PEMBIB: Trial Of Pembrolizumab And Nintedanib

• Sponsor: Gustave Roussy, Cancer Campus, Grand Paris (Other)
• Overall Status: Recruiting
• CT.gov ID: NCT02856425
• Collaborator: (none)
• Enrollment: 18
• Location: 1
• Arms: 8
• Anticipated Duration (Months): 115.6
• Patients Per Site Per Month: 0.2

Study Details

Study Description

Brief Summary

Both anti-angiogenesis and anti PD1 immunotherapy have shown beneficial efficacy in solid tumors and in particular in NSCLC. Therefore it is of interest to investigate whether the combination of these two approaches is tolerable. Moreover, comprehensive pre-clinical and clinical rationale sustain the hypothesis that anti-VEGF could synergize with immunotherapy for the benefit of the patients.

Condition or Disease	Intervention/Treatment	Phase
Patients With Any Advanced Solid Tumors	Drug: Nintedanib; Drug: Pembrolizumab	Phase 1

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 18 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase Ib Trial Of Pembrolizumab And Nintedanib
• Actual Study Start Date: Nov 10, 2016
• Anticipated Primary Completion Date: Jul 1, 2021
• Anticipated Study Completion Date: Jul 1, 2026

Arms and Interventions

Arm	Intervention/Treatment
Experimental: NSCLC of adenocarcinoma tumor hist	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: NSCLC of squamous cell tumor histo	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: Urothelial cancer	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: Renal Cell cancer (RCC)	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: Colo Rectal Cancer	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: Ovarian cancer (OC)	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: Hepatocellular (HCC)	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details
Experimental: Mesothelioma (MPM)	Drug: Nintedanib; Nintedanib oral tablets. An angiokinase inhibitor targeting VEGFR 1-3, FGFR 1-3, and PDGFR α/β as well as RET. Refer to current IB for product details; Drug: Pembrolizumab; Pembrolizumab, Intravenous. An IgG4 anti-PD-1 blocking monoclonal antibody. Refer to current IB for product details

Outcome Measures

Primary Outcome Measures

1. MTD of Nintedanib [Assessed within 24 months after study start]

   The primary endpoint is to determine the MTD of nintedanib based on the assessment of DLT occurrence during treatment Course 1.

Eligibility Criteria

Criteria

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

Inclusion Criteria:

1. Age ≥ 18

2. Cytologically or histologically confirmed diagnosis of advanced solid tumor for the initial cohort (all tumor types).

And for the Expansion cohorts:

2.1. Patients with locally advanced, metastatic or locally recurrent non-small cell lung cancer (NSCLC) of adenocarcinoma tumor histology in the first line of systemic therapy. Relapsing stage III previously irradiated are allowed if the irradiation has been performed more than 6 months before C1D1.

2.2 Patients with locally advanced, metastatic or locally recurrent non-small cell lung cancer (NSCLC) of squamous cell tumor histology in the first line of systemic therapy. Relapsing stage III previously irradiated are allowed if the irradiation has been performed more than 6 months before C1D1.

2.3. Patients with advanced Urothelial cancer

2.4. Patients with advanced Renal Cell cancer (RCC)

2.5. Patients with advanced Mesothelioma (MPM)

2.6. Patients with advanced squamous cell carcinoma in cervical cancer

2.7. Patients with advanced Hepatocellular (HCC)

2.8. Patients with advanced thymic carcinoma

1. ECOG performance status of score 0 or 1

2. Adequate organ function as defined by the following criteria:

• Proteinuria ≤ Grade 2 NCI CTCAE v4.03

• Serum creatinine ≤1.5 x ULN or calculated creatinine clearance ≥ 40 mL/min

• Total bilirubin within normal range ≤1.5 x ULN (≤ 3 if HCC)

• AST and ALT ≤1.5 x upper limit of normal (ULN); if liver metastases AST and ALT ≤2.5 x ULN if HCC

• Coagulation parameter : International normalized ratio (INR) < 2, prothrombin time (PT) and partial thromboplastin time (PTT) < 50% of deviation of ULN

• Absolute Neutrophils count (ANC) ≥1 000 cells/mm3

• Platelets ≥100 000 cells/mm3

• Hemoglobin ≥ 9.0 g/dL

1. Failure of at least one prior line of chemotherapy (except for the NSCLC cohorts)

2. At least one measurable lesion according to RECIST v1.1 criteria and modified RECIST for mesothelioma only or any other baseline prerequisite for the assessment of the principal judgment criteria.

3. Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test within 7 days prior to initiation of treatment. Both sexually active females and males (and their female partners) patients must agree to use two methods of effective contraception, one of them being a barrier method, or to abstain from sexual activity during the study and for at least 4 months after last study drug administration.

