xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06010095</url>
    </required_header>
    <id_info>
      <org_study_id>A092105</org_study_id>
      <nct_id>NCT06010095</nct_id>
    </id_info>
    <brief_title>Testing Nivolumab and Ipilimumab Immunotherapy With or Without the Targeted Drug Cabozantinib in Recurrent, Metastatic, or Incurable Nasopharyngeal Cancer</brief_title>
    <official_title>Randomized Phase 2 Study of Nivolumab and Ipilimumab With or Without Cabozantinib in Patients With Advanced Nasopharyngeal Carcinoma That Have Progressed After Platinum Treatment and Immunotherapy</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Alliance for Clinical Trials in Oncology</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Alliance for Clinical Trials in Oncology</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>Yes</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        This phase II trial tests how well nivolumab and ipilimumab immunotherapy with or without&#xD;
        cabozantinib in treating patients with nasopharyngeal cancer that has come back (after a&#xD;
        period of improvement) (recurrent), has spread from where it first started (primary site) to&#xD;
        other places in the body (metastatic), or for which no treatment is currently available&#xD;
        (incurable). Immunotherapy with monoclonal antibodies, such as nivolumab and ipilimumab, may&#xD;
        help the body's immune system attack the cancer, and may interfere with the ability of tumor&#xD;
        cells to grow and spread. Cabozantinib is in a class of medications called kinase inhibitors.&#xD;
        It works by blocking the action of an abnormal protein that signals cancer cells to multiply.&#xD;
        This helps slow or stop the spread of cancer cells. Giving immunotherapy with nivolumab and&#xD;
        ipilimumab and targeted therapy with cabozantinib may help shrink and stabilize&#xD;
        nasopharyngeal cancer.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        PRIMARY OBJECTIVE:&#xD;
  &#xD;
        I. To determine if the progression-free survival (PFS) of the triplet combination&#xD;
        (cabozantinib S-malate, nivolumab, and ipilimumab [CaboNivoIpi]) is more favorable than the&#xD;
        doublet (nivolumab and ipilimumab [NivoIpi]).&#xD;
  &#xD;
        SECONDARY OBJECTIVES:&#xD;
  &#xD;
        I. To compare safety and tolerability between the two arms (Common Terminology Criteria for&#xD;
        Adverse Events [CTCAE] version [v]5.0.).&#xD;
  &#xD;
        II. To compare overall response rate (ORR) between the two arms via both Response Evaluation&#xD;
        Criteria in Solid Tumors (RECIST) v1.1 and immune-modified Response Evaluation Criteria in&#xD;
        Solid Tumors (iRECIST) criteria.&#xD;
  &#xD;
        III. To compare overall survival (OS) between the two arms. IV. To assess response by primary&#xD;
        or acquired PD-1/L1 inhibitor resistance in the prior line of therapy.&#xD;
  &#xD;
        EXPLORATORY OBJECTIVE:&#xD;
  &#xD;
        I. To evaluate molecular and immunologic predictors of response (Epstein-Barr virus [EBV]&#xD;
        viral load; PD-L1 score) between arms.&#xD;
  &#xD;
        OUTLINE: Patients are randomized to 1 of 2 arms.&#xD;
  &#xD;
        ARM A: Patients receive nivolumab intravenously (IV) over 30 minutes and ipilimumab IV over&#xD;
        30 minutes on day 1 of each cycle. Cycles repeat every 28 days for up to 2 years in the&#xD;
        absence of disease progression or unacceptable toxicity. Patients undergo computed tomography&#xD;
        (CT) or magnetic resonance imaging (MRI) at baseline, every 3 cycles on treatment, and every&#xD;
        8-12 weeks during follow-up. Patients may also undergo collection of blood samples at&#xD;
        baseline, day 1 of cycle 2, and at progression or end of treatment.&#xD;
  &#xD;
        ARM B: Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 30 minutes on day&#xD;
        1 and cabozantinib S-malate orally (PO) daily on days 1-28 of each cycle. Cycles repeat every&#xD;
        28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.&#xD;
        Patients may continue with cabozantinib S-malate after 2 years per treating investigator.&#xD;
        Patients undergo CT or MRI at baseline, every 3 cycles on treatment, and every 8-12 weeks&#xD;
        during follow-up. Patients may also undergo collection of blood samples at baseline, day 1 of&#xD;
        cycle 2, and at progression or end of treatment.&#xD;
  &#xD;
