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NCT05112601PHASE2Recruiting

Testing Nivolumab With or Without Ipilimumab in Deficient Mismatch Repair System (dMMR) Recurrent Endometrial Carcinoma

National Cancer Institute (NCI)

Start Date

6/2/2022

Completion Date

7/30/2032

Summary

This phase II trial tests whether the combination of nivolumab and ipilimumab is better than nivolumab alone to shrink tumors in patients with deficient mismatch repair system (dMMR) endometrial carcinoma that has come back after a period of time during which the cancer could not be detected (recurrent). Deoxyribonucleic acid (DNA) mismatch repair (MMR) is a system for recognizing and repairing damaged DNA. In 2-3% of endometrial cancers this may be due to a hereditary condition resulted from gene mutation called Lynch Syndrome (previously called hereditary nonpolyposis colorectal cancer or HNPCC). MMR deficient cells usually have many DNA mutations. Tumors that have evidence of mismatch repair deficiency tend to be more sensitive to immunotherapy. There is some evidence that nivolumab with ipilimumab can shrink or stabilize cancers with deficient mismatch repair system. However, it is not known whether this will happen in endometrial cancer; therefore, this study is designed to answer that question. Monoclonal antibodies, such as nivolumab and ipilimumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving nivolumab in combination with ipilimumab may be better than nivolumab alone in treating dMMR recurrent endometrial carcinoma.

