RECRUITING

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

Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

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.

Official Title

A Randomized Phase II Trial of Nivolumab and Ipilimumab Compared to Nivolumab Monotherapy in Patients With Deficient Mismatch Repair System Recurrent Endometrial Carcinoma

Quick Facts

Study Start:2022-06-02
Study Completion:2026-04-30
Study Type:Not specified
Phase:Not Applicable
Enrollment:Not specified
Status:RECRUITING

Study ID

NCT05112601

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years
Sexes Eligible for Study:FEMALE
Accepts Healthy Volunteers:No
Standard Ages:ADULT, OLDER_ADULT
Inclusion CriteriaExclusion Criteria
  1. * Patients with measurable or non-measurable (detectable) recurrent endometrial cancer
  2. * 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
  3. * 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:
  4. * 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
  5. * Ascites and/or pleural effusion attributed to tumor
  6. * Solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions
  7. * 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)
  8. * 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
  9. * 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.)
  10. * Patients may have received 1-2 prior lines of systemic therapy:
  11. * 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
  12. * 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
  13. * 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
  14. * 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)
  15. * Age \>= 18
  16. * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1, or 2
  17. * Platelets \>= 100,000/mcl
  18. * Absolute neutrophil count (ANC) \>= 1,500/mcl
  19. * Creatinine =\< 1.5 x institutional/laboratory upper limit of normal (ULN)
  20. * Total serum bilirubin level =\< 1.5 x ULN (patients with known Gilbert's disease who have bilirubin level =\<3 x ULN may be enrolled)
  21. * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 3 x ULN
  22. * Adequate oxygen saturation via pulse oximeter (CTCAE v.5.0 hypoxia \< grade 2 within 28 days prior to registration)
  23. * 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
  24. * Patients must have recovered from effects of recent surgery, radiotherapy or chemotherapy. At least 4 weeks must have elapsed since major surgery
  25. * 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
  26. * 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
  27. * 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
  28. * 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
  29. * 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
  30. * Patients with evidence of chronic hepatitis B virus (HBV) infection must have an undetectable HBV viral load on suppressive therapy, if indicated
  31. * 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
  32. * 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
  33. * 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
  34. * Patients with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible
  35. * 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
  1. * Patients with a diagnosis of endometrial serous carcinoma or carcinosarcoma
  2. * 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
  3. * Patients who received anti-CTLA-4 therapy or other immunotherapeutic agents
  4. * Patients on chronic steroid therapy except those on replacement therapy at a daily dose of 10mg or less prednisone or equivalent
  5. * Patients on immunosuppressive therapy, with the exception of:
  6. * Intra-nasal, inhaled, topical or local steroid injections
  7. * Premedication for hypersensitivity reaction
  8. * 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
  9. * Patients with known immune impairment who may be unable to respond to anti-CTLA-4 antibody
  10. * 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
  11. * Women who are pregnant or unwilling to discontinue nursing
  12. * Prior therapy with CTLA-4 inhibitors, or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways
  13. * 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

Contacts and Locations

Principal Investigator

Haider S Mahdi
PRINCIPAL_INVESTIGATOR
NRG Oncology

Study Locations (Sites)

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 Cancer Center
Urbana, Illinois, 61801
United States
IU Health North Hospital
Carmel, Indiana, 46032
United States
Northwest Cancer Center - Main Campus
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
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
United Hospital
Saint Paul, Minnesota, 55102
United States
Essentia Health Sandstone
Sandstone, Minnesota, 55072
United States
Essentia Health Virginia Clinic
Virginia, Minnesota, 55792
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
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
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
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
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
University of Pittsburgh Cancer Institute (UPCI)
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
Fred Hutchinson Cancer Center
Seattle, Washington, 98109
United States
Duluth Clinic Ashland
Ashland, Wisconsin, 54806
United States
Northwest Wisconsin Cancer Center
Ashland, Wisconsin, 54806
United States

Collaborators and Investigators

Sponsor: National Cancer Institute (NCI)

  • Haider S Mahdi, PRINCIPAL_INVESTIGATOR, NRG Oncology

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2022-06-02
Study Completion Date2026-04-30

Study Record Updates

Study Start Date2022-06-02
Study Completion Date2026-04-30

Terms related to this study

Additional Relevant MeSH Terms

  • Endometrial Adenocarcinoma
  • Endometrial Clear Cell Adenocarcinoma
  • Endometrial Dedifferentiated Carcinoma
  • Endometrial Endometrioid Adenocarcinoma
  • Endometrial Mixed Cell Adenocarcinoma
  • Endometrial Mucinous Adenocarcinoma
  • Endometrial Undifferentiated Carcinoma
  • Endometrioid Adenocarcinoma
  • Recurrent Endometrial Carcinoma