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Phase II Anti-PD1 Epigenetic Therapy Study in NSCLC. (NA_00084192)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT01928576
Recruitment Status : Recruiting
First Posted : August 26, 2013
Last Update Posted : June 24, 2019
Rising Tide Foundation
Stand Up To Cancer
Information provided by (Responsible Party):
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Brief Summary:
Response Rate

Condition or disease Intervention/treatment Phase
Non-Small Lung Cancer, Epigenetic Therapy Drug: Azacitidine Drug: Entinostat Drug: Nivolumab Phase 2

Detailed Description:
Objective response rate to Nivolumab preceded by epigenetic priming. Response will be assessed by RECIST 1.1 criteria, baseline scans for this assessment will be the baseline scans done within 4 weeks of enrollment.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Phase II Study of Epigenetic Therapy With Azacitidine and Entinostat With Concurrent Nivolumab Versus Nivolumab Alone in Subjects With Recurrent Metastatic Non-Small Cell Lung Cancer.
Study Start Date : August 2013
Estimated Primary Completion Date : August 2022
Estimated Study Completion Date : August 2022

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Arm C
Nivolumab 3mg/kg every 2 weeks until progression
Drug: Nivolumab
Other Name: Opdivo

Experimental: Arm D

Every 28 days for 6 cycles Azacitidine 40mg/m2 days 1-5 and 8-10 Entinostat 5mg Days 3 and 10 Nivolumab 3mg/kg Days 1 and 15

Followed by:

Nivolumab 3mg/kg every 2 weeks until prgoression

Drug: Azacitidine
Other Name: 5-AZA, Vidaza

Drug: Entinostat
Drug: Nivolumab
Other Name: Opdivo

Primary Outcome Measures :
  1. Response [ Time Frame: 32 weeks ]
    Being progression-free at 32 weeks after randomization. Response will be assessed from baseline scans at randomization (i.e., within 4 weeks prior to starting epigenetic therapy).

Secondary Outcome Measures :
  1. Progression free survival [ Time Frame: 2 years ]
    Progression-free survival (overall) will be measured from the time of randomizationuntil radiologic or clinical progression is noted. Estimation will be by the Kaplan-Meier method.

  2. Time to Progression [ Time Frame: 2 years ]
    Time to progression (nivolumab) on nivolumab will be measured from the time nivolumab begins until radiologic or clinical progression is noted. Estimation will be by the Kaplan-Meier method.

  3. Overall survival [ Time Frame: 2 years ]
    Overall survival will be measured from the time of randomization until death. Estimation will be by the Kaplan-Meier method.

  4. Safety and tolerability [ Time Frame: 2 years ]
    Toxicities observed in both phases of the study will be assessed by CTCAE 4.0 criteria. We will tabulate toxicities and compare the two treatment groups via methods appropriate for categorical data.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients must have histologically proven stage IIIB, IV or recurrent non-small cell lung cancer. Patients must be willing to undergo a pre-treatment biopsy, either core needle biopsy or equivalent amount or via excisional specimen. (cytology specimen not acceptable for this purpose).
  2. Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >20 mm with conventional techniques or as >10 mm with spiral CT scan, MRI, or calipers by clinical exam. See Section 11 for the evaluation of measurable disease.
  3. Patients must have received at least one platinum based chemotherapy, and not more than three, prior therapies for stage IIIB/IV disease.
  4. Patients who received adjuvant or neoadjuvant platinum-doublet chemotherapy (after surgery and/or radiation therapy) and developed recurrent or metastatic disease within 6 months of completing therapy are eligible and the adjuvant or neoadjuvant chemotherapy will count as a line of therapy as above.
  5. Subjects with recurrent disease > 6 months after adjuvant or neoadjuvant platinum-based chemotherapy, who also subsequently progressed during or after a platinum-doublet regimen given to treat the recurrences, are eligible and do not count as another line of therapy for advanced disease.
  6. Subjects who received pemetrexed, bevacizumab, or erlotinib as maintenance therapy (nonprogressors with platinum-based doublet chemotherapy) and subsequently progressed after maintenance therapy) are eligible and do not count as a line of therapy. However, subject who received a tyrosine kinase inhibitor after failure of a prior platinum-based therapy, that tyrosine kinase inhibitor therapy would count as an additional line of therapy.
  7. Age >18 years. Because no dosing or adverse event data are currently available on the use of azacitidine with entinostat, or of Nivolumab, in patients <18 years of age, children are excluded from this study.
  8. Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1.
  9. Life expectancy of greater than 12 weeks.
  10. Patients must have adequate organ and marrow function.
  11. The effects of entinostat, azacitidine, and Nivolumab, on the developing human fetus are unknown. For this reason women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation and for up to 23 weeks after the last dose of nivolumab. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men who are sexually active with women of childbearing potential must also use an adequate contraceptive method for up to 31 weeks after fhe last dose of nivolumab.
  12. Ability to understand and the willingness to sign a written informed consent document.
  13. Patients with documented EGFR or ALK mutations must have been treated with prior EGFR or ALK therapy as well as a platinum containing doublet.
  14. All adenocarcinoma patients will be tested for ALK rearrangements and EGFR (Exon 19 Deletion and Exon 21 L8585R Substitution) mutations and must have been treated with prior EGFR or ALK therapy as well as a platinum containing doublet.
  15. Patients must have disease amenable to biopsy at the time of enrollment as biopsies are required for study participation.

