Metronomic Cyclophosphamide With Pembrolizumab in Checkpoint Inhibitor Refractory Melanoma

Launched by UNIVERSITY OF CALIFORNIA, IRVINE · Jan 7, 2025

Keywords

ClinConnect Summary

This clinical trial is studying a combination of two medications, Cyclophosphamide and Pembrolizumab, to see how effective they are in treating patients with advanced melanoma, which is a type of skin cancer that has spread and cannot be removed with surgery. This study is specifically looking at patients who have already tried other treatments that didn’t work.

To participate, you need to be at least 18 years old and have Stage III or IV melanoma that cannot be treated with local methods. You’ll also need to have measurable cancer that has progressed, and your overall health must be stable enough to handle the treatment. If you join the trial, you will receive the study medications and be monitored closely by the research team for any side effects or changes in your condition. It’s important to know that women who can become pregnant will need to take precautions to avoid pregnancy during the study. This trial is currently recruiting participants, so if you think you might qualify, it could be a valuable opportunity to explore new treatment options.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Age ≥18 years at the time of signing informed consent form (ICF)
• • Patients must have unresectable Stage III or Stage IV non-ocular melanoma per American Joint Committee on Cancer 8th Edition Staging Criteria not amenable to local therapy
• • Participants must have measurable disease by RECIST v1.1 criteria as assessed by investigator/ radiology. Lesions situated in a previously irradiated area are considered measurable if progression has been shown in such lesions.
• • Participants must have Eastern Cooperative Group (ECOG) performance status score of 0, 1 or 2 at screening visit.
• • Life expectancy of at least 12 weeks
• • Adequate bone marrow, liver, and renal function
• • Hemoglobin ≥8.0 g/dL
• • Platelets ≥75/mm3
• • ANC ≥1.5/mm3
• • Creatinine Clearance ≥ 30mL/min Cockcroft-Gault CrCl, mL/min = (140 - age) × (weight, kg) × (0.85 if female) / (72 × Cr, mg/dL).
• • AST and ALT less than 3 times the Upper Limit of Normal or less than 5 times the Upper Limit of normal with liver metastases. T Bilirubin \< 3.1 mg/dL.
• • Recovered from toxicities of pembrolizumab, excluding endocrine toxicities
• • Receipt of PD-1/PD-L1
• • For melanoma patients: within 6 weeks (every 3 week dosing) or 9 weeks (every 6 week dosing) prior to the first dose of the investigational therapy
• • Women of childbearing potential must have had a negative pregnancy test performed within 7 days prior to the start of treatment
• • Females of childbearing potential and males must be willing and able to use an adequate method of contraception to avoid pregnancy for the duration of the study.
• • Male and female participants of childbearing potential who are sexually active with a non-sterilized partner must agree to use highly effective methods of birth control from the trial screening date until 3 months after the final dose of study intervention; cessation of birth control after this point shall be discussed with a responsible physician.
• • Pregnant or lactating women are prohibited from enrolling in this study.
• • Male participants are not allowed to donate sperm from the time of enrollment until 6 months after administration of study interventions.
• Exclusion Criteria:
• • Participants with a diagnosis of ocular or metastatic uveal melanoma
• * Participants with a history of a malignant disease other than those being treated in this study. The following exceptions are permitted:
• • Malignancies that were treated curatively and have not recurred within 2 years. Shorter intervals can be considered after discussion with the Principal Investigator.
• • Completely resected basal cell and squamous cell skin cancers.
• • Any malignancy considered to be indolent and that has never required therapy, such as chronic lymphocytic leukemia.
• • Completely resected carcinoma in situ of any type
• • Participants ineligible to be retreated with pembrolizumab due to a treatment-related AE while on a prior anti-PD(L)-1 regimen that led to discontinuation of that prior therapy and would thus prevent retreatment or with an immune-related adverse event (irAE) of grade 3 or greater
• * Participants with known untreated or symptomatic central nervous system (CNS) metastases and/or carcinomatous meningitis. NOTE: Participants with previously treated brain metastases may participate provided ALL of the following apply:
• • Treated CNS lesions are radiographically stable (without evidence of progression for ≥ 28 days prior to the first dose of study intervention) after intervention (eg, surgery and/or radiation).
• • Neurologically stable and on stable dose of ≤ 10mg of prednisone equivalent steroids for at least 7 days prior to the first dose of study intervention.
• • Investigational or standard immunotherapy (with exception of pembrolizumab, nivolumab, or relatlimab), chemotherapy or radiation within 6-9 weeks of the first dose of the investigational therapy (see Inclusion Criteria)
• • Presence of B-RAF driver mutation without prior receipt of BRAF +/- MEK inhibitors, unless patient declines BRAF +/-MEK inhibition for any reason or is unable to tolerate BRAF and/or MEK inhibitors.
• • Participants with a known history of chronic viral infections as indicated below. If patients do not have a known history, testing is not required during the screening period to confirm the patient has an active infection.
• • Known HBV infection defined as hepatitis B surface antigen reactive. NOTE: Participants with HBV infection on stable anti-viral therapy for \> 4 weeks prior to the planned first study intervention and viral load confirmed as undetectable during Screening may be eligible.
• • Known active HCV infection defined as detectable HCV RNA (qualitative) infection. NOTE: History of HCV is not exclusionary if participant has received curative treatment and viral load is confirmed as undetectable during Screening.
• • Active HIV infection. Those with HIV infections on combination antiretroviral medications with stable CD4 count \>200/microliters as measured within screening time period. If the patient does not have a known history of HIV, then testing is not required during screening to confirm presence or absence of HIV.
• • Positive serum pregnancy test
• • Participants with out-of-range screening laboratory values as defined below. NOTE: Hematology evaluations must be performed \>7 days from any blood transfusion. Or blood product transfusion or from any dose of hematologic growth factor.
• • Glomerular filtration rate (calculated using the Chronic Kidney Disease Epidemiology Collaboration formula) \< 30 mL/min
• • Total bilirubin \> 1.5 × ULN; participants with Gilbert's syndrome are excluded if total bilirubin \> 3.0 × ULN; or direct bilirubin \> 1.5 × ULN
• • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST): \> 2.5 × ULN (\> 5 × ULN for participants with liver metastases)
• • Albumin \< 3.0 g/dL
• • Absolute neutrophil count \< 1.5 × 10\^9/L
• • Absolute lymphocyte count \< 0.5 × 10\^9/L
• • Platelet count \< 100 × 10\^9/L
• • Hemoglobin \< 9 g/dL
• • Participants with a history of allogeneic tissue/solid organ transplant