Pembrolizumab + Gemcitabine for Cutaneous T-Cell Lymphoma

Recruiting in Palo Alto (17 mi)

+14 other locations

Overseen by Alison Moskowitz, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Memorial Sloan Kettering Cancer Center

Must not be taking: Immunosuppressants, Live vaccines

Disqualifiers: Pregnancy, Active infection, Autoimmune, others

No Placebo Group

Prior Safety Data

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This trial is testing a combination of two drugs, pembrolizumab and gemcitabine, to treat patients with mycosis fungoides and Sézary syndrome. Pembrolizumab helps the immune system attack cancer, while gemcitabine kills cancer cells directly. The goal is to see if this combination is more effective than current treatments. IPH4102 is a new antibody specifically developed for treating cutaneous T-cell lymphoma.

Will I have to stop taking my current medications?

The trial requires that any previous systemic anti-cancer therapy be stopped at least 2 weeks before starting the study treatment. However, if you are on a stable dose of topical or systemic steroids (up to 10 mg/day of prednisone), you may continue if stopping them could cause a flare-up or other issues.

What data supports the effectiveness of the drug combination Pembrolizumab and Gemcitabine for Cutaneous T-Cell Lymphoma?

Gemcitabine has shown effectiveness as a single agent in treating cutaneous T-cell lymphoma, with studies reporting a 48% overall response rate and a 20% complete response rate in pretreated patients. Additionally, Pembrolizumab, although not extensively studied in this context, is an immune response modifier that has shown promise in treating other types of lymphomas. ^{1 2 3 4 5}

Is the combination of Pembrolizumab and Gemcitabine safe for humans?

Gemcitabine, used alone, has shown a generally favorable safety profile in treating cutaneous T-cell lymphoma, though it can sometimes cause side effects like myelosuppression (a decrease in bone marrow activity) and infections. No severe blood or liver-related side effects were reported in some studies. Pembrolizumab's safety wasn't specifically covered in these studies, but it is generally known to be safe for use in humans. ^{1 2 6 7 8}

How is the drug combination of Pembrolizumab and Gemcitabine unique for treating cutaneous T-cell lymphoma?

This treatment is unique because it combines Pembrolizumab, an immunotherapy drug that helps the immune system attack cancer cells, with Gemcitabine, a chemotherapy drug known for its effectiveness in treating cutaneous T-cell lymphoma, potentially offering a novel approach by using both immune and chemotherapy strategies together. ^{1 6 7 9 10}

Research Team

Alison Moskowitz, MD

Principal Investigator

Memorial Sloan Kettering Cancer Center

Eligibility Criteria

Adults over 18 with mycosis fungoides or Sézary syndrome, who have tried at least one systemic therapy before, can join this trial. They should be relatively healthy (ECOG score 0-1) and not have had certain treatments recently. People with organ transplants, other active cancers, severe infections, or immune conditions that need treatment are excluded.

Inclusion Criteria

I have been treated with gemcitabine before.

Participant provides written informed consent

I have received at least one treatment for my cutaneous T-cell lymphoma.

Exclusion Criteria

I have been diagnosed with active lymphoma in my brain or spinal cord.

I have not received a live vaccine in the last 30 days.

I have an active case of tuberculosis.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive pembrolizumab and gemcitabine to assess efficacy in treating mycosis fungoides and Sézary syndrome

6 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Gemcitabine (Anti-metabolites)
• Pembrolizumab (Monoclonal Antibodies)

Trial Overview The trial is testing if pembrolizumab combined with gemcitabine works for advanced mycosis fungoides and Sézary syndrome. Participants will receive both drugs to see how effective they are together in treating these conditions.

Participant Groups

Group I: Participants with confirmed mycosis fungoides/Sezary syndrome Experimental Treatment 2 Interventions

Participants will have confirmed mycosis fungoides/Sezary syndrome, disease stage IB (defined as patches, plaque, or papules that involve 10% of the skin surface viscera) or higher.

Gemcitabine is already approved in Canada, Japan for the following indications:

Approved in Canada as Gemzar for:

• Pancreatic cancer
• Breast cancer
• Ovarian cancer
• Non-small cell lung cancer

Approved in Japan as Gemzar for:

• Pancreatic cancer
• Breast cancer
• Ovarian cancer
• Non-small cell lung cancer

Who Is Running the Clinical Trial?

Memorial Sloan Kettering Cancer Center

Lead Sponsor

Trials

1,998

Recruited

602,000+

Lisa M. DeAngelis

Memorial Sloan Kettering Cancer Center

Chief Medical Officer since 2021

MD from Columbia University

Selwyn M. Vickers

Memorial Sloan Kettering Cancer Center

Chief Executive Officer since 2022

MD from Johns Hopkins University

Findings from Research

In a phase II study involving patients with cutaneous T-cell lymphoma who had previously failed standard treatments, the combination of gemcitabine and bexarotene showed that 80% of patients had a reduction in disease severity, but only 31% achieved a partial response after 12 weeks.

