March 23, 2016
|
March 29, 2016
|
December 4, 2023
|
August 15, 2016
|
December 31, 2025 (Final data collection date for primary outcome measure)
|
- Non-progression rate defined as the proportion of subjects in the analysis population who have no progression of disease [ Time Frame: At 27 weeks ]
Assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 or immune-related (ir)RECIST or according to tumor evaluation criteria best suitable and accepted for the tumor type evaluate. Response for the primary analysis will be determined by the investigator assessment, and a confirmation assessment is required.
- Incidence of adverse events [ Time Frame: Up to 27 weeks ]
Will be graded using Common Terminology Criteria for Adverse Events version 4.03. Safety will be assessed by quantifying the toxicities and grades experienced by subjects who have received pembrolizumab, including serious adverse events, events of clinical interest and immune-related adverse experiences.
|
Non-Progression Rate (NPR) of Pembrolizumab in Participants with Rare Tumors [ Time Frame: 27 weeks ] Clinical efficacy measured by non-progression rate (NPR) defined as the percentage of patients who are alive and progression-free at 27 weeks as assessed RECIST criteria.
|
|
- Objective response (complete response [CR] or partial response [PR]) [ Time Frame: Up to 27 weeks ]
As evaluated according to RECIST 1.1 or irRECIST. Summary tabulations of the number and percentage of subjects within each category (with a category for missing data) of the parameter will be presented, as well as two-sided 95% confidence intervals, unless otherwise stated.
- Clinical benefit (CR, PR, or stable disease [SD] >= 4 months) [ Time Frame: Up to 27 weeks ]
Will be evaluated according to RECIST 1.1 or irRECIST.
- Duration of response defined as time from first response to disease progression in subjects who achieve SD >= 4 months or better by RECIST 1.1 or irRECIST [ Time Frame: Up to 2 years ]
Summarized using Kaplan-Meier methodology using 25th, 50th (median), and 75th percentiles with associated 2-sided 95% confidence intervals, as well as percentage of censored observations.
- Progression free survival [ Time Frame: Baseline to the first documented disease progression or death due to any cause, assessed up to 27 weeks ]
Will be evaluated according to RECIST 1.1 or irRECIST. Summarized using Kaplan-Meier methodology using 25th, 50th (median), and 75th percentiles with associated 2-sided 95% confidence intervals, as well as percentage of censored observations.
- Overall survival [ Time Frame: Up to 24 months ]
Summarized using Kaplan-Meier methodology using 25th, 50th (median), and 75th percentiles with associated 2-sided 95% confidence intervals, as well as percentage of censored observations.
- Non-progression-rate and objective response (complete response or partial response) [ Time Frame: Up to 27 weeks ]
Will be evaluated according to irRECIST. Summary tabulations of the number and percentage of subjects within each category (with a category for missing data) of the parameter will be presented, as well as two-sided 95% confidence intervals, unless otherwise stated.
- Laboratory safety assessments [ Time Frame: Up to 24 months ]
Blood and urine samples will be obtained to ensure normal ranges.
- Eastern Cooperative Oncology Group (ECOG) performance status [ Time Frame: Up to 24 months ]
ECOG performance status will be assessed.
- Temperature [ Time Frame: Up to 24 months ]
degrees Celsius [degrees Fahrenheit
- Pulse [ Time Frame: Up to 24 months ]
number per minute
- Respiratory rate [ Time Frame: Up to 24 months ]
breaths per minute
- Weight [ Time Frame: Up to 24 months ]
Weight Pulse (number per minute)
- Blood pressure [ Time Frame: Up to 24 months ]
systolic/ diastolic
- Height [ Time Frame: Up to 24 months ]
Height (only at screening) (centimeters [inches])
- Physiological parameter [ Time Frame: Up to 24 months ]
Performed to provide information on the patient's health. Each body system is examined.
|
Overall Response Rate of Pembrolizumab in Participants with Rare Tumors [ Time Frame: 13 weeks ] Overall response rate assessed using modified RECIST 1.1 criteria.
|
Pseudoprogression [ Time Frame: Up to 27 weeks ] Quantitative imaging will be reviewed for non-invasive assessments of cell death (apoptosis), active tumor proliferation, tumor invasion, tumor density, vascularity, vascular permeability, microvascular density and metabolite profiles.
|
Not Provided
|
|
Pembrolizumab in Treating Patients With Rare Tumors That Cannot Be Removed by Surgery or Are Metastatic
|
Phase II Study for the Evaluation of Efficacy of Pembrolizumab (MK-3475) in Patients With Rare Tumors
|
This phase II trial studies how well pembrolizumab works in treating patients with rare tumors that cannot be removed by surgery or have spread to other parts of the body. Monoclonal antibodies, such as pembrolizumab, may block specific proteins found on white blood cells which may strengthen the immune system and control tumor growth.
|
PRIMARY OBJECTIVES:
I. To obtain early indication of efficacy by evaluation of non-progression rate (NPR) at 27 weeks as defined as the percentage of patients who are alive and progression-free at 27 weeks as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1 or immune-related(ir)RECIST or method of tumor evaluation criteria best suitable and accepted for the tumor type evaluated in patients with advanced tumor types receiving pembrolizumab.
