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A Study of Immunotherapy Drugs Nivolumab and Ipilimumab in Patients w/Resectable Malignant Peritoneal Mesothelioma

Published: September 10, 2021

Primary Outcome Measures

  1. Major Pathologic (Disease) Response of Tumor to Nivolumab Combined with Ipilimumab Before Surgery [ Time Frame: 24 months ]
    The response of participant’s tumor to treatment with nivolumab and ipilimumab before surgery by analyzing tissue samples collected from participant during surgery for the presence of cancerous tumour cells. Major pathologic response will be defined as tissue samples containing less than or equal to 10% of residual (leftover) tumor/cancer in the tissue after surgery.

Secondary outcome Measures

  1. Rate of Participants Who Report Serious Side Effects to Nivolumab Combined with Ipilimumab Before Surgery (Neoadjuvant Treatment) [ Time Frame: 3 weeks (timeframe for surgery ) + 30 days (timeframe for assessing side effects after surgery) ]
    The rate of participants who report Grade 3 or 4 serious adverse events (side effects) after taking nivolumab combined with Ipilimumab before sugery. These side effects will be measured according to Common Terminology Criteria for Adverse Events v5.0 for up to 30 days after surgery.
  2. Number of Participants Who Proceed to Surgery Without Delays After Receiving Nivolumab Combined with Ipilimumab [ Time Frame: 19 weeks ]
    Number of participants who complete treatment with nivolumab and ipilimumab before surgery and proceed to surgery without extended treatment-related delays or progression precluding surgery as assessed by clinical /study records.
  3. Overall Survival of Participants Who Take Nivolumab Combined with Ipilimumab Before Surgery [ Time Frame: 42 Months ]
    Overall survival of participants who receive neoadjuvant nivolumab combined with ipilimumab, defined as time from enrollment on study to death from any cause.
  4. Progression-Free Survival of Participants Who Take Nivolumab Combined with Ipilimumab Before Surgery [ Time Frame: 42 months ]
    Progression-free survival of participants who receive neoadjuvant nivolumab combined with ipilimumab, defined as time from enrollment on study to death from any cause.
  5. Rate of Participants Who Report Serious Side Effects to Taking Nivolumab Combined with Ipilimumab After Surgery (Adjuvant Treatment) [ Time Frame: 12 weeks ]
    The rate of participants who report Grade 3 or 4 serious adverse events (side effects) after taking nivolumab combined with Ipilimumab after sugery. These side effects will be measured according to Common Terminology Criteria for Adverse Events v5.0.
  6. Radiologic response to nivolumab and ipilimumab before surgery [ Time Frame: 24 months ]
    Radiologic response to nivolumab and ipilimumab before surgery using radiology images of tumor pre- and post-treatment.
  7. Peritoneal Carcinomatosis index (PCI) of Participants Who Taking Nivolumab Combined with Ipilimumab Before Surgery [ Time Frame: 12 weeks ]
    The effect of nivolumab and ipilimumab on participant’s tumor as assessed by a peritoneal carcinomatosis index (PCI) score, a score determined based on the size of participant’s tumor after abdominal surgery.

Inclusion Criteria

  1. Have a diagnosis of histologically or cytologically confirmed peritoneal mesothelioma, of epithelial, biphasic, or sarcomatoid subtypes
  2. Have disease burden amenable to cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC), as determined by a surgeon specializing in mesothelioma
  3. Have measurable or evaluable disease based on RECIST 1.1 or on laparoscopy
  4. Have no definitive evidence of visceral metastases by best staging
  5. Be willing to undergo laparoscopy or mini-laparotomy for peritoneal staging
  6. Adequate organ function as determined by screening labs,
  7. Have an ECOG performance status of < 2
  8. Be 18 years of age on day of signing informed consent
  9. Be willing and able to provide written informed consent for the trial

Exclusion Criteria

  1. Is currently participating in a study of an investigational agent and received an investigational agent within 4 weeks of the first dose of treatment on this protocol
  2. Has received any immunotherapy agents outside of this protocol within 4 weeks of the first dose of treatment on this protocol
  3. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (>10 mg of prednisone daily or equivalent) or any other form of immunosuppressive therapy within 14 days prior to the first dose of study drug.
  4. Has a known history of active TB infection (Bacillus tuberculosis)
  5. Has active COVID-19 infection
  6. Has known history of, or any evidence of active, non-infectious pneumonitis that required steroids, or active pneumonitis
  7. Has a severe hypersensitivity to nivolumab or any of its excipients
  8. Has a severe hypersensitivity to ipilimumab or any of its excipients
  9. Has an active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs)
  10. Has a known additional malignancy that is progressing or required active treatment within the 3 years prior to enrollment – exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer or other tumors that will not affect life expectancy
  11. Has an active infection requiring systemic therapy
  12. Has a known history of HIV, Hepatitis B, or Hepatitis C
  13. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  14. Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment
    1. Female subjects of childbearing potential should have a negative urine or serum pregnancy within 72 hours prior to receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
    2. Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication (Reference Section 5.8.2). Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year.
    3. Male subjects should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy.
  15. Is on anticoagulation that cannot be discontinued in the perioperative period
  16. Has received a live vaccine within 30 days of planned start of study therapy
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