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Identification of Pathways to Mitigate Immune-Related Adverse Events With Cancer Immunotherapy

NCT04283539 — Completed, 255 participants, National Jewish Health

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RegistryNCT04283539
StatusCompleted
Study typeObservational
Enrollment255 (Actual)
SponsorNational Jewish Health (Other); collaborators: Memorial Sloan Kettering Cancer Center
ConditionsCancer, Skin Disease, Immunotherapy, Patients With Solid Tumors Receiving Immunotherapy With an ICI Will be Randomized to Participate in an SDoH and Side Effects Navigation Program vs. Control
Interventionssystemic corticosteroid or biologic (Drug)
Datesstart 2020-09-23, primary completion 2025-03-25, completion 2026-02-28, first posted 2020-02-25, last updated 2026-06-16
Locations3 sites in United States

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-Summary

This protocol is a prospective, observational study of participants receiving immunotherapy (checkpoint inhibitors, CPI) for cancer therapy, testing the hypothesis that patients with immune related cutaneous adverse events (ircAEs) have unique immunologic endotypes associated with polarized immune responses.

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+Detailed description

This is a prospective, observational study of participants receiving immunotherapy (checkpoint inhibitors, CPI) for cancer therapy, testing the hypothesis that patients with immune related cutaneous adverse events (ircAEs) have unique immunologic endotypes associated with polarized immune responses.

In addition, this 2-arm pilot randomized controlled trial evaluating the impact of a patient navigation/side effects management intervention versus usual and customary care, on immune checkpoint inhibitor (ICI) continuation at 6 months (primary outcome) as well as occurrence, severity, and management of immune-related AEs (irAEs); quality of life; and progression-free survival (PFS) (secondary outcomes) in a cohort of minoritized and/or low socioeconomic status (SES) cancer patients receiving ICIs.

+Arms and interventions

ArmTypeInterventionsDescription
CPI with ircAEDrug: systemic corticosteroid or biologicParticipants on check point inhibitors with immune related cutaneous adverse event
no ircAEParticipants who do not have a cutaneous adverse event
  • systemic corticosteroid or biologic (Drug): Treatment with systemic corticosteroids or biologic therapies (for corticosteroid refractory patients or these in which corticosteroids are not the treatment of choice)

+Outcome measures

Primary outcomes

  • Immune Biomarkers [30 days]: cytokines and chemokines

Secondary outcomes

  • Presence of skin and circulating lipid biomarkers which occur during and after ircAEs [30 days]: Proportion of long-chain and short-chain ceramides Amounts and relative proportion of lysophosphatidylcholine molecular species. sphingosine-1-phosphate, platelet activating factor, leukotriene E4, prostaglandin F2α, endocannabinoids anandamide and 2- arachidonoylglycerol. Peripheral blood mononuclear cell RNA for expression of GRalpha, GRbeta, Vitamin D 24- Hydroxylase FK506 binding protein 5, mitogen induced kinase phosphatase 1, interleukin, tumor necrosis factor alphal
  • Mechanisms associated with corticosteroid unresponsiveness in patients with ircAE [12 months]: Proportion of long-chain and short-chain ceramides Amounts and relative proportion of lysophosphatidylcholine molecular species. sphingosine-1-phosphate, platelet activating factor, leukotriene E4, prostaglandin F2α, endocannabinoids anandamide and 2- arachidonoylglycerol. Peripheral blood mononuclear cell RNA for expression of GRalpha, GRbeta, Vitamin D 24- Hydroxylase FK506 binding protein 5, mitogen induced kinase phosphatase 1, interleukin, tumor necrosis factor alphal

+Eligibility

Sex: All, ages: 18 Years to 99 Years

Inclusion Criteria:

1. Provision of signed and dated informed consent form
2. Stated willingness to comply with all study procedures and availability for the duration of the study
3. Male or female, >18 yo
4. Diagnosis of solid tumor including, but not limited to, genitourinary/gynecologic, lung, gastrointestinal and melanoma
5. Received or receiving a Check Point Inhibitor, or prior to starting on a checkpoint inhibitor
6. Grade ≥ 1 ircAE (CTCAE v 5.0) (for cohort 1 only)
7. No ircAE (cohort 2 only)
8. An indication for system corticosteroids or biologic therapies as determined by the treating physician (for cohort 1 only)