Exclusion Criteria:

  1. Any active history of a known autoimmune disease. Subjects with vitiligo, type 1 diabetes mellitus, residual hypothyroidism requiring hormone replacement, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
  2. Subjects with a history of interstitial lung disease. Patients requiring continuous supplemental oxygen are excluded to avoid possible complications from pneumonitis.
  3. Patients who have had chemotherapy or radiotherapy within 2 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 2 weeks earlier.
  4. Patients who are receiving any other anticancer therapy.
  5. Patients with uncontrolled brain metastases. Patients with brain metastases must have stable neurologic status following local therapy (surgery or radiation) for at least 2 weeks without the use of steroids or on stable or decreasing dose of < 10mg daily prednisone (or equivalent), and must be without neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Patients with a history of carcinomatous meningitis are not eligible.
  6. Patients with advanced malignant hepatic tumors.
  7. History of allergic reactions attributed to compounds of similar chemical or biologic composition to entinostat, azacitidine, or Nivolumab.
  8. Known or suspected hypersensitivity to azacitidine or mannitol
  9. Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  10. Pregnant women are excluded from this study because entinostat, azacitidine, and Nivolumab are agents 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 entinostat, azacitidine, or Nivolumab breastfeeding should be discontinued if the mother is treated on this protocol.
  11. HIV-positive patients are excluded.
  12. Patients with active hepatitis B or hepatitis C are excluded.
  13. Patients with a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization. Inhaled or topical steroids and adrenal replacement steroid doses > 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.
  14. Patients with malabsorption in the small intestine or other conditions that would preclude administration of oral medication.
  15. Prior therapy with anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-CTLA-4 antibody therapies, any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways, DNA methyltransferase therapy or HDAC inhibitor therapy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01928576

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Contact: Julie Brahmer, MD 410-502-7159
Contact: Jessica Wakefield 410-502-3696

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United States, California
University of Southern California Completed
Los Angeles, California, United States, 90033
United States, Maryland
Julie Brahmer, MD Recruiting
Baltimore, Maryland, United States, 21224
Contact: Julie Brahmer, MD    410-502-7159   
Julie Brahmer, MD Recruiting
Baltimore, Maryland, United States, 21287
Contact: Julie Brahmer, MD    410-502-7159   
United States, Pennsylvania
UPMC Cancer Center- Hillman Cancer Center Recruiting
Pittsburgh, Pennsylvania, United States, 15213
Contact: James G Herman, MD    412-692-4724   
Sponsors and Collaborators
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Rising Tide Foundation
Stand Up To Cancer
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Principal Investigator: Julie Brahmer, MD Johns Hopkins University

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Responsible Party: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Identifier: NCT01928576     History of Changes
Other Study ID Numbers: J1353
NA_00084192 ( Other Identifier: JHMIRB )
119134 ( Other Grant/Funding Number: Rising Tide Foundation )
105558 ( Other Grant/Funding Number: Stand Up To Cancer )
First Posted: August 26, 2013    Key Record Dates
Last Update Posted: June 24, 2019
Last Verified: September 2018
Additional relevant MeSH terms:
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Lung Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Antineoplastic Agents, Immunological
Antineoplastic Agents
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors
Histone Deacetylase Inhibitors