        After completion of study treatment, patients are followed up every 8-12 weeks until&#xD;
        progression of disease occurs or a new non-protocol anti-cancer therapy is initiated and then&#xD;
        every 6 months for up to 2 years.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">September 18, 2023</start_date>
    <completion_date type="Anticipated">February 15, 2028</completion_date>
    <primary_completion_date type="Anticipated">January 15, 2028</primary_completion_date>
    <phase>Phase 2</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Treatment</primary_purpose>
      <masking>None (Open Label)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Progression-free survival (PFS)</measure>
      <time_frame>From randomization to the first of either progression or death from any cause, assessed up to 2 years</time_frame>
      <description>PFS will be estimated using the Kaplan-Meier method, where the log-rank test will be used to compare the 2 treatment arms.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Overall survival (OS)</measure>
      <time_frame>From randomization to death from any cause, assessed up to 2 years</time_frame>
      <description>OS will be estimated using the Kaplan-Meier method, where the log-rank test will be used to compare the 2 treatment arms</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Incidence of adverse events</measure>
      <time_frame>Up to 2 years</time_frame>
      <description>The maximum grade for each type of adverse event will be summarized using Common Terminology Criteria for Adverse Events version 5.0. The frequency and percentage of grade 3+ adverse events will be compared between the 2 treatment arms. Comparisons between arms will be made by using either the chi-square or Fisher's exact test</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Response by subgroups of interest</measure>
      <time_frame>Up to 2 years</time_frame>
      <description>Will also report and compare the overall response rate (ORR) between different subgroups of interest (primary or acquired PD-1/L1 inhibitor resistance in the prior line of therapy (further defined below), etc.). These comparisons will be done via chi-square or Fisher's exact tests. We'll also assess primary versus acquired resistance to prior PD-1 inhibition in each arm as well. While not a formal stratification, in the interim and final analysis we'll also descriptively assess these subgroups between arms as well.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Overall Response Rate (ORR)</measure>
      <time_frame>Up to 2 years</time_frame>
      <description>The response rate will be compared via chi-square or Fisher's exact tests between the 2 treatment arms using both the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and also separately for the immune-modified RECIST criteria.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Predictors of response</measure>
      <time_frame>Up to 2 years</time_frame>
      <description>Will correlate the baseline data (Epstein-Barr virus viral load, p16 immunohistochemistry status, smoking history, and PD-L1 score) with ORR data. For this analysis, logistic regression models will be assessed using the baseline data to predict binary response data. Odds ratios and 95% confidence intervals will be reported. Will also summarize the data using descriptive statistics and graphical methods.</description>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">50</enrollment>
    <condition>Metastatic Nasopharyngeal Carcinoma</condition>
    <condition>Recurrent Nasopharyngeal Carcinoma</condition>
    <condition>Stage IV Nasopharyngeal Carcinoma AJCC v8</condition>
    <arm_group>
      <arm_group_label>Arm A (nivolumab, ipilimumab)</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI at baseline, every 3 cycles on treatment, and every 8-12 weeks during follow-up. Patients may also undergo collection of blood samples at baseline, day 1 of cycle 2, and at progression or end of treatment.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 30 minutes on day 1 and cabozantinib S-malate PO daily on days 1-28 of each cycle. Cycles repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients may continue with cabozantinib S-malate after 2 years per treating investigator. Patients undergo CT or MRI at baseline, every 3 cycles on treatment, and every 8-12 weeks during follow-up. Patients may also undergo collection of blood samples at baseline, day 1 of cycle 2, and at progression or end of treatment.</description>
