A Phase II Study of Core Needle Biopsy and Cryoablation of an Enlarging Tumor in Patients With Advanced Melanoma Receiving Post-progression Dual Immune Checkpoint Inhibitor Therapy

Status: Recruiting
Location: See location...
Intervention Type: Drug, Procedure
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

The aim of this study is to find out whether the combination of two approved drugs, ipilimumab and nivolumab, in combination with cryoablation are safe and effective for participants who have an unresectable melanoma that is resistant, or is growing, after receiving immunotherapy with a PD-1 inhibitor. The names of the study interventions involved in this study are: * Cryoablation (an interventional radiology procedure that freezes part of a tumor) * Ipilimumab (an immunotherapy) * Nivolumab (an immunotherapy)

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
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• Adult patients (age \> 18) with unresectable melanoma who have progressed on immune checkpoint inhibitor therapy (pembrolizumab, nivolumab, nivolumab-relatimab, atezolizumab, ipilimumab) and for whom their treating physician plans to initiate dual ICI with ipilimumab and nivolumab. Progression on adjuvant PD-1 inhibition is permitted. PD-1 does not have to be the last therapy received. This is no limited on prior lines of ICI received. There is no wash-out period required from the time of their last therapy.

• Patients are medically eligible for dual checkpoint inhibition (i.e. no untreated/uncontrolled intercurrent medical issue including ongoing immune-related adverse event or need for systemic steroids \>10mg PO prednisone or its equivalent, ECOG PS ≤2) with ipilimumab 3mg/kg and nivolumab 1mg/kg by their treating physician

• Must have a tumor amenable to percutaneous image-guided cryoablation based on routine Interventional Radiology criteria.

• Patients must have measurable disease (by RECIST) independent of the lesion to be ablated. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as ≥20 mm with conventional techniques or as ≥10 mm with spiral CT scan, MRI, or calipers by clinical exam. See Section 11 (Measurement of Effect) for evaluation of measurable disease.

• Prior radiation therapy to any site is allowed; with an exception of the target site for planned cryoablation

• ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A)

• Life expectancy of greater than 3 months

• Participants must have adequate organ and marrow function as defined below:

‣ Leukocytes ≥3,000/mcL

⁃ Absolute neutrophil count ≥1,000/mcL

⁃ Platelets ≥75,000/mcL

⁃ Total bilirubin ≤3 institutional upper limit of normal (ULN)

⁃ AST(SGOT)/ALT(SGPT) ≤5 × institutional ULN

⁃ CrCL \> 30 ml/min

• Known Human immunodeficiency virus (HIV)-infected participants on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial. (HIV testing not required at screening).

• For participants with known evidence of known chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated. (HBV testing not required at screening).

• Participants with a history of known hepatitis C virus (HCV) infection must have been treated and cured. For participants with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load. (HCV testing not required at screening).

• Participants with asymptomatic brain metastases are eligible.

• Participants with new or progressive asymptomatic brain metastases (active brain metastases) or leptomeningeal disease are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first cycle of therapy.

• Participants with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.

• Ability to understand and the willingness to sign a written informed consent document.

Locations
United States
Massachusetts
Massachusetts General Hospital Cancer Center
RECRUITING
Boston
Contact Information
Primary
Meghan J Mooradian, MD
mmooradian@mgh.harvard.edu
617-724-4000
Time Frame
Start Date: 2023-09-23
Estimated Completion Date: 2028-01-01
Participants
Target number of participants: 37
Treatments
Experimental: Ipilimumab + Nivolumab + Cryoablation
Study will be conducted in two stages:~Stage 1: Will enroll 15 participants, and if 6 or more have clinical benefit, the study will proceed to Stage 2.~* Baseline CT scan.~* Cycle 1-4: Pre-determined doses of ipilimumab and nivolumab. Medications administered under direction of treating oncologist.~* Day 2 - 14: Core Needle Biopsy followed by cryoablation between Cycle 1 - 2~* Surveillance CT scan at weeks 8 - 12, weeks 16 - 24.~* Follow up for 6 months to assess safety after cryoablation. Participants followed for duration of response.~Stage 2: Will enroll 22 participants~* Baseline CT scan.~* Cycle 1-4: Pre-determined doses of ipilimumab and nivolumab. Medications administered under direction of treating oncologist.~* Day 2- 14: Core Needle Biopsy followed by cryoablation between Cycle 1 - 2.~* Surveillance CT scan at weeks 8 - 12, weeks 16 - 24~* Follow up period to assess safety 6 months after cryoablation. Patients followed for duration of response.
Related Therapeutic Areas
Sponsors
Leads: Massachusetts General Hospital

This content was sourced from clinicaltrials.gov