Ipilimumab and Local Radiation Therapy in Treating Patients With Recurrent Melanoma, Non-Hodgkin Lymphoma, Colon, or Rectal Cancer

• Sponsor: Stanford University (Other)
• Overall Status: Terminated
• CT.gov ID: NCT01769222
• Collaborator: National Cancer Institute (NCI) (NIH)
• Enrollment: 3
• Location: 1
• Arms: 2
• Duration (Months): 27.9
• Patients Per Site Per Month: 0.1

Study Details

Study Description

Brief Summary

This pilot phase I/II trial studies the side effects and best of dose ipilimumab when given together with local radiation therapy and to see how well it works in treating patients with recurrent melanoma, non-Hodgkin lymphoma, colon, or rectal cancer. Monoclonal antibodies, such as ipilimumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Radiation therapy uses high energy x rays to kill cancer cells. Giving monoclonal antibody therapy together with radiation therapy may be an effective treatment for melanoma, non-Hodgkin lymphoma, colon, or rectal cancer

Condition or Disease	Intervention/Treatment	Phase
Adult Nasal Type Extranodal NK/T-cell Lymphoma; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Cutaneous B-cell Non-Hodgkin Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Hepatosplenic T-cell Lymphoma; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Peripheral T-cell Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/Lymphoma; Recurrent Colon Cancer; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Melanoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Rectal Cancer; Recurrent Small Lymphocytic Lymphoma; Refractory Hairy Cell Leukemia; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; T-cell Large Granular Lymphocyte Leukemia; Testicular Lymphoma; Waldenström Macroglobulinemia	Biological: Ipilimumab; Radiation: Radiation therapy	Phase 1/Phase 2

Detailed Description

PRIMARY OBJECTIVES:

1. To assess the safety of combining intratumoral anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4) immunotherapy with local radiation therapy in patients with melanoma, non-Hodgkin lymphoma, and colorectal carcinoma with a monotherapy ipilimumab safety lead-in.

SECONDARY OBJECTIVES:

1. To assess the induction of an anti-tumor immune responses using laboratory correlative studies.

2. To determine tumor response rates and duration of response at unirradiated tumor sites in patients with advanced malignancies.

3. To identify putative immunologic biomarkers of tumor response.

OUTLINE: This is a phase I dose-escalation study of ipilimumab, followed by a phase 2 study. Only a few subjects participated in the phase 1 portion of this study. The phase 2 portion of this study was not conducted.

Patients receive ipilimumab intratumorally on day 1 and undergo local radiation therapy within 48 hours for at least 3 fractions.

After completion of study treatment, patients are followed up at 4 and 8 weeks, and then every 24 weeks for 5 years.

Study Design

• Study Type: Interventional
• Actual Enrollment: 3 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A PHASE I/II STUDY OF INTRATUMORAL INJECTION OF IPILIMUMAB IN COMBINATION WITH LOCAL RADIATION IN MELANOMA, NON-HODGKIN LYMPHOMA AND COLORECTAL CARCINOMA
• Study Start Date: Feb 1, 2013
• Actual Primary Completion Date: Nov 1, 2014
• Actual Study Completion Date: Jun 1, 2015

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Ipilimumab 25 mg Participants receive ipilimumab intratumorally on Day 1	Biological: Ipilimumab; Given intratumorally; Other Names: Anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody MDX-010 MDX-CTLA-4 Monoclonal antibody CTLA-4
Experimental: Ipilimumab 25 mg and radiation therapy Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions	Biological: Ipilimumab; Given intratumorally; Other Names: Anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody MDX-010 MDX-CTLA-4 Monoclonal antibody CTLA-4 ; Radiation: Radiation therapy; Undergo local radiation therapy, 10 Gy x 3 fractions; Other Names: Irradiation Radiotherapy Therapy, radiation

Outcome Measures

Primary Outcome Measures

1. Dose-limiting Toxicity [4 weeks]

   Safety as the percentage of patients experiencing dose-limiting toxicities (DLTs) or serious adverse events (SAEs) using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I)

Secondary Outcome Measures

1. Immune Response (Phase 2 Only) [4 weeks]

   Data will be summarized using proportions with exact 95% confidence intervals, means, standard deviations, and ranges.

