search
Back to results

Nivolumab in Epstein-Barr Virus (EBV)-Positive Lymphoproliferative Disorders and EBV-Positive Non-HodgkinLymphomas

Primary Purpose

Epstein-Barr Virus Infections, Lymphoma, Lymphoproliferative Disorder

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Nivolumab
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Epstein-Barr Virus Infections focused on measuring Monoclonal Antibody

Eligibility Criteria

12 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:
  • Subjects must have histologically or cytologically confirmed EBV-positive LPD or an EBV-positive NHL confirmed by the Laboratory of Pathology, NCI.

    • EBV-positive LPD. Subjects may be previously untreated or relapsed from prior therapy.

      1. Lymphomatoid granulomatosis (LYG), grades I-II
      2. Chronic active EBV disease (CAEBV) of B-cells or T-cells
      3. EBV-positive post-transplantation lymphoproliferative disorder (PTLD)

        NOTE: PTLD after solid organ transplantation is excluded. Patients who, at the discretion of the investigator, need urgent therapy with standard agents will not be eligible.

    • EBV-positive B-cell NHL. Subjects must have relapsed from previous treatment with an anthracycline and rituximab-based regimen or be considered not eligible for the same.

      1. Lymphomatoid granulomatosis (LYG), grade III
      2. EBV-positive immunodeficiency-associated diffuse large B-cell lymphoma (DLBCL)
      3. EBV-positive DLBCL
  • Subjects must be at least 2 weeks from prior anti-lymphoma therapy (including radiation therapy)
  • Subjects must be at least 100 days from prior stem cell transplant (autologous or allogeneic) or Donor Lymphocyte Infusion (DLI)

    • Age greater than or equal to 12 years
    • Patients greater than or equal to 12 and less than 18 years of age should weigh at least 40 kilograms (kg); there is no weight requirement for adult subjects.
    • NOTE: If a pediatric patient is identified for possible enrollment who weighs less than 40 kg, the safety of the nivolumab dosing strategy used in this study must be discussed with the PI and manufacturer to confirm safety, and this discussion/approval for enrollment documented in the medical record prior to declaring the pediatric patient eligible.
  • Adequate performance status as follows:

    • Patients greater than or equal to 16 years must have ECOG Performance Status 0-2 (Karnofsky greater than or equal to 60%)
    • Pediatric patients less than 16 years must have Lansky play-performance of 60-100%
  • Subjects must have measurable or evaluable disease.
  • Subjects must have adequate organ and bone marrow reserve (unless disease-related) as defined below:

    • absolute neutrophil count - greater than or equal to 750/mcL; greater than or equal to 500/mcL if impairment is due to LPD/NHL
    • platelets - greater than or equal to 50,000/mcL; greater than or equal to 25,000/mcL if impairment is due to LPD/NHL; (transfusions not permitted)
    • Hemoglobin greater than or equal to 9g/dL (transfusion permitted)
    • total bilirubin - < 3.0g/dl OR < 5.0g/dl if Gilbert s syndrome or disease infiltration of the liver is present
    • AST(SGOT)/ALT(SGPT) - less than or equal to 3 X institutional upper limit of normal
    • serum creatinine OR creatinine clearance - Adults: less than or equal to 1.5 mg/dL; Minors: serum Cr less than or equal to age-adjusted normal OR greater than or equal to 40 ml/min/1.73m^2
  • A formalin fixed tissue block or at least 15 slides of tumor sample (archival or fresh) must be available for performance of correlative studies. NOTE: Patient must be willing to have a pre-treatment tumor biopsy if adequate archival tissue is not available.
  • The toxicity profile of nivolumab in patients with disease involvement of the central nervous system (CNS) is unknown. For this reason, we will introduce early stopping rules.
  • The effects of nivolumab on the developing human fetus are unknown. For this reason, the following measures apply:

    • Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) during screening and within 48 hours prior to the first dose of nivolumab.
    • WOCBP and men who are sexually active with WOCBP must use adequate contraception (e.g., hormonal or 2 barrier methods with a failure rate of less than 1% per year or abstinence) prior to study entry and throughout study drug administration. WOCBP receiving nivolumab will be instructed to adhere to contraception for a period of 23 weeks after the last dose of investigational product. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 31 weeks after the last dose of investigational product.
    • Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile as well as azoospermic men do not require contraception.
    • WOCBP is defined as any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral ophorectomy), and who is not postmenopausal. Post menopause is defined as:

      1. Amenorrhea greater than or equal to 12 consecutive months without another cause, and a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL or
      2. Women with irregular menstrual periods and a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL or NOTE: FSH level testing is not required for women greater than or equal to 62 years old with amenorrhea of greater than or equal to 1 year
      3. Women on hormone replacement therapy (HRT)
  • Pregnant women are excluded from this study because nivolumab is an IgG monoclonal antibody with the potential for teratogenic or abortifacient effects.
  • Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with nivolumab, breastfeeding should be discontinued if the mother is treated with nivolumab.
  • Ability of subject or Legally Authorized Representative (LAR) to understand and sign the written informed consent document.

EXCLUSION CRITERIA:

  • Subjects who are receiving any other investigational agents.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab.
  • Subjects with second malignancies requiring active systemic therapy are excluded. Subjects with second malignancies not requiring active systemic therapy or premalignant conditions such as monoclonal B-cell lymphocytosis (MBL) or monoclonal gammopathy of undetermined significance (MGUS) may be eligible.
  • Subjects with any condition or autoimmune disease that requires systemic corticosteroids (> 10 mg daily prednisone equivalents) or immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids are permitted.
  • Subjects with active graft-vs-host disease (GVHD) requiring steroids or other immunosuppressive agents; history of greater than or equal to grade II acute GVHD or extensive chronic GVHD.
  • Subjects who have had solid organ transplant.
  • Prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137 or anti CTLA-4 antibody.
  • Non-oncology vaccine therapies for prevention of infectious disease within 4 weeks of study drug administration.
  • A serious uncontrolled medical condition requiring therapy.
  • Seizures disorder not controlled by anti-seizure medications.
  • Subjects with CNS involvement may be included on the study as long as they have not had any seizure activity in past 4 weeks.
  • Hepatitis B virus surface antigen positive.
  • Active Hepatitis C infection with a positive PCR; subjects who are Hepatitis C antibody positive and PCR negative may be eligible. In these cases the subjects will be monitored via HCV PCR throughout the study.
  • History of anaphylactic reaction to monoclonal antibody therapy.
  • HIV positive subjects are excluded because the function of their T-cell immune responses is impaired.

Sites / Locations

  • National Institutes of Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Nivolumab (A)

Nivolumab (B)

Arm Description

Nivolumab, 3mg/kg IV every 2 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment (closed effective with activation of Amendment C)

Nivolumab, 480 mg IV every 4 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment

Outcomes

Primary Outcome Measures

overall response rate of nivolumab in patients with EBV-positive LPD and EBV-positive NHL
number of patients who respond to the protocol therapy (CR, PR, SD)

Secondary Outcome Measures

toxicity profile of nivolumab in patients with EBV-LPD
number and type of AEs experienced
PFS of patients with EBV-LPD treated with nivolumab
number of patients who do not experience progressive disease
overall survival of patients with EBV-LPD treated with nivolumab
number of patients that survive 5 years or more
duration of remission for patients who respond to nivolumab
number of months patients stay in remission

Full Information

First Posted
August 22, 2017
Last Updated
October 4, 2023
Sponsor
National Cancer Institute (NCI)
search

1. Study Identification

Unique Protocol Identification Number
NCT03258567
Brief Title
Nivolumab in Epstein-Barr Virus (EBV)-Positive Lymphoproliferative Disorders and EBV-Positive Non-HodgkinLymphomas
Official Title
Phase 2 Trial of Nivolumab in Epstein-Barr Virus (EBV)-Positive Lymphoproliferative Disorders and EBV-Positive Non-Hodgkin Lymphomas
Study Type
Interventional

