Immunotherapy + Cryoablation for Pediatric Solid Cancers

No longer recruiting at 1 trial location

Overseen By Ann Liew, MS

Age: < 65

Sex: Any

Trial Phase: Phase 2

Sponsor: Children's National Research Institute

Must not be taking: Immunosuppressants, Chemotherapy

Disqualifiers: Autoimmune disorders, Organ transplant, others

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

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a combination of treatments—cryoablation therapy and two immunotherapy drugs, nivolumab (Opdivo) and ipilimumab (Yervoy)—to determine their effectiveness against stubborn solid tumors in young patients. It targets those whose cancers, such as osteosarcoma or rhabdomyosarcoma, have recurred or resisted standard treatments. Eligible participants should have previously tried treatments like surgery or chemotherapy, but their cancer must have returned or not improved, and they must have at least two measurable tumors. The goal is to assess whether this combination can effectively stop or slow the cancer. As a Phase 2 trial, this research focuses on measuring the treatment's effectiveness in an initial, smaller group, offering a chance to contribute to significant findings.

Will I have to stop taking my current medications?

The trial does not allow any concurrent chemotherapy or biologic therapy for cancer treatment. However, hormonal therapy for non-cancer-related conditions is acceptable. The protocol does not specify other medications, so it's best to discuss your current medications with the study team.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that the treatments in this trial have been safe in earlier studies. Cryoablation therapy, which freezes tumors to destroy cancer cells, has proven to be a safe method for treating solid tumors in children. Studies indicate it effectively controls tumor growth.

For ipilimumab, a type of immunotherapy, past research in children has shown it can be safely administered by following special guidelines to manage immune-related side effects. This ensures doctors can handle these side effects if they occur.

Nivolumab, another immunotherapy, has also been studied in children and young adults with solid tumors. Research suggests it is safe and generally well-tolerated in this group.

Overall, these treatments have a good safety record in previous studies with children. However, like any medical treatment, they can still cause side effects, and researchers will monitor this closely during the trial. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about combining immunotherapy with cryoablation for pediatric solid cancers because it offers a unique approach to treatment. While standard treatments often involve chemotherapy and radiation, this combination uses the body's immune system to fight cancer cells. Ipilimumab and Nivolumab are checkpoint inhibitors that help the immune system recognize and attack cancer cells more effectively. Cryoablation, on the other hand, involves freezing and destroying tumor cells, which may also enhance the immune response. This dual strategy could potentially lead to better outcomes and fewer side effects than traditional treatments.

What evidence suggests that this trial's treatments could be effective for pediatric solid cancers?

Research has shown that cryoablation therapy successfully controls tumors in about 82.1% of cases based on past follow-ups. In this trial, participants will receive a combination of treatments, including cryoablation therapy, ipilimumab, and nivolumab. Studies have shown mixed results for ipilimumab alone; it is less effective on its own for pediatric solid tumors but is used in combination treatments. However, when combined with nivolumab, ipilimumab has shown promise, with a 25% response rate in some sarcoma patients. Nivolumab alone has been found to be safe and shows some positive effects in young patients with recurring solid tumors. This combination of treatments aims to boost the immune system's ability to fight cancer and improve outcomes in children. ^{1 2 3 6 7}

Who Is on the Research Team?

AeRang Kim, MD, PhD

Principal Investigator

Children's National Research Institute

Are You a Good Fit for This Trial?

This trial is for pediatric and young adult patients aged between 1 and less than 40 years with relapsed or refractory solid tumors, including osteosarcoma and Ewing sarcoma. Participants must have measurable disease, be candidates for cryoablation therapy, and have no other curative treatment options available. They should not be part of another clinical study or have unresolved severe side effects from previous treatments.

Inclusion Criteria

My organs and bone marrow are functioning well.

My cancer came back or didn't respond after initial treatment meant to cure it.

I have recovered from side effects of my previous cancer treatments.

Exclusion Criteria

I have or had an autoimmune or inflammatory disorder.

I do not have any unmanaged ongoing illnesses.