Detailed Description

PRIMARY OBJECTIVE: I. To assess efficacy in terms of progression-free survival (PFS) for immunotherapy with dual immune checkpoint blockade (nivolumab/ipilimumab) versus (vs.) monotherapy (nivolumab) in patients with recurrent mismatch repair (MMR) deficient endometrial carcinoma with measurable or non-measurable (detectable) disease. SECONDARY OBJECTIVES: I. To evaluate the overall survival (OS) as estimated from time of enrollment to last follow-up or death. II. To evaluate the objective response rate by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in those with measurable disease at start of treatment. III. To evaluate progression-free survival at 6 months. IV. To evaluate the nature, frequency and degree of toxicity as assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0. V. To evaluate PFS and objective response rate in patients with prior anti-PD1/PDL1 therapy and compare efficacy of dual immune checkpoint inhibition vs. anti-PD1 monotherapy. OUTLINE: Patients are randomized into 1 of 2 arms. ARM I: Patients receive nivolumab intravenously (IV) over 30 minutes on day 1 of each cycle and ipilimumab IV over 90 minutes on day 1 of every other cycle. Cycles repeat every three weeks. Treatment with nivolumab and ipilimumab repeats for up to 8 cycles in the absence of disease progression, unacceptable toxicity, or complete response (CR). Patients then receive nivolumab alone on day 1 of each cycle. Cycles repeat every 4 weeks in the absence of disease progression, unacceptable toxicity, or CR. ARM II: Patients receive nivolumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 3 weeks for up to 8 cycles, then every 4 weeks thereafter in the absence of disease progression, unacceptable toxicity, or CR. MAINTENANCE THERAPY: Patients achieving CR on Arm I or II receive nivolumab for an additional 12 months in the absence of disease progression or unacceptable toxicity. Additionally, all patients may optionally undergo collection of tissue samples on study as well as blood samples throughout the trial. All patients also undergo computed tomography (CT) scan and/or magnetic resonance imaging (MRI) throughout the trial. Patients are followed every 3 months for 2 years, and then, every 6 months for 3 years.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * Patients with measurable or non-measurable (detectable) recurrent endometrial cancer * Measurable disease will be defined and monitored by RECIST v 1.1. Measurable disease is defined per RECIST 1.1 criteria as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each lesion must be \>= 10 mm when measured by computed tomography (CT) or magnetic resonance imaging (MRI). Lymph nodes must be \>= 15 mm in short axis when measured by CT or MRI * Non-measurable (detectable) disease in a patient is defined in this protocol per RECIST 1.1 criteria as one who does not have measurable disease but has at least one of the following conditions: * All other lesions (or sites of disease), including small lesions (longest diameter \<10 mm or pathological lymph nodes with \>= 10 to \< 15 mm short axis), are considered non-measurable disease * Ascites and/or pleural effusion attributed to tumor * Solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions * Patients must have endometrial cancer with deficient mismatch repair system. All patients must have institutional immunohistochemistry (IHC) and/or microsatellite instability (MSI) testing to determine mismatch repair (MMR) status. MMR deficiency is defined as lack of expression of one or more mismatch repair proteins (MLH1, PMS2, MSH2, MSH6, EPCAM) by immunohistochemistry and/or presence of microsatellite instability high using the National Cancer Institute (NCI)-5plex and Promega v1.2 assays, or institutional standards (e.g. next-generation sequencing \[NGS\] panel) * Method(s) of detection of MMR deficiency will be recorded for each patient. An institutional pathology report, and additional reports if available, documenting these results must be submitted. Patients with "equivocal" results on MMR testing by immunohistochemistry may be eligible if they have documented evidence of microsatellite instability by MSI testing or by next generation sequencing assays. MMR testing by IHC may be used to resolve equivocal/indeterminate MSI results * Histologic confirmation of the original primary tumor is required (submission of pathology report(s) is required). Patients with the following histologic types are eligible: Endometrioid adenocarcinoma, mucinous adenocarcinoma, dedifferentiated/undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, adenocarcinoma not otherwise specified (N.O.S.) * Patients may have received 1-2 prior lines of systemic therapy: * Prior anti-PD1/PD-L1 therapy is allowed if given in combination with chemotherapy or radiation therapy in adjuvant or primary metastatic/recurrent settings. Patients must have had a complete response and have disease