Phase II Trial of Pembrolizumab and Radiotherapy in Cutaneous T-cell Lymphoma
Phase II Trial of Pembrolizumab and Radiotherapy in Cutaneous T-cell Lymphoma
Trial Subjects (patients), will receive single infusions of pembrolizumab every 3 weeks until disease progression or unacceptable toxicity develops. They will receive radiotherapy at week 12.
Trial Subjects (patients) who are deemed eligible for the trial will be administered a single infusion of pembrolizumab (200mg) every 3 weeks. At week 12, patients will be planned to start radiotherapy at a dose of 12 Gray (Gy) in 3 fractions which will be given concomitantly with pembrolizumab. Patients who progress on pembrolizumab before week 12 will start radiotherapy as soon as possible after progression. Following completion of radiotherapy, patients will continue receiving pembrolizumab at 3 weekly intervals for a maximum of 2 years until disease progression or unacceptable toxicity develops. Patients on pembrolizumab will be seen every 3 weeks until 2 years after study entry, while Patients who progressed/ stopped pembrolizumab will be seen annually for survival/disease status only. Patients completing 2 years of treatment will then be followed up annually for survival and disease status until the end of trial is declared (2 years after the last patient is registered).
Inclusion Criteria:
Age ≥ 18 years
Diagnosis of Stage IB-IVB CTCL mycosis fungoides (MF)/Sézary Syndrome (SS)
Have relapsed, are refractory or progressed after at least 1 systemic therapy
Skin biopsy at the time of or within 6 months prior to study entry
Patients must have a total mSWAT (modified Severity Weighted Assessment Tool) score of ≥10 OR have 2 or more measurable tumours of any size. Of this area: there should be at least 1 cutaneous lesion (MF) or a defined area of involved skin (erythrodermic MF or SS) which is an appropriate target for palliative radiotherapy. There should be an area of skin involved by measurable Mycosis Fungoides/SS that will not be irradiated (To assess the abscopal effect of radiotherapy)
Have a minimum wash-out and adverse event (AE) recovery period from previous treatments (e.g. topical therapy, phototherapy, local radiotherapy, monoclonal antibody, systemic cytotoxic anticancer treatment or other novel agents) prior to the first dose of pembrolizumab
Have ECOG performance status of 0 or 1
Life expectancy of at least 6 months
Demonstrate adequate organ function
Female patients of childbearing potential must have a negative urine or serum pregnancy test at pre-registration. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
Willing to comply with the contraception requirements
Written informed consent
•Exclusion Criteria:
Received chemotherapy or targeted small molecule therapy within 4 weeks prior to study entry or has not recovered from adverse events due to agents administered >4 weeks earlier (except patients with ≤ grade 2 neuropathy)
Is currently or has participated in an IMP or device study within 4 weeks prior to the first dose of pembrolizumab
Received any other monoclonal antibody within 15 weeks prior to the first dose of pembrolizumab or has not recovered (≤ grade 1 or to baseline level) from adverse events due to agents administered >4 weeks earlier. The exception to this is alemtuzumab which should not have been administered in the previous 12 weeks
Additional malignancy that is progressing or requires active treatment
Patients with known central nervous system (CNS) involvement with lymphoma
Hypersensitivity to pembrolizumab or its excipients
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 (such as thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Stable use of corticosteroids (at a dose no higher than 10mg prednisolone per day over the preceding 4 weeks) is allowed
Diagnosis of prior immunodeficiency or organ-transplant requiring immunosuppressive therapy
Current or prior use of immunosuppressive therapy within 7 days prior to start of treatment except the following: intranasal, inhaled, topical steroids or local steroid injections (eg. Intra-articular injection); systemic corticosteroids at physiologic doses (10mg/day or less of prednisolone or equivalent)
Prior treatment with anti-PD-1, anti-PD-L1, anti-PD-L2 therapy
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris or cardiac arrhythmia
Has known history of, or any evidence of active, non-infectious pneumonitis
History of other pulmonary disease such as interstitial lung disease, emphysema or chronic obstructive pulmonary disease
Is pregnant or breastfeeding
Has a known history of active TB
Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial or interfere with the subject's participation for the full duration of the trial or to participate in the trial is not in the patient's best interest, in the opinion of the treating investigator
Has known psychiatric or substance abuse disorders that would interfere with the requirements of the trial
Has a known history of HIV
Has known active Hepatitis B or Hepatitis C
Has received a live vaccine within 30 days prior to the planned start of study medication
Patients who have previously received a solid organ transplant
Patients who have previously received any allogeneic transplantation