I don't have lasting side effects from cancer treatment, except for hair loss or skin changes.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the pediatric RP2D of nivolumab and ipilimumab for one cycle and undergo cryoablation therapy of one tumor site. Treatment continues with cycles of checkpoint inhibition for up to 12 months unless there is disease progression or unacceptable toxicity.

12 months

Visits prior to every odd cycle for imaging and assessment

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Cryoablation Therapy
• Ipilimumab
• Nivolumab

Trial Overview The trial investigates the effectiveness of combining cryoablation therapy (freezing cancer cells) with two immune checkpoint inhibitors: nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4). It's a phase II study where all participants receive this combination to see how well it works against various solid tumors in children and young adults.

How Is the Trial Designed?

Group I: All patients Experimental Treatment 3 Interventions

Patients less than 40 years old with relapsed/refractory solid tumors and at least 2 sites of measurable disease will receive the current pediatric RP2D of nivolumab and ipilimumab for one cycle and undergo cryoablation therapy of one tumor site. Patients will continue to receive cycles of checkpoint inhibition as long as there is no disease progression of unacceptable toxicity (maximum of 13 cycles \[12 months\]). There are 4 patient cohorts: 1. Osteosarcoma 2. Ewing sarcoma 3. Rhabdomyosarcoma 4. All other solid tumors (non-statistical)

Who Is Running the Clinical Trial?

Children's National Research Institute

Lead Sponsor

Trials

227

Recruited

258,000+

Bristol-Myers Squibb

Industry Sponsor

Trials

2,731

Recruited

4,127,000+

Headquarters

New York City, USA

Known For

Oncology & Cardiovascular

Top Products

Eliquis, Opdivo, Revlimid, Orencia

Christopher Boerner

Bristol-Myers Squibb

Chief Executive Officer since 2023

PhD in Business Administration from the Haas School of Business, University of California, Berkeley; BA in Economics and History from Washington University in St. Louis

Deepak L. Bhatt

Bristol-Myers Squibb

Chief Medical Officer since 2024

MD from Yale University; MSc in Clinical Epidemiology from the University of Pennsylvania

Published Research Related to This Trial

The combination of nivolumab and ipilimumab is well tolerated in children and young adults with recurrent solid tumors, with a recommended phase II dose (RP2D) established at 3 mg/kg nivolumab and 1 mg/kg ipilimumab, showing some clinical activity.

At the RP2D, two patients achieved sustained partial responses, while increasing the ipilimumab dose to 3 mg/kg resulted in higher toxicity without any observed clinical benefit.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Phase I/II Trial of Nivolumab plus Ipilimumab in Children and Young Adults with Relapsed/Refractory Solid Tumors: A Children's Oncology Group Study ADVL1412. Davis, KL., Fox, E., Isikwei, E., et al.[2023]

Ipilimumab, a monoclonal antibody used to enhance anti-tumor T-cell responses, can cause significant side effects, including ipilimumab-induced hypophysitis (IH), which affects hormone levels and requires hormone replacement therapy in most cases.

In a review of 10 patients with IH, early detection and management guidelines were developed, highlighting the importance of monitoring hormone levels and recognizing imaging abnormalities, which often resolve without high-dose glucocorticoid therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ipilimumab-induced hypophysitis in melanoma patients: an Australian case series. Lam, T., Chan, MM., Sweeting, AN., et al.[2022]

In a study of 56 patients with metastatic melanoma who had severe immune-related adverse events (AEs) from ipilimumab, 36% experienced at least one immune-related AE after receiving anti-PD-1 therapy, indicating a notable risk of recurrence but also a manageable safety profile.

Despite the risk of AEs, anti-PD-1 therapy showed a 43% overall response rate and a median overall survival of 21 months, suggesting it may offer improved outcomes for patients previously affected by severe toxic effects from ipilimumab.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Anti-Programmed Cell Death 1 Antibody Treatment With Risk of Recurrence of Toxic Effects After Immune-Related Adverse Events of Ipilimumab in Patients With Metastatic Melanoma. Brunot, A., Grob, JJ., Jeudy, G., et al.[2021]

Ipilimumab, an immune checkpoint inhibitor, was safely administered to 33 pediatric patients with recurrent or progressive solid tumors, showing a similar spectrum of immune-related adverse events as seen in adults, although some toxicities appeared after just one dose.

