search
Back to results

Enfortumab Vedotin With or Without Pembrolizumab in Rare Genitourinary Tumors

Primary Purpose

Adenocarcinoma of the Bladder, Squamous Cell Carcinoma of the Bladder, Testicular Germ Cell Tumors

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Enfortumab vedotin
Pembrolizumab
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adenocarcinoma of the Bladder focused on measuring Immunotherapy, nectin 4, rare genitourinary cancers, programmed cell death 1 ligand 1

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: Participants must have histologically confirmed locally advanced or metastatic pure adenocarcinoma of the urinary tract, pure squamous cell carcinoma of the uriniary tract, or treatment-refractory testicular germ cell tumors. Participants must have measurable disease, per RECIST 1.1. Participants must have locally advanced or metastatic disease defined as new or progressive lesions on cross sectional imaging. Participants in Cohorts A1, B1, and C1 must have received prior anti-PD-1/PD-L1 therapy in any setting. Participants in Cohorts A2, B2, and C2 must be immune checkpoint inhibitor naive. Participants may be systemic treatment naive except for participants with testicular germ cell tumors, whom must have received and be refractory to all standard options of curative-intent treatment. Age >= 18 years. Eastern Cooperative Oncology Group (ECOG) performance status <= 1 (Karnofsky >= 70%) Participants must have adequate organ and marrow function as defined below: Hemoglobin >= 9g/dL Absolute neutrophil count (ANC) >= 1,500/mcL Platelets >= 100,000/mcL Total bilirubin <= 1.5 x upper limit of normal (ULN) (<= 3 x ULN in participants with known/suspected Gilbert s disease) AST(SGOT/ALT(SGPT) <= 2.5 X institutional upper limit of normal (ULN) Creatinine clearance (CrCl) >= 30 mL/min/1.73m^2 as estimated per institution standards. Pre-study treatment tissue availability (sufficient tissue for 25 unstained slides) is mandatory for enrollment. If tissue is determined to be insufficient/unsuitable, a fresh biopsy prior to study therapy will be required. Human immunodeficiency virus (HIV) positive participants are eligible if on stable dose of highly active antiretroviral therapy (HAART) for at least 3 months, CD4 counts are > 200 cells/mm^3 and viral load is undetectable. Hepatitis B virus (HBV) positive participants are eligible if they have been treated or are on an appropriate course of antivirals at study entry and with planned monitoring and management according to appropriate guidance. For previously treated participants or those with prior infection that has been cleared, prophylaxis is permitted, and hepatology consultation recommended. Hepatitis C virus (HCV) positive participants are eligible if participants are on active HCV therapy at study entry and on a stable dose of antivirals without documented clinically significant impaired liver function test or hematologic abnormalities and with planned monitoring and management according to appropriate labeling, or if they are post-treatment for HCV. Participants that are positive for hepatitis C must have a negative polymerase chain reaction (PCR). Women of child-bearing potential (WOCBP) and men must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence for the duration of study participation, and for at least 4 months after the last dose of study drug(s). Men must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence) for the duration of the study treatment and up to 4 months after the last dose of the study drug(s). We also will recommend men with female partners of childbearing potential to ask female partners to be on an effective birth control (hormonal, intrauterine device (IUD), surgical sterilization). Breastfeeding participants must be willing to discontinue breastfeeding from study treatment initiation through 4 months after the last dose of the pembrolizumab and 3 weeks after the last dose of EV. Participants must be able to understand and willing to sign a written informed consent document. EXCLUSION CRITERIA: Participants with prior investigational drug, chemotherapy, immunotherapy, or any prior radiotherapy (except for palliative bone directed therapy) within the past 2 weeks prior to the first study drug administration. Note: FDA-approved hormonal therapy for the treatment or prevention of other malignancies (e.g., breast cancer, prostate cancer) are allowed to be continued where in the opinion of the investigator stopping such therapies may increase the risk of disease progression. Potential drug-drug interactions with the hormonal agent will be assessed by the investigator prior to enrollment. Participants with prior treatment with EV or other MMAE-based ADCs. Participants with preexisting sensory or motor neuropathy Grade >= 2. History of severe allergic reactions attributed to compounds of similar chemical or biologic composition to EV and/or pembrolizumab. Symptomatic or untreated central nervous system (CNS) metastases. Note: Participants with previously treated brain or CNS metastases are eligible if the subjects have recovered from any acute effects of radiotherapy and not requiring steroids, and any whole brain radiation therapy or any stereotactic radiosurgery was completed at least 2 weeks prior to initiation of study therapy. Participants will be excluded if they have an active autoimmune disease that might deteriorate when receiving pembrolizumab except for: Diabetes type I, eczema, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment. Subjects requiring hormone replacement with corticosteroids are eligible if the steroids are administered only for the purpose of hormonal replacement and at doses <= 10 mg of prednisone or equivalent per day. Administration of steroids for other conditions through a route known to result in a minimal systemic exposure (topical, intranasal, intro-ocular, or inhalation). Subjects on systemic intravenous or oral corticosteroid therapy with the exception of physiologic doses of corticosteroids (<= the equivalent of prednisone 10 mg/day) or other immunosuppressive agents such as azathioprine or cyclosporin A are excluded on the basis of potential immune suppression. For these subjects these excluded treatments must be discontinued at least 1 week prior to treatment initiation for recent short course use (<= 14 days) or discontinued at least 4 weeks prior to treatment initiation for long term use (> 14 days). In addition, the use of corticosteroids as premedication for contrast-enhanced studies is allowed prior to treatment initiation and on study. History of uncontrolled diabetes mellitus within 3 months before the first dose of EV. Uncontrolled diabetes is defined as hemoglobin A1C (HbA1c) >= 8% or HbA1c between 7 and < 8% with associated diabetes symptoms (polyuria or polydipsia) that are not otherwise explained. Active keratitis or corneal ulcerations. Participants who have received or will receive a live vaccine within 30 days prior to the first administration of study intervention. Seasonal flu vaccines that do not contain a live virus are permitted. Locally approved COVID-19 vaccines are permitted. Pregnant women as evaluated by a positive serum or urine beta-human chorionic gonadotropin (Beta-hCG) test at screening. Participants with severe uncontrolled intercurrent illness that would limit compliance with study requirements, as evaluated by history, physical exam, and chemistry panel.

