Nivolumab + Plinabulin for Lung Cancer

Overseen By Sauntee Braddock

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: Lyudmila Bazhenova, M.D.

Must not be taking: Immunosuppressants, Systemic steroids

Disqualifiers: Cardiovascular illness, Autoimmune disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Compensation: Varies

Number of Visits: 1

Duration: Until disease progression

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how plinabulin, an investigational drug, works with nivolumab (also known as Opdivo, an immunotherapy drug) to treat metastatic squamous non-small cell lung cancer. Researchers believe plinabulin fights cancer by stopping blood supply to tumors and killing cancer cells. The trial targets individuals whose lung cancer has worsened after platinum-based chemotherapy. Those who have had at least one prior cancer treatment for their metastatic disease and can manage daily life activities might be a good fit. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering participants the opportunity to be among the first to receive this new treatment.

Do I need to stop my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, you cannot use immunosuppressive medications or systemic steroids, and you must not have used other investigational drugs within 28 days before starting the trial.

Is there any evidence suggesting that this treatment is likely to be safe for humans?

Research has shown that combining nivolumab and plinabulin is generally safe. In a study with 38 patients, a specific dose of plinabulin (30 mg/m2) was well-tolerated, meaning patients did not experience serious side effects that outweighed the treatment's potential benefits.

Nivolumab is a common treatment for some lung cancers, while plinabulin remains under investigation. Early results suggest that adding plinabulin to nivolumab does not cause unexpected safety issues. Individual experiences can vary, and trial participants will receive close monitoring by healthcare professionals. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about the combination of Nivolumab and Plinabulin for lung cancer because it brings a novel approach to treatment. While standard therapies often involve chemotherapy or targeted drugs, Nivolumab is an immunotherapy that helps the immune system better recognize and attack cancer cells. Plinabulin, on the other hand, is being studied for its ability to prevent certain side effects of chemotherapy and enhance the immune response. This dual action aims to not only tackle the cancer more effectively but also improve patients' overall treatment experience.

What evidence suggests that the combination of nivolumab and plinabulin could be effective for lung cancer?

Research has shown that plinabulin might help fight lung cancer by cutting off the blood supply to the tumor and directly killing cancer cells. In this trial, participants will receive a combination of plinabulin and nivolumab. Used together, these drugs have shown some promising results. For instance, in a study with patients who didn't respond to other treatments, tumor sizes shrank by 68% and 52% in two patients. However, the overall benefits for larger groups of patients have been limited. Nivolumab alone is already an approved treatment for non-small cell lung cancer and works well for many patients. Researchers continue to study whether combining it with plinabulin can improve these results. ^{1 4 6 7 8}

Who Is on the Research Team?

Lyudmilla Bazhenova, MD

Principal Investigator

University of California, San Diego

Are You a Good Fit for This Trial?

This trial is for adults with metastatic non-small cell lung cancer (NSCLC) that worsened after platinum-based chemo. They must have had at least one other systemic treatment, be in fairly good health (ECOG ≤1), and expected to live at least 12 weeks. Participants need a measurable tumor and adequate organ function, should be past certain treatments like brain radiation or surgery by specific times, and can't have untreated brain metastases.

Inclusion Criteria

Must have at least 1 measurable lesion per Response Evaluation Criteria in Solid Tumors (RECIST).

Adequate hematopoietic, electrolyte, hepatic, and renal laboratory findings.

I've had at least one treatment for cancer that has spread, but treatments for early-stage cancer don't count unless I got worse within 6 months.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive nivolumab and escalating doses of plinabulin in 4-week cycles until disease progression

Until disease progression

Visits on Days 1, 8, and 15 of each 4-week cycle

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Nivolumab
• Plinabulin

Trial Overview The study tests plinabulin combined with nivolumab against NSCLC. Plinabulin is experimental and aims to block tumor blood supply and kill cancer cells. Nivolumalb is standard for this cancer post-chemo failure. Up to 38 patients will join the study to see if this combo improves their condition.

How Is the Trial Designed?

Group I: Nivolumab + Plinabulin Experimental Treatment 1 Intervention

Nivolumab 240mg IV, day 1 and 15 until disease progression Plinabulin 3.5mg/m2, 20mg/m2, 30 mg/m2 or 40mg/m2 IV, day 1,8 and 15 until disease progression

Nivolumab is already approved in United States, European Union, Canada, Switzerland for the following indications:

Approved in United States as Opdivo for:

• Advanced or metastatic gastric cancer
• Gastroesophageal junction cancer
• Esophageal adenocarcinoma
• Melanoma
• Non-small cell lung cancer
• Renal cell carcinoma
• Hodgkin lymphoma
• Head and neck squamous cell carcinoma
• Urothelial carcinoma
• Colorectal cancer
• Hepatocellular carcinoma
• Esophageal squamous cell carcinoma

Approved in European Union as Opdivo for:

• Melanoma
• Non-small cell lung cancer
• Renal cell carcinoma
• Hodgkin lymphoma
• Head and neck squamous cell carcinoma
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Gastroesophageal junction cancer
• Esophageal adenocarcinoma

Approved in Canada as Opdivo for:

• Melanoma
• Non-small cell lung cancer
• Renal cell carcinoma
• Hodgkin lymphoma
• Head and neck squamous cell carcinoma
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Gastroesophageal junction cancer
• Esophageal adenocarcinoma

Approved in Switzerland as Opdivo for:

• Melanoma
• Non-small cell lung cancer
• Renal cell carcinoma
• Hodgkin lymphoma
• Head and neck squamous cell carcinoma
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Gastroesophageal junction cancer
• Esophageal adenocarcinoma

Who Is Running the Clinical Trial?

Lyudmila Bazhenova, M.D.

Lead Sponsor

Trials

2

Recruited

30+

BeyondSpring Pharmaceuticals Inc.

Industry Sponsor

Trials

9

Recruited

1,200+

Published Research Related to This Trial

Nivolumab, an immune checkpoint inhibitor, significantly improves overall survival and progression-free survival in patients with advanced stage squamous cell non-small cell lung cancer (NSCLC) compared to docetaxel, as shown in the CHECKMATE 017 study.

The safety and tolerability of nivolumab are favorable, and interestingly, the expression of the PD-L1 ligand does not predict treatment outcomes, suggesting that other factors may influence the effectiveness of this therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab in the treatment of metastatic squamous non-small cell lung cancer: a review of the evidence. Lim, JS., Soo, RA.[2018]

In a phase 2 trial involving 117 patients with advanced, refractory squamous non-small-cell lung cancer, nivolumab demonstrated a 14.5% objective response rate, indicating its potential effectiveness as a treatment option.

The safety profile of nivolumab was manageable, with 17% of patients experiencing severe treatment-related adverse events, suggesting that while there are risks, the benefits may outweigh them for patients with limited treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Activity and safety of nivolumab, an anti-PD-1 immune checkpoint inhibitor, for patients with advanced, refractory squamous non-small-cell lung cancer (CheckMate 063): a phase 2, single-arm trial. Rizvi, NA., Mazières, J., Planchard, D., et al.[2022]

Nivolumab (Opdivo) significantly improves overall survival and response rates in previously-treated patients with advanced nonsquamous non-small cell lung cancer (NSCLC) compared to docetaxel, as shown in the CheckMate 057 trial.

Nivolumab has a manageable adverse event profile and is better tolerated than docetaxel, making it a valuable treatment option for patients who have progressed after chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab: A Review in Advanced Nonsquamous Non-Small Cell Lung Cancer. Keating, GM.[2018]

In a meta-analysis of 16 clinical trials involving 6208 patients with non-small cell lung cancer, the overall incidence of immune-related adverse events (irAEs) was found to be 22%, with a higher rate of severe irAEs (4%) associated with PD-1 inhibitors compared to PD-L1 inhibitors.

The most common organ-specific irAEs occurred in the endocrine system, skin, pulmonary tract, and gastrointestinal tract, with pneumonitis being the leading cause of death among the 14 patients (0.34%) who died due to irAEs, highlighting the importance of monitoring and managing these side effects during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immune-related adverse events associated with programmed cell death protein-1 and programmed cell death ligand 1 inhibitors for non-small cell lung cancer: a PRISMA systematic review and meta-analysis. Sun, X., Roudi, R., Dai, T., et al.[2020]

Nivolumab, an immune checkpoint inhibitor, significantly improved overall survival and progression-free survival compared to docetaxel in patients with advanced squamous non-small cell lung cancer (NSCLC) in the CheckMate 017 trial.

Nivolumab was better tolerated than docetaxel, with manageable adverse effects, making it a promising treatment option for patients who have already undergone chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab: a review in advanced squamous non-small cell lung cancer. Keating, GM.[2022]

Nivolumab (Opdivo) is the first PD-1 inhibitor approved for advanced-stage squamous cell non-small-cell lung cancer, showing improved overall survival and progression-free survival compared to docetaxel in the Phase III CHECKMATE 017 trial.

Nivolumab demonstrated better safety and tolerability, along with improved patient-reported outcomes, although PD-L1 expression did not predict treatment outcomes, indicating a need for further research on predictive biomarkers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Profile of nivolumab in the treatment of metastatic squamous non-small-cell lung cancer. Ang, YL., Lim, JS., Soo, RA.[2020]

Nivolumab, an immune checkpoint inhibitor, showed a tolerable safety profile in 52 patients with advanced non-small-cell lung cancer (NSCLC), with 71% experiencing treatment-related adverse events, primarily fatigue and rash.

The treatment resulted in a confirmed objective response rate of 23%, with some patients achieving ongoing complete responses, and a median overall survival of 19.4 months, indicating its potential as an effective first-line therapy for advanced NSCLC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab Monotherapy for First-Line Treatment of Advanced Non-Small-Cell Lung Cancer. Gettinger, S., Rizvi, NA., Chow, LQ., et al.[2022]

In a study of 79 pre-treated patients with advanced non-small cell lung cancer, nivolumab significantly prolonged progression-free survival, especially in patients who had a partial response to prior treatments.

The occurrence of skin rash during nivolumab treatment was associated with improved long-term survival, suggesting that this side effect may indicate a favorable response to the therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analysis of Pleiotropic Effects of Nivolumab in Pretreated Advanced or Recurrent Non-small Cell Lung Cancer Cases. Akano, Y., Kuribayashi, K., Funaguchi, N., et al.[2020]

In a study of patients with non-small cell lung cancer treated with nivolumab, those who experienced serious adverse events (grade ≥3) had significantly better overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) compared to those without such events.

The findings suggest that while serious adverse events are typically concerning, they may be associated with a more favorable treatment response in patients receiving nivolumab, indicating a complex relationship between adverse effects and treatment efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serious Immune-related Adverse Events Are Associated With Greater Efficacy of Nivolumab Therapy Against Non-small Cell Lung Cancer. Blazek, J., Hosek, P., Hrabcova, K., et al.[2023]

Monoclonal antibodies like nivolumab and pembrolizumab, which target PD-1, have shown a survival benefit and better tolerability compared to standard second-line chemotherapy in non-small cell lung cancer, as demonstrated in three phase III trials.

Patients receiving PD-1 inhibitors may experience unique immune-related adverse events that require early recognition and a multidisciplinary management approach, highlighting the need for ongoing education among healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Monitoring and Management of Immune-Related Adverse Events Associated With Programmed Cell Death Protein-1 Axis Inhibitors in Lung Cancer. O'Kane, GM., Labbé, C., Doherty, MK., et al.[2018]

Nivolumab, a PD-1 receptor inhibitor, shows an objective response rate of 18% and a 1-year overall survival rate of 45% in patients with advanced non-small-cell lung cancer, based on a meta-analysis of 20 studies involving 3404 patients.

The presence of PD-L1 expression in patients is associated with a better response to nivolumab, indicating that PD-L1 status can help predict treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The benefit and risk of nivolumab in non-small-cell lung cancer: a single-arm meta-analysis of noncomparative clinical studies and randomized controlled trials. Zhao, B., Zhang, W., Yu, D., et al.[2019]

In a study of 145 patients with PD-L1 strongly positive non-small-cell lung cancer (NSCLC), those with higher PD-L1 expression (≥ 75%) experienced better treatment outcomes with pembrolizumab, showing a higher objective response rate (51% vs. 33%) and longer progression-free survival (13.9 months vs. 5.2 months).

Patients with liver metastasis had significantly poorer responses to pembrolizumab, with an objective response rate of only 20% compared to 47% in those without liver metastasis, indicating that both PD-L1 expression and liver metastasis are important predictors of treatment efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential Efficacy of Pembrolizumab According to Metastatic Sites in Patients With PD-L1 Strongly Positive (TPS ≥ 50%) NSCLC. Takeyasu, Y., Yoshida, T., Shibaki, R., et al.[2021]

Citations

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Phase I/II trial of plinabulin in combination with nivolumab ... In the efficacy analysis in 27 patients, the median PFS was 1.6 months (95 % CI 1.2 to 2.7) and the trial did not meet the pre-specified target median PFS of ...

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A phase I trial of plinabulin in combination with nivolumab ... In the two CPI-resistant patients with confirmed response, the tumor reduction was 68% and 52%. Conclusions: Plinabulin in combination with ...

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603 Phase II trial of plinabulin in combination with ... Conclusions Plinabulin in combination with nivolumab and ipilimumab had limited clinical benefit for the treatment of pre-treated, PD(L)-1 ...

5. opdivohcp.com opdivohcp.com/efficacy/nsclc

Efficacy Data for Non-Small Cell Lung Cancer (NSCLC) - Opdivo Find OPDIVO® (nivolumab) efficacy information for the treatment of non-small cell lung cancers. Please see Indications and Important Safety Information.

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Nivolumab and Plinabulin in Treating Patients With Stage ... Giving nivolumab and plinabulin together may work better at treating patients with non-small cell lung cancer. Detailed Description. PRIMARY OBJECTIVES: I. To ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0169500224004665

Phase I/II trial of plinabulin in combination with nivolumab ... In a phase 1 first-in-human trial in 38 patients, plinabulin at the recommended phase 2 dose (RP2D) of 30 mg/m2, showed a favorable safety profile as well as ...

8. onclive.com onclive.com/view/dr-malhotra-on-the-safety-profile-of-plinabulin-nivolumab-ipilimumab-in-relapsed-sclc

Dr. Malhotra on the Safety Profile of Plinabulin/Nivolumab ... Jyoti Malhotra, MD, MPH, discusses the safety profile of plinabulin in combination with nivolumab and ipilimumab in relapsed/refractory small ...