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Anti-CTLA-4 Antibody Followed by Anti-PD-1 Antibody in Recurrent or Metastatic NSCLC (SEQUENCE)

Primary Purpose

Non Small Cell Lung Cancer

Status
Unknown status
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Ipilimumab
SHR-1210
Sponsored by
Sun Yat-sen University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non Small Cell Lung Cancer focused on measuring clinical trial, phase I, CTLA-4 antibody, PD-1 antibody, non-small cell lung cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age >=18 years old, male or female;
  • Histologically confirmed locally advanced or metastatic non-small-cell lung cancer;
  • At least one systemic chemotherapy regimen for locally advanced or metastatic disease (patients received neoadjuvant chemotherapy, concurrent chemoradiotherapy, or adjuvant chemotherapy within 6 months can be considered as first-line system therapy);
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-1;
  • At least one measurable lesion according to criteria RECIST v1.1;
  • Life expectancy of at least 12 weeks;
  • Patient has adequate bone marrow as defined by the following laboratory values:

White blood cell ≥ 3.0 × 109/L Absolute neutrophil count ≥ 1.5 × 109/L Platelets ≥ 75 × 109/L

  • Patient has adequate organ function as defined by the following laboratory values:

In absence of liver metastases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) should be below 2.5 × ULN. If the patient has liver metastases, ALT and AST should be < 5 × ULN Total serum bilirubin < ULN; or total bilirubin ≤ 3.0 × ULN with direct bilirubin within normal range of the central laboratory in patients with well documented Gilbert's Syndrome Serum creatinine ≤ 1.5 × ULN

  • Provide written, informed consent to participate in the study and follow the study procedures;
  • Women of childbearing potential must agree and commit to the use of a highly effective non-hormonal method of contraception, ie, intrauterine device, bilateral tubal ligation, vasectomized partner, or abstinence (only when it is the preferred lifestyle of the patient), from the time of informed consent until 28 days after the last dose of the investigational products. Men and their female partners of childbearing potential must agree and commit to use a highly effective method of contraception (ie, any of the above methods or hormonal contraception associated with inhibition of ovulation) while on treatment and for 3 months after last dose of investigational products

Exclusion Criteria:

  • Driver gene EGFR, ALK and ROS were positive;
  • In presence of active autoimmune disease or a history of autoimmune disease (such as the following, but not limited to: interstitial pneumonia, uveitis, enteritis, hepatitis, pituitary inflammation, vasculitis, nephritis, hyperthyroidism, hypothyroidism; Patients with hormone replacement therapy can be included; Patients with vitiligo or asthma in childhood have been completely relieved, and no intervention in adults can be included; The subjects who needed medical intervention with bronchial dilation were ineligible;
  • Patients are using immunity inhibitors or systemic hormone therapy for immunosuppression purpose (such as prednisone > 10 mg/day), except for local hormone therapy.
  • Patients were known to be allergic to macromolecular protein, or any components in ipilimumab or SHR-1210;
  • Patients with clinical symptoms of central nervous system metastasis (e.g. brain edema, requirement of hormone intervention, or brain metastases progression);
  • Another malignancy within 2 years prior to screening, with the exception of adequately treated in-situ carcinoma of the cervix, uteri, basal or squamous cell carcinoma or non-melanomatous skin cancer;
  • Patients with congenital or acquired immunodeficiency (such as HIV infection), or active hepatitis (HBV DNA≥10⁴/ml);
  • Any severe and / or uncontrolled medical conditions.

Sites / Locations

  • Cancer Center of Sun-Yat Sen University (CCSYSU)Recruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Sequential group

Arm Description

intravenous ipilimumab following by intravenous SHR-1210

Outcomes

Primary Outcome Measures

Safety in the treatment of ipilimumab followed by SHR1210
Adverse events occurring up to 30 days after the last dose of ipilimumab or SHR1210 are evaluated and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.

