Study of Nivolumab and Ipilimumab in Children and Young Adults With INI1-Negative Cancers

• ClinicalTrials.gov Identifier: NCT04416568
• Recruitment Status: Recruiting
• First Posted: June 4, 2020
• Last Update Posted: November 28, 2023
• Sponsor: Dana-Farber Cancer Institute
• Collaborator: Gateway for Cancer Research
• Information provided by (Responsible Party): Suzanne Forrest, MD, Dana-Farber Cancer Institute

Study Description

Brief Summary:

This clinical trial is studying two immunotherapy drugs (nivolumab and ipilimumab) given together as a possible treatment for INI1-negative tumors.

Condition or disease	Intervention/treatment	Phase
Malignant Rhabdoid Tumor; Rhabdoid Tumor of the Kidney; Epithelioid Sarcoma; Chordoma (Poorly Differentiated or De-differentiated); Atypical Teratoid/Rhabdoid Tumor; Other INI1 Negative Tumors (With PI Approval); Other SMARCA4-deficient Malignant Tumors (With PI Approval)	Drug: Nivolumab; Drug: Ipilimumab	Phase 2

Detailed Description:

This research study is a Phase II clinical trial, which tests the safety and effectiveness of an investigational drug or drug combination to learn whether the drug or drug combination works in treating a specific disease. "Investigational" means that the drug combination is being studied.

The names of the study drugs involved in this study are:

• Nivolumab (OPDIVO)
• Ipilimumab (YERYOY)

This trial is studying whether nivolumab and ipilimumab work to treat INI1-negative cancers.

The U.S. Food and Drug Administration (FDA) has not approved combination nivolumab and ipilimumab for the specific diseases in this study but it has been approved for other diseases. Nivolumab and ipilimumab have been tested in children to find out a safe dose of this combination.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 45 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase 2 Proof of Concept Study of Nivolumab and Ipilimumab in Children and Young Adults With Relapsed or Refractory INI1-negative Cancers
• Actual Study Start Date: August 14, 2020
• Estimated Primary Completion Date: October 2024
• Estimated Study Completion Date: October 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: Solid Tumor (Stratum 1); Patients will receive combination therapy with nivolumab at a predetermined dose and ipilimumab at a predetermined dose day 1 of a 21-day cycle for 4 cycles; Starting with cycle 5, patients will receive nivolumab monotherapy at a predetermined dose on day 1 and day 15 of a 28-day cycle; Patients with INI1-negative relapsed or refractory extracranial solid tumors	Drug: Nivolumab; Combination Therapy: Nivolumab at predetermined dosage day 1 of a 21-day cycle for 4 cycles. Monotherapy: Starting with cycle 5 nivolumab at predetermined dosage on day 1 and day 15 of a 28-day cycle; Other Name: OPDIVO; Drug: Ipilimumab; Combination Therapy: Ipilimumab at predetermined dosage day 1 of a 21-day cycle for 4 cycles; Other Name: YERYOY
Experimental: CNS (Stratum 2); Patients will receive combination therapy with nivolumab at a predetermined dose and ipilimumab at a predetermined dose day 1 of a 21-day cycle for 4 cycles; Starting with cycle 5, patients will receive nivolumab monotherapy at a predetermined dose on day 1 and day 15 of a 28-day cycle; Patients with INI1-negative relapsed or refractory CNS tumors	Drug: Nivolumab; Combination Therapy: Nivolumab at predetermined dosage day 1 of a 21-day cycle for 4 cycles. Monotherapy: Starting with cycle 5 nivolumab at predetermined dosage on day 1 and day 15 of a 28-day cycle; Other Name: OPDIVO; Drug: Ipilimumab; Combination Therapy: Ipilimumab at predetermined dosage day 1 of a 21-day cycle for 4 cycles; Other Name: YERYOY

Outcome Measures

Primary Outcome Measures :

1. Objective Overall Response Rate (Stratum 1) [ Time Frame: 12 months ]
   Based on Response Evaluation in Solid Tumors (RECIST) version 1.1
2. Objective Overall Response Rate (Stratum 2) [ Time Frame: 12 months ]
   Based on Response Assessment in Neuro-Oncology (RANO) Criteria

Secondary Outcome Measures :

1. Progression-free survival (PFS) [ Time Frame: 3 years ]
   Time from study enrollment until the first occurrence of disease progression, relapse or death due to disease
2. Overall survival (OS) [ Time Frame: 3 years ]
   Time from study enrollment until death from any cause
3. Disease control rate at 12 months [ Time Frame: 12 Months ]
   The proportion of patients who are progression-free at 12 months
4. Occurrence of toxicities (Grade 3-5 per CTCAE) [ Time Frame: 13 months ]
   Assessed by National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0