2. Immune Response (Phase 2 Only) [8 weeks]

   Data will be summarized using proportions with exact 95% confidence intervals, means, standard deviations, and ranges.

3. Response Rate (Phase 2 Only) [8 weeks]

   Response rates calculated based on the Response Evaluation Criteria in Solid Tumors (RECIST)/RECIST Immunotherapy and Cheson criteria (Phase 2 only). Response rate data will be summarized using proportions with exact 95% confidence intervals, means, standard deviations, and ranges.

4. Overall Survival (Phase 2 Only) [Up to 5 years]

   Data will be summarized using Kaplan-Meier estimates for time to event data.

5. Duration of Response (Phase 2 Only) [Up to 5 years]

   Data will be summarized using Kaplan-Meier estimates for time to event data.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Willing and able to give written informed consent

• Before any study procedures are performed, subjects (or their legally acceptable representatives) will have the details of the study described to them, and they will be given a written informed consent document to read; then, if subjects consent to participate in the study, they will indicate that consent by signing and dating the informed consent document in the presence of study personnel

• Histologically confirmed malignancy

• In Phase 1, histologically confirmed melanoma.

• In Phase 2, histologically confirmed melanoma, non-Hodgkin lymphoma, or colorectal carcinoma

• Must have failed at least one systemic therapy or be intolerant to at least one prior systemic treatment

• Must have at least two lesions of evaluable size by modified World Health Organization (mWHO)/Cheson criteria; one of two lesions must be amenable to biopsy (core or fine needle aspirate) and intratumoral injection of up to 5ml (diameter >= 10mm)

• Subjects with asymptomatic brain metastases are eligible; (systemic steroids should be avoided if possible, or the subject should be stable on the lowest clinically effective dose, as steroids as they may interfere with the activity of ipilimumab if administered at the time of the first ipilimumab dose)

• Must be at least 28 days since treatment with standard or investigational chemotherapy, biochemotherapy, surgery, radiation, cytokine therapy, or immunotherapy, and recovered from any clinically significant toxicity experienced during treatment

• Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2

• Life expectancy of >= 16 weeks

• Subjects must have baseline (screening/baseline) radiographic images, (e.g. brain, chest, abdomen, pelvis, and bone scans with specific imaging tests to be determined by the attending physician) within 6 weeks of initiation of ipilimumab

• White blood cell (WBC) >= 2000/uL (~2 x 10^9/L)

• Absolute neutrophil count (ANC) >= 1000/uL (~0.5 x 10^9/L)

• Platelets >= 75 x 10^{3/uL (~75 x 10}9/L)

• Hemoglobin >= 9 g/dL (may be transfused)

• Creatinine =< 2.0 x upper limit of normal (ULN)

• Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x ULN for subjects without liver metastasis =< 5 times for liver metastases

• Bilirubin =< 2.0 x ULN (except for subjects with Gilbert's syndrome, who must have a total bilirubin of less than 3.0 mg/dL)

• No active or chronic infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C

• Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 26 weeks after the last dose of investigational product, in such a manner that the risk of pregnancy is minimized; WOCBP include any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not post-menopausal; post-menopause is defined as:

• Amenorrhea >= 12 consecutive months without another cause, or

• For women with irregular menstrual periods and taking hormone replacement therapy (HRT), a documented serum follicle stimulating hormone (FSH) level >= 35 mIU/mL

• Women who are using oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing abstinence or where their partner is sterile (eg, vasectomy) should be considered to be of childbearing potential; WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 72 hours before the start of ipilimumab

• Men of fathering potential must be using an adequate method of contraception to avoid conception throughout the study (and for up to 26 weeks after the last dose of investigational product) in such a manner that the risk of pregnancy is minimized

Exclusion Criteria:

• Any other malignancy from which the patient has been disease-free for less than 5 years, with the exception of adequately treated and cured basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the cervix