Secondary Outcome Measures

Overall Response Rate (ORR)
ORR as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Clinical Benefit Response (CBR)
CBR as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Progression-free Survival (PFS)
PFS as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Overall survival (OS)
OS as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Duration of response (DOR)
DOR as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time To Progression (TTP)
TTP as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1

Full Information

First Posted
April 28, 2018
Last Updated
May 27, 2018
Sponsor
Sun Yat-sen University
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1. Study Identification

Unique Protocol Identification Number
NCT03527251
Brief Title
Anti-CTLA-4 Antibody Followed by Anti-PD-1 Antibody in Recurrent or Metastatic NSCLC
Acronym
SEQUENCE
Official Title
A Phase I Study Evaluating the Safety and Efficacy of CTLA-4 Antibody Ipilimumab Followed by PD-1 Antibody SHR-1210 in Patients With Recurrent or Metastatic Non-small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
May 2018
Overall Recruitment Status
Unknown status
Study Start Date
May 15, 2018 (Actual)
Primary Completion Date
December 31, 2018 (Anticipated)
Study Completion Date
December 31, 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Sun Yat-sen University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Immunotherapy has made rapid progress in melanoma, Hodgkin's lymphoma, non-small cell lung cancer, and bladder cancer, etc. Preclinical data suggested that the use of anti-PD-1 antibody in combination with CTLA-4 receptor blockers may increase antitumor activity. The CheckMate-012 study showed that nivolumab and ipilimumab combination therapy achieved an overall response rate of 43% in unselected patients with non-small cell lung cancer, compared with 23% in the nivolumab monotherapy group; and in the PD-L1 positive subgroup, nivolumab in combination with ipilimumab showed a response rate of 57%, while nivolumab alone was 28%. This showed that the combination therapy of nivolumab and ipilimumab can increase the efficacy, but the adverse events of grade 3 or above of combination therapy reach 37%. The toxic side effects limit the widespread use of nivolumab in combination with ipilimumab therapy. However, since the action of ipilimumab is limited to the initiation of the immune response (antigen presentation and immune cell activation), and its long half-time of 15.4 days, ipilimumab can used as an induction therapy, following by the PD1 monoclonal antibody. This phase I study is aimed to evaluated the safety and efficacy of CTLA-4 antibody followed by PD-1 antibody in patients with recurrent or metastatic non-small cell lung cancer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non Small Cell Lung Cancer
Keywords
clinical trial, phase I, CTLA-4 antibody, PD-1 antibody, non-small cell lung cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
Patients received two doses of intravenous ipilimumab (at a dose of 1 mg per kilogram of body weight) every 3 weeks, following by intravenous SHR-1210 (at a fixed dose of 200mg) every 2 weeks.
Masking
None (Open Label)
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Sequential group
Arm Type
Experimental
Arm Description
intravenous ipilimumab following by intravenous SHR-1210
Intervention Type
Drug
Intervention Name(s)
Ipilimumab
Other Intervention Name(s)
Yervoy
Intervention Description
Patients received two doses of intravenous ipilimumab (at a dose of 1 mg per kilogram of body weight) every 3 weeks, following by intravenous SHR-1210 (at a fixed dose of 200mg) every 2 weeks.
Intervention Type
Drug
Intervention Name(s)
SHR-1210
Intervention Description
Patients received two doses of intravenous ipilimumab (at a dose of 1 mg per kilogram of body weight) every 3 weeks, following by intravenous SHR-1210 (at a fixed dose of 200mg) every 2 weeks.
Primary Outcome Measure Information:
Title
Safety in the treatment of ipilimumab followed by SHR1210
Description
Adverse events occurring up to 30 days after the last dose of ipilimumab or SHR1210 are evaluated and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Overall Response Rate (ORR)
Description
ORR as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time Frame
Up to 4 weeks
Title
Clinical Benefit Response (CBR)
Description
CBR as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time Frame
Up to 4 weeks
Title
Progression-free Survival (PFS)
Description