Eligibility Criteria

• Ages Eligible for Study: 6 Months to 40 Years (Child, Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• All participants must have one of the following histologically confirmed tumors at original diagnosis or relapse:

  • Stratum 1

    • Malignant rhabdoid tumor (MRT)
    • Rhabdoid tumor of the kidney (RTK)
    • Epithelioid sarcoma
    • Chordoma (poorly differentiated or de-differentiated)
    • Other INI1-negative or SMARCA4-deficient malignant tumors (with PI approval)

  • Stratum 2

    • Atypical teratoid rhabdoid tumor (ATRT)
    • Other INI1-negative or SMARCA4-deficient primary CNS malignant tumors (with PI approval)

• All participants must have tumor assessment at original diagnosis or relapse showing the following:

  • Loss of INI1 confirmed by immunohistochemistry (IHC), OR
  • Molecular confirmation of tumor bi-allelic SMARCB1 (INI1) loss or mutation when INI1 IHC is equivocal or unavailable
  • Loss of SMARCA4 confirmed by IHC or molecular confirmation of tumor bi-allelic SMARCA4 loss or mutation when SMARCA4 is equivocal or unavailable
• Relapsed or refractory disease and no standard treatment options as determined by locally or regionally available standards of care and treating physician's discretion
• Measurable disease as defined by RECIST v1.1 (Stratum 1) or RANO criteria (Stratum 2)
• Karnofsky performance status ≥ 50% for participants ≥16 years of age and Lansky performance status ≥ 50% for participants <16 years of age

• Participants must have fully recovered from the acute toxic effects of all prior anti-cancer therapy. Participants must meet the following minimum washout periods prior to first day of study treatment:

  • Myelosuppressive chemotherapy: At least 14 days after the last dose of myelosuppressive chemotherapy

  • Radiotherapy

    • At least 14 days after local palliative XRT (small port)
    • At least 90 days must have elapsed after prior TBI, craniospinal XRT or if >50% radiation of pelvis
    • At least 42 days must have elapsed if other substantial BM radiation
    • At least 42 days must have passed since last radionuclide therapy (e.g. samarium or radium)
  • Small molecule biologic therapy: At least 7 days following the last dose of a nonmonoclonal biologic agent
  • Monoclonal antibody: At least 21 days after the last dose
  • Myeloid growth factors: At least 14 days following the last dose of long-acting growth factor (e.g. Neulasta) or 7 days following short-acting growth factor
  • Stem Cell or Autologous T Cell Infusion: At least 42 days must have elapsed after stem cell or autologous T cell infusion

• Participants must have adequate organ function as defined below

  • Bone Marrow Function

    • Absolute neutrophil count ≥500/uL
    • Platelets ≥50,000/uL and transfusion independent

  • Hepatic Function

    • Total bilirubin ≤ 1.5 x upper limit of normal for age
    • ALT (SGPT) ≤ 3 x upper limit of normal

  • Renal function

    • A serum creatinine within protocol limits based on age/sex. OR
    • Creatinine clearance ≥ 70 mL/min/1.73 m2 for participants with creatinine levels above institutional normal
  • Adequate Pulmonary Function Defined as: no evidence of dyspnea at rest, no exercise intolerance due to pulmonary insufficient and a pulse oximetry > 92% while breathing room air
  • Adequate pancreatic function defined as serum lipase ≤ ULN at baseline
  • Negative B-HCG pregnancy test in females of childbearing potential (must be drawn within 24 hours prior to initial administration of nivolumab)
  • Women of childbearing potential (WOCBP) receiving nivolumab agree to adhere to contraception for a period of 5 months after the last dose of nivolumab. Men receiving nivolumab and who are sexually active with WOCBP will agree to adhere to contraception for a period of 7 months after the last dose of nivolumab.
  • Ability to understand and/or the willingness of the patient (or parent or legally authorized representative, if minor) to provide informed consent using an institutionally approved informed consent procedure.