progression/relapse with treatment-free interval of 12 months or more from last dose of therapy with immune check inhibition * Patients may have received prior radiation therapy for treatment of endometrial cancer. Prior radiation therapy may have included pelvic radiation therapy, extended field pelvic/para aortic radiation therapy, intravaginal brachytherapy, and/or palliative radiation therapy. All radiation therapy must be completed at least 4 weeks prior to registration * Patients may have received prior hormonal therapy for treatment of endometrial cancer. All hormonal therapy must be discontinued at least three weeks prior to registration * Any other prior therapy directed at the malignant tumor including chemotherapy, targeted agents, biologic agents, immunologic agents, and any investigational agents, must be discontinued at least 4 weeks prior to registration (6 weeks for nitrosoureas or mitomycin C) * Age \>= 18 * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1, or 2 * Platelets \>= 100,000/mcl * Absolute neutrophil count (ANC) \>= 1,500/mcl * Creatinine =\< 1.5 x institutional/laboratory upper limit of normal (ULN) * Total serum bilirubin level =\< 1.5 x ULN (patients with known Gilbert's disease who have bilirubin level =\<3 x ULN may be enrolled) * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 3 x ULN * Adequate oxygen saturation via pulse oximeter (CTCAE v.5.0 hypoxia \< grade 2 within 28 days prior to registration) * Thyroid-stimulating hormone (TSH) within normal limits (TSH \< ULN allowed in euthyroid patients on thyroid replacement therapy). TSH testing is only required if clinically indicated * Patients must have recovered from effects of recent surgery, radiotherapy or chemotherapy. At least 4 weeks must have elapsed since major surgery * As clinically indicated, patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better and have a corrected QT (QTc) interval \< 450 msec * The effects of nivolumab, and ipilimumab on the developing human fetus are unknown. For this reason and because nivolumab and ipilimumab are known to be teratogenic, women of child-bearing potential (WOCBP) must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for 5 months after the last dose of investigational drug. Women of childbearing potential must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin \[HCG\]) within 24 hours prior to the start of nivolumab. Women must not be breastfeeding. Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile) do not require contraception * WOCBP is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. In addition, women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level less than 40 mIU/mL * Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial * Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of registration are eligible for this trial * Patients with evidence of chronic hepatitis B virus (HBV) infection must have an undetectable HBV viral load on suppressive therapy, if indicated * Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load * Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression and the patient is stable off steroids for at least one month * The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information * Patients with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible * Patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible Exclusion Criteria: * Patients with a diagnosis of endometrial serous carcinoma or carcinosarcoma * Patients who received prior anti-PD1/PD-L1 therapy and had grade 3-4 or recurring grade 2 immune-related toxicities that led to dose delay or discontinuation of immunotherapy due to those toxicities * Patients who received anti-CTLA-4 therapy or other immunotherapeutic agents * Patients on chronic steroid therapy except those on replacement therapy at a daily dose of 10mg or less prednisone or equivalent * Patients on immunosuppressive therapy, with the exception of: * Intra-nasal, inhaled, topical or local steroid injections * Premedication for hypersensitivity reaction * Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, should be excluded. These include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome should be excluded because of the risk of recurrence or exacerbation of disease * Patients with known immune impairment who may be unable to respond to anti-CTLA-4 antibody * Patients with uncontrolled intercurrent illness including, but not limited to: ongoing or active infection (except for uncomplicated urinary tract infection), interstitial lung disease or active, non-infectious pneumonitis, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Women who are pregnant or unwilling to discontinue nursing * Prior therapy with CTLA-4 inhibitors, or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways * History of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab, and/or ipilimumab including severe hypersensitivity reactions to any monoclonal antibody