• Autoimmune disease: patients with a history of inflammatory bowel disease, including ulcerative colitis and Crohn's disease, are excluded from this study, as are patients with a history of symptomatic disease (eg, rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [eg, Wegener's Granulomatosis]); motor neuropathy considered of autoimmune origin (e.g. Guillain-Barre Syndrome and Myasthenia Gravis)

• Any underlying medical or psychiatric condition, which in the opinion of the investigator will make the administration of ipilimumab hazardous or obscure the interpretation of adverse events (AEs), such as a condition associated with frequent diarrhea

• Patients with underlying heart conditions who are deemed ineligible for surgery by cardiology consult

• Any non-oncology vaccine therapy used for prevention of infectious diseases (for up to 1 month before or after any dose of ipilimumab)

• A history of prior treatment with ipilimumab or prior CD137 agonist or CTLA 4 inhibitor or agonist

• Concomitant therapy with any of the following: interleukin-2 (IL 2), interferon, or other non-study immunotherapy regimens; cytotoxic chemotherapy; immunosuppressive agents; other investigation therapies; or chronic use of systemic corticosteroids

• A history of AEs with prior IL-2 or Interferon will not preclude subjects from entering the current study

• Any investigational agents

• Immunosuppressive agents (unless required for treating potential AEs)

• Chronic systemic corticosteroids (unless required for treating treatment emergent AEs or required for management of signs or symptoms due to brain metastases, upon discussion with Bristol-Myers Squibb [BMS] medical monitor)

• Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (eg, infectious) illness

• Women of childbearing potential (WOCBP) who:

• Are unwilling or unable to use an acceptable method of contraception to avoid pregnancy for their entire study period and for at least 8 weeks after cessation of study drug, or

• Have a positive pregnancy test at baseline, or

• Are pregnant or breastfeeding

• Persons of reproductive potential must agree to use an adequate method of contraception throughout treatment and for at least 8 weeks after ipilimumab is stopped; sexually active WOCBP must use an effective method of birth control during the course of the study, in a manner such that risk of failure is minimized; before study enrollment, WOCBP must be advised of the importance of avoiding pregnancy during study participation and the potential risk factors for an unintentional pregnancy; all WOCBP MUST have a negative pregnancy test before first receiving ipilimumab; if the pregnancy test is positive, the patient must not receive ipilimumab and must not be enrolled in the study

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Stanford University	Stanford	California	United States	94305

Sponsors and Collaborators

• Stanford University
• National Cancer Institute (NCI)

Investigators

• Principal Investigator: George A. Fisher, MD, PhD, Stanford University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: George Albert Fisher, Colleen Haas Chair in the School of Medicine, Stanford University
• ClinicalTrials.gov Identifier: NCT01769222
• Other Study ID Numbers: IRB-25597; NCI-2012-02988; VAR0090
• First Posted: Jan 16, 2013
• Last Update Posted: Mar 3, 2017
• Last Verified: Jan 1, 2017

• Additional relevant MeSH terms: Burkitt Lymphoma; Mycoses; Lymphoma; Leukemia; Melanoma; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Rectal Neoplasms; Lymphoma, B-Cell; Lymphoma, Mantle-Cell; Lymphoma, B-Cell, Marginal Zone; Lymphoma, T-Cell; Lymphoma, T-Cell, Peripheral; Leukemia, Lymphocytic, Chronic, B-Cell; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Large-Cell, Immunoblastic; Plasmablastic Lymphoma; Mycosis Fungoides; Sezary Syndrome; Leukemia, T-Cell; Lymphoma, T-Cell, Cutaneous; Leukemia-Lymphoma, Adult T-Cell; Waldenstrom Macroglobulinemia; Lymphoma, Large-Cell, Anaplastic; Leukemia, Hairy Cell; Lymphomatoid Granulomatosis; Lymphoma, Extranodal NK-T-Cell; Intraocular Lymphoma; Leukemia, Large Granular Lymphocytic; Immunoblastic Lymphadenopathy; Recurrence; Antineoplastic Agents, Immunological; Ipilimumab; Antibodies; Immunoglobulins; Antibodies, Monoclonal

