A Study of Pembrolizumab With Trastuzumab and Chemotherapy in People With Esophagogastric Cancer

Sponsor

Memorial Sloan Kettering Cancer Center (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT06123338

Collaborator

Genentech, Inc. (Industry), Merck Sharp & Dohme LLC (Industry)

Enrollment

Locations

Arm

Anticipated Duration (Months)

2.8

Patients Per Site

0.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study to find out whether adding trastuzumab and pembrolizumab to standard chemotherapy is an effective treatment for resectable HER2+ esophagogastric cancer.

Condition or Disease	Intervention/Treatment	Phase
Esophageal Cancer Gastric Adenocarcinoma HER2 Gene Mutation	Drug: Pembrolizumab Drug: Trastuzumab	Phase 2

Study Design

Study Type:

Interventional

Anticipated Enrollment :

25 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Single-Arm, Multicenter Phase 2 Study of Neoadjuvant Pembrolizumab With Trastuzumab and Chemotherapy in Resectable HER2+ Esophagogastric Tumors

Anticipated Study Start Date :

Nov 30, 2023

Anticipated Primary Completion Date :

Nov 30, 2027

Anticipated Study Completion Date :

Nov 30, 2027

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Participants with Esophagogastric Cancer Participants will have a diagnosis of resectable HER2+ (IHC 3+ or IHC 2+/FISH ratio >2.0) esophageal, GEJ or gastric cancer.	Drug: Pembrolizumab Pembrolizumab will be administered on an every 3-week dosing schedule Drug: Trastuzumab Trastuzumab will be administered on an every 3-week dosing schedule

Arm

Intervention/Treatment

Experimental: Participants with Esophagogastric Cancer

Participants will have a diagnosis of resectable HER2+ (IHC 3+ or IHC 2+/FISH ratio >2.0) esophageal, GEJ or gastric cancer.

Drug: Pembrolizumab

Pembrolizumab will be administered on an every 3-week dosing schedule

Drug: Trastuzumab

Trastuzumab will be administered on an every 3-week dosing schedule

Outcome Measures

Primary Outcome Measures

Pathological Complete Response Rate (pCR) [Up to 18 months]
pCR is defined as the absence of residual viable tumor or pathologic lymph nodes in the surgically resected specimen as determined by pathologic review.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Age 18 years or older at time of signing informed consent.
ECOG performance status 0-1.
HER2+ esophageal, GEJ, or gastric adenocarcinoma biopsy or resection specimen as defined by local HER2 IHC3+ or IHC 2+/FISH>2.0 expression.
Complete surgical resection of the primary tumor must be achievable
Demonstrate adequate organ function as defined in Table 1.

Table 1 - Organ Function Requirements for Eligibility Hematological

Absolute neutrophil count (ANC): ≥1,500 /mcL
Platelets: ≥100,000 / mcL
Hemoglobin: ≥9 g/dL Renal
Serum creatinine : ≤1.5 X upper limit of normal (ULN) Hepatic
Serum total bilirubin: ≤ 1.5 X ULN OR Direct bilirubin ≤ ULN for subjects with total bilirubin levels > 1.5 ULN. Except patients with Gilbert's disease (≤3x ULN)
AST and ALT: ≤ 2.5 X ULN
Albumin: >3 mg/dL Coagulation
International normalized ratio (INR) OR prothrombin time (PT) Activated partial thromboplastin time (aPTT): <1.5 x ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants
Male participants: A male participant must agree to use contraception as detailed in Section 15.3 of this protocol during the treatment period and for at least 230 days (5 terminal half-lives of trastuzumab [140] plus an additional 90 days [spermatogenesis cycle]) after the last dose of study treatment and refrain from donating sperm during this period.
Female participants: A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least one of the following conditions applies:

Not a woman of childbearing potential (WOCBP) as defined in section 15.3 OR
A WOCBP who agrees to follow the contraceptive guidance in section 15.3 during the treatment period and for at least 170 days (140 days plus an additional 30 days [menstruation cycle]) after the last dose of study treatment.

Exclusion Criteria:

Presence of metastatic or recurrent disease.
Has received prior treatment for esophagogastric cancer
Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-CTLA-4 agent.
Has received prior therapy with an anti-HER2 agent
Left ventricular ejection fraction <50% within 1 month of screening by MUGA or echocardiogram.
Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment.
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.
Patients who have received acute, low dose, systemic immunosuppressant medications (e.g., dexamethasone containing antiemetic regimen or steroids as CT scan contrast premedication) may be enrolled.
The use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed.
Has a known history of active TB (Bacillus tuberculosis)
Hypersensitivity to pembrolizumab or any of its excipients
Has been diagnosed or treated for another malignancy in the past 3 years (not including non-melanoma skin cancer)
Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis
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.
A WOCBP who has a positive urine pregnancy test within 72 hours prior to allocation. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
Has had an allogeneic tissue or solid organ transplant
Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease; systemic lupus erythematosus; Wegener syndrome [granulomatosis with polyangiitis]; myasthenia gravis; Graves' disease; rheumatoid arthritis, hypophysitis, uveitis) within the past 3 years prior to the start of treatment. The following are exceptions to this criterion:
Subjects with vitiligo or alopecia
Subjects with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement or psoriasis not requiring systemic treatment.
Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV 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 unwilling to give written informed consent, unwilling to participate, or unable to comply with the protocol for the duration of the study.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Johns Hopkins University (Data Collection Only)	Baltimore	Maryland	United States	21287
2	Massachusetts General Hospital (Data Collection Only)	Boston	Massachusetts	United States	02114
3	Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities)	Basking Ridge	New Jersey	United States	07920
4	Memorial Sloan Kettering Monmouth (Limited Protocol Activities)	Middletown	New Jersey	United States	07748
5	Memorial Sloan Kettering Bergen (Limited Protocol Activities)	Montvale	New Jersey	United States	07645
6	Memorial Sloan Kettering Cancer Center @ Suffolk-Commack (Limited protocol activity)	Commack	New York	United States	11725
7	Memorial Sloan Kettering Westchester (Limited Protocol Activities)	Harrison	New York	United States	10604
8	Memorial Sloan Kettering Cancer Center (All Protocol Activities)	New York	New York	United States	10065
9	Memorial Sloan Kettering Nassau (Limited Protocol Activities)	Uniondale	New York	United States	11553