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Pembrolizumab in Patients With Advanced Malignant Pleural Mesothelioma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02784171
Recruitment Status : Active, not recruiting
First Posted : May 26, 2016
Last Update Posted : January 16, 2024
Sponsor:
Collaborators:
National Cancer Institute, Naples
Merck Sharp & Dohme LLC
Intergroupe Francophone de Cancerologie Thoracique
Information provided by (Responsible Party):
Canadian Cancer Trials Group

Study Description
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Brief Summary:
Pembrolizumab is a new type of drug for mesothelioma (immunotherapy). Laboratory tests show that this drug works by helping improve the body's immune response to help fight cancer. Pembrolizumab may help the immune system to recognize cancer cells and slow down the growth and/or spreading of cancer.

Condition or disease Intervention/treatment Phase
Mesothelioma Drug: Cisplatin Drug: Pemetrexed Drug: Pembrolizumab Phase 2 Phase 3

Detailed Description:
The purpose of this study is to find out what effects a new drug, pembrolizumab has on this type of cancer and if it can offer better results than standard pemetrexed and platinum-based chemotherapy alone. This study will also look at side effects and how the treatments impact quality of life
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 520 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II/III Randomized Study of Pembrolizumab in Patients With Advanced Malignant Pleural Mesothelioma
Actual Study Start Date : November 11, 2016
Actual Primary Completion Date : April 24, 2023
Estimated Study Completion Date : June 30, 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Mesothelioma

Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Arm A - Cisplatin/Pemetrexed
Pemetrexed 500 mg/m2 IV Day 1 every 21 days for 6 cycles Cisplatin 75 mg/m2 IV Day 1 every 21 days for 6 cycles
 Drug: Cisplatin
Drug: Pemetrexed
Active Comparator: Arm B - Cisplatin/Pemetrexed/Pembrolizumab
Pembrolizumab 200 mg* IV Day 1 over 30 min every 21 days for a total of 2 years Pemetrexed 500 mg/m2 IV Day 1 every 21 days for 6 cycles Cisplatin 75 mg/m2 IV Day 1 every 21 days for 6 cycles
 Drug: Cisplatin
Drug: Pemetrexed
Drug: Pembrolizumab
Active Comparator: Arm C - Pembrolizumab (Phase II only)
Pembrolizumab 200 mg* IV 30 min Day 1 every 21 days for a total of 2 years
 Drug: Pembrolizumab


Outcome Measures
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Primary Outcome Measures :
  1. Phase II: Progression free survival measured as time from randomization to first observation of objective disease relapse or progression [ Time Frame: 32 months ]
  2. Phase III: Overall Survival defined as time from randomization to the date of death from any cause [ Time Frame: 32 months ]

Secondary Outcome Measures :
  1. Number and severity of adverse events [ Time Frame: 32 months ]
  2. Overall Survival [ Time Frame: 32 months ]
  3. Quality of Life using EORTC QLQ-C30 [ Time Frame: 32 months ]
  4. Objective Response rate compared using Fisher's exact test [ Time Frame: 32 months ]

Eligibility Criteria
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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have histologically confirmed malignant pleural mesothelioma. Patients must be eligible to receive standard chemotherapy with pemetrexed and cisplatin and have no contraindications to standard chemotherapy.
  • Patients must have unresectable advanced and/or metastatic disease, incurable by standard therapies.
  • All patients must have a cellular tumour block from their primary or metastatic tumour available and consent to release the block/recently cut slides for correlative analyses (See Section 11.0) and the centre/pathologist must have agreed to the submission of the specimen(s).

  • Presence of radiologically documented disease. At least one site of disease must be unidimensionally measurable as follows:

    • CT scan (with slice thickness of ≤ 5 mm): ≥ 10 mm --> longest diameter
    • Physical exam (using calipers): ≥ 10 mm
    • Lymph nodes by CT scan ≥ 15 mm --> measured in short axis
  • All radiology studies must be performed within 21 days prior to registration (exception: within 28 days if negative).
  • Age ≥ 18 years.
  • ECOG performance status 0 or 1.

Previous Therapy

Cytotoxic Chemotherapy:

  • Patients must not have received prior chemotherapy for any stage of advanced/metastatic disease.
  • Patients who received previous (neo)adjuvant cisplatin-based systemic chemotherapy must have received the last dose of chemotherapy at least 12 months before registration. Please contact CCTG PRIOR to randomization for such patients.

Other Anti-Cancer Therapy:

  • Patients may not have received targeted small molecule therapy, immunotherapies and viral therapies, biologic therapies and angiogenesis inhibitors for advanced/metastatic disease, or any prior immunotherapy for any stage of disease.