SECONDARY OBJECTIVES:
I. To correlate efficacy by evaluation of tumor size to programmed cell death 1 ligand 1 (PD-L1) status among patients with advanced tumor types receiving pembrolizumab.
II. To evaluate safety and tolerability of pembrolizumab in patients with advanced tumors.
III. To evaluate the percentage of patients with objective response (complete response [CR] or partial response [PR]), clinical benefit (CR, PR, or stable disease [SD] >= 4 months), progression free survival (PFS), overall survival (OS), and duration of response (DOR) as assessed by RECIST v1.1 in patients with advanced tumor types receiving pembrolizumab.
IV. To evaluate the percentage of patients with objective response (CR or PR), clinical benefit (CR, PR, or SD >= 4 months), PFS, and DOR as assessed by irRECIST in patients with advanced tumor types receiving pembrolizumab.
V. To correlate the NPR at 27 weeks (9 cycles), objective response (CR or PR), clinical benefit CR, PR, or SD >= 4 months), PFS, OS, and DOR to PD-L1 status among patients with advanced tumor types receiving pembrolizumab.
EXPLORATORY OBJECTIVES:
I. To evaluate the potential role of tumor-associated immune biomarkers for prediction of therapy effectiveness in patients with advanced tumor types receiving pembrolizumab.
II. To correlate the potential role of tumor-associated immune biomarkers for prediction of therapy effectiveness to PD-L1 status among patients with advanced tumor types receiving pembrolizumab.
III. To identify imaging characteristics associated with immunological changes in tumor following treatment with pembrolizumab.
IV. To compare tumor mutation burden and serial assessment of mutation status in biopsies obtained at baseline and progression in patients with advanced tumor types receiving pembrolizumab.
V. To evaluate patient-reported outcomes (PRO) utilizing the National Cancer Institute (NCI) Patient-Reported Outcomes of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) questionnaires.
OUTLINE:
Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1. Treatment repeats every 21 days for up to 24 months in the absence of disease progression or toxicity. Patients with clinical response or disease stabilization may continue treatment for up to an additional 12 months.
After completion of study treatment, patients are followed up at 30 days and then every 12 weeks.
|
Interventional
|
Phase 2
|
Allocation: N/A Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment
|
- Advanced Malignant Solid Neoplasm
- Carcinoma of Unknown Primary
- Metastatic Adrenal Gland Pheochromocytoma
- Metastatic Kidney Medullary Carcinoma
- Metastatic Malignant Germ Cell Tumor
- Metastatic Malignant Solid Neoplasm
- Metastatic Paraganglioma
- Metastatic Penile Carcinoma
- Metastatic Skin Squamous Cell Carcinoma
- Small Cell Carcinoma
- Stage III Adrenal Cortex Carcinoma AJCC v7
- Stage IV Adrenal Cortex Carcinoma AJCC v7
- Stage IV Penile Cancer AJCC v7
- Stage IV Renal Cell Cancer AJCC v7
- Unresectable Adrenal Gland Pheochromocytoma
- Unresectable Paraganglioma
- Unresectable Skin Squamous Cell Carcinoma
- Unresectable Solid Neoplasm
- Vascular Neoplasm
|
- Other: Laboratory Biomarker Analysis
Correlative studies
- Biological: Pembrolizumab
Given IV
Other Names:
- Keytruda
- Lambrolizumab
- MK-3475
- SCH 900475
- Other: Questionnaire Administration
Ancillary studies
|
Experimental: Treatment (pembrolizumab)
Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 21 days for up to 24 months in the absence of disease progression or toxicity. Patients with clinical response or disease stabilization may continue treatment for up to an additional 12 months.
Interventions:
- Other: Laboratory Biomarker Analysis
- Biological: Pembrolizumab
- Other: Questionnaire Administration
|
- Mendoza TR, Hong DS, Peterson CB, Stephen B, Dumbrava E, Pant S, Tsimberidou AM, Yap TA, Sheshadri A, Altan M, George G, Castillo L, Rodriguez E, Gong J, Subbiah V, Janku F, Fu S, Piha-Paul SA, Ahnert JR, Karp DD, Cleeland C, Meric-Bernstam F, Naing A. Patient-reported symptom burden in patients with rare cancers receiving pembrolizumab in a phase II Clinical Trial. Sci Rep. 2022 Aug 23;12(1):14367. doi: 10.1038/s41598-022-16588-3.