The median progression-free survival was 5.3 months and median overall survival was 21.2 months, indicating that while the combination treatment was feasible, its efficacy was lower than expected compared to gemcitabine used alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase II study of gemcitabine and bexarotene (GEMBEX) in the treatment of cutaneous T-cell lymphoma. Illidge, T., Chan, C., Counsell, N., et al.[2022]

Gemcitabine, a purine analogue, has been identified as a practical and effective treatment option for mycosis fungoides that has transformed into large cerebriform cells, which typically resist other treatments.

The review includes three illustrative cases demonstrating that gemcitabine monotherapy is not only safe but also shows efficacy in managing this more aggressive form of cutaneous T cell lymphoma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of transformed mycosis fungoides with intermittent low-dose gemcitabine. Awar, O., Duvic, M.[2022]

In a retrospective study of 25 patients with advanced cutaneous T cell lymphoma (CTCL) who had previously undergone 1 to 8 therapies, gemcitabine treatment resulted in a 48% overall response rate and a 20% complete response rate, indicating its efficacy as a second-line treatment.

The long-term outcomes showed a 15-year overall survival rate of 47%, with no severe hematological adverse events reported, confirming gemcitabine's safety and effectiveness as a single-agent therapy for pretreated CTCL patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term outcome of patients with advanced-stage cutaneous T cell lymphoma treated with gemcitabine. Pellegrini, C., Stefoni, V., Casadei, B., et al.[2022]

In a study of 118 patients with cutaneous T-cell lymphomas (CTCL), including mycosis fungoides (MF) and Sézary syndrome (SS), the overall survival for MF patients was 17.7 years, while SS patients had a median survival of 3.5 years, indicating significant differences in outcomes based on the type of CTCL.

The most common treatments for MF included low-dose methotrexate and interferon-alpha, while SS patients often received bexarotene and extracorporeal photopheresis, highlighting the need for more innovative therapies to be integrated into earlier treatment lines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Retrospective Analysis of 118 Patients With Cutaneous T-Cell Lymphomas: A Single-Center Experience. Polgárová, K., Polívka, J., Kodet, O., et al.[2022]

A retrospective study of 64 patients with advanced-stage cutaneous T-cell lymphoma (CTCL) and blastic plasmacytoid dendritic cell neoplasia (BPDCN) showed that low-dose gemcitabine (1,800 mg/m2) achieved an overall response rate of 62% and a median progression-free survival of 12 months, comparable to standard dosing.

The low-dose regimen significantly improved safety, with only 3 out of 63 patients experiencing serious adverse events, while 73% reported only minor to moderate side effects, indicating better tolerability compared to the standard higher dose.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Outcomes of Advanced-Stage Cutaneous Lymphoma under Low-Dose Gemcitabine Treatment: Real-Life Data from the German Cutaneous Lymphoma Network. Blazejak, C., Stranzenbach, R., Gosman, J., et al.[2022]

In a small case series of four patients with advanced cutaneous T-cell lymphoma (CTCL), a combination of gemcitabine and vinorelbine resulted in partial remission for all patients, although the remission lasted only 2 to 6 months.

The treatment was associated with some side effects, including neutropenia in two patients and acute hepatitis in one, which led to the discontinuation of therapy, highlighting the need to balance efficacy with safety in treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gemcitabine and vinorelbine treatment in cutaneous T-cell lymphoma in four patients. Affandi, AM., Blumetti, TP., Wells, J., et al.[2022]

In a Phase II trial involving 32 untreated patients with advanced cutaneous T-cell lymphoma (CTCL), gemcitabine demonstrated significant efficacy, with 22% achieving a complete response and 53% achieving a partial response.

The treatment was well tolerated, showing only mild hematologic toxicity and no severe side effects, indicating that gemcitabine could be a safe option for patients with untreated CTCL.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gemcitabine as frontline treatment for cutaneous T-cell lymphoma: phase II study of 32 patients. Marchi, E., Alinari, L., Tani, M., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Phase II study of gemcitabine and bexarotene (GEMBEX) in the treatment of cutaneous T-cell lymphoma. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Gemcitabine treatment in pretreated cutaneous T-cell lymphoma: experience in 44 patients. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Treatment of transformed mycosis fungoides with intermittent low-dose gemcitabine. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

Long-term outcome of patients with advanced-stage cutaneous T cell lymphoma treated with gemcitabine. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Retrospective Analysis of 118 Patients With Cutaneous T-Cell Lymphomas: A Single-Center Experience. [2022]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Clinical Outcomes of Advanced-Stage Cutaneous Lymphoma under Low-Dose Gemcitabine Treatment: Real-Life Data from the German Cutaneous Lymphoma Network. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Gemcitabine treatment in cutaneous T-cell lymphoma: a multicentre study of 23 cases. [2022]

8. Japan pubmed.ncbi.nlm.nih.gov

[Gemcitabine Monotherapy for Advanced Mycosis Fungoides--Two Case Reports and a Literature Review]. [2022]

9. Australia pubmed.ncbi.nlm.nih.gov

Gemcitabine and vinorelbine treatment in cutaneous T-cell lymphoma in four patients. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Gemcitabine as frontline treatment for cutaneous T-cell lymphoma: phase II study of 32 patients. [2022]