Safety and Efficacy of Brodalumab in the Treatment of Immune-Related Adverse Events: A Pilot Study
Summary
The purpose of this study is to test the safety and effectiveness of using brodalumab in patients who develop side effects from cancer immune therapy. Immune-related side effects are due to activation of the immune system in patients who previously received immunotherapy and the goal of this study is to help better control these side effects. Brodalumab is often used to treat patients with autoimmune diseases (diseases where the immune system is activated against normal organs) and safe doses and treatment schedules have been determined in these patients. Immune-related side effects appear to closely mirror these autoimmune conditions. Brodalumab has not been approved by the United States Food and Drug Administration (FDA) for use in immunotherapy side effects but it has been approved for treatment of autoimmune conditions.
Detailed description
The proposed study will evaluate the safety and efficacy of brodalumab in improving and resolving Immune-Related Adverse Events (irAEs) in patients treated with brodalumab. Eligible subjects must have an immune-related adverse event with the intent to treat it with steroids. Subjects will receive subcutaneous brodalumab for 24 weeks. Peripheral blood will be collected at all in-person study visits for mechanistic studies. Participants will be evaluated at week 0, 1, 2, 4, and then every 4 weeks after that until week 24 as dictated by the standard of care using a combination of telemedicine and face-to-face evaluations. Additional safety follow-up visits will occur at weeks 28 and 36. All patients will have the Columbia Suicide Severity Rating Scale (C-SSRS), and Patient Health Questionnaire-9 (PHQ-9) administered at all visits. The treatment protocol consists of subcutaneous brodalumab 210 mg administered at baseline and then at weeks 0, 1, and 2, then bi-weekly for a total of 24 weeks (the current FDA-approved dosing for plaque psoriasis). Glucocorticoids may be used at baseline at the discretion of the investigators, with the goal of tapering off of steroids over 4-8 weeks if tolerated (see proposed taper in appendix). Continued treatment beyond the 24-week course can be evaluated by the treating investigator and the Sponsor-Investigator, weighing risks versus clinical benefit.
Arms & interventions
- DrugBrodalumab
Brodalumab 210 mg subcutaneous injection
- RadiationCT scan
CT scans within 4 weeks of starting brodalumab and every 3 months during the study for tumor assessment
Outcome measures
Primary
Number of Adverse Events
The number of adverse events of each grade that occur and the number of adverse events attributed to brodalumab, as per the Common Terminology Criteria for Adverse Events version 5 (CTCAE v5).
Time frame: Up to 36 weeks
Percentage of primary Immune-Related Adverse Event (irAE) severity decreased
The percentage of patients whose primary irAE severity decreased by \>1 grade per CTCAE criteria from study completion to treatment discontinuation.
Time frame: 24 weeks
Secondary
Percentage net decrease in the average steroid dose required for irAE management
Time frame: Up to 36 weeks
Proportion of Patients Successfully Tapered Off Steroids
Time frame: Up to 36 weeks
Mean Time to Complete Resolution of irAE Symptoms
Time frame: Up to 36 weeks
Change in Tumor Burden Assessed by RECIST Criteria at 24 Weeks
Time frame: 24 weeks
Proportion of Patients with Grade 3 or Higher Infection Events
Time frame: Up to 36 weeks
Cumulative Steroid Exposure over 24 Weeks
Time frame: 24 weeks
FACT-G global assessment score
Time frame: Baseline and 24 weeks
Progression-free survival (PFS)
Time frame: Up to 36 weeks
Overall Survival (OS)
Time frame: Up to 36 weeks
Eligibility criteria
Study locations (1)
Columbia University Irving Medical Center
New York, New York, 10032