- Raghav KP, Stephen B, Karp DD, Piha-Paul SA, Hong DS, Jain D, Chudy Onwugaje DO, Abonofal A, Willett AF, Overman M, Smaglo B, Huey RW, Meric-Bernstam F, Varadhachary GR, Naing A. Efficacy of pembrolizumab in patients with advanced cancer of unknown primary (CUP): a phase 2 non-randomized clinical trial. J Immunother Cancer. 2022 May;10(5):e004822. doi: 10.1136/jitc-2022-004822.
- Pant S, Moyers JT, Naing A. Letter to the editor from Pant et al. J Immunother Cancer. 2021 Nov;9(11):e003991. doi: 10.1136/jitc-2021-003991. No abstract available.
- Ferrarotto R, Sousa LG, Qing Y, Kaya D, Stephen B, Jain D, Bell D, Pant S, Tsimberidou AM, Janku F, Blumenschein G, Glisson BS, Ahnert JR, Piha-Paul SA, Lee JJ, Wong MK, Lu C, Meric-Bernstam F, Naing A. Pembrolizumab in Patients with Refractory Cutaneous Squamous Cell Carcinoma: A Phase II Trial. Adv Ther. 2021 Aug;38(8):4581-4591. doi: 10.1007/s12325-021-01807-6. Epub 2021 Jul 9.
- Hahn AW, Chahoud J, Campbell MT, Karp DD, Wang J, Stephen B, Tu SM, Pettaway CA, Naing A. Pembrolizumab for advanced penile cancer: a case series from a phase II basket trial. Invest New Drugs. 2021 Oct;39(5):1405-1410. doi: 10.1007/s10637-021-01100-x. Epub 2021 Mar 26.
- Tsimberidou AM, Vo HH, Subbiah V, Janku F, Piha-Paul S, Yilmaz B, Gong J, Naqvi MF, Tu SM, Campbell M, Meric-Bernstam F, Naing A. Pembrolizumab in Patients with Advanced Metastatic Germ Cell Tumors. Oncologist. 2021 Jul;26(7):558-e1098. doi: 10.1002/onco.13682. Epub 2021 Feb 12.
- Majd N, Waguespack SG, Janku F, Fu S, Penas-Prado M, Xu M, Alshawa A, Kamiya-Matsuoka C, Raza SM, McCutcheon IE, Naing A. Efficacy of pembrolizumab in patients with pituitary carcinoma: report of four cases from a phase II study. J Immunother Cancer. 2020 Dec;8(2):e001532. doi: 10.1136/jitc-2020-001532.
- How JA, Jazaeri A, Westin SN, Sood AK, Ramondetta LM, Xu M, Abonofal A, Karp DD, Subbiah V, Stephen B, Rodon JA, Yang F, Naing A. The clinical efficacy and safety of single-agent pembrolizumab in patients with recurrent granulosa cell tumors of the ovary: a case series from a phase II basket trial. Invest New Drugs. 2021 Jun;39(3):829-835. doi: 10.1007/s10637-020-01043-9. Epub 2021 Jan 7.
- Frumovitz M, Westin SN, Salvo G, Zarifa A, Xu M, Yap TA, Rodon AJ, Karp DD, Abonofal A, Jazaeri AA, Naing A. Phase II study of pembrolizumab efficacy and safety in women with recurrent small cell neuroendocrine carcinoma of the lower genital tract. Gynecol Oncol. 2020 Sep;158(3):570-575. doi: 10.1016/j.ygyno.2020.05.682. Epub 2020 Jun 11.
- Tapia C, Aung PP, Roy-Chowdhuri S, Xu M, Ouyang F, Alshawa A, Hajjar J, Singh G, Yang V, Castillo L, Le H, Murthy R, Stephen B, Hess KR, Wistuba I, Naing A. Decrease in tumor content assessed in biopsies is associated with improved treatment outcome response to pembrolizumab in patients with rare tumors. J Immunother Cancer. 2020 Apr;8(1):e000665. doi: 10.1136/jitc-2020-000665.