While no objective tumor regressions were observed, patients experiencing immune-related toxicities had improved overall survival, suggesting that these adverse effects may correlate with a beneficial immune response against the tumors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase I Clinical Trial of Ipilimumab in Pediatric Patients with Advanced Solid Tumors. Merchant, MS., Wright, M., Baird, K., et al.[2022]

Ipilimumab, a monoclonal antibody that enhances the immune response against melanoma, can lead to immune-related adverse effects such as dermatitis, colitis, and hepatitis, which are typically managed with high-dose steroids.

In a reported case, a patient undergoing radiotherapy for metastatic melanoma developed an atypical generalized rash that worsened with concurrent ipilimumab treatment, highlighting the need for careful monitoring of skin reactions during combined therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ipilimumab may increase the severity of cutenaous toxicity related to radiotherapy. Eryılmaz, MK., Mutlu, H., Salim, DK., et al.[2018]

Nivolumab, a PD-1 blocking antibody, was found to be safe and well tolerated in a study involving 85 children and young adults with recurrent or refractory non-CNS solid tumors or lymphoma, establishing a recommended phase 2 dose of 3 mg/kg without significant dose-limiting toxicities.

The treatment showed clinical activity specifically in lymphoma cases, with responses observed in patients with Hodgkin and non-Hodgkin lymphoma, but did not demonstrate significant effectiveness against other common pediatric solid tumors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nivolumab in children and young adults with relapsed or refractory solid tumours or lymphoma (ADVL1412): a multicentre, open-label, single-arm, phase 1-2 trial. Davis, KL., Fox, E., Merchant, MS., et al.[2021]

Two cases of patients with multiple in-transit metastatic melanomas were successfully treated using intensity-modulated radiotherapy (IMRT) combined with immune checkpoint inhibitors ipilimumab or nivolumab.

The combination of IMRT and immune checkpoint inhibitors suggests a potential enhancement of antitumor effects, indicating a promising approach for improving treatment outcomes in melanoma patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful treatment of multiple in-transit melanomas on the leg with intensity-modulated radiotherapy and immune checkpoint inhibitors: Report of two cases. Fujimura, T., Kambayashi, Y., Furudate, S., et al.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10377811/

Role of Percutaneous Cryoablation in Bone and Soft ... For patients undergoing cryoablation with a curative aim, local tumor control was achieved in 82.1% of cases at an average follow-up of around ...

2. ascopubs.org ascopubs.org/doi/10.1200/JCO.2020.38.15_suppl.e22516

Percutaneous cryoablation in pediatric solid tumors: A case ... Results: A total of 40 metastatic lesions were treated by percutaneous cryoablation in 7 patients (ages 5-22yo, median 15yo) with a wide range ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0385814610002531

Clinical outcomes of rhabdomyosarcoma and Ewing's ... Five children are disease free after a median of 7.7 years from initial diagnosis. Two patients relapsed after 10 and 29 months from initial diagnosis ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT00526240

Therapy to Treat Ewing's Sarcoma, Rhabdomyosarcoma or ... Patients with recurrent or metastatic pediatric solid tumors experience low survival rates, but using current standard therapies, many patients with these ...

5. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/cam4.6026

A single‐institution pediatric and young adult interventional ... Of the 19 patients with benign disease, 11 CRs were achieved, and eight patients achieved either a PR or SD. Four patients with benign disease ...

6. centerwatch.com centerwatch.com/clinical-trials/listings/condition/489/sarcoma-pediatric

Sarcoma Pediatric Clinical Research Trials The following data are collected and stored: - Demographics - Comorbidities - Clinical characteristics at diagnosis, relapse and progression - Radiologic images ...

7. nationwidechildrens.org nationwidechildrens.org/research/clinical-research/cancer-clinical-research/sarcoma-and-solid-tumor-studies

Sarcoma and Solid Tumor Clinical Studies The purpose of this study is to evaluate the safety, tolerability, pharmacokinetics (PK), recommended phase 2 dose (RP2D), and effectiveness of lurbinectedin ...