prior to registration (4 weeks for brain radiotherapy
as noted above).

- Is currently participating in or has participated in a study of an investigational
agent or using an investigational device within 4 weeks of the first dose of
treatment.

- History of other invasive malignancy that is currently active and/or has been treated
within 12 months of registration. (Notable exceptions include: basal cell carcinoma,
squamous cell carcinoma of the skin, localized prostate cancer, in situ carcinomas of
the cervix and breast, and superficial bladder cancers [non-muscle-invasive]).

- Has known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).

- Active autoimmune disease that has required systemic treatment in 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.

- Pulmonary conditions such as sarcoidosis, silicosis, idiopathic pulmonary fibrosis, or
hypersensitivity pneumonitis.

- Has a history of pneumonitis that required steroids or current pneumonitis.

- Pre-existing peripheral neuropathy that is ≥ Grade 2 by CTCAE v 4.0 criteria.

- Known significant liver disease including viral, alcoholic, active hepatitis B or C,
and/or cirrhosis.

- Abnormal liver or renal function as defined as: bilirubin ≥ 1.5 mg/dL; AST or ALT ≥
2.5 x the ULN; alkaline phosphatase > 2.5 x the ULN, there is no upper limit if bone
metastasis is present in the absence of liver metastasis; creatinine > 1.5 mg/dL

- Abnormal baseline hematologic or coagulation parameters as defined as: absolute
neutrophil count (ANC) <1.5 x 10^9/L; hemoglobin < 9.0 g/dL; platelets < 100 x 10^9/L;
International Normalized Ratio (INR) of prothrombin time (PT) ≥ 1.5 x ULN unless
subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic
range of intended use of anticoagulants; Activated Partial Thromboplastin Time (aPTT)
≥ 1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is
within therapeutic range of intended use of anticoagulants

- Has received a live vaccine within 30 days prior to the first dose of study drug.

- Known activating EGFR mutation or ALK translocation

- Is pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the trial, starting with the pre-screening or screening visit
through 120 days after the last dose of pembrolizumab.
We found this trial at
5
sites
Duarte, California 91010
Principal Investigator: Marianna Koczywas, MD
Phone: 626-256-4373
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1300 Jefferson Park Avenue
Charlottesville, Virginia 22908
434-243-6784
Phone: 434-924-4251
University of Virginia Cancer Center We are fortunate in having state of the art clinical...
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Chicago, Illinois 60611
Phone: 312-695-6180
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535 Barnhill Dr
Indianapolis, Indiana 46202
(888) 600-4822
Phone: 317-274-4505
Indiana University Melvin and Bren Simon Cancer Center At the IU Simon Cancer Center, more...
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6845 Rama Drive
Indianapolis, Indiana 46219
Principal Investigator: Andrew Greenspan, MD
Phone: 317-678-2738
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