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A Phase II Study of Pembrolizumab as Post-Remission Treatment of Patients ≥ 60 With AML

Primary Purpose

Acute Myeloid Leukemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
pembrolizumab
Sponsored by
Michael Boyiadzis
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia

Eligibility Criteria

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

Inclusion Criteria:

  • be willing and able to provide written informed consent for the trial
  • be ≥ 60 years of age on day of signing informed consent
  • have a newly diagnosed AML based on the World Health Organization (WHO) criteria, currently in first complete remission (CR) on a bone marrow biopsy performed within 4 weeks of treatment initiation
  • have received the last dose of induction or consolidation chemotherapy within 3 months of treatment initiation
  • not be eligible for or willing to proceed with allogeneic stem cell transplant or for whom allogeneic stem cell transplant is not considered standard of care
  • have a performance status of ≤ 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale
  • demonstrate adequate organ function, with all screening labs performed within 10 days of treatment initiation
  • transfusion independent (no red blood cell or platelet transfusions in the preceding 2 weeks of screening)
  • negative urine and/or serum pregnancy test
  • subjects of reproductive potential must agree to use acceptable birth control method

Exclusion Criteria:

  • have a diagnosis of Acute Promyelocytic Leukemia (APL) as defined by the WHO
  • currently participating in or has participated in a study of an investigational agent or device within 4 weeks of treatment initiation
  • have a diagnosis of immunodeficiency or are receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to treatment initiation
  • have prior monoclonal antibody within 4 weeks prior to study Day 1 or have not recovered from adverse events due to agents administered more than 4 weeks earlier
  • have prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 have not recovered from adverse events due to previously administered agent(s)
  • have a known additional malignancy that is progressing or requires active treatment except for basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy
  • have known active central nervous system (CNS) involvement
  • have an active autoimmune disease requiring systemic treatment within the past 3 months
  • has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis
  • have an uncontrolled, life-threatening active infection
  • have a history or current evidence of condition, therapy, or laboratory abnormality that would preclude study participation in the opinion of the treating investigator
  • have known psychiatric or substance abuse disorders that would interfere with cooperation with the trial requirements
  • is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial
  • have received prior therapy with any antibody targeting the T-cell co-stimulation or checkpoint pathways
  • have a known history of HIV
  • have known active Hepatitis B or Hepatitis C
  • have received a live vaccine within 30 days prior to treatment initiation

Sites / Locations

  • Hillman Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

AML patients

Arm Description

pembrolizumab 200 mg given IV once every three weeks

Outcomes

Primary Outcome Measures

Time to Relapse (TTR)
Time to recurrence of AML, including only deaths related to recurrence. Relapse of AML is defined as patients reaching remission (bone marrow contains <5% blast cells, blood cell counts return to within normal limits, no signs disease) followed by a return of leukemia cells in the marrow and a decrease in normal blood cells.
Worst Grade of Adverse Events Experienced (Unrelated to Relatedness to Study Therapy)
Worst Grade of AE experienced, regardless of relatedness to study therapy, per CTCAE v5.0.
Worst Grade of Adverse Events Experienced (at Least Probably Related to Treatment)
Worst Grade of AE experienced, at least probably related to treatment, per CTCAE v5.0.

Secondary Outcome Measures

Overall Survival (OS)
The length of time from date of start of treatment that patients are still alive.

Full Information

First Posted
March 10, 2016
Last Updated
July 16, 2021
Sponsor
Michael Boyiadzis
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02708641
Brief Title
A Phase II Study of Pembrolizumab as Post-Remission Treatment of Patients ≥ 60 With AML
Official Title
A Phase II Study of Pembrolizumab as Post-Remission Treatment of Patients ≥ 60 With Acute Myeloid Leukemia (AML) Who Are Not Transplantation Candidates
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Completed
Study Start Date
October 4, 2016 (Actual)
Primary Completion Date
June 11, 2020 (Actual)
Study Completion Date
December 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Michael Boyiadzis
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