Interventions

PROCEDURE

Biospecimen Collection

PROCEDURE

Computed Tomography

BIOLOGICAL

Ipilimumab

PROCEDURE

Magnetic Resonance Imaging

BIOLOGICAL

Nivolumab

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Conditions

Endometrial AdenocarcinomaEndometrial Clear Cell AdenocarcinomaEndometrial Dedifferentiated CarcinomaEndometrial Endometrioid AdenocarcinomaEndometrial Mixed Cell AdenocarcinomaEndometrial Mucinous AdenocarcinomaEndometrial Undifferentiated CarcinomaEndometrioid AdenocarcinomaRecurrent Endometrial Carcinoma

Locations

University of Alabama at Birmingham Cancer Center

Birmingham, Alabama 35233

United States

University Cancer and Blood Center LLC

Athens, Georgia 30607

United States

Augusta University Medical Center

Augusta, Georgia 30912

United States

Saint Alphonsus Cancer Care Center-Boise

Boise, Idaho 83706

United States

Saint Luke's Cancer Institute - Boise

Boise, Idaho 83712

United States

Saint Alphonsus Cancer Care Center-Caldwell

Caldwell, Idaho 83605

United States

Kootenai Health - Coeur d'Alene

Coeur d'Alene, Idaho 83814

United States

Saint Luke's Cancer Institute - Fruitland

Fruitland, Idaho 83619

United States

Saint Luke's Cancer Institute - Meridian

Meridian, Idaho 83642

United States

Saint Alphonsus Cancer Care Center-Nampa

Nampa, Idaho 83687

United States

Saint Luke's Cancer Institute - Nampa

Nampa, Idaho 83687

United States

Kootenai Clinic Cancer Services - Post Falls

Post Falls, Idaho 83854

United States

Kootenai Clinic Cancer Services - Sandpoint

Sandpoint, Idaho 83864

United States

University of Illinois

Chicago, Illinois 60612

United States

Carle at The Riverfront

Danville, Illinois 61832

United States

Carle Physician Group-Effingham

Effingham, Illinois 62401

United States

Carle Physician Group-Mattoon/Charleston

Mattoon, Illinois 61938

United States

Carle BroMenn Medical Center

Normal, Illinois 61761

United States

Carle Cancer Institute Normal

Normal, Illinois 61761

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

IU Health North Hospital

Carmel, Indiana 46032

United States

Northwest Cancer Center - Crown Point

Crown Point, Indiana 46307

United States

Northwest Oncology LLC

Dyer, Indiana 46311

United States

Northwest Cancer Center - Hobart

Hobart, Indiana 46342

United States

Saint Mary Medical Center

Hobart, Indiana 46342

United States

Indiana University/Melvin and Bren Simon Cancer Center

Indianapolis, Indiana 46202

United States

Saint Catherine Hospital

Indianapolis, Indiana 46312

United States

The Community Hospital

Munster, Indiana 46321

United States

Women's Diagnostic Center - Munster

Munster, Indiana 46321

United States

Northwest Cancer Center - Valparaiso

Valparaiso, Indiana 46383

United States

University of Iowa/Holden Comprehensive Cancer Center

Iowa City, Iowa 52242

United States

The James Graham Brown Cancer Center at University of Louisville

Louisville, Kentucky 40202

United States

UofL Health Medical Center Northeast

Louisville, Kentucky 40245

United States

MaineHealth Maine Medical Center- Scarborough

Scarborough, Maine 04074

United States

Bronson Battle Creek

Battle Creek, Michigan 49017

United States

Corewell Health Grand Rapids Hospitals - Butterworth Hospital

Grand Rapids, Michigan 49503

United States

Trinity Health Grand Rapids Hospital

Grand Rapids, Michigan 49503

United States

Bronson Methodist Hospital

Kalamazoo, Michigan 49007

United States

West Michigan Cancer Center

Kalamazoo, Michigan 49007

United States

Beacon Kalamazoo Cancer Center

Kalamazoo, Michigan 49009

United States

Trinity Health Muskegon Hospital

Muskegon, Michigan 49444

United States

Corewell Health Lakeland Hospitals - Niles Hospital

Niles, Michigan 49120

United States

Cancer and Hematology Centers of Western Michigan - Norton Shores

Norton Shores, Michigan 49444

United States

Corewell Health Reed City Hospital

Reed City, Michigan 49677

United States

Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center

Saint Joseph, Michigan 49085

United States

Corewell Health Lakeland Hospitals - Saint Joseph Hospital

Saint Joseph, Michigan 49085

United States

Munson Medical Center

Traverse City, Michigan 49684

United States

University of Michigan Health - West

Wyoming, Michigan 49519

United States

Mercy Hospital

Coon Rapids, Minnesota 55433

United States

Essentia Health - Deer River Clinic

Deer River, Minnesota 56636

United States

Essentia Health Cancer Center

Duluth, Minnesota 55805

United States

Miller-Dwan Hospital

Duluth, Minnesota 55805

United States

Fairview Southdale Hospital

Edina, Minnesota 55435

United States

Essentia Health Hibbing Clinic

Hibbing, Minnesota 55746

United States

Abbott-Northwestern Hospital

Minneapolis, Minnesota 55407

United States

Park Nicollet Clinic - Saint Louis Park

Saint Louis Park, Minnesota 55416

United States

Regions Hospital

Saint Paul, Minnesota 55101

United States

United Hospital

Saint Paul, Minnesota 55102

United States

Essentia Health Sandstone

Sandstone, Minnesota 55072

United States

Saint Francis Regional Medical Center

Shakopee, Minnesota 55379

United States

Essentia Health Virginia Clinic

Virginia, Minnesota 55792

United States

MU Health - University Hospital/Ellis Fischel Cancer Center

Columbia, Missouri 65212

United States

Washington University School of Medicine

St Louis, Missouri 63110

United States

Community Hospital of Anaconda

Anaconda, Montana 59711

United States

Billings Clinic Cancer Center

Billings, Montana 59101

United States

Saint Vincent Frontier Cancer Center

Billings, Montana 59102

United States