Exclusion Criteria:

• Participants who are receiving any other investigational agents.
• Participants must not be receiving concomitant systemic steroid medications The use of physiologic doses of corticosteroids (up to 5 mg/m2/day prednisone equivalent) may be approved after consultation with the PI (treatment with topical, inhaled or ophthalmic corticosteroid is acceptable)
• Participants with a known history of HIV, hepatitis B, and/or hepatitis C
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection or any other concurrent disease which in the judgment of the Investigator would make the subject inappropriate for enrollment on this study
• Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis
• Has active autoimmune disease that has required systemic treatment in the past 12 months, or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. Subjects with vitiligo or resolved childhood asthma/atopy are exceptions. Intermittent use of bronchodilators or local steroid injections are not excluded. 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. Autoimmune diagnoses not listed must be approved by the Principal Investigator.
• Patients who have received prior solid organ transplantation are not eligible.
• Pregnancy or Breast-Feeding. Pregnant or breast-feeding women will not be entered on this study due to risks of fetal and teratogenic adverse events as there is yet no available information regarding human fetal or teratogenic toxicities. Pregnancy tests must be obtained in girls who are post-menarchal.
• Has received prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2 or anti-CTLA4 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (e.g. OX-40, CD137)
• Participants who have received live / attenuated vaccine within 30 days of first dose of study treatment.

Contacts and Locations

Contacts

Contact: Suzanne Forrest, MD; (617) 632-6443; suzanne_forrest@dfci.harvard.edu

Locations

United States, California

UCSF Benioff Children's Hospital; Recruiting

San Francisco, California, United States, 94158

Contact: Alyssa Reddy, MD Alyssa.Reddy@ucsf.edu

Contact: Sunya Akhter Sunya.Akhter@ucsf.edu

Principal Investigator: Alyssa Reddy, MD

United States, Georgia

Children's Healthcare of Atlanta-Egleston; Recruiting

Atlanta, Georgia, United States, 30322

Contact: Olivia Floyd Olivia.Floyd@choa.org

Principal Investigator: Thomas Cash, MD

Children's Healthcare of Atlanta-Scottish Rite; Recruiting

Atlanta, Georgia, United States, 30342

Contact: Olivia Floyd olivia.floyd@choa.org

Principal Investigator: Thomas Cash, MD

United States, Massachusetts

Massachusetts General Hospital; Recruiting

Boston, Massachusetts, United States, 02114

Contact: Gregory Cote, MD, PhD gcote@partners.org

Principal Investigator: Gregory Cote, MD, PhD

Boston Children's Hospital; Recruiting

Boston, Massachusetts, United States, 02115

Contact: Suzanne Forrest, MD 617-632-6443

Principal Investigator: Suzanne Forrest

Dana-Farber Cancer Institute; Recruiting

Boston, Massachusetts, United States, 02215

Contact: Suzanne Forrest, MD 617-632-6443 Suzanne_Forrest@dfci.harvard.edu

Contact: Jeffrey Czaplinski 617-632-5063 JeffreyT_Czaplinski@dfci.harvard.edu

Principal Investigator: Suzanne Forrest, MD

United States, Pennsylvania

Children's Hospital of Philadelphia; Recruiting

Philadelphia, Pennsylvania, United States, 19104

Contact: Cassie Kline, MD klinec@chop.edu

Contact: Alyssa Ciampaglia ciampaglia@chop.edu

Principal Investigator: Cassie Kline, MD

United States, Texas

Texas Children's Hospital; Recruiting

Houston, Texas, United States, 77030

Contact: Joanna Yi, MD 832-824-6699 jsyi@texaschildrens.org

Contact: Julieta Simovich (832) 824-4217 mjsimovi@texaschildrens.org

Principal Investigator: Joanna Yi, MD

Sponsors and Collaborators

Dana-Farber Cancer Institute

Gateway for Cancer Research

Investigators

• Principal Investigator: Suzanne Forrest, MD; Dana-Farber Cancer Institute

More Information

• Responsible Party: Suzanne Forrest, MD, Sponsor Investigator, Dana-Farber Cancer Institute
• ClinicalTrials.gov Identifier: NCT04416568
• Other Study ID Numbers: 20-041
• First Posted: June 4, 2020
• Last Update Posted: November 28, 2023
• Last Verified: November 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to Sponsor Investigator or designee. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF)
• Time Frame: Data can be shared no earlier than 1 year following the date of publication
• Access Criteria: DFCI - Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Suzanne Forrest, MD, Dana-Farber Cancer Institute:

Malignant Rhabdoid Tumor; Rhabdoid Tumor of the Kidney; Epithelioid Sarcoma; Chordoma (poorly differentiated or de-differentiated); Atypical Teratoid/Rhabdoid Tumor; INI1 negative tumors; SMARCA4-deficient malignant tumors

Additional relevant MeSH terms:

Chordoma; Neoplasms; Sarcoma; Rhabdoid Tumor; Kidney Neoplasms; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms, Complex and Mixed; Neoplasms, Germ Cell and Embryonal; Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Kidney Diseases; Urologic Diseases; Male Urogenital Diseases; Nivolumab; Ipilimumab; Antineoplastic Agents, Immunological; Antineoplastic Agents; Immune Checkpoint Inhibitors; Molecular Mechanisms of Pharmacological Action