    </arm_group>
    <intervention>
      <intervention_type>Biological</intervention_type>
      <intervention_name>Nivolumab</intervention_name>
      <description>Given IV</description>
      <arm_group_label>Arm A (nivolumab, ipilimumab)</arm_group_label>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
      <other_name>Opdivo</other_name>
    </intervention>
    <intervention>
      <intervention_type>Biological</intervention_type>
      <intervention_name>Ipilimumab</intervention_name>
      <description>Given IV</description>
      <arm_group_label>Arm A (nivolumab, ipilimumab)</arm_group_label>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
      <other_name>Yervoy</other_name>
    </intervention>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Cabozantinib S-malate</intervention_name>
      <description>Given PO</description>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
      <other_name>Cabozantinib</other_name>
      <other_name>Cometriq</other_name>
    </intervention>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>Computed Tomography</intervention_name>
      <description>Undergo CT scan</description>
      <arm_group_label>Arm A (nivolumab, ipilimumab)</arm_group_label>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
      <other_name>CAT Scan</other_name>
      <other_name>CT Scan</other_name>
    </intervention>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>Magnetic Resonance Imaging</intervention_name>
      <description>Undergo MRI</description>
      <arm_group_label>Arm A (nivolumab, ipilimumab)</arm_group_label>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
      <other_name>MRI</other_name>
    </intervention>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>Biospecimen Collection</intervention_name>
      <description>Undergo blood sample collection</description>
      <arm_group_label>Arm A (nivolumab, ipilimumab)</arm_group_label>
      <arm_group_label>Arm B (nivolumab, ipilimumab, cabozantinib)</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Patients must have histologically documented nasopharyngeal carcinoma (NPC) regardless&#xD;
               of World Health Organization (WHO) classification (keratinizing squamous cell&#xD;
               carcinoma, non-keratinizing, or basaloid squamous cell carcinoma) and regardless of&#xD;
               association with Epstein-Barr virus (EBV) and/or human papillomavirus (HPV)&#xD;
  &#xD;
            -  Recurrent, metastatic and incurable disease treated with platinum-gemcitabine and&#xD;
               prior PD-1/L1 blockade (as first or second-line therapy) where immunotherapy was part&#xD;
               of the most recent prior line of therapy&#xD;
  &#xD;
            -  Patients are eligible regardless of prior smoking history, p16 immunohistochemistry&#xD;
               (IHC) status, PD-L1 expression status, EBV tumor status, EBV viral load at baseline,&#xD;
               or tumor genomic alteration status&#xD;
  &#xD;
            -  Patients must have at least one measurable lesion (by RECIST v1.1) which has not been&#xD;
               previously irradiated that can be accurately measured in at least one dimension&#xD;
               (longest diameter to be recorded for non-nodal lesions as &gt;= 10 mm (&gt;= 1 cm) (and&#xD;
               short axis for nodal lesions, LN &gt;= 15 mm) with CT scan, MRI, or calipers by clinical&#xD;
               exam&#xD;
  &#xD;
            -  Patients may have had no more than 2 prior lines of prior systemic therapy for&#xD;
               recurrent, metastatic NPC&#xD;
  &#xD;
            -  No prior VEGFR targeted therapy permitted&#xD;
  &#xD;
            -  Age &gt;= 18 years&#xD;
  &#xD;
            -  Eastern Cooperative Oncology Group Performance (ECOG) performance status 0-2&#xD;
  &#xD;
            -  Absolute neutrophil count (ANC) &gt;= 1,000/mm^3&#xD;
  &#xD;
            -  Hemoglobin &gt;= 9 g/dL&#xD;
  &#xD;
            -  Platelet count &gt;= 100,000/mm^3&#xD;
  &#xD;
            -  Creatinine or creatinine clearance =&lt; 1.5 mg/dL or &gt;= 30 Modification of Diet in Renal&#xD;
               Disease (MDRD)&#xD;
  &#xD;
            -  Total bilirubin =&lt; 1.5 x institutional upper limit of normal (ULN); except subjects&#xD;
               with Gilbert syndrome who can have a total bilirubin &lt; 3 mg/dL&#xD;
  &#xD;
            -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase&#xD;
               [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase =&lt; 3 x&#xD;