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm 1

Arm 2

Arm Description

Treatment with enfortumab vedotin

Treatment with enfortumab vedotin and pembrolizumab

Outcomes

Primary Outcome Measures

Objective response rate (ORR)
Percentage of participants by best overall response (e.g., CR, PR, SD, PD) to therapy

Secondary Outcome Measures

Second Objective response rate (ORR2) and second progression-free survival (PFS2) after second course of pembrolizumab
Percentage of participants with the best overall response of CR or PR to therapy and duration of time from start of treatment to time of progression or death, whichever occurs first.
Duration of response (DoR)
Time from start of treatment to disease progression or death in participants who achieve CR or PR
Overall survival (OS)
Time from the start of treatment that participants are still alive.
Progression-free survival (PFS)
Duration of time from start of treatment to time of progression or death, whichever occurs first
Clinical benefit rate (CBR)
Percentage of participant who have achieved CR, PR, and SD while on treatment.
Safety of EV with or without pembrolizumab
Adverse events (AEs) will be reported by type and grade of toxicity

Full Information

First Posted
September 15, 2023
Last Updated
October 24, 2023
Sponsor
National Cancer Institute (NCI)
search

1. Study Identification

Unique Protocol Identification Number
NCT06041503
Brief Title
Enfortumab Vedotin With or Without Pembrolizumab in Rare Genitourinary Tumors
Official Title
A Phase II Multicenter Study of Enfortumab Vedotin With or Without Pembrolizumab in Rare Genitourinary Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
October 20, 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 30, 2023 (Anticipated)
Primary Completion Date
October 1, 2027 (Anticipated)
Study Completion Date
October 1, 2028 (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: Many cancers of the testicles and urinary tract are rare diseases; these are diseases that affect less than 200,000 people in the United States. It can be hard to study treatments for these diseases. One combination of drugs-enfortumab vedotin (EV) and pembrolizumab-has already been approved to treat some urinary cancers. Researchers want to see if they can help people with other types of testicle and urinary cancers. Objective: To test EV, with or without pembrolizumab, in patients with rarer cancers of the testicles or urinary tract. Eligibility: People aged 18 and older with rarer cancers of the testicles or urinary tract. Design: Participants will be screened. They will have a physical exam with blood and urine tests. Their ability to perform normal daily activities will be tested. They will have exams of their skin and eyes. They will have imaging scans. A biopsy may be needed: A sample of tissue will be removed from the tumor. The study drugs are both given through a tube attached to a needle inserted into a vein in the arm. Some participants will receive treatments 3 times during 28-week cycles; others will receive treatments 2 times during 21-day cycles. All participants may continue to receive treatments for up to 5 years. Imaging scans and other tests will be repeated. Participants who stop taking the drugs will have follow-up visits every 3 to 4 weeks until the disease gets worse. They will have imaging scans and blood tests. After that, follow-up visits will continue by phone every 3 months for up to 5 years after study therapy is finished.
Detailed Description