- Naing A, Meric-Bernstam F, Stephen B, Karp DD, Hajjar J, Rodon Ahnert J, Piha-Paul SA, Colen RR, Jimenez C, Raghav KP, Ferrarotto R, Tu SM, Campbell M, Wang L, Sabir SH, Tapia C, Bernatchez C, Frumovitz M, Tannir N, Ravi V, Khan S, Painter JM, Abonofal A, Gong J, Alshawa A, McQuinn LM, Xu M, Ahmed S, Subbiah V, Hong DS, Pant S, Yap TA, Tsimberidou AM, Dumbrava EEI, Janku F, Fu S, Simon RM, Hess KR, Varadhachary GR, Habra MA. Phase 2 study of pembrolizumab in patients with advanced rare cancers. J Immunother Cancer. 2020 Mar;8(1):e000347. doi: 10.1136/jitc-2019-000347. Erratum In: J Immunother Cancer. 2020 Apr;8(1):
- Habra MA, Stephen B, Campbell M, Hess K, Tapia C, Xu M, Rodon Ahnert J, Jimenez C, Lee JE, Perrier ND, Boraddus RR, Pant S, Subbiah V, Hong DS, Zarifa A, Fu S, Karp DD, Meric-Bernstam F, Naing A. Phase II clinical trial of pembrolizumab efficacy and safety in advanced adrenocortical carcinoma. J Immunother Cancer. 2019 Sep 18;7(1):253. doi: 10.1186/s40425-019-0722-x.
|
|
Active, not recruiting
|
157
|
250
|
December 31, 2025
|
December 31, 2025 (Final data collection date for primary outcome measure)
|
Inclusion Criteria:
Exclusion Criteria:
- Is currently participating and receiving study therapy or concurrent chemotherapy, immunotherapy, biologic, or hormonal therapy for cancer treatment at the time of administration of first dose of trial treatment; continuation of hormone replacement therapy is permitted; stable regimens of hormonal therapy i.e. for prostate cancer (e.g. leuprolide, a gonadotrophin releasing hormone [GnRH] agonist), ovarian, or breast cancer are not exclusionary
- 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
- Has a known history of active TB (bacillus tuberculosis)
- Hypersensitivity to pembrolizumab or any of its excipients
- Has not recovered (i.e., =< grade 1 or at baseline) from adverse events due to a previously administered agent; Note: subjects with =< grade 2 neuropathy are an exception to this criterion and may qualify for the study; Note: if subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy
- Has a known additional malignancy that is progressing or requires active treatment; 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, and diseases for which the treatment could reasonably include pembrolizumab and are not part of the excluded tumor type list or not eligible for the phase I trial
- Has 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
- Has 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 (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment; immunosuppressive corticosteroid doses (> 10 mg prednisone daily or equivalent) within 4 weeks prior to the first dose of pembrolizumab; Note: corticosteroids given within 24 hours of an imaging study for purposes of pre-medication in patients with hypersensitivity to radiologic contrast agents are allowed
- Has known history of, or any evidence of active, non-infectious pneumonitis
- 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 pre-screening or screening visit through 120 days after the last dose of trial treatment
- Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent
- Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies)
- Has known active hepatitis B (e.g., hepatitis B surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected)
- Has received a live vaccine within 30 days of planned start of study therapy; Note: seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist) are live attenuated vaccines, and are not allowed
- Is participating in cohort 10 and has melanoma; non-small cell lung cancer; hepatocellular carcinoma; Merkel cell carcinoma; colon or rectal adenocarcinoma; anal canal squamous cell carcinoma; pancreas adenocarcinoma; esophageal squamous cell carcinoma or adenocarcinoma (including gastroesophageal [GE] junction); biliary tract adenocarcinoma (gallbladder and biliary tree but excluding ampulla of vater cancers); carcinoid tumors; neuroendocrine carcinomas (well or moderately differentiated pancreatic neuroendocrine tumor); estrogen receptor (ER)-positive human epidermal growth factor receptor 2 (HER2)-negative breast cancer; triple negative breast cancer; ovarian epithelial, fallopian tube or primary peritoneal carcinoma; endometrial carcinoma; cervical squamous cell cancer; vulvar squamous cell carcinoma; small cell lung cancer; mesothelioma (malignant pleural mesothelioma); thyroid cancer (papillary or follicular subtype); salivary gland carcinoma; nasopharyngeal carcinoma; glioblastoma multiforme; leiomyosarcoma; prostate adenocarcinoma; gastric adenocarcinoma; or small bowel malignancy
|
Sexes Eligible for Study: |
All |
|
18 Years and older (Adult, Older Adult)
|
No
|
Contact information is only displayed when the study is recruiting subjects
|
United States
|
|
|
NCT02721732
|
2015-0948 NCI-2016-00545 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) 2015-0948 ( Other Identifier: M D Anderson Cancer Center )
|
No
|
Studies a U.S. FDA-regulated Drug Product: |
Yes |
Studies a U.S. FDA-regulated Device Product: |
No |
|
Not Provided
|
M.D. Anderson Cancer Center
|
Same as current
|
M.D. Anderson Cancer Center
|
Same as current
|
National Cancer Institute (NCI)
|
Principal Investigator: |
Aung Naing |
M.D. Anderson Cancer Center |
|
M.D. Anderson Cancer Center
|
November 2023
|