               upper limit of normal (ULN)&#xD;
  &#xD;
               * Up to =&lt; 5 allowed with liver metastases&#xD;
  &#xD;
            -  Not pregnant and not nursing, because this study involves an investigational agent&#xD;
               whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn&#xD;
               are unknown. Therefore, for women of childbearing potential only, a negative urine or&#xD;
               serum pregnancy test, per institution standard, done =&lt; 7 days prior to registration&#xD;
               is required.&#xD;
  &#xD;
               * Pregnant women are excluded from this study because nivolumab, ipilimumab, and&#xD;
               cabozantinib are all Class C or D agents with the potential for teratogenic or&#xD;
               abortifacient effects. Because there is an unknown but potential risk for adverse&#xD;
               events in nursing infants, secondary to treatment of the mother with any of the study&#xD;
               agents, breastfeeding should be discontinued if the mother is treated with as part of&#xD;
               this study (in either arm)&#xD;
  &#xD;
            -  No active tumor bleeding: or radiographic evidence of major blood vessel infiltration&#xD;
               as judged by the treating investigator&#xD;
  &#xD;
            -  Prior -anti-cancer therapy is allowed: Patients need to be recovered from adverse&#xD;
               events due to prior anti-cancer therapy (i.e., have residual toxicities &gt; grade 1),&#xD;
               with the exception of alopecia. Any life-threatening events clearly attributable to&#xD;
               prior immunotherapy exposure that have a high possibility of recurring should warrant&#xD;
               exclusion: including severe pneumonitis, grade 4 bullous dermatitis/drug reaction with&#xD;
               eosinophilia and systemic symptoms (DRESS), neurologic events such as autoimmune&#xD;
               encephalitis transverse myelitis, and/or myocarditis. Maintenance hormonal replacement&#xD;
               or long-term hormonal therapy exposure is permitted.&#xD;
  &#xD;
               * No chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or&#xD;
               mitomycin C) prior to registration. Palliative (limited-field) radiation therapy is&#xD;
               permitted, if all of the following criteria are met:&#xD;
  &#xD;
                 -  Repeat imaging demonstrates no new sites of bone metastases.&#xD;
  &#xD;
                 -  The lesion being considered for palliative radiation is not a target lesion&#xD;
  &#xD;
            -  No patients with a prior malignancy whose natural history or treatment has the&#xD;
               potential to interfere with the safety or efficacy assessment of the investigational&#xD;
               regimen&#xD;
  &#xD;
            -  Brain metastases allowed: Patients with treated brain metastases are eligible if&#xD;
               follow-up brain imaging 4 weeks after central nervous system (CNS)-directed therapy&#xD;
               shows no evidence of progression. Patients with new or progressive brain metastases&#xD;
               (active brain metastases) or leptomeningeal disease are eligible if the treating&#xD;
               physician determines that immediate CNS specific treatment is not required and is&#xD;
               unlikely to be required during the first cycle of therapy&#xD;
  &#xD;
            -  Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral&#xD;
               therapy with undetectable viral load within 6 months prior to registration are&#xD;
               eligible for this trial&#xD;
  &#xD;
            -  For patients with evidence of chronic hepatitis B (HBV) infection, the HBV viral load&#xD;
               must be undetectable on suppressive therapy, if indicated&#xD;
  &#xD;
               * Patients with a history of hepatitis C virus (HCV) infection must have been treated&#xD;
               and cured. For patients with HCV infection who are currently receiving treatment, they&#xD;
               are eligible if they have an undetectable HCV viral load&#xD;
  &#xD;
            -  Solid organ or tissue transplant is allowed: - subsequent therapy with nivolumab&#xD;
               increases the risk of organ/tissue rejection. Patients must be instructed that it is&#xD;
               crucial they stay in touch with their transplant team during treatment&#xD;
  &#xD;
            -  No active autoimmune disease: or history of autoimmune disease that might recur, and&#xD;