Radiation:

  • Patients may have had prior radiation therapy, but NOT to the thorax unless clear disease progression has been demonstrated and confirmed with CCTG. A minimum of 28 days must have elapsed between the end of radiotherapy and registration onto the study. Radiation must have involved < 30% of functioning bone marrow and there must be measurable disease outside the previously irradiated area (patients whose sole site of disease (for example pleural rind) is in a previously irradiated area are ineligible UNLESS there is evidence of progression, or new lesions have been documented, in the irradiated field). Please contact CCTG PRIOR to randomization if the patient has received prior thoracic radiation. Patients must have recovered from any acute toxic effects from radiation prior to registration.

Previous Surgery:

  • Previous major surgery is permitted provided that it has been at least 28 days prior to patient registration and that wound healing has occurred.

  • Lab Requirements:

    • Absolute neutrophils ≥ 1.5 x 10^9/L
    • Platelets ≥ 100 x 10^9/L
    • Hemoglobin ≥ 90 g/L
    • Bilirubin ≤ 1.5 x ULN (upper limit of normal)
    • AST and ALT ≤ 2.5 x ULN
    • Serum creatinine < 1.25 x ULN or Creatinine clearance ≥ 50 mL/min
  • Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements.
  • Patients must be accessible for treatment, response assessment and follow-up. Patients registered on this trial must be treated and followed at the participating centre.
  • In accordance with CCTG policy, protocol treatment is to begin within 2 working days of patient randomization.
  • Women/men of childbearing potential must have agreed to use two highly effective contraceptive methods during the study and for six months after discontinuation.
  • Patient must be able (i.e. sufficiently fluent) and willing to complete the quality of life questionnaires.

Exclusion Criteria:

  • Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy (at doses more than 10 mg prednisone or equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first and any dose of trial treatment.
  • Has active autoimmune disease that has required systemic treatment in the past 3 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs) or history of allogeneic transplantation. 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.
  • Must not have received a live vaccine within 30 days of planned start of study therapy.
  • Patients with known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects 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 trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.
  • Patients who have experienced untreated and/or uncontrolled cardiovascular conditions and/or have symptomatic cardiac dysfunction including cardiac ventricular arrhythmias requiring medication, history of 2nd or 3rd degree atrioventricular conduction defects) or who have had unstable angina congestive heart failure or myocardial infarction within the previous year. Patients with a significant cardiac history, this includes hypertension, even if controlled, should have a LVEF ≥ 50%.
  • Patients with a history of other malignancies unless having undergone curative therapy (i.e. resection, radiation, etc) and do not require concurrent anticancer therapy.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to pembrolizumab or any of the other chemotherapy agents.
  • Concurrent treatment with other investigational drugs or anti0cancer therapy.

  • Patients with serious illness or medical condition that would not permit the patient to be managed according to the protocol including, but not limited to:

    • History of significant neurologic or psychiatric disorder which would impair the ability to obtain consent or limit compliance with study requirements.
    • Active infection requiring systemic therapy; (including any patient known to have active hepatitis B, hepatitis C or human immunodeficiency virus (HIV) [note: testing in asymptomatic patients is not required] or tuberculosis).
    • Known history of, or any evidence of active, non-infectious pneumonitis.
    • Any other medical conditions that might be aggravated by treatment.
    • Serious or non-healing wound, ulcer, or bone fracture.
  • Patients with evidence of interstitial lung disease.
  • Patients with severe/uncontrollable tumor pain that requires radiation prior to starting on systemic therapy.
  • Pregnant or lactating women. (N.B.: All women of childbearing potential must have a negative pregnancy test within 72 hours prior to registration).
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02784171


Locations
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Sponsors and Collaborators
Canadian Cancer Trials Group
National Cancer Institute, Naples
Merck Sharp & Dohme LLC
Intergroupe Francophone de Cancerologie Thoracique
Investigators
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Study Chair: Quincy Chu Cross Cancer Institute, Edmonton Alberta Canada
Study Chair: Francesco Perrone National Cancer Institute of Naples, Italy
Study Chair: Laurent Greillier Marseille Hopital Nord, France
More Information
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Publications of Results:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Canadian Cancer Trials Group
ClinicalTrials.gov Identifier: NCT02784171    
Other Study ID Numbers: I227
2016-002286-60 ( EudraCT Number )
IFCT-1901 ( Other Identifier: Intergroupe Francophone de Cancerologie Thoracique )
First Posted: May 26, 2016    Key Record Dates
Last Update Posted: January 16, 2024
Last Verified: August 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Mesothelioma
Mesothelioma, Malignant
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
Pembrolizumab
Pemetrexed
Antineoplastic Agents
Antineoplastic Agents, Immunological
Immune Checkpoint Inhibitors
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors
Folic Acid Antagonists
Nucleic Acid Synthesis Inhibitors