CLINICAL TRIAL / NCT03990961
Pembrolizumab for Patients With PD-L1 Diffuse Large B Cell Lymphoma (DLBCL)
- Interventional
- Recruiting
- NCT03990961
Contact Information
Phase II Study of Pembrolizumab for PD-L1 Gene-Altered, Relapsed/Refractory DLBCL
A non randomized, unblinded, open label phase 2 study to investigate the efficacy of pembrolizumab in patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) with PD-L1 genetic alterations
Gender
All
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
1. Male/female participants who are at least 18 years of age on the day of signing
informed consent with a histologically confirmed diagnosis of DLBCL will be enrolled
in this study.
Note: Patients with high-grade B cell lymphomas not otherwised specified and those
with MYC and BCL2 translocations (double hit lymphoma) are eligible, as are patients
with transformed indolent lymphoma, so long as PD-L1 gene alterations are present.
2. A male participant must agree to use a contraception during the treatment period and
for at least 120 days after the last dose of study treatment. Participants must
refrain from donating sperm during this period.
3. A female participant is eligible to participate if she is not pregnant, not
breastfeeding, and at least one of the following conditions applies:
1. Not a woman of childbearing potential (WOCBP)
2. A WOCBP who agrees to follow the contraceptive guidance during the treatment
period and for at least 120 days after the last dose of study treatment.
C.) patient must have negative pregnancy test within 72 hours of beginning treatment
if WOCBP
4. The participant (or legally acceptable representative if applicable) provides
written informed consent for the trial.
5. Have measurable disease, defined as at least one lesion that can be accurately
measured in at least two dimensions by CT scan. Minimum measurement must be >15 mm
in the longest diameter by >10 mm in the short axis. Lesions situated in a
previously irradiated area are considered measurable if radiographic progression has
been demonstrated in such lesions.
6. Participants must have available archived biopsy material (ideally to be performed
shortly before enrollment at the time of most recent relapse) for PD-L1 FISH and
correlative studies.
7. There is evidence of a PD-L1 gene alteration within lymphoma cells as assessed by
FISH.
8. Participants must have received ≥ 2 lines of prior systemic therapy, ≥ 1 line of
prior systemic therapy (if ineligible for or refused autologous stem cell
transplantation), or have received 1 line of prior therapy with primary-refractory
disease or have relapsed within 12 months from the time of initial diagnosis.
Note: patients having undergone prior CAR T cell therapy are eligible, as are
patients having received a prior allogeneic transplantation, provided they do not
meet any of the exclusionary GVHD criteria, and are at least 5 years removed from
the date of their transplant.
9. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
10. Have adequate organ function within 10 days prior to the date of treatment
allocation. Please see below for Adequate Organ Function Laboratory Values:
- Hematological
- Absolute neutrophil count (ANC) less than or equal to 1,000/microliters
- Platelets less than or equal to 50,000/microliters
- Hemoglobin less than or equal to 8.0 grams per decilitre
- Renal
- Creatinine OR measured or calculated clearance (GFR can also be used in
place of creatinine or CrCl) greater than or equal to 1.5XULN OR less than
or equal to 30mL/min for participant with creatinine levels less than 1.5
X institutional ULN
- Hepatic
- Total bilirubin greater than or equal to 1.5 X ULN or direct bilirubin
greater than or equal to ULN for participants with total bilirubin levels
less than 1.5 x ULN
- AST (SGOT) and ALT (SGPT) greater than or equal to 2.5 x ULN (greater than
or equal to 5 x ULN for participants with liver metastases)
- Coagulation
- International normalized ratio (INR) OR prothrombin time (PT) and
Activated partial thromboplastin time (aPTT) greater than or equal to 1.5
x ULN unless participant is receiving anticoagulant therapy as long as PT
or aPTT is within therapeutic range of intended use of anticoagulants.
Exclusion Criteria:
1. A WOCBP who has a positive urine pregnancy test within 72 hours prior to treatment
allocation . If the urine test is positive or cannot be confirmed as negative, a
serum pregnancy test will be required.
2. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or
with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg,
CTLA-4, OX-40, CD137).
3. Has received chemotherapy, monoclonal antibody therapy, or targeted small molecule
therapy within 4 weeks prior to the first dose of study medication. Subjects must
have recovered (≤ Grade 1) from adverse events related to a previously administered
agent (patients with ≤ Grade 2 neuropathy are eligible). Subjects who have
previously received CAR T cell therapy are eligible provided that relapse occurred >
90 days following the date of CAR T cell infusion.
Note: If a participant received major surgery, he or she must have recovered
adequately from complications from the intervention prior to starting study
treatment.
4. Has received prior radiotherapy within 1 week of start of study treatment.
Participants must have recovered from all radiation-related toxicities, not require
corticosteroids, and not have had radiation pneumonitis.
5. Has a histologic diagnosis of primary mediastinal lymphoma or gray zone lymphoma.
6. Has known active CNS lymphoma and/or lymphomatous meningitis. Participants with
previously treated brain metastases may participate provided they are radiologically
stable, i.e. without evidence of progression for at least 4 weeks by repeat imaging
(note that the repeat imaging should be performed during study screening),
clinically stable and without requirement of steroid treatment for at least 14 days
prior to first dose of study treatment.
7. Has received a live vaccine within 30 days prior to the first dose of study drug.
Examples of live vaccines include, but are not limited to, the following: measles,
mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus
Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for
injection are generally killed virus vaccines and are allowed; however, intranasal
influenza vaccines (eg, FluMist®) are live attenuated vaccines and are not allowed.
8. Is currently participating in or has participated in a study of an investigational
agent or has used an investigational device within 4 weeks prior to the first dose
of study treatment.
9. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
(in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of
immunosuppressive therapy within 7 days prior to the first dose of study drug. Short
courses of corticosteroids will be allowed for palliation of symptoms related to
lymphoma, but must be discontinued within 7 days prior to the first dose of study
drug.
10. Subjects having received prior allogeneic stem cell transplant, must be at least 5
years removed from the date of their transplant. The also must have no history of
severe (grade 3-4) acute GVHD, and/or current > grade 1 acute GHVD. Subjects must
not have active chronic GVHD that requires active immune suppression or more than 10
mg of prednisone/day or equivalent.
11. Has a history of a solid organ transplant.
12. Has a known additional malignancy that is progressing or has required active
treatment within the past 3 years.
Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of
the skin, or carcinoma in situ (e.g. breast carcinoma, cervical cancer in situ) that
have undergone potentially curative therapy are not excluded
13. Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its
excipients.
14. Has active autoimmune disease that has required systemic treatment in the past 2
years (i.e. with use of disease modifying agents, corticosteroids or
immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or
physiologic corticosteroid replacement therapy for adrenal or pituitary
insufficiency, etc.) is not considered a form of systemic treatment.
15. Has a history of (non-infectious) pneumonitis that required steroids or has current
pneumonitis.
16. Has an active infection requiring systemic therapy.
17. Has a known history of Human Immunodeficiency Virus (HIV) infection.
18. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg]
reactive) or known active Hepatitis C virus (defined as detection of HCV RNA)
infection.
19. Has a known history of active TB (Bacillus Tuberculosis).
20. Has a history or current evidence of any condition, therapy, or laboratory
abnormality that might confound the results of the study, interfere with the
subject's participation for the full duration of the study, or is not in the best
interest of the subject to participate, in the opinion of the treating investigator.
21. Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.
22. Is pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the study, starting with the screening visit through 120 days
after the last dose of trial treatment.