Cervical Adenocarcinoma Clinical Trial
Official title:
A Phase I Trial of Sequential Ipilimumab After Chemoradiation for the Primary Treatment of Patients With Locally Advanced Cervical Cancer Stages IB2/IIA With Positive Para-Aortic Lymph Nodes Only and Stage IIB/IIIB/IVA With Positive Lymph Nodes
This phase I trial studies the side effects and best dose of ipilimumab when given after chemoradiation therapy in treating patients with stages IB2-IIB or IIIB-IVA cervical cancer. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Monoclonal antibodies, such as ipilimumab, may find tumor cells and help carry tumor-killing substances to them. Giving ipilimumab together with chemoradiation therapy may be a better way treat cervical cancer.
PRIMARY OBJECTIVES:
I. To estimate the maximum tolerated dose (MTD) and dose-limiting toxicities (DLT) of
adjuvant ipilimumab following concurrent weekly cisplatin and extended field radiation in
women with newly diagnosed locally advanced cervical cancer stage IB2/ IIA with-positive
para-aortic lymph nodes only and stage IIB/IIIB/IVA with positive lymph nodes.
II. To determine the feasibility of the treatment regimen over the four cycles of adjuvant
ipilimumab once the MTD is estimated.
III. To assess the toxicities of the treatment regimen per the National Cancer Institute
(NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
SECONDARY OBJECTIVES:
I. To examine progression free survival for 1 year after study completion. II. To determine
site of recurrence, loco-regional versus distant, for one year after completion of therapy.
III. To estimate the frequency of chronic toxicities experienced within one year after
completion of therapy.
TERTIARY OBJECTIVES:
I. To enumerate the human papillomavirus (HPV)-subtype-specific T-cells and characterize the
kinetics of HPV-subtype-specific T-cell expansion associated with chemoradiation and
ipilimumab treatment.
II. To characterize the association between differential expression of immune markers on
leukocytes from human leukocyte antigen (HLA)-A*0201 patients and response to chemoradiation
and ipilimumab treatment.
III. To assess qualitative changes in maximum standardized uptake value (SUVmax) from
positron emission tomography (PET)/computed tomography (CT) after treatment with
chemoradiation and ipilimumab.
IV. To bank residual plasma (obtained from leukocyte processing) for future research.
OUTLINE: This is a dose-escalation study of ipilimumab.
Patients receive cisplatin intravenously (IV) over 1 hour on days 1, 8, 15, 22, 29, and 36,
undergo external beam radiation therapy 5 days a week for 6 weeks, and then undergo
intracavitary brachytherapy for approximately 2 weeks. Within 2 weeks, patients receive
ipilimumab IV over 90 minutes once every 3 weeks for 12 weeks.
After completion of study treatment, patients are followed up every 3 months for 1 year and
then every 6 months for 1 year.
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