Background: Rare genitourinary (GU) tumors are tumors of aberrant histology occurring in the GU tract including kidney, unrinary tract, ureters, testes, and penis. Due to their rarity, they are not systematically captured by currently available registries, treatment protocols or tissue banks. Large randomized clinical trials are logistically difficult in these small patient populations. Therefore, treatment information is obtained from case reports, retrospective studies, and small clinical trials, and is frequently extrapolated from trials on similar tumor types. Pembrolizumab is a potent and highly selective humanized monoclonal antibody that targets immune checkpoint programmed cell death protein 1 (PD-1) receptor. Nectin-4 is a type 1 transmembrane protein and member of a family of related immunoglobulinlike adhesion molecules implicated in cell-cell adhesion. Nectin-4 is highly expressed in cancer cells, particularly in urothelial carcinomas (UCs). Enfortumab vedotin (EV) is an antibody-drug conjugate consisting of a human monoclonal antibody to nectin-4 and monomethyl auristatin E (MMAE), a microtubule disrupting cytotoxic agent. EV has demonstrated a survival benefit in the setting of metastatic urothelial carcinoma, which has almost universally high nectin-4 expression. There is data in UC and unrinary tract cancer variants showing co-existence of nectin-4 expression and programmed cell death 1 ligand 1 (PD-L1) expression and mismatch repair deficiency. There is currently very limited data on the level of nectin-4 expression in rare GU tumors and no evidence for the activity of EV in these tumors. Objective: -To assess the objective response rate (ORR) per RECIST v 1.1 in participants with rare genitourinary (GU) tumors treated with enfortumab vedotin (EV) with or without pembrolizumab. Eligibility: Age >= 18 years Histologically confirmed diagnosis of locally advanced or metastatic pure adenocarcinoma of the unrinary tract, pure squamous cell carcinoma of the unrinary tract, or treatment-refractory testicular germ cell tumors. Participants may have received any number of prior anti-cancer treatments or be treatment na(SqrRoot) ve (with the exception of participants with testicular germ cell tumors, whom must have exhausted all standard curative-intent options). Design: This multisite study is a phase II, open label, multicohort, nonrandomized study with two arms. Participants with: Adenocarcinoma of the unrinary tract will be enrolled in Cohort A (Cohort A1: prior anti-1/PD-L1 therapy; Cohort A2: no prior anti-PD-1/PD-L1 therapy). Squamous cell carcinoma of the unrinary tract will be enrolled in Cohort B (Cohort B1: prior anti-PD-1/PD-L1 therapy; Cohort B2: no prior anti-PD-1/PD-L1 therapy). Testicular germ cell tumors will be enrolled in Cohort C (Cohort C1: prior anti-PD-1/PDL1 therapy; Cohort C2: no prior anti-PD-1/PD-L1 therapy). All participants will receive EV. Participants without prior immune checkpoint inhibitor (ICI) exposure will be eligible to receive concurrent pembrolizumab. Arm 1: EV monotherapy will be given in 28-day cycles for a maximum of 5 years, or until disease progression or intolerable side effects. EV will be administered I.V. at 1.25 mg/kg on days 1, 8, and 15 of each cycle. Arm 2: EV and pembrolizumab will be given in 21-day cycles. EV will be administered I.V. at 1.25 mg/kg on days 1 and 8 of each cycle. Pembrolizumab will be administered I.V. at 200 mg on day 1. EV and pembrolizumab will be given for 35 cycles, or until a confirmed complete response, disease progression or intolerable side effects. After the 35th cycle, EV may be continued to be given for a maximum of 5 years, or until disease progression or intolerable side effects. Participants who have completed 35 cycles of pembrolizumab or stopped pembrolizumab for confirmed complete response may be eligible for up to additional 17 cycles of pembrolizumab if there is investigator-determined progressive disease by RECIST 1.1 after initial treatment. The accrual ceiling will be set at 68 participants to allow for inevaluable participants.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adenocarcinoma of the Bladder, Squamous Cell Carcinoma of the Bladder, Testicular Germ Cell Tumors
Keywords
Immunotherapy, nectin 4, rare genitourinary cancers, programmed cell death 1 ligand 1