PFS as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time Frame
Up to 4 weeks
Title
Overall survival (OS)
Description
OS as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time Frame
Up to 4 weeks
Title
Duration of response (DOR)
Description
DOR as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time Frame
Up to 4 weeks
Title
Time To Progression (TTP)
Description
TTP as measured in accordance with the Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1
Time Frame
Up to 4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age >=18 years old, male or female; Histologically confirmed locally advanced or metastatic non-small-cell lung cancer; At least one systemic chemotherapy regimen for locally advanced or metastatic disease (patients received neoadjuvant chemotherapy, concurrent chemoradiotherapy, or adjuvant chemotherapy within 6 months can be considered as first-line system therapy); Eastern Cooperative Oncology Group (ECOG) performance status 0-1; At least one measurable lesion according to criteria RECIST v1.1; Life expectancy of at least 12 weeks; Patient has adequate bone marrow as defined by the following laboratory values: White blood cell ≥ 3.0 × 109/L Absolute neutrophil count ≥ 1.5 × 109/L Platelets ≥ 75 × 109/L Patient has adequate organ function as defined by the following laboratory values: In absence of liver metastases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) should be below 2.5 × ULN. If the patient has liver metastases, ALT and AST should be < 5 × ULN Total serum bilirubin < ULN; or total bilirubin ≤ 3.0 × ULN with direct bilirubin within normal range of the central laboratory in patients with well documented Gilbert's Syndrome Serum creatinine ≤ 1.5 × ULN Provide written, informed consent to participate in the study and follow the study procedures; Women of childbearing potential must agree and commit to the use of a highly effective non-hormonal method of contraception, ie, intrauterine device, bilateral tubal ligation, vasectomized partner, or abstinence (only when it is the preferred lifestyle of the patient), from the time of informed consent until 28 days after the last dose of the investigational products. Men and their female partners of childbearing potential must agree and commit to use a highly effective method of contraception (ie, any of the above methods or hormonal contraception associated with inhibition of ovulation) while on treatment and for 3 months after last dose of investigational products Exclusion Criteria: Driver gene EGFR, ALK and ROS were positive; In presence of active autoimmune disease or a history of autoimmune disease (such as the following, but not limited to: interstitial pneumonia, uveitis, enteritis, hepatitis, pituitary inflammation, vasculitis, nephritis, hyperthyroidism, hypothyroidism; Patients with hormone replacement therapy can be included; Patients with vitiligo or asthma in childhood have been completely relieved, and no intervention in adults can be included; The subjects who needed medical intervention with bronchial dilation were ineligible; Patients are using immunity inhibitors or systemic hormone therapy for immunosuppression purpose (such as prednisone > 10 mg/day), except for local hormone therapy. Patients were known to be allergic to macromolecular protein, or any components in ipilimumab or SHR-1210; Patients with clinical symptoms of central nervous system metastasis (e.g. brain edema, requirement of hormone intervention, or brain metastases progression); Another malignancy within 2 years prior to screening, with the exception of adequately treated in-situ carcinoma of the cervix, uteri, basal or squamous cell carcinoma or non-melanomatous skin cancer; Patients with congenital or acquired immunodeficiency (such as HIV infection), or active hepatitis (HBV DNA≥10⁴/ml); Any severe and / or uncontrolled medical conditions.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wenfeng Fang, MD
Phone
86-15322302066
Email
fangwf@sysucc.org.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Li Zhang, MD
Organizational Affiliation
Sun Yat-sen University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cancer Center of Sun-Yat Sen University (CCSYSU)
City
GuangZhou
State/Province
Guangdong
ZIP/Postal Code
510060
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Li Zhang, Master
Phone
86-20-8734-3458
Email
zhangli6@mail.sysu.edu.cn

12. IPD Sharing Statement

Learn more about this trial

Anti-CTLA-4 Antibody Followed by Anti-PD-1 Antibody in Recurrent or Metastatic NSCLC

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