Recombinant Interleukin-15 in Combination With Checkpoint Inhibitors Nivolumab and Ipilimumab in People With Refractory Cancers

Metastatic Solid Tumors Clinical Trial

Official title: Phase I Study of Recombinant Interleukin 15 in Combination With Checkpoint Inhibitors Nivolumab and Ipilimumab in Subjects With Refractory Cancers

Status Recruiting

Clinical Trial Summary

Background:

The drug IL-15 activates the immune system. The drugs nivolumab and ipilimumab unblock immune cells. The drugs together may allow immune cells to recognize and attack cancer cells, causing tumors to shrink.

Objective:

To test the effects and maximum dose of IL-15, nivolumab, and ipilimumab.

Eligibility:

People ages 18 and older who have cancer that does not respond to treatment

Design:

Participants will be screened with:

• Medical history

• Physical exam

• Heart, blood, and urine tests

• Scans

Tumor biopsy: A small needle removes a tumor sample.

Participants will be in 1 of 3 treatment groups:

• IL-15 with nivolumab

• IL-15 with ipilimumab

• IL-15 with nivolumab and ipilimumab

Participants will take the drugs in four 6-week cycles. IL-15 is injected under the skin. The other two drugs are injected into an arm vein over 60-90 minutes. Participants may need to stay at the hospital 2-3 hours after the first dose of any drug to watch for side effects.

Each cycle will include:

• Weekly blood and urine tests

• 5 IL-15 injections

• 1 ipilimumab injection if applicable

• 3 nivolumab injections if applicable

• Scans and a tumor biopsy on day 42

After cycle 4, participants will stop taking IL-15. They will continue the other drugs until they can no longer tolerate the side effects or their cancer gets worse. Those cycles will include:

• Blood tests on 3-4 days

• Urine tests on 1 day

• 1 ipilimumab injection if applicable

• 3 nivolumab injections if applicable

• Scans every other cycle

After participants stop treatment, their doctor will monitor their side effects for 4 months or until they go away.

Clinical Trial Description

BACKGROUND:

• IL-15 is a stimulatory cytokine that activates the immune system, inducing proliferation of T lymphocytes and NK cells. Administration of recombinant human IL-15 (rhIL-15) has been shown to result in a dramatic increase of circulating CD8+T cells and NK cells; these changes in immune cell populations suggest potential for anti-tumor activity.

• Immune checkpoint inhibitors, including nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4), block the engagement of specific T-cell signaling pathways by tumor cells. These regulatory pathways typically act to downregulate T cell activity and are co-opted by tumors to allow the malignant cells to evade the immune response.

• The combination of rhIL-15 with two checkpoint inhibitor therapies has potential to lead to enhanced immune activation, resulting in anti-tumor T cell responses that are effective in refractory cancers.

PRIMARY OBJECTIVE:

• Determine the safety, toxicity profile, dose-limiting toxicity (DLT) and maximum tolerated doses (MTD) of subcutaneous administration of rhIL-15 given in combination with the anti- CTLA-4 antibody ipilimumab and the anti-PD-1 antibody nivolumab in patients with metastatic or treatment-refractory cancers.

EXPLORATORY OBJECTIVE:

• Assess the clinical activity of rhIL-15, ipilimumab, and nivolumab combination therapy as characterized by RECIST 1.1 and immune RECIST (iRECIST) response rate of patients treated in this trial.

• Investigate the biological effects of this combination on circulating T cell subsets and on PD-1/PD-L1 expression and immune cell activation in tumor tissue.

ELIGIBILITY:

• Patients greater than or equal to 18 years of age with histologically confirmed solid tumor malignancy that is metastatic or treatment-refractory cancers.

STUDY DESIGN:

• The first 4-6 patients enrolling in the study will be placed into lead-in doublets with a combination of rhIL-15 and either nivolumab OR ipilimumab; once toxicity is cleared in both doublets (i.e., 2 patients enrolled on each doublet remain free of DLTs for 6 weeks) and a safety analysis is reviewed and approved by the IRB, new patients will be enrolled directly onto the triple agent combination.

• For the first four 42-day cycles on the triplet, patients will receive SC rhIL-15 on days 1-8 and 22-29, intravenous (IV) nivolumab on days 8, 22, and 36, and IV ipilimumab on day 8. Cycles 5 and onwards will not include treatment with rhIL-15.

• Patients will be encouraged to report any and all adverse events, given the high likelihood of toxicities with the triplet combination therapy.

• Blood for PD endpoints will be collected throughout the study and tumor biopsies will be collected pretreatment and on C1D42 (optional during the doublets and triplet escalation phase, mandatory during the triplet expansion phase) ;

Related Conditions & MeSH terms

• Metastatic Solid Tumors
• Treatment-Refractory Cancers

• NCT number: NCT03388632
• Study type: Interventional
• Source: National Institutes of Health Clinical Center (CC)
• Contact: Ashley B Bruns
• Phone: (240) 858-3162
• Email: ashley.bruns@nih.gov
• Status: Recruiting
• Phase: Phase 1
• Start date: February 5, 2018
• Completion date: December 1, 2024