4. Signed and dated written informed consent prior to admission to the study

5. Patient affiliated to a social security regimen or beneficiary or the same

Exclusion Criteria:

1. Prior treatment with nintedanib

2. Known hypersensitivity to trial drugs or their excipients, peanut or soya or to contrast media

3. Prior treatment with pembrolizumab or any other anti PD1 or anti-PDL1 agents

4. Concurrent steroid medication (except topical or aerosol steroids). Any steroid medication should have been stopped for more than 7 days prior beginning of therapy.

5. History of autoimmune/immune mediated inflammatory disease, including but not limited to colitis, pneumonitis, hepatitis, hypophysitis, nephritis, hyperthyroidism, systemic lupus erythematous, rheumatoid arthritis, inflammatory bowel disease, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, vasculitis, or glomerulonephritis. Patients with a history of auto-immune endocrinopathy (hypo/hyper thyroiditis,type 1 diabetes mellitus, …) and who are stable on hormone replacement therapy are eligible for the study. Patients with a history of vitiligo, pelade, cutaneous psoriasis and grade 1-2 Sjogren syndrome are eligible.

6. Chemo-, hormono-, radio- (except for brain and extremities) or immunotherapy or therapy with monoclonal antibodies or small tyrosine kinase inhibitors within the past 4 weeks or 5 half-life times (whatever the shortest) prior to treatment with the trial drugs.

7. Administration of a live, attenuated vaccine within 4 weeks before registration

8. Treatment with systemic immunosuppressive medications (including but not limited to steroids azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) within 2 weeks prior to registration

9. Radiotherapy to the target lesion (unless a progression after radiotherapy has been documented)

10. Persistence of clinically relevant treatment-related toxicity from previous chemotherapy, targeted therapy and/or radiotherapy

11. Active brain metastases or leptomeningeal disease. Clinically asymptomatic brain metastases and clinically asymptomatic leptomeningeal disease are allowed (treatment with steroids prior initiation of the trial is not allowed). Patients with Diffuse Intrinsic Pontine Gliomas, even asymptomatic, are not allowed.

12. Radiographic evidence of cavitary or necrotic tumors or tumors with local invasion of major blood vessels

13. History of clinically significant hemoptysis within the past 3 months (more than one teaspoon of fresh blood per day)

14. Treatment with other investigational drugs or treatment in another clinical trial within the past 4 weeks before start of therapy or concomitantly with the trial

15. Therapeutic anticoagulation with drugs requiring INR monitoring (except low-dose heparin and/or heparin flush as needed for maintenance of an in-dwelling intravenous devise) or anti-platelet therapy (except for low-dose therapy with acetylsalicylic acid < 325mg per day)

16. Major injuries and/or surgery within the past 4 weeks prior to start of study treatment with incomplete wound healing and/or planned surgery during the on-treatment study period

17. History of clinically significant hemorrhagic or thromboembolic event in the past 6 months

18. Known inherited (genetic) predisposition to bleeding or thrombosis (such deficit in protein C/S) or acquired predisposition to thrombosis (such as anti-phospholipid syndromes)

19. History of significant cardiovascular diseases ( i.e. uncontrolled hypertension, unstable angina, history of infarction within the past 12 months prior to start of study treatment, congestive heart failure > NYHA II, serious cardiac arrhythmia, pericardial effusion)

20. Ongoing uncontrolled auto-immune thyroiditis. Ancient thyroiditis currently stable with substitutive therapy should not be excluded from the trial.

21. Other malignancies within the past 5 years other than basal cell skin cancer or carcinoma in situ of the cervix. A history of more than 3 years of local prostate cancer treated by surgery and without PSA elevation since surgery, or local breast carcinoma treated by surgery without relapse are eligible.

22. Active serious infections in particular if requiring systemic antibiotic or antimicrobial therapy

23. Known to be human immunodeficiency virus (HIV) positive; 25. Gastrointestinal disorders or abnormalities that would interfere with absorption of the study drug 26. Serious illness or concomitant non-oncological disease such as neurologic, psychiatric, infectious disease or active ulcers (gastro-intestinal tract, skin) or laboratory abnormality that may increase the risk associated with study participation or study drug administration and in the judgment of the investigator would make the patient inappropriate for entry into the study.

24. Pregnancy or breast feeding, 28. Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up schedule 29. Active alcohol or drug abuse

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Gustave Roussy	Villejuif	Val De Marne	France	94805

Sponsors and Collaborators

• Gustave Roussy, Cancer Campus, Grand Paris

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Gustave Roussy, Cancer Campus, Grand Paris
• ClinicalTrials.gov Identifier: NCT02856425
• Other Study ID Numbers: 2015-004511-21; 2015/2329
• First Posted: Aug 4, 2016
• Last Update Posted: Apr 7, 2020
• Last Verified: Apr 1, 2020

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Additional relevant MeSH terms: Pembrolizumab; Nintedanib

Study Results

No Results Posted as of Apr 7, 2020