2. Study Status

Record Verification Date
October 3, 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 26, 2018 (Actual)
Primary Completion Date
June 1, 2029 (Anticipated)
Study Completion Date
June 1, 2031 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: The drug Nivolumab has been approved to treat some cancers. Researchers want to see if it can slow the growth of other cancers. They want to study its effects on cancers that may have not responded to chemotherapy or other treatments. Objectives: To see if Nivolumab slows the growth of some types of cancer or stops them from getting worse. To test the safety of the drug. Eligibility: People 12 and older who have Epstein-Barr Virus (EBV)-positive lymphoproliferative disorders or EBV-positive non-Hodgkin lymphomas with no standard therapy Design: Participants will be screened with: Medical history Physical exam Blood and urine tests CAT scan of the chest, abdomen, and pelvis Tumor and bone marrow biopsies (sample taken) Magnetic resonance imaging scan of the brain Lumbar puncture (also known as spinal tap) Positron emission tomography/computed tomography scan with a radioactive tracer Every 2 weeks, participants will get Nivolumab by vein over about 1 hour. They will also have: Physical exam Blood and pregnancy tests Review of side effects and medications During the study, participants will repeat most of the screening tests. They may also have other biopsies. After stopping treatment, participants will have a visit every 3 months for 1 year. Then they will have a visit every 6 months for years 2-5, and then once a year. They will have a physical exam and blood tests.
Detailed Description
BACKGROUND: Epstein-Barr virus (EBV) is a chronic viral infection associated with a heterogeneous group of lymphoproliferative disorders (LPD) and non-Hodgkin lymphomas (NHL). The shared pathobiology of EBV-positive LPDs and NHLs includes a defect in host mechanisms of immune tolerance and immunosurveillance. Programmed death-1 (PD-1) is a surface protein present on T cells, B cells, and macrophages that serves a co-inhibitory role to negatively regulate immune responses PD-1 and its ligands, PD-L1 and PD-L2, are overexpressed in EBV-positive lymphoproliferative disorders and are markers of aggressive behavior. Blockade of the PD-1 pathway induces T-cell responses against tumor antigens in a variety of cancers, including Hodgkin lymphoma, that lead to clinical remissions. Nivolumab is a fully human IgG4 monoclonal anti-PD-1 receptor antibody with clinical activity in both indolent and lymphomas. OBJECTIVE: -To determine the best overall response rate of nivolumab in subjects with EBV-positive LPD and EBV-positive NHL ELIGIBLITY: Subjects must have a confirmed diagnosis of an EBV-positive B-cell LPD or an EBV- positive NHL confirmed by Laboratory of Pathology, NCI --NOTE: LPD subjects may be previously untreated or relapsed from prior therapy; patients with EBV-positive B-cell NHL subjects must have relapsed from previous treatment with an anthracycline and rituximab-based regimen or be considered not eligible for the same Adequate bone marrow function (unless disease-related) defined as: Absolute neutrophil count greater than or equal to 750/mcL Hemoglobin greater than 9g/dL (transfusion permitted) Platelet count greater than or equal to 50,000/mcL (transfusion not permitted) Age greater than or equal to 12 years <TAB> DESIGN: Phase II study of subjects with EBV-positive LPD and EBV-positive NHL, both relapsed and untreated. Subjects will be treated with nivolumab 480 mg IV every 4 weeks for up to 2 years if responding disease with clinical improvement and no unacceptable toxicity. All responding subjects (CR, PR, or SD with clinical benefit) who subsequently relapse or progress within 1 year after discontinuation of study drug are eligible for re-treatment. An optimal two-stage phase II trial design will be used to rule out a best overall response rate of 20%. If fewer than 3 of the first 17 subjects respond, the study would accrue no more subjects. Subjects withboth EBV-positive LPD EBV-positive NHL will be enrolled on this protocol for a total of 37 evaluable subjects. In order to allow for inevaluable subjects and screen failures, the accrual ceiling will be set at 40 subjects..