Study Results

Participant Flow

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
Period Title: Overall Study
STARTED	3	0
COMPLETED	3	0
NOT COMPLETED	0	0

Baseline Characteristics

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy	Total
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions	Total of all reporting groups
Overall Participants	3	0	3
Age (Count of Participants)
<=18 years	0 0%	0 NaN	0 0%
Between 18 and 65 years	2 66.7%	0 NaN	2 66.7%
>=65 years	1 33.3%	0 NaN	1 33.3%
Age (years) [Median (Full Range) ]
Median (Full Range) [years]	61	61
Gender (Count of Participants)
Female	2 66.7%	2 Infinity
Male	1 33.3%	1 Infinity
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	0 0%	0 NaN
Not Hispanic or Latino	3 100%	3 Infinity
Unknown or Not Reported	0 0%	0 NaN
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%	0 NaN
Asian	0 0%	0 NaN
Native Hawaiian or Other Pacific Islander	0 0%	0 NaN
Black or African American	0 0%	0 NaN
White	3 100%	3 Infinity
More than one race	0 0%	0 NaN
Unknown or Not Reported	0 0%	0 NaN
Region of Enrollment (Count of Participants)
United States	3 100%	3 Infinity

Outcome Measures

1. Primary Outcome

Title	Dose-limiting Toxicity
Description	Safety as the percentage of patients experiencing dose-limiting toxicities (DLTs) or serious adverse events (SAEs) using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I)
Time Frame	4 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
Measure Participants	3	0
Number [percentage of participants]	0 0%

2. Secondary Outcome

Title	Immune Response (Phase 2 Only)
Description	Data will be summarized using proportions with exact 95% confidence intervals, means, standard deviations, and ranges.
Time Frame	4 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
Measure Participants	0	0

3. Secondary Outcome

Title	Immune Response (Phase 2 Only)
Description	Data will be summarized using proportions with exact 95% confidence intervals, means, standard deviations, and ranges.
Time Frame	8 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
Measure Participants	0	0

4. Secondary Outcome

Title	Response Rate (Phase 2 Only)
Description	Response rates calculated based on the Response Evaluation Criteria in Solid Tumors (RECIST)/RECIST Immunotherapy and Cheson criteria (Phase 2 only). Response rate data will be summarized using proportions with exact 95% confidence intervals, means, standard deviations, and ranges.
Time Frame	8 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title

Arm/Group Description

5. Secondary Outcome

Title	Overall Survival (Phase 2 Only)
Description	Data will be summarized using Kaplan-Meier estimates for time to event data.
Time Frame	Up to 5 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
Measure Participants	0	0

6. Secondary Outcome

Title	Duration of Response (Phase 2 Only)
Description	Data will be summarized using Kaplan-Meier estimates for time to event data.
Time Frame	Up to 5 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Ipilimumab 25 mg	Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally	Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
Measure Participants	0	0

Adverse Events

Arm/Group Title	Ipilimumab 25 mg		Ipilimumab 25 mg and Radiation Therapy
Arm/Group Description	Participants receive ipilimumab intratumorally on Day 1 Ipilimumab: Given intratumorally		Participants receive ipilimumab intratumorally on Day 1 and undergo local radiation therapy (10 Gy/fraction) within 48 hours for at least 3 fractions Ipilimumab: Given intratumorally Radiation therapy: Undergo local radiation therapy, 10 Gy x 3 fractions
All Cause Mortality
	Ipilimumab 25 mg		Ipilimumab 25 mg and Radiation Therapy
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Ipilimumab 25 mg		Ipilimumab 25 mg and Radiation Therapy
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/3 (0%)		0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Ipilimumab 25 mg		Ipilimumab 25 mg and Radiation Therapy
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	1/3 (33.3%)		0/0 (NaN)
Skin and subcutaneous tissue disorders
Pain, injection site	1/3 (33.3%)	1	0/0 (NaN)	0

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.