               which may affect vital organ function or require immune suppressive treatment&#xD;
               including systemic corticosteroids. These include but are not limited to patients with&#xD;
               a history of&#xD;
  &#xD;
                 -  Immune related neurologic disease,&#xD;
  &#xD;
                 -  Multiple sclerosis,&#xD;
  &#xD;
                 -  Autoimmune (demyelinating) neuropathy,&#xD;
  &#xD;
                 -  Guillain-Barre syndrome (GBS),&#xD;
  &#xD;
                 -  Myasthenia gravis;&#xD;
  &#xD;
                 -  Systemic autoimmune disease such as SLE,&#xD;
  &#xD;
                 -  Connective tissue diseases,&#xD;
  &#xD;
                 -  Scleroderma, inflammatory bowel disease (IBD),&#xD;
  &#xD;
                 -  Crohn's, ulcerative colitis,&#xD;
  &#xD;
                 -  Patients with a history of toxic epidermal necrolysis (TEN),&#xD;
  &#xD;
                 -  Stevens-Johnson syndrome, or phospholipid syndrome should be excluded because of&#xD;
                    the risk of recurrence or exacerbation of disease&#xD;
  &#xD;
            -  Patients with vitiligo, endocrine deficiencies including thyroiditis managed with&#xD;
               replacement hormones including physiologic corticosteroids are eligible&#xD;
  &#xD;
            -  Patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome, and&#xD;
               psoriasis controlled with topical medication and patients with only positive serology,&#xD;
               such as antinuclear antibodies (ANA) or anti-thyroid antibodies, should be evaluated&#xD;
               for the presence of target organ involvement and potential need for systemic treatment&#xD;
               but should otherwise be eligible&#xD;
  &#xD;
            -  Pneumonitis should be evaluated for the nature of the disease process, need for&#xD;
               treatment prior study treatment, and the risk of exacerbation with study treatment&#xD;
  &#xD;
            -  Able to swallow oral medication: No known medical condition causing an inability to&#xD;
               swallow oral formulations of agents&#xD;
  &#xD;
            -  No condition requiring systemic treatment with either corticosteroids (&gt; 10 mg daily&#xD;
               prednisone equivalent) or other immunosuppressive medications within 14 days of study&#xD;
               registration. Patients are permitted the use of topical, ocular, intra-articular,&#xD;
               intranasal, and inhalational corticosteroids (with minimal systemic absorption).&#xD;
               Adrenal replacement steroid doses &gt; 10 mg daily prednisone are permitted. A brief&#xD;
               (less than 3 weeks) course of corticosteroids for prophylaxis (e.g., contrast dye&#xD;
               allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type&#xD;
               hypersensitivity reaction caused by a contact allergen) is permitted&#xD;
  &#xD;
            -  Concomitant anticoagulation with coumarin agents (e.g., warfarin), direct thrombin&#xD;
               inhibitors (e.g., dabigatran), direct factor Xa inhibitor betrixaban, or platelet&#xD;
               inhibitors (e.g., clopidogrel) is prohibited. Allowed anticoagulants are the&#xD;
               following:&#xD;
  &#xD;
                 -  Prophylactic use of low-dose aspirin for cardio-protection (per local applicable&#xD;
                    guidelines) and low-dose low molecular weight heparins (LMWH).&#xD;
  &#xD;
                 -  Therapeutic doses of LMWH or anticoagulation with direct factor Xa inhibitors&#xD;
                    rivaroxaban, edoxaban, or apixaban in subjects without known brain metastases who&#xD;
                    are on a stable dose of the anticoagulant for at least 1 week before first dose&#xD;
                    of study treatment without clinically significant hemorrhagic complications from&#xD;
                    the anticoagulation regimen or the tumor&#xD;
  &#xD;
            -  Concomitant use of any medications or substances that are strong inhibitors or&#xD;
               inducers of CYP3A4 is discouraged; if unavoidable, the dose of cabozantinib on study&#xD;
               should be adjusted accordingly. Any complementary medications (e.g., herbal&#xD;
               supplements or traditional Chinese medicines) intended to treat the disease under&#xD;
               study are prohibited&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>N/A</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_contact>