8\. Life expectancy ≥ 12 weeks

Exclusion Criteria:

1. Daily use of systemic steroid treatment in the past 4 weeks (prednisone >10mg a day or equivalent) except for indications other than the cutaneous adverse event, and/or as an anti-emetic pre- or post-chemotherapy infusions.
2. Enrollment in any investigational drug trial with a drug that has not been approved
3. Taking other checkpoint inhibitors beyond anti-PD-(L)-1 or anti-CTLA-4 not yet indicated/approved for use
4. Pregnancy
5. Known blood borne infectious disease
6. Current or previous diagnosis of a leukemia or lymphoma
7. Unable to give consent for study participation
8. Life expectancy < 12 weeks
9. Any other condition or diagnosis in the opinion of the investigator that would interfere with the study results

+Locations (3)

FacilityCityCountryStatus
National Jewish HealthDenver, ColoradoUnited States
The Melanoma and Skin Cancer InstituteDenver, ColoradoUnited States
Memorial Sloan Kettering Cancer CenterNew York, New YorkUnited States

+Publications

  • Wang EA, Goleva E, Ketosugbo K, Kern JA, Kraehenbuehl L, Lacouture ME, Leung DYM. Effect of immune checkpoint inhibitors on asthma. Ann Allergy Asthma Immunol. 2022 Aug;129(2):257-258. doi: 10.1016/j.anai.2022.05.019. Epub 2022 May 24. No abstract available. PMID 35623586
  • Luo J, Beattie JA, Fuentes P, Rizvi H, Egger JV, Kern JA, Leung DYM, Lacouture ME, Kris MG, Gambarin M, Santomasso BD, Faleck DM, Hellmann MD. Beyond Steroids: Immunosuppressants in Steroid-Refractory or Resistant Immune-Related Adverse Events. J Thorac Oncol. 2021 Oct;16(10):1759-1764. doi: 10.1016/j.jtho.2021.06.024. Epub 2021 Jul 12. PMID 34265432
  • Goleva E, Lyubchenko T, Kraehenbuehl L, Lacouture ME, Leung DYM, Kern JA. Our current understanding of checkpoint inhibitor therapy in cancer immunotherapy. Ann Allergy Asthma Immunol. 2021 Jun;126(6):630-638. doi: 10.1016/j.anai.2021.03.003. Epub 2021 Mar 11. PMID 33716146
  • Geisler AN, Phillips GS, Barrios DM, Wu J, Leung DYM, Moy AP, Kern JA, Lacouture ME. Immune checkpoint inhibitor-related dermatologic adverse events. J Am Acad Dermatol. 2020 Nov;83(5):1255-1268. doi: 10.1016/j.jaad.2020.03.132. Epub 2020 May 23. PMID 32454097
  • Results publication: Wang E, Kraehenbuehl L, Ketosugbo K, Kern JA, Lacouture ME, Leung DYM. Immune-related cutaneous adverse events due to checkpoint inhibitors. Ann Allergy Asthma Immunol. 2021 Jun;126(6):613-622. doi: 10.1016/j.anai.2021.02.009. Epub 2021 Feb 17. PMID 33609771
  • Results publication: Goleva E, Lacouture ME, Moy AP, Kern JA, Leung DYM. Phenotype/Immunologic Profiling in ircAEs-Response. Clin Cancer Res. 2024 Dec 16;30(24):5694. doi: 10.1158/1078-0432.CCR-24-2949. No abstract available. PMID 39676538
  • Results publication: Lacouture ME, Goleva E, Shah N, Rotemberg V, Kraehenbuehl L, Ketosugbo KF, Merghoub T, Maier T, Bang A, Gu S, Salvador T, Moy AP, Lyubchenko T, Xiao O, Hall CF, Berdyshev E, Crooks J, Weight R, Kern JA, Leung DYM. Immunologic Profiling of Immune-Related Cutaneous Adverse Events with Checkpoint Inhibitors Reveals Polarized Actionable Pathways. Clin Cancer Res. 2024 Jul 1;30(13):2822-2834. doi: 10.1158/1078-0432.CCR-23-3431. PMID 38652814

+Investigators

My Notes