A Pilot Study of Pentostatin Plus Cyclophosphamide Immune Depletion to Decrease Immunogenicity of SS1P in Patients With Mesothelioma
BACKGROUND:
Platinum-based chemotherapy is the standard of care for advanced unresectable malignant
mesothelioma. New options for treatment are necessary in patients with advanced disease that
have progressed on platinum-based therapy. Mesothelin is a cell surface glycoprotein present
on normal mesothelial cells that is highly expressed in many human cancers including lung
adenocarcinoma. SS1 (dsFv) PE38 is a recombinant anti-mesothelin immunotoxin that has
undergone phase I testing and has been evaluated in combination with pemetrexed and
cisplatin for treatment of malignant pleural mesothelioma. SS1 (dsFv)PE38 is highly
immunogenic and the majority of patients develop antibodies to it at end of one cycle.
Pre-clinical studies demonstrate that SS1(dsFv)PE38 may be administered multiple times in
combination with an immune-depleting regimen consisting of pentostatin and cyclophosphamide.
OBJECTIVES:
Primary Objectives:
-To assess the safety, tolerability, and feasibility of a conditioning regimen of
pentostatin and
cyclophosphamide in combination with SS1(dsFv)PE38
- To monitor antibody formation to SS1(dsFv)PE38 and to assess the impact of the
conditioning regimen on the formation of these antibodies
ELIGIBILITY:
- Patients with histologically confirmed malignant pleural or peritoneal mesothelioma
with epithelial or biphasic tumors having less than a 50% sarcomatoid component who
have previously been treated on at least one platinum-containing chemotherapy regimen
with progressive disease documented prior to study entry
- Measurable disease by modified RECIST criteria for pleural mesothelioma or by RECIST
criteria for peritoneal mesothelioma
- Adequate renal, hepatic and hematopoietic function
- No major surgery, radiotherapy, chemotherapy or biologic therapy within 28 days of
therapy
DESIGN:
- The first eleven patients enrolled in this study received a conditioning regimen of
pentostatin on days 1, 5 and 9 of the first cycle and day 1 of subsequent cycles in
combination with cyclophosphamide on days 1 through 12 of the first cycle and days 1
through 4 of subsequent cycles (Regimen A)
- The next 10 evaluable patients will receive conditioning regimen of pentostatin on days
1, 5, 9, 13 and 17 of the first cycle and day 1 and 5 of subsequent cycles in
combination with cyclophosphamide on days 1 through 20 of the first cycle and days 1
through 8 of subsequent cycles (Regimen B)
- Patients receiving Regimen A are treated with SS1(dsFv)PE38 on days 10, 12 and 14 of
the first cycle and days 2, 4, and 6 of each subsequent cycle
- Patients receiving regimen B will be treated with SS1(dsFv)PE38 on days 18, 20 and 22
of the first cycle and days 6, 8, and 10 of each subsequent cycle
- In regimen A, the first cycle consisted of 30 days, and each subsequent cycle consisted
of 21 days. Treatment cycles will be repeated for up to six cycles if patients do not
develop neutralizing antibodies, which will be assessed by a biological assay 14 and 20
days (+/- 2 days) following the first dose of SS1P in each cycle (corresponding to Days
24 and 30 of Cycle 1, and Days 16 and 22 of Cycles 2 through 6)
- In regimen B, the first cycle will consist of 38 days, and each subsequent cycle will
consist of 25 days. SS1(dsFv)PE38 will be given at a dose of 35 mcg/kg. Treatment
cycles will be repeated for up to six cycles if patients do not develop neutralizing
antibodies, which will be assessed by a biological assay 14 and 20 days (+/- 2 days)
following the first dose of SS1P in each cycle (corresponding to Days 32 and 38 of
Cycle 1, and Days 20 and 26 of Cycles 2 through 6)
- Toxicity will be assessed by the CTEP Version 4.0 of CTCAE
- Tumor response assessments will be performed at the end of 2 cycles and at the end of
treatment
- Tumor biopsies will be performed before treatment, after 2 cycles, and after the last
cycle or at follow-up.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Determining safety, tolerability, and feasibility of a conditioning regimen of pentostatin and cyclophosphamide in combination with SS1(dsFv)PE38
Raffit Hassan, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
110160
NCT01362790
May 2011
Name | Location |
---|---|
National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |