60 Participants Needed

Tazemetostat + Topotecan + Pembrolizumab for Small Cell Lung Cancer

Recruiting at 8 trial locations
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Breakthrough TherapyThis drug has been fast-tracked for approval by the FDA given its high promise

Trial Summary

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

The trial protocol does not specify if you need to stop taking your current medications. However, you cannot participate if you have had chemotherapy, immune checkpoint inhibitors, or radiotherapy within 2 weeks before the study, or if you are on systemic steroid therapy or other immunosuppressive treatments within 7 days prior to the first dose of trial treatment.

What data supports the effectiveness of the drug pembrolizumab in treating small cell lung cancer?

Pembrolizumab has shown significant durability of responses in patients with previously treated extensive-stage small-cell lung cancer (SCLC), leading to its accelerated approval by the FDA as a second- or third-line treatment. Additionally, in a clinical trial, pembrolizumab combined with other drugs met its progression-free survival endpoint in patients with previously untreated extensive-stage SCLC.12345

Is the combination of Tazemetostat, Topotecan, and Pembrolizumab generally safe for humans?

Pembrolizumab, one of the drugs in the combination, has been associated with some immune-related side effects, such as type 1 diabetes in rare cases (0.2%) and other immune-mediated reactions like thyroid issues and lung inflammation. These side effects have been observed in various cancer treatments, indicating that while generally safe, there are potential risks to be aware of.16789

What makes the drug combination of Tazemetostat, Topotecan, and Pembrolizumab unique for treating small cell lung cancer?

This drug combination is unique because it combines Tazemetostat, which targets specific genetic changes in cancer cells, with Topotecan, a chemotherapy drug, and Pembrolizumab, an immunotherapy that helps the immune system attack cancer. This multi-faceted approach is different from standard treatments that typically use chemotherapy alone.135810

What is the purpose of this trial?

This phase I trial tests the safety, side effects, and best dose of tazemetostat in combination with topotecan and pembrolizumab in treating patients with small cell lung cancer that has come back after a period of improvement (recurrent). Tazemetostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving tazemetostat in combination with topotecan and pembrolizumab may shrink or stabilize recurrent small cell lung cancer.

Research Team

AT

Anish Thomas

Principal Investigator

National Cancer Institute LAO

Eligibility Criteria

Adults with recurrent small cell lung cancer who've had platinum-based chemotherapy can join. They must have measurable disease, stable brain metastases if present, and adequate organ function. HIV-positive patients on effective therapy are eligible. Participants need to use contraception and cannot be pregnant or breastfeeding.

Inclusion Criteria

My kidney function is within the safe range for the trial.
Your hemoglobin level is higher than 9 g/dL or 5.6 mmol/L.
Your AST and ALT liver enzymes are not more than 2.5 times the normal level.
See 15 more

Exclusion Criteria

My tests show genetic changes linked to MDS or MPN.
I have had T-cell lymphoblastic lymphoma or T-cell acute leukemia in the past.
I haven't had certain cancer treatments in the last 2 to 6 weeks.
See 12 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Dose-Escalation

Patients receive tazemetostat, pembrolizumab, and topotecan to determine the maximum tolerated dose and recommended phase II dose

21 days per cycle, up to 2 years
Cycle visits every 21 days

Dose-Expansion

Evaluate safety and tolerability of the combination treatment at the recommended phase II dose

21 days per cycle, up to 2 years
Cycle visits every 21 days

Follow-up

Participants are monitored for safety and effectiveness after treatment

Every 3 months until study closure or death

Treatment Details

Interventions

  • Pembrolizumab
  • Tazemetostat Hydrobromide
  • Topotecan Hydrochloride
Trial Overview The trial is testing the combination of Tazemetostat (an enzyme inhibitor), Topotecan (chemotherapy), and Pembrolizumab (immunotherapy) to see if it's safe and effective for treating recurrent small cell lung cancer by targeting tumor growth in various ways.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: Treatment (tazemetostat, pembrolizumab, topotecan)Experimental Treatment6 Interventions
Patients receive tazemetostat PO BID on days 1-21 of each cycle, pembrolizumab intravenously (IV) over 30 minutes on day 1 of each cycle, and topotecan IV over 30 minutes on days 1-3 or days 1-5 of each cycle. Cycles repeat every 21 days for 2 years in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan throughout the study and may also undergo biopsy and collection of blood on study.

Pembrolizumab is already approved in United States, European Union, United Kingdom for the following indications:

🇺🇸
Approved in United States as KEYTRUDA for:
  • Head and neck squamous cell carcinoma (HNSCC) with PD-L1 CPS ≥1
  • Melanoma
  • Non-small cell lung cancer (NSCLC)
  • Urothelial carcinoma
  • Colorectal cancer
  • Gastric cancer
  • Hepatocellular carcinoma
  • Renal cell carcinoma
  • Cervical cancer
  • Endometrial carcinoma
🇪🇺
Approved in European Union as KEYTRUDA for:
  • Head and neck squamous cell carcinoma (HNSCC) with PD-L1 CPS ≥1
  • Melanoma
  • Non-small cell lung cancer (NSCLC)
  • Urothelial carcinoma
  • Colorectal cancer
  • Gastric cancer
  • Hepatocellular carcinoma
  • Renal cell carcinoma
  • Cervical cancer
  • Endometrial carcinoma
🇬🇧
Approved in United Kingdom as KEYTRUDA for:
  • Untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) with PD-L1 CPS ≥1

Find a Clinic Near You

Who Is Running the Clinical Trial?

National Cancer Institute (NCI)

Lead Sponsor

Trials
14,080
Recruited
41,180,000+

Findings from Research

In a phase II trial involving 15 patients with resectable non-small cell lung cancer (NSCLC), neoadjuvant treatment with pembrolizumab showed a major pathologic response in 27% of patients, indicating promising antitumor activity before surgery.
The treatment was found to be feasible and safe, with only 33% of patients experiencing moderate adverse events, and no postoperative mortality, suggesting that pembrolizumab does not compromise surgical outcomes.
Neoadjuvant anti-programmed death-1 immunotherapy by pembrolizumab in resectable non-small cell lung cancer: First clinical experience.Eichhorn, F., Klotz, LV., Kriegsmann, M., et al.[2022]
Pembrolizumab, an immune checkpoint inhibitor targeting the PD-1 pathway, has shown significant durability of responses in previously treated patients with extensive-stage small-cell lung cancer (ES-SCLC), leading to its accelerated approval by the FDA for second- or third-line treatment.
In a recent clinical trial, pembrolizumab combined with platinum/etoposide improved progression-free survival in previously untreated ES-SCLC patients, although it did not demonstrate a significant improvement in overall survival compared to standard treatments.
Evidence to Date: Evaluating Pembrolizumab in the Treatment of Extensive-Stage Small-Cell Lung Cancer.Riano, I., Patel, SR., Liu, SV., et al.[2021]
In a real-life study of 121 patients with advanced non-squamous non-small cell lung cancer, the combination of pembrolizumab and chemotherapy resulted in a median progression-free survival of 9 months and overall survival of 20.6 months, demonstrating its efficacy as a first-line treatment.
The treatment was generally well-tolerated, with manageable side effects; however, 17.5% of patients experienced grade 3-4 adverse events, and there were two treatment-related deaths, indicating the need for careful monitoring during therapy.
Pembrolizumab plus pemetrexed-carboplatin combination in first-line treatment of advanced non-squamous non-small cell lung cancer: a multicenter real-life study (CAP29).Renaud, E., Ricordel, C., Corre, R., et al.[2023]

References

Neoadjuvant anti-programmed death-1 immunotherapy by pembrolizumab in resectable non-small cell lung cancer: First clinical experience. [2022]
Evidence to Date: Evaluating Pembrolizumab in the Treatment of Extensive-Stage Small-Cell Lung Cancer. [2021]
Pembrolizumab plus pemetrexed-carboplatin combination in first-line treatment of advanced non-squamous non-small cell lung cancer: a multicenter real-life study (CAP29). [2023]
Health-Related Quality of Life With Carboplatin-Paclitaxel or nab-Paclitaxel With or Without Pembrolizumab in Patients With Metastatic Squamous Non-Small-Cell Lung Cancer. [2020]
A phase II study of pembrolizumab and paclitaxel in patients with relapsed or refractory small-cell lung cancer. [2020]
KEYNOTE-022: Pembrolizumab with trametinib in patients with BRAF wild-type melanoma or advanced solid tumours irrespective of BRAF mutation. [2022]
Programmed Cell Death-1 Inhibitor-Induced Type 1 Diabetes Mellitus. [2022]
New Approved Use for Keytruda. [2022]
FDA Approval Summary: Pembrolizumab for the Treatment of Patients with Unresectable or Metastatic Melanoma. [2022]
10.United Statespubmed.ncbi.nlm.nih.gov
Pembrolizumab Approved for Esophageal or Gastroesophageal Cancer. [2023]
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