Study of Avelumab and/or Radiation Therapy in People With Advanced Merkel Cell Carcinoma

Launched by MEMORIAL SLOAN KETTERING CANCER CENTER · Mar 8, 2021

Keywords

ClinConnect Summary

This clinical trial is studying a combination of a medication called avelumab and a special type of radiation therapy known as comprehensive ablative radiation therapy (CART) for people with advanced Merkel cell carcinoma (MCC). MCC is a rare and aggressive skin cancer that can be difficult to treat, especially when it can’t be surgically removed. Researchers want to see if using CART along with avelumab can help improve treatment outcomes for patients whose cancer has continued to grow after initial therapies.

To participate in this study, individuals must be at least 18 years old and have a confirmed diagnosis of advanced MCC that has not responded to earlier treatments. They should also be in good enough health to tolerate the treatments, meaning they should not have serious health issues that could interfere with the study. Participants will receive both the radiation therapy and the immunotherapy, and they will be monitored closely throughout the trial. This study is currently recruiting participants, so if you think you might be eligible, it could be a good opportunity to explore new treatment options.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Biopsy proven Merkel cell carcinoma which is unresectable or metastatic, stage III or IV
• • Prior first-line treatment with aPD1 monotherapy (defined as at least one dose of pembrolizumab, avelumab, nivolumab, etc.) with evidence of progression of disease ≥10 weeks after starting therapy, in the absence of significant clinical deterioration
• • Patients with clinical deterioration during aPD1 monotherapy are eligible ≥6 weeks after starting aPD1 therapy
• • Criteria for clinical deterioration to be determined and agreed upon by treating physician and Principal Investigator
• • All detectable sites of MCC are amenable to comprehensive ablative radiation therapy in opinion of treating radiation oncologist and principal investigator
• • ≥18 years of age
• • Performance status ≤2 on the Eastern Cooperative Oncology Group Performance Scale
• • Able to provide valid written informed consent
• • Normal organ and marrow function
• • Hematologic: Neutrophil count ≥1500/mm\^3, platelet count ≥100,000/mm\^3, hemoglobin ≥9 g/dL
• • Hepatic: Total bilirubin ≤ 1.5 times the upper limit of normal, unless Gilbert's syndrome; aspartate transaminase and alanine transaminase ≤ 2.5 times the upper limit of normal (in the absence of hepatobiliary metastases); ≤ 3.0 times the upper limit of normal (in the presence of hepatobiliary metastases)
• • Renal: Estimated creatinine clearance ≥ 30 mL/min according to the Cockcroft-Gault formula.
• Exclusion Criteria:
• • Prior systemic therapy for MCC other than first-line aPD1 monotherapy (ie, chemotherapy)
• • Pregnancy or breastfeeding
• • Adverse events due to prior cancer therapy which are grade 3 or higher and have not resolved
• • °Patients with prior grade 3 or higher immune related adverse events are not eligible, even if they have resolved
• • Prior severe hypersensitivity reaction (CTCAE version 5.0 grade ≥3) to avelumab
• • Prior radiotherapy which precludes the ability to safely deliver comprehensive ablative radiation therapy in the opinion of the treating radiation oncologist and principal investigator
• • °Institutional guidelines for reirradiation will be used when making this determination
• • Known central nervous system metastases
• * Known clinically significant cardiovascular disease, defined as:
• • Stroke or myocardial infarction within 6 months of first dose of avelumab
• • Symptomatic congestive heart failure (New York Heart Association Class 2 or higher)
• • Serious arrhythmia requiring anti-arrhythmic agents
• • Known Human Immunodeficiency Virus infection
• • Known Hepatitis B or C infection requiring ongoing treatment
• • Vaccination within 4 weeks of first dose of avelumab
• • °Inactivated vaccines are permissible
• • Iatrogenic immunosuppression with daily systemic corticosteroid equivalent of \>10 mg of prednisone
• • Active autoimmune disease that may cause clinical deterioration during immunotherapy
• °Including, but not limited to:
• • Inflammatory bowel disease or immune colitis
• • Immune mediated pneumonitis or pulmonary fibrosis
• • History of solid organ or hematopoietic transplant
• • Active infection requiring systemic therapy
• • Active suicidal ideation or behavior
• • Comorbid or diagnostic abnormalities which would interfere with interpretation of study results
• • Known hematopoietic cancer or dysfunction (i.e., leukemia, lymphoma)
• • Known non-MCC solid tumor with known metastasis or estimated risk of metastasis \>20% within 3 months