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm 1
Arm Type
Experimental
Arm Description
Treatment with enfortumab vedotin
Arm Title
Arm 2
Arm Type
Experimental
Arm Description
Treatment with enfortumab vedotin and pembrolizumab
Intervention Type
Drug
Intervention Name(s)
Enfortumab vedotin
Intervention Description
EV is administered IV at 1.25 mg/kg on days 1, 8, and 15 of each 28-day cycle or on days 1 and 8 of each 21-day cycle.
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Intervention Description
Pembrolizumab is administered IV at 200 mg on day 1 of each 21-day cycle.
Primary Outcome Measure Information:
Title
Objective response rate (ORR)
Description
Percentage of participants by best overall response (e.g., CR, PR, SD, PD) to therapy
Time Frame
At every restaging (prior to every 2nd or 3rd cycle) until the end of the study therapy and during follow-up until PD
Secondary Outcome Measure Information:
Title
Second Objective response rate (ORR2) and second progression-free survival (PFS2) after second course of pembrolizumab
Description
Percentage of participants with the best overall response of CR or PR to therapy and duration of time from start of treatment to time of progression or death, whichever occurs first.
Time Frame
At every restaging (prior to every 2nd or 3rd cycle) until the end of the study therapy and during follow-up until PD
Title
Duration of response (DoR)
Description
Time from start of treatment to disease progression or death in participants who achieve CR or PR
Time Frame
At every restaging (prior to every 2nd or 3rd cycle) until the end of the study therapy and during follow-up until PD
Title
Overall survival (OS)
Description
Time from the start of treatment that participants are still alive.
Time Frame
Day 1 of each cycle, at EoT, at the Safety visits, and every 90 days for up to a total of 5 years after the end of therapy.
Title
Progression-free survival (PFS)
Description
Duration of time from start of treatment to time of progression or death, whichever occurs first
Time Frame
At every restaging (prior to every 2nd or 3rd cycle) until the end of the study therapy and during follow-up until PD
Title
Clinical benefit rate (CBR)
Description
Percentage of participant who have achieved CR, PR, and SD while on treatment.
Time Frame
At every restaging (prior to every 2nd or 3rd cycle) until the end of the study therapy and during follow-up until PD
Title
Safety of EV with or without pembrolizumab
Description
Adverse events (AEs) will be reported by type and grade of toxicity
Time Frame
From first dose through 30 days after last treatment with EV and 90 days after last treatment with pembrolizumab