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

5. Study Description

Brief Summary
This study evaluates the effect of pembrolizumab on the duration of remission in acute myeloid leukemia. Pembrolizumab is given after complete remission is obtained in those with AML at least 60 years old who are not candidates for allogeneic stem cell transplant. The primary purpose of this study is determine if the time to relapse can be extended. Additionally, the safety and tolerability of pembrolizumab will be closely monitored.
Detailed Description
Patients >60 years old with AML often have a dismal prognosis. Even though many of these patients are able to obtain a Complete Response to treatment, relapse occurs in the vast majority of patients. Transplants may reduce relapse rates in this population, but is only feasible in a minority of patients. AML's immunosuppressive microenvironment in general and PD-1/PD-L1 upregulation in particular appears to increase the risk of relapse. Importantly, PD-1 and its ligands are particularly increased after therapy compared to initial diagnosis. As such, PD-1 inhibition with pembrolizumab offers to limit leukemic cell immune escape, thereby allowing the patient's immune system to eradicate the submicroscopic residual disease and reducing relapse rates. Treatment for this study is 200 mg Q3W as an appropriate dose for the switch to fixed dosing is based on simulations performed using the population PK model of Pembrolizumab showing that the fixed dose of 200 mg every 3 weeks will provide exposures that 1) are optimally consistent with those obtained with the 2 mg/kg dose every 3 weeks, 2) will maintain individual patient exposures in the exposure range established in melanoma as associated with maximal efficacy response and 3) will maintain individual patients exposure in the exposure range established in melanoma that are well tolerated and safe.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AML patients
Arm Type
Experimental
Arm Description
pembrolizumab 200 mg given IV once every three weeks
Intervention Type
Drug
Intervention Name(s)
pembrolizumab
Other Intervention Name(s)
Keytruda
Intervention Description
200 mg IV given every three weeks
Primary Outcome Measure Information:
Title
Time to Relapse (TTR)
Description
Time to recurrence of AML, including only deaths related to recurrence. Relapse of AML is defined as patients reaching remission (bone marrow contains <5% blast cells, blood cell counts return to within normal limits, no signs disease) followed by a return of leukemia cells in the marrow and a decrease in normal blood cells.
Time Frame
Up to 24 months
Title
Worst Grade of Adverse Events Experienced (Unrelated to Relatedness to Study Therapy)
Description
Worst Grade of AE experienced, regardless of relatedness to study therapy, per CTCAE v5.0.
Time Frame
Up to 24 months
Title
Worst Grade of Adverse Events Experienced (at Least Probably Related to Treatment)
Description
Worst Grade of AE experienced, at least probably related to treatment, per CTCAE v5.0.
Time Frame
Up to 24 months
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
The length of time from date of start of treatment that patients are still alive.
Time Frame
Up to 48 months
Other Pre-specified Outcome Measures:
Title
Quantification of Activated T Cells
Description
Determination of activated T cells level (percentages) in peripheral blood. Increased levels of activated T cells may indicate decreasing disease progression.
Time Frame
Up to 24 months
Title
Quantification of Activated NK Cells
Description
Determination of activated NK cells level (percentages) in peripheral blood. Increased levels of activated T cells may indicate decreasing disease progression.
Time Frame
Up to 24 months
Title
Quantification of Regulatory T Cells (Treg)
Description
Determination of regulatory T cell (Treg) levels (percentages) in peripheral blood. Treg cells are involved in cancer progression by inhibiting anti-cancer immunity. Increased levels of Treg cells may indicate progressing disease.
Time Frame
Up to 24 months
Title
Cytokine Expression
Description
Determination of cytokine expression levels (percentages) in peripheral blood. Cytokine expression is associated with cancer progression, immuno-suppression, and decreased anti-cancer response.
Time Frame
Up to 24 months
Title
Granzyme B/Perforin Expression
Description
Determination of Granzyme B/perforin expression levels (percentages) in peripheral blood. Granzyme B/perforin expression is associated with the suppression of cancer progression.
Time Frame
Up to 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: be willing and able to provide written informed consent for the trial be ≥ 60 years of age on day of signing informed consent have a newly diagnosed AML based on the World Health Organization (WHO) criteria, currently in first complete remission (CR) on a bone marrow biopsy performed within 4 weeks of treatment initiation have received the last dose of induction or consolidation chemotherapy within 3 months of treatment initiation not be eligible for or willing to proceed with allogeneic stem cell transplant or for whom allogeneic stem cell transplant is not considered standard of care have a performance status of ≤ 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale demonstrate adequate organ function, with all screening labs performed within 10 days of treatment initiation transfusion independent (no red blood cell or platelet transfusions in the preceding 2 weeks of screening) negative urine and/or serum pregnancy test subjects of reproductive potential must agree to use acceptable birth control method Exclusion Criteria: have a diagnosis of Acute Promyelocytic Leukemia (APL) as defined by the WHO currently participating in or has participated in a study of an investigational agent or device within 4 weeks of treatment initiation have a diagnosis of immunodeficiency or are receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to treatment initiation have prior monoclonal antibody within 4 weeks prior to study Day 1 or have not recovered from adverse events due to agents administered more than 4 weeks earlier have prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 have not recovered from adverse events due to previously administered agent(s) have a known additional malignancy that is progressing or requires active treatment except for basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy have known active central nervous system (CNS) involvement have an active autoimmune disease requiring systemic treatment within the past 3 months has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis have an uncontrolled, life-threatening active infection have a history or current evidence of condition, therapy, or laboratory abnormality that would preclude study participation in the opinion of the treating investigator have known psychiatric or substance abuse disorders that would interfere with cooperation with the trial requirements is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial have received prior therapy with any antibody targeting the T-cell co-stimulation or checkpoint pathways have a known history of HIV have known active Hepatitis B or Hepatitis C have received a live vaccine within 30 days prior to treatment initiation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Boyiadzis, MD, MHSc
Organizational Affiliation
UPMC Hillman Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hillman Cancer Center
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15232
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Phase II Study of Pembrolizumab as Post-Remission Treatment of Patients ≥ 60 With AML

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