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epstein-Barr Virus Infections, Lymphoma, Lymphoproliferative Disorder, Disorders, Lymphoproliferative
Keywords
Monoclonal Antibody

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Nivolumab (A)
Arm Type
Experimental
Arm Description
Nivolumab, 3mg/kg IV every 2 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment (closed effective with activation of Amendment C)
Arm Title
Nivolumab (B)
Arm Type
Experimental
Arm Description
Nivolumab, 480 mg IV every 4 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment
Intervention Type
Biological
Intervention Name(s)
Nivolumab
Intervention Description
Nivolumab, 480 mg IV every 4 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment
Primary Outcome Measure Information:
Title
overall response rate of nivolumab in patients with EBV-positive LPD and EBV-positive NHL
Description
number of patients who respond to the protocol therapy (CR, PR, SD)
Time Frame
one year
Secondary Outcome Measure Information:
Title
toxicity profile of nivolumab in patients with EBV-LPD
Description
number and type of AEs experienced
Time Frame
4 weeks
Title
PFS of patients with EBV-LPD treated with nivolumab
Description
number of patients who do not experience progressive disease
Time Frame
annually
Title
overall survival of patients with EBV-LPD treated with nivolumab
Description
number of patients that survive 5 years or more
Time Frame
annually
Title
duration of remission for patients who respond to nivolumab
Description
number of months patients stay in remission
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Subjects must have histologically or cytologically confirmed EBV-positive LPD or an EBV-positive NHL confirmed by the Laboratory of Pathology, NCI. EBV-positive LPD. Subjects may be previously untreated or relapsed from prior therapy. Lymphomatoid granulomatosis (LYG), grades I-II Chronic active EBV disease (CAEBV) of B-cells or T-cells EBV-positive post-transplantation lymphoproliferative disorder (PTLD) NOTE: PTLD after solid organ transplantation is excluded. Patients who, at the discretion of the investigator, need urgent therapy with standard agents will not be eligible. EBV-positive B-cell NHL. Subjects must have relapsed from previous treatment with an anthracycline and rituximab-based regimen or be considered not eligible for the same. Lymphomatoid granulomatosis (LYG), grade III EBV-positive immunodeficiency-associated diffuse large B-cell lymphoma (DLBCL) EBV-positive DLBCL Subjects must be at least 2 weeks from prior anti-lymphoma therapy (including radiation therapy) Subjects must be at least 100 days from prior stem cell transplant (autologous or allogeneic) or Donor Lymphocyte Infusion (DLI) Age greater than or equal to 12 years Patients greater than or equal to 12 and less than 18 years of age should weigh at least 40 kilograms (kg); there is no weight requirement for adult subjects. NOTE: If a pediatric patient is identified for possible enrollment who weighs less than 40 kg, the safety of the nivolumab dosing strategy used in this study must be discussed with the PI and manufacturer to confirm safety, and this discussion/approval for enrollment documented in the medical record prior to declaring the pediatric patient eligible. Adequate performance status as follows: Patients greater than or equal to 16 years must have ECOG Performance Status 0-2 (Karnofsky greater than or equal to 60%) Pediatric patients less than 16 years must have Lansky play-performance of 60-100% Subjects must have measurable or evaluable disease. Subjects must have adequate organ and bone marrow reserve (unless disease-related) as defined below: absolute neutrophil count - greater than or equal to 750/mcL; greater than or equal to 500/mcL if impairment is due to LPD/NHL platelets - greater than or equal to 50,000/mcL; greater than or equal to 25,000/mcL if impairment is due to LPD/NHL; (transfusions not permitted) Hemoglobin greater than or equal to 9g/dL (transfusion permitted) total bilirubin - < 3.0g/dl OR < 5.0g/dl if Gilbert s syndrome or disease infiltration of the liver is present AST(SGOT)/ALT(SGPT) - less than or equal to 3 X institutional upper limit of normal serum creatinine OR creatinine clearance - Adults: less than or equal to 1.5 mg/dL; Minors: serum Cr less than or equal to age-adjusted normal OR greater than or equal to 40 ml/min/1.73m^2 A formalin fixed tissue block or at least 15 slides of tumor sample (archival or fresh) must be available for performance of correlative studies. NOTE: Patient must be willing to have a pre-treatment tumor biopsy if adequate archival tissue is not available. The toxicity profile of nivolumab in patients with disease involvement of the central nervous system (CNS) is unknown. For this reason, we will introduce early stopping rules. The effects of nivolumab on the developing human fetus are unknown. For this reason, the following measures apply: Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) during screening and within 48 hours prior to the first dose of nivolumab. WOCBP and men who are sexually active with WOCBP must use adequate contraception (e.g., hormonal or 2 barrier methods with a failure rate of less than 1% per year or abstinence) prior to study entry and throughout study drug administration. WOCBP receiving nivolumab will be instructed to adhere to contraception for a period of 23 weeks after the last dose of investigational product. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 31 weeks after the last dose of investigational product. Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile as well as azoospermic men do not require contraception. WOCBP is defined as any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral ophorectomy), and who is not postmenopausal. Post menopause is defined as: Amenorrhea greater than or equal to 12 consecutive months without another cause, and a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL or Women with irregular menstrual periods and a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL or NOTE: FSH level testing is not required for women greater than or equal to 62 years old with amenorrhea of greater than or equal to 1 year Women on hormone replacement therapy (HRT) Pregnant women are excluded from this study because nivolumab is an IgG monoclonal antibody with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with nivolumab, breastfeeding should be discontinued if the mother is treated with nivolumab. Ability of subject or Legally Authorized Representative (LAR) to understand and sign the written informed consent document. EXCLUSION CRITERIA: Subjects who are receiving any other investigational agents. History of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab. Subjects with second malignancies requiring active systemic therapy are excluded. Subjects with second malignancies not requiring active systemic therapy or premalignant conditions such as monoclonal B-cell lymphocytosis (MBL) or monoclonal gammopathy of undetermined significance (MGUS) may be eligible. Subjects with any condition or autoimmune disease that requires systemic corticosteroids (> 10 mg daily prednisone equivalents) or immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids are permitted. Subjects with active graft-vs-host disease (GVHD) requiring steroids or other immunosuppressive agents; history of greater than or equal to grade II acute GVHD or extensive chronic GVHD. Subjects who have had solid organ transplant. Prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137 or anti CTLA-4 antibody. Non-oncology vaccine therapies for prevention of infectious disease within 4 weeks of study drug administration. A serious uncontrolled medical condition requiring therapy. Seizures disorder not controlled by anti-seizure medications. Subjects with CNS involvement may be included on the study as long as they have not had any seizure activity in past 4 weeks. Hepatitis B virus surface antigen positive. Active Hepatitis C infection with a positive PCR; subjects who are Hepatitis C antibody positive and PCR negative may be eligible. In these cases the subjects will be monitored via HCV PCR throughout the study. History of anaphylactic reaction to monoclonal antibody therapy. HIV positive subjects are excluded because the function of their T-cell immune responses is impaired.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
NCI Medical Oncology Referral Office
Phone
(240) 760-6050
Email
ncimo_referrals@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Christopher J Melani, M.D.
Phone
(240) 760-6057
Email
christopher.melani@nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher J Melani, M.D.
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
For more information at the NIH Clinical Center contact National Cancer Institute Referral Office
Phone
888-624-1937

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.There is a plan to make IPD and related data dictionaries available. In addition, all large scale genomic sequencing data will be shared with subscribers to dbGaP.
IPD Sharing Time Frame
Clinical data will be available during the study and indefinitely. Genomic data will be available once genomic data are uploaded per protocol GDS plan for as long as database is active.
IPD Sharing Access Criteria
Clinical data will be made available via subscription to BTRIS and with the permission of the study PI. Genomic data will be made available via dbGaP through requests to the data custodians.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2017-C-0125.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Nivolumab in Epstein-Barr Virus (EBV)-Positive Lymphoproliferative Disorders and EBV-Positive Non-HodgkinLymphomas

We'll reach out to this number within 24 hrs