Intermountain Health West End Clinic

Billings, Montana 59106

United States

Bozeman Health Deaconess Hospital

Bozeman, Montana 59715

United States

Benefis Sletten Cancer Institute

Great Falls, Montana 59405

United States

Logan Health Medical Center

Kalispell, Montana 59901

United States

Community Medical Center

Missoula, Montana 59804

United States

Nebraska Methodist Hospital

Omaha, Nebraska 68114

United States

Women's Cancer Center of Nevada

Las Vegas, Nevada 89106

United States

University of New Mexico Cancer Center

Albuquerque, New Mexico 87106

United States

Roswell Park Cancer Institute

Buffalo, New York 14263

United States

University of Rochester

Rochester, New York 14642

United States

State University of New York Upstate Medical University

Syracuse, New York 13210

United States

Wilmot Cancer Institute at Webster

Webster, New York 14580

United States

Duke University Medical Center

Durham, North Carolina 27710

United States

Duke Women's Cancer Care Raleigh

Raleigh, North Carolina 27607

United States

Essentia Health Cancer Center-South University Clinic

Fargo, North Dakota 58103

United States

UHHS-Chagrin Highlands Medical Center

Beachwood, Ohio 44122

United States

Miami Valley Hospital South

Centerville, Ohio 45459

United States

Geauga Hospital

Chardon, Ohio 44024

United States

Good Samaritan Hospital - Cincinnati

Cincinnati, Ohio 45220

United States

Case Western Reserve University

Cleveland, Ohio 44106

United States

Cleveland Clinic Cancer Center/Fairview Hospital

Cleveland, Ohio 44111

United States

Cleveland Clinic Foundation

Cleveland, Ohio 44195

United States

Ohio State University Comprehensive Cancer Center

Columbus, Ohio 43210

United States

Hillcrest Hospital Cancer Center

Mayfield Heights, Ohio 44124

United States

UH Seidman Cancer Center at Lake Health Mentor Campus

Mentor, Ohio 44060

United States

University Hospitals Parma Medical Center

Parma, Ohio 44129

United States

UH Seidman Cancer Center at Saint John Medical Center

Westlake, Ohio 44145

United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma 73104

United States

Oklahoma Cancer Specialists and Research Institute-Tulsa

Tulsa, Oklahoma 74146

United States

Saint Alphonsus Cancer Care Center-Ontario

Ontario, Oregon 97914

United States

Providence Portland Medical Center

Portland, Oregon 97213

United States

Providence Saint Vincent Medical Center

Portland, Oregon 97225

United States

UPMC-Heritage Valley Health System Beaver

Beaver, Pennsylvania 15009

United States

UPMC Hillman Cancer Center at Butler Health System

Butler, Pennsylvania 16001

United States

UPMC Hillman Cancer Center - Passavant - Cranberry

Cranberry Township, Pennsylvania 16066

United States

UPMC Hillman Cancer Center Erie

Erie, Pennsylvania 16505

United States

UPMC Cancer Center at UPMC Horizon

Farrell, Pennsylvania 16121

United States

UPMC Cancer Centers - Arnold Palmer Pavilion

Greensburg, Pennsylvania 15601

United States

IRMC Cancer Center

Indiana, Pennsylvania 15701

United States

UPMC-Johnstown/John P. Murtha Regional Cancer Center

Johnstown, Pennsylvania 15901

United States

UPMC Cancer Center at UPMC McKeesport

McKeesport, Pennsylvania 15132

United States

UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion

Mechanicsburg, Pennsylvania 17050

United States

UPMC Hillman Cancer Center - Monroeville

Monroeville, Pennsylvania 15146

United States

UPMC Hillman Cancer Center in Coraopolis

Moon Township, Pennsylvania 15108

United States

UPMC Hillman Cancer Center - Part of Frick Hospital

Mount Pleasant, Pennsylvania 15666

United States

Arnold Palmer Cancer Center Medical Oncology Norwin

N. Huntingdon, Pennsylvania 15642

United States

UPMC Cancer Center-Natrona Heights

Natrona Heights, Pennsylvania 15065

United States

UPMC Hillman Cancer Center - New Castle

New Castle, Pennsylvania 16105

United States

UPMC-Magee Womens Hospital

Pittsburgh, Pennsylvania 15213

United States

UPMC-Saint Margaret

Pittsburgh, Pennsylvania 15215

United States

UPMC-Mercy Hospital

Pittsburgh, Pennsylvania 15219

United States

UPMC Hillman Cancer Center

Pittsburgh, Pennsylvania 15232

United States

UPMC-Passavant Hospital

Pittsburgh, Pennsylvania 15237

United States

UPMC-Saint Clair Hospital Cancer Center

Pittsburgh, Pennsylvania 15243

United States

UPMC Cancer Center at UPMC Northwest

Seneca, Pennsylvania 16346

United States

UPMC Cancer Center-Washington

Washington, Pennsylvania 15301

United States

UPMC West Mifflin-Cancer Center Jefferson

West Mifflin, Pennsylvania 15122

United States

Women and Infants Hospital

Providence, Rhode Island 02905

United States

Parkland Memorial Hospital

Dallas, Texas 75235

United States

UT Southwestern/Simmons Cancer Center-Dallas

Dallas, Texas 75390

United States

UT Southwestern/Simmons Cancer Center-Fort Worth

Fort Worth, Texas 76104

United States

UT Southwestern Clinical Center at Richardson/Plano

Richardson, Texas 75080

United States

University of Virginia Cancer Center

Charlottesville, Virginia 22908

United States

Henrico Doctor's Hospital

Richmond, Virginia 23229

United States

VCU Massey Comprehensive Cancer Center

Richmond, Virginia 23298

United States

Swedish Cancer Institute-Edmonds

Edmonds, Washington 98026

United States

Swedish Cancer Institute-Issaquah

Issaquah, Washington 98029

United States

Fred Hutchinson Cancer Center

Seattle, Washington 98109

United States

Swedish Medical Center-First Hill

Seattle, Washington 98122

United States

Duluth Clinic Ashland

Ashland, Wisconsin 54806

United States

Northwest Wisconsin Cancer Center

Ashland, Wisconsin 54806

United States