Locally Advanced Bladder Urothelial Carcinoma, Locally Advanced Renal Pelvis Urothelial Carcinoma, Locally Advanced Ureter Urothelial Carcinoma, Locally Advanced Urethral Urothelial Carcinoma, Locally Advanced Urothelial Carcinoma, Metastatic Bladder Urothelial Carcinoma, Metastatic Renal Pelvis Urothelial Carcinoma, Metastatic Ureter Urothelial Carcinoma, Metastatic Urethral Urothelial Carcinoma, Metastatic Urothelial Carcinoma, Recurrent Bladder Urothelial Carcinoma, Recurrent Renal Pelvis Urothelial Carcinoma, Recurrent Ureter Urothelial Carcinoma, Recurrent Urethral Urothelial Carcinoma, Recurrent Urothelial Carcinoma, Stage IIIA Bladder Cancer AJCC v8, Stage IIIB Bladder Cancer AJCC v8, Stage III Bladder Cancer AJCC v8, Stage III Renal Pelvis Cancer AJCC v8, Stage III Ureter Cancer AJCC v8, Stage III Urethral Cancer AJCC v8, Stage IVA Bladder Cancer AJCC v8, Stage IVB Bladder Cancer AJCC v8, Stage IV Bladder Cancer AJCC v8, Stage IV Renal Pelvis Cancer AJCC v8, Stage IV Ureter Cancer AJCC v8, Stage IV Urethral Cancer AJCC v8, Unresectable Bladder Urothelial Carcinoma, Unresectable Renal Pelvis Urothelial Carcinoma, Unresectable Ureter Urothelial Carcinoma, Unresectable Urethral Urothelial Carcinoma, Unresectable Urothelial Carcinoma
Conditions
Brief summary
This phase II trial studies the effect of nivolumab in urothelial cancer that has spread to other places in the body (metastatic), specifically in patients with aberrations in ARID1A gene (ARID1A mutation) and correlate with expression level of CXCL13, an immune cytokine. Immunotherapy with monoclonal antibodies, such as nivolumab, 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 may help control the disease in patients with urothelial cancer or solid tumors. This trial aims at enriching patient selection based on genomic and immunological attributes of the tumor.
Detailed description
PRIMARY OBJECTIVE: I. To estimate objective response rate (ORR) and overall survival (OS) in participants with ARID1A and/or KDM6A mutations receiving nivolumab and relatlimab combination therapy. II. To estimate objective response rate (ORR) and overall survival (OS) in participants with ARID1A and/or KDM6A mutations plus CXCL13-high expression and ARID1A and/or KDM6A mutations plus CXCL13-low expression, receiving nivolumab and relatlimab therapy. SECONDARY OBJECTIVES: I. To estimate progression free survival (PFS) in subjects with harboring ARID1A and/or KDM6A mutation treated with nivolumab and relatlimab combination therapy. II. To estimate progression free survival (PFS) in subjects with ARID1A and/or KDM6A mutations plus CXCL13-high expression and ARID1A and/or KDM6A mutations plus CXCL13-low expression, treated with nivolumab and relatlimab combination therapy. III. To assess peripheral and tumor infiltrating immune cell sub-populations in patients with ARID1A mutations, KDM6A mutations, ARID1A plus CXCL13-high and ARID1A plus CXCL13-low expression, KDM6A plus CXCL13-high and KDM6A plus CXCL13-low expression, to determine predictors of response and resistance. IV. To determine the expression pattern of CXCL13 in ARID1A and/or KDM6A mutant tumors OUTLINE: Patients receive nivolumab intravenously (IV) over 30 minutes on day 1. Cycles repeats 28 days (4 weeks) for up to 2 years in the absence of disease or unacceptable toxicity. After the completion of study treatment, patients are followed up for 100 days, then every 3-6 months thereafter.