      <last_name>Beth Smith</last_name>
      <phone>773-834-6493</phone>
      <email>beth10@bsd.uchicago.edu</email>
    </overall_contact>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>August 21, 2023</study_first_submitted>
    <study_first_submitted_qc>August 21, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 24, 2023</study_first_posted>
    <last_update_submitted>August 21, 2023</last_update_submitted>
    <last_update_submitted_qc>August 21, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 24, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor</responsible_party_type>
    </responsible_party>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Carcinoma</mesh_term>
      <mesh_term>Nasopharyngeal Carcinoma</mesh_term>
    </condition_browse>
    <intervention_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Nivolumab</mesh_term>
      <mesh_term>Ipilimumab</mesh_term>
    </intervention_browse>
    <patient_data>
      <sharing_ipd>Undecided</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06010095
  org study id: A092105
  nct id: NCT06010095
  lead sponsor: 
  has dmc: No
  is fda regulated drug: Yes
  is fda regulated device: No
  This phase II trial tests how well nivolumab and ipilimumab immunotherapy with or without
        cabozantinib in treating patients with nasopharyngeal cancer that has come back (after a
        period of improvement) (recurrent), has spread from where it first started (primary site) to
        other places in the body (metastatic), or for which no treatment is currently available
        (incurable). Immunotherapy with monoclonal antibodies, such as nivolumab and ipilimumab, may
        help the body's immune system attack the cancer, and may interfere with the ability of tumor
        cells to grow and spread. Cabozantinib is in a class of medications called kinase inhibitors.
        It works by blocking the action of an abnormal protein that signals cancer cells to multiply.
        This helps slow or stop the spread of cancer cells. Giving immunotherapy with nivolumab and
        ipilimumab and targeted therapy with cabozantinib may help shrink and stabilize
        nasopharyngeal cancer.
  PRIMARY OBJECTIVE:
  
        I. To determine if the progression-free survival (PFS) of the triplet combination
        (cabozantinib S-malate, nivolumab, and ipilimumab [CaboNivoIpi]) is more favorable than the
        doublet (nivolumab and ipilimumab [NivoIpi]).
  
        SECONDARY OBJECTIVES:
  
        I. To compare safety and tolerability between the two arms (Common Terminology Criteria for
        Adverse Events [CTCAE] version [v]5.0.).
  
        II. To compare overall response rate (ORR) between the two arms via both Response Evaluation
        Criteria in Solid Tumors (RECIST) v1.1 and immune-modified Response Evaluation Criteria in
        Solid Tumors (iRECIST) criteria.
  
        III. To compare overall survival (OS) between the two arms. IV. To assess response by primary
        or acquired PD-1/L1 inhibitor resistance in the prior line of therapy.
  
        EXPLORATORY OBJECTIVE:
  
        I. To evaluate molecular and immunologic predictors of response (Epstein-Barr virus [EBV]
        viral load; PD-L1 score) between arms.
  
        OUTLINE: Patients are randomized to 1 of 2 arms.
  
        ARM A: Patients receive nivolumab intravenously (IV) over 30 minutes and ipilimumab IV over
        30 minutes on day 1 of each cycle. Cycles repeat every 28 days for up to 2 years in the
        absence of disease progression or unacceptable toxicity. Patients undergo computed tomography
        (CT) or magnetic resonance imaging (MRI) at baseline, every 3 cycles on treatment, and every
        8-12 weeks during follow-up. Patients may also undergo collection of blood samples at
        baseline, day 1 of cycle 2, and at progression or end of treatment.
  
        ARM B: Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 30 minutes on day
        1 and cabozantinib S-malate orally (PO) daily on days 1-28 of each cycle. Cycles repeat every
        28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
        Patients may continue with cabozantinib S-malate after 2 years per treating investigator.
        Patients undergo CT or MRI at baseline, every 3 cycles on treatment, and every 8-12 weeks
        during follow-up. Patients may also undergo collection of blood samples at baseline, day 1 of
        cycle 2, and at progression or end of treatment.