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Participants must have histologically confirmed locally advanced or metastatic pure adenocarcinoma of the urinary tract, pure squamous cell carcinoma of the uriniary tract, or treatment-refractory testicular germ cell tumors. Participants must have measurable disease, per RECIST 1.1. Participants must have locally advanced or metastatic disease defined as new or progressive lesions on cross sectional imaging. Participants in Cohorts A1, B1, and C1 must have received prior anti-PD-1/PD-L1 therapy in any setting. Participants in Cohorts A2, B2, and C2 must be immune checkpoint inhibitor naive. Participants may be systemic treatment naive except for participants with testicular germ cell tumors, whom must have received and be refractory to all standard options of curative-intent treatment. Age >= 18 years. Eastern Cooperative Oncology Group (ECOG) performance status <= 1 (Karnofsky >= 70%) Participants must have adequate organ and marrow function as defined below: Hemoglobin >= 9g/dL Absolute neutrophil count (ANC) >= 1,500/mcL Platelets >= 100,000/mcL Total bilirubin <= 1.5 x upper limit of normal (ULN) (<= 3 x ULN in participants with known/suspected Gilbert s disease) AST(SGOT/ALT(SGPT) <= 2.5 X institutional upper limit of normal (ULN) Creatinine clearance (CrCl) >= 30 mL/min/1.73m^2 as estimated per institution standards. Pre-study treatment tissue availability (sufficient tissue for 25 unstained slides) is mandatory for enrollment. If tissue is determined to be insufficient/unsuitable, a fresh biopsy prior to study therapy will be required. Human immunodeficiency virus (HIV) positive participants are eligible if on stable dose of highly active antiretroviral therapy (HAART) for at least 3 months, CD4 counts are > 200 cells/mm^3 and viral load is undetectable. Hepatitis B virus (HBV) positive participants are eligible if they have been treated or are on an appropriate course of antivirals at study entry and with planned monitoring and management according to appropriate guidance. For previously treated participants or those with prior infection that has been cleared, prophylaxis is permitted, and hepatology consultation recommended. Hepatitis C virus (HCV) positive participants are eligible if participants are on active HCV therapy at study entry and on a stable dose of antivirals without documented clinically significant impaired liver function test or hematologic abnormalities and with planned monitoring and management according to appropriate labeling, or if they are post-treatment for HCV. Participants that are positive for hepatitis C must have a negative polymerase chain reaction (PCR). Women of child-bearing potential (WOCBP) and men must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence for the duration of study participation, and for at least 4 months after the last dose of study drug(s). Men must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence) for the duration of the study treatment and up to 4 months after the last dose of the study drug(s). We also will recommend men with female partners of childbearing potential to ask female partners to be on an effective birth control (hormonal, intrauterine device (IUD), surgical sterilization). Breastfeeding participants must be willing to discontinue breastfeeding from study treatment initiation through 4 months after the last dose of the pembrolizumab and 3 weeks after the last dose of EV. Participants must be able to understand and willing to sign a written informed consent document. EXCLUSION CRITERIA: Participants with prior investigational drug, chemotherapy, immunotherapy, or any prior radiotherapy (except for palliative bone directed therapy) within the past 2 weeks prior to the first study drug administration. Note: FDA-approved hormonal therapy for the treatment or prevention of other malignancies (e.g., breast cancer, prostate cancer) are allowed to be continued where in the opinion of the investigator stopping such therapies may increase the risk of disease progression. Potential drug-drug interactions with the hormonal agent will be assessed by the investigator prior to enrollment. Participants with prior treatment with EV or other MMAE-based ADCs. Participants with preexisting sensory or motor neuropathy Grade >= 2. History of severe allergic reactions attributed to compounds of similar chemical or biologic composition to EV and/or pembrolizumab. Symptomatic or untreated central nervous system (CNS) metastases. Note: Participants with previously treated brain or CNS metastases are eligible if the subjects have recovered from any acute effects of radiotherapy and not requiring steroids, and any whole brain radiation therapy or any stereotactic radiosurgery was completed at least 2 weeks prior to initiation of study therapy. Participants will be excluded if they have an active autoimmune disease that might deteriorate when receiving pembrolizumab except for: Diabetes type I, eczema, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment. Subjects requiring hormone replacement with corticosteroids are eligible if the steroids are administered only for the purpose of hormonal replacement and at doses <= 10 mg of prednisone or equivalent per day. Administration of steroids for other conditions through a route known to result in a minimal systemic exposure (topical, intranasal, intro-ocular, or inhalation). Subjects on systemic intravenous or oral corticosteroid therapy with the exception of physiologic doses of corticosteroids (<= the equivalent of prednisone 10 mg/day) or other immunosuppressive agents such as azathioprine or cyclosporin A are excluded on the basis of potential immune suppression. For these subjects these excluded treatments must be discontinued at least 1 week prior to treatment initiation for recent short course use (<= 14 days) or discontinued at least 4 weeks prior to treatment initiation for long term use (> 14 days). In addition, the use of corticosteroids as premedication for contrast-enhanced studies is allowed prior to treatment initiation and on study. History of uncontrolled diabetes mellitus within 3 months before the first dose of EV. Uncontrolled diabetes is defined as hemoglobin A1C (HbA1c) >= 8% or HbA1c between 7 and < 8% with associated diabetes symptoms (polyuria or polydipsia) that are not otherwise explained. Active keratitis or corneal ulcerations. Participants who have received or will receive a live vaccine within 30 days prior to the first administration of study intervention. Seasonal flu vaccines that do not contain a live virus are permitted. Locally approved COVID-19 vaccines are permitted. Pregnant women as evaluated by a positive serum or urine beta-human chorionic gonadotropin (Beta-hCG) test at screening. Participants with severe uncontrolled intercurrent illness that would limit compliance with study requirements, as evaluated by history, physical exam, and chemistry panel.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lisa Ley, R.N.
Phone
(240) 858-3524
Email
lisa.ley@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Andrea B Apolo, M.D.
Phone
(301) 480-0536
Email
apoloab@mail.nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrea B Apolo, 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
Facility Contact:
First Name & Middle Initial & Last Name & Degree
National Cancer Institute Referral Office
Phone
888-624-1937

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.All collected IPD will be shared
IPD Sharing Time Frame
Data from this study may be requested from other researchers at least 1 year after the completion of the primary endpoint.
IPD Sharing Access Criteria
Data from this study may be requested by contacting the PI.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_001533-C.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Enfortumab Vedotin With or Without Pembrolizumab in Rare Genitourinary Tumors

We'll reach out to this number within 24 hrs