Interventions
Correlative studies
Given IV
Given IV
Sponsors
Study design
Eligibility
Inclusion criteria
1. Participants will have a tumor harboring genomic mutation of ARID1A and/or KDM6A. ARID1A and/or KDM6A mutation testing will be performed as standard of care. 2. Histological or cytological evidence of metastatic or surgically unresectable urothelial cell carcinoma of the urothelial involving the bladder, urethra, ureter, or renal pelvis. Minor histologic variants (\< 50% overall) are acceptable. 3. Participants must have progression or recurrence after treatment i) with at least 1 platinum-containing chemotherapy regimen for metastatic or surgically unresectable locally advanced urothelial cancer, or ii) are ineligible or refused frontline chemotherapy. 4. All participants must have measurable disease by CT or MRI per RECIST 1.1 criteria. 5. Evaluable tumor tissue (archived or new biopsy) must be provided for biomarker analysis as FFPE tumor block or minimum of 10 slides. Archived tissue may be from prior biopsy of unresectable or metastatic disease or from prior surgical resection. Request for available archival tissue must be in process prior to registration. 6. Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1. 7. Prior palliative radiotherapy must have been completed at least 2 weeks prior to study drug administration. Participants with progression in a previously radiated field will also be eligible. 8. Screening laboratory values must meet the following criteria and must be obtained within 7 days prior to first dose: i. Neutrophils ≥ 1000/µL ii. Platelets ≥ 100 x1 x103/µL iii. Hemoglobin ≥ 8.0 g/dL iv. AST and ALT ≤ 3 x ULN (or ≤ 5 X ULN for participants with liver metastases). v. Total Bilirubin ≤ 1.5 x ULN (except subjects with Gilbert Syndrome, who can have total bilirubin \< 3.0 mg/dL) vi. Serum creatinine ≤ 2 x ULN or creatinine clearance (CrCl) ≥ 30 mL/min (using the Cockcroft-Gault formula): Female CrCl = (140 - age in years) x weight in kg x 0.85 72 x serum creatinine in mg/dL Male CrCl = (140 - age in years) x weight in kg x 1.00 72 x serum creatinine in mg/dL vii. Troponin T (TnT) or I (TnI) ≤ 2 x institutional ULN. Participants with TnT or TnI levels between \> 1 to 2 × ULN will be permitted if a repeat levels within 24 hours are ≤ ULN. If TnT or TnI levels are between \> 1 to 2 × ULN within 24 hours, the participant may undergo a cardiac consultation and be considered for treatment, following cardiologist recommendation. When repeat levels within 24 hours are not available, a repeat test should be conducted as soon as possible. If TnT or TnI repeat levels beyond 24 hours are \< 2 × ULN, the participant may undergo a cardiac consultation and be considered for treatment, following cardiologist recommendation. viii. Re-enrollment: This study permits the re-enrollment of a participant that has discontinued the study as a pre-treatment failure (ie, subject has not been treated). If re-enrolled, the participant must be re-consented and inclusion/
Exclusion criteria
reassessed. 9. Participants are required to participate in PA13-0291 for correlative studies. Participants will need to consent for biopsy and peripheral blood collection as documented in the study calendar. 10. Females of childbearing potential (FCBP) must agree to follow instructions for method(s) of contraception from the time of enrollment, for the duration of study treatment, and for 5 months after the last study dose of study treatment (see Section 8.5). 11. Males who are sexually active with FCBP must agree to follow instructions for method(s) of contraception for the duration of study treatment (see Section 8.5). Male participants should refrain from donating sperm during the study. 12. FCBP must have a negative serum or urine pregnancy test within 24 hours prior to the start of study treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective response rate (ORR) | Up to 2 years | Defined as the rate of confirmed complete responses + partial responses as determined by Response Evaluation Criteria in Solid Tumors 1.1 criteria and as assessed by the investigator. In addition, will also calculate the posterior probability that ORR is bigger in CXCL13 high group than in the CXCL low group. |
| Overall survival (OS) | From date of first study treatment to death due to any cause, assessed up to 2 years | The Kaplan-Meier method will be used to estimate the median OS and 1-year survival rate; the 95% confidence interval (CI) of the 1-year survival rate will also be reported. |
Countries
United States
Contacts
M.D. Anderson Cancer Center