  
        After completion of study treatment, patients are followed up every 8-12 weeks until
        progression of disease occurs or a new non-protocol anti-cancer therapy is initiated and then
        every 6 months for up to 2 years.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Treatment
  masking: None (Open Label)
  measure: Progression-free survival (PFS)
  time frame: From randomization to the first of either progression or death from any cause, assessed up to 2 years
  description: PFS will be estimated using the Kaplan-Meier method, where the log-rank test will be used to compare the 2 treatment arms.
  measure: Overall survival (OS)
  time frame: From randomization to death from any cause, assessed up to 2 years
  description: OS will be estimated using the Kaplan-Meier method, where the log-rank test will be used to compare the 2 treatment arms
  measure: Incidence of adverse events
  time frame: Up to 2 years
  description: The maximum grade for each type of adverse event will be summarized using Common Terminology Criteria for Adverse Events version 5.0. The frequency and percentage of grade 3+ adverse events will be compared between the 2 treatment arms. Comparisons between arms will be made by using either the chi-square or Fisher's exact test
  measure: Response by subgroups of interest
  time frame: Up to 2 years
  description: Will also report and compare the overall response rate (ORR) between different subgroups of interest (primary or acquired PD-1/L1 inhibitor resistance in the prior line of therapy (further defined below), etc.). These comparisons will be done via chi-square or Fisher's exact tests. We'll also assess primary versus acquired resistance to prior PD-1 inhibition in each arm as well. While not a formal stratification, in the interim and final analysis we'll also descriptively assess these subgroups between arms as well.
  measure: Overall Response Rate (ORR)
  time frame: Up to 2 years
  description: The response rate will be compared via chi-square or Fisher's exact tests between the 2 treatment arms using both the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and also separately for the immune-modified RECIST criteria.
  measure: Predictors of response
  time frame: Up to 2 years
  description: Will correlate the baseline data (Epstein-Barr virus viral load, p16 immunohistochemistry status, smoking history, and PD-L1 score) with ORR data. For this analysis, logistic regression models will be assessed using the baseline data to predict binary response data. Odds ratios and 95% confidence intervals will be reported. Will also summarize the data using descriptive statistics and graphical methods.
  arm group label: Arm A (nivolumab, ipilimumab)
  arm group type: Active Comparator
  description: Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI at baseline, every 3 cycles on treatment, and every 8-12 weeks during follow-up. Patients may also undergo collection of blood samples at baseline, day 1 of cycle 2, and at progression or end of treatment.
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  arm group type: Experimental
  description: Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 30 minutes on day 1 and cabozantinib S-malate PO daily on days 1-28 of each cycle. Cycles repeat every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients may continue with cabozantinib S-malate after 2 years per treating investigator. Patients undergo CT or MRI at baseline, every 3 cycles on treatment, and every 8-12 weeks during follow-up. Patients may also undergo collection of blood samples at baseline, day 1 of cycle 2, and at progression or end of treatment.
  intervention type: Biological
  intervention name: Nivolumab
  description: Given IV
  arm group label: Arm A (nivolumab, ipilimumab)
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  other name: Opdivo
  intervention type: Biological
  intervention name: Ipilimumab
  description: Given IV
  arm group label: Arm A (nivolumab, ipilimumab)
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  other name: Yervoy
  intervention type: Drug
  intervention name: Cabozantinib S-malate
  description: Given PO
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  other name: Cabozantinib
  other name: Cometriq
  intervention type: Procedure
  intervention name: Computed Tomography
  description: Undergo CT scan
  arm group label: Arm A (nivolumab, ipilimumab)
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  other name: CAT Scan
  other name: CT Scan
  intervention type: Procedure
  intervention name: Magnetic Resonance Imaging
  description: Undergo MRI
  arm group label: Arm A (nivolumab, ipilimumab)
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  other name: MRI
  intervention type: Procedure
  intervention name: Biospecimen Collection
  description: Undergo blood sample collection
  arm group label: Arm A (nivolumab, ipilimumab)
  arm group label: Arm B (nivolumab, ipilimumab, cabozantinib)
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: N/A
  healthy volunteers: No
  last name: Beth Smith
  phone: 773-834-6493
  email: beth10@bsd.uchicago.edu
  responsible party type: Sponsor
  mesh term: Carcinoma
  mesh term: Nasopharyngeal Carcinoma
  mesh term: Nivolumab
  mesh term: Ipilimumab
  sharing ipd: Undecided