GU-114: Overcoming Checkpoint Inhibitor Resistance With Epigenetic Therapy in Urothelial Cancer
Description
Brief Summary
This is a single arm Phase II study with a safety run-in to identify the recommended phase II
dose of the combination therapy of atezolizumab and guadecitabine. Patients with
recurrent/advanced urothelial carcinoma (stage IV) who had previously progressed on
check-point inhibitor therapy with PD-1 or PD-L1 targeting agents are eligible for this
study. After a dose that is safe and tolerable has been established, a dose expansion phase
(Phase II) will begin. This study will enroll a total of 4 to 53 patients depending upon the
number of patients treated in the safety run-in phase and the number of subjects replaced
during the phase II portion.
Phase
N/AInclusion and Exclusion Criteria
- Patients must have histologically confirmed urothelial carcinoma that is advanced or metastatic.
- Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension in accordance with RECIST criteria v. 1.1 and ≥ 1 site safe for biopsy.
- Patient must agree to provide fresh biopsy specimens and peripheral blood samples at the time of screening and during the study.
- Patients must have received or be ineligible for platinum based chemotherapy and must have received at least one line of therapy with a PD-L1 or PD-1 targeting agent.
- Age > 18 years.
- ECOG performance status ≤ 2
- Life expectancy ≥ 12 weeks
- Patients must have normal organ and marrow function as defined below - Leukocytes > 3,000/mcL - Absolute neutrophil count > 1,500/mcL - Platelets > 100,000/mcL - Hemoglobin > 9 g/dl (blood transfusion is allowed to meet the eligibility criteria as long as post transfusion hemoglobin is maintained at ≥9.0 g/dL for 7 days or longer) - Total bilirubin ≤ 2.5 x institutional upper limit of normal (ULN). - AST/ALT (SGOT/SGPT) < 2.5 times institutional normal limits unless liver metastases are present in which case AST and ALT must be ≤ 5 x IULN. - Creatinine within normal institutional limits OR - Creatinine clearance > 30 Ml/min (Cockcroft-Gault formula or measured with 24h urine) - INR or PTT/PT ≤ 1.5 ULN unless patient is on stable therapeutic dose of warfarin
- Ability to understand and willingness to sign a written informed consent and HIPAA consent document
- Women of child bearing potential and men must agree to remain abstinent or use adequate contraception (failure rate <1%) for the duration of study and for 90 days after the completion of the therapy.
- Patients who have had anti-cancer therapy within 2 weeks prior to entering the study.
- Patients receiving any other investigational agents
- Patients with active or untreated CNS disease. Patients previously treated for CNS disease must be asymptomatic and must not be using steroids for at least 4 weeks prior to starting the study treatment.
- Patients with active auto-immune disease requiring immunosuppressive medication.
- Patients treated with systemic immunostimulatory agents (such as interferons, IL 12) within 6 weeks of the start of the treatment or 5 half-lives of the drug, whichever is shorter.
- Treatment with systemic corticosteroids within 2 weeks prior to the start of the treatment. Patients that require inhaled or low-dose corticosteroids for COPD or asthma, mineralocorticoids are allowed.
- Patients with active malignancies in addition to urothelial carcinoma.
- Patients with prior treatment with hypomethylating agents.
- History of leptomeningeal disease
- Prior allogeneic stem cell or solid organ transplant.
- Uncontrolled effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently)
- Uncontrolled symptomatic hypercalcemia (>1.5mmol/L ionized calcium or calcium > 12mg/dl or corrected serum calcium > ULN)
- Mean QT interval corrected for heart rate (QTc) ≥ 470ms calculated from 3 ECGs using Frediricia's correction.
- Any prior Grade ≥3 immune-related adverse event (irAE) while receiving any previous immunotherapy agent, or any unresolved irAE >Grade 1 except for endocrine AEs managed with replacement therapy. Any other AEs unresolved toxicities grade 2 or more from previous anti-cancer therapy, except alopecia, peripheral neuropathy or non-clinically significant lab abnormalities.
- Receipt of therapeutic oral or IV antibiotics within 2 weeks prior to the start of the study treatment.
- Active or prior documented inflammatory bowel disease (e.g. Crohn's disease, ulcerative colitis)
- History of severe allergic, anaphylactic or hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins.
- History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g. bronchiolitis obliterations), drug-induced pneumonitis or idiopathic pneumonitis or evidence of interstitial lung disease or active non-infectious pneumonitis.
- Active tuberculosis
- Known hypersensitivity to Chinese hamster ovary cell products or any of the study drugs.
- Administration of a live, attenuated vaccine within 4 weeks of the start of treatment or anticipation that such a live, attenuated vaccine will be required during the study.
- Uncontrolled intercurrent 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.
- Known HIV-positive patients on combination antiretroviral therapy are ineligible.
- Known history of HBV or HCV infection.
- Pregnant or breast feeding.
Sites
Please contact the trial administrator to learn more about where you can participate in this trial. Please use the contact form on the right side.
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