Gender
Female
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
- Measurable stage III, measurable stage IVA, stage IVB (with or without measurable
disease) or recurrent (with or without measurable disease) endometrial cancer.
- Pathology report showing results of institutional MMR IHC testing.
- Histologic confirmation of the original primary tumor is required (submission of
pathology report(s) is required). Patients with the following histologic types are
eligible: Endometrioid adenocarcinoma, serous adenocarcinoma,
dedifferentiated/undifferentiated carcinoma, clear cell adenocarcinoma, mixed
epithelial carcinoma, adenocarcinoma not otherwise specified (N.O.S.).
- Submission of tumor specimens for centralized MMR IHC testing is required after Step
1 and before Step 2 registration.
- In patients with measurable disease, lesions will be defined and monitored by RECIST
version (v) 1.1. Measurable disease is defined as at least one lesion that can be
accurately measured in at least one dimension (longest diameter to be recorded).
Each lesion must be >= 10 mm when measured by computed tomography (CT) or magnetic
resonance imaging (MRI). Lymph nodes must be >= 15 mm in short axis when measured by
CT or MRI.
- Patients may have received
- NO prior chemotherapy for treatment of endometrial cancer OR
- Prior adjuvant chemotherapy (e.g., paclitaxel/carboplatin alone or as a
component of concurrent chemotherapy and radiation therapy [with or without
cisplatin]) provided adjuvant chemotherapy was completed >= 12 months prior to
STEP 2 registration.
- Patients may have received prior radiation therapy for treatment of endometrial
cancer. Prior radiation therapy may have included pelvic radiation therapy, extended
field pelvic/para aortic radiation therapy, intravaginal brachytherapy and/or
palliative radiation therapy. All radiation therapy must be completed at least 4
weeks prior to STEP 2 registration.
- Patients may have received prior hormonal therapy for treatment of endometrial
cancer. All hormonal therapy must be discontinued at least three weeks prior to STEP
2 registration.
- Interval or cytoreductive surgery, after start of treatment on this trial, and prior
to documentation of disease progression, is NOT permitted.
- Age >= 18
- Performance status of 0, 1 or 2.
- Platelets >= 100,000/mcl.
- Absolute neutrophil count (ANC) >= 1,500/mcl.
- Creatinine =< 1.5 x institutional/laboratory upper limit of normal (ULN).
- Total serum bilirubin level =< 1.5 x upper limit of normal (ULN) (patients with
known Gilbert's disease who have bilirubin level =< 3 x ULN may be enrolled).
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN.
- Thyroid stimulating hormone (TSH) within normal limits. If TSH is not within normal
range despite no symptoms of thyroid dysfunction, normal Free T4 level is required.
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral
therapy with undetectable viral load within 6 months of Step 2 registration are
eligible for this trial.
- For patients of child bearing potential: negative urine or serum pregnancy test. If
the urine test is positive or cannot be confirmed as negative, a serum pregnancy
test is required.
- Administration of study drugs (pembrolizumab [MK-3475], paclitaxel, carboplatin) may
have an adverse effect on pregnancy and poses a risk to the human fetus, including
embryo-lethality. Women of childbearing potential (WOCBP) must agree to use adequate
contraception (hormonal or barrier method of birth control; abstinence) from at
least 14 days prior to Step 2 registration (for oral contraceptives), during
treatment, and for 120 days after the last dose of study medication. Should a woman
become pregnant or suspect she is pregnant while she is participating in this study,
she should inform her treating physician immediately. Patients will be considered of
nonreproductive potential if they are either:
- Postmenopausal (defined as at least 12 months with no menses without an
alternative medical cause; in women < 45 years of age, a high follicle
stimulating hormone (FSH) level in the postmenopausal range may be used to
confirm a postmenopausal state in women not using hormonal contraception or
hormonal replacement therapy. In the absence of 12 months of amenorrhea, a
single FSH measurement is insufficient); OR
- Have a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy or
bilateral tubal ligation/occlusion, at least 6 weeks prior to Step 2
registration; OR
- Have a congenital or acquired condition that prevents childbearing.
- Patients with a prior or concurrent malignancy whose natural history or treatment
does not have the potential to interfere with the safety or efficacy assessment of
the investigational regimen are eligible for this trial.
- The patient or a legally authorized representative must provide study-specific
informed consent prior to study entry and, for patients treated in the United States
(U.S.), authorization permitting release of personal health information.
Exclusion Criteria:
- Patients with prior treatment with anti-PD-1, anti-PD-L1 or anti-CTLA-4 therapeutic
antibody or other similar agents.
- Patients who have a history of a severe hypersensitivity reaction to monoclonal
antibody or pembrolizumab (MK-3475) and/or its excipients; and/or a severe
hypersensitivity reaction to paclitaxel and/or carboplatin
- Patients who are currently participating and receiving cancer-directed study therapy
or have participated in a study of an investigational agent and received
cancer-directed study therapy within 4 weeks prior to Step 2 registration.
- Patients who have a diagnosis of immunodeficiency or are receiving systemic steroid
therapy or any other form of immunosuppressive therapy within 7 days prior to Step 2
registration.
- Patients who have received steroids as CT scan contrast premedication may be
enrolled.
- The use of inhaled or topical corticosteroids is allowed.
- The use of mineralocorticoids (e.g., fludrocortisone) for patients with
orthostatic hypotension or adrenocortical insufficiency is allowed.
- The use of physiologic doses of corticosteroids may be approved after
consultation with the study chair.
- Patients with treated brain metastases are eligible if follow-up brain imaging after
central nervous system (CNS)-directed therapy shows no evidence of progression, and
they have been off steroids for at least 4 weeks prior to Step 2 registration and
remain clinically stable.
- Patients with active autoimmune disease or history of autoimmune disease that might
recur, which may affect vital organ function or require immune suppressive treatment
including systemic corticosteroids. This includes, but is not limited to, patients
with a history of immune related neurologic disease, multiple sclerosis, autoimmune
(demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic
autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue
diseases, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative
colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN),
Stevens-Johnson syndrome, or phospholipid syndrome because of the risk of recurrence
or exacerbation of disease.
- Patients with vitiligo, endocrine deficiencies including type I diabetes mellitus,
thyroiditis managed with replacement hormones including physiologic corticosteroids
are eligible.
- Patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and
psoriasis controlled with topical medication and patients with positive serology,
such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated
for the presence of target organ involvement and potential need for systemic
treatment but should otherwise be eligible.
- Patients who have a history of (non-infectious) pneumonitis that required steroids,
or current pneumonitis.
- Uncontrolled intercurrent illness including, but not limited to: ongoing or active
infection (except for uncomplicated urinary tract infection), interstitial lung
disease or active, non-infectious pneumonitis, symptomatic congestive heart failure,
unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social
situations that would limit compliance with study requirements.
- Known clinically significant liver disease, including active viral, alcoholic, or
other hepatitis; and cirrhosis.
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the
HBV viral load must be undetectable on suppressive therapy, if indicated.
- Patients with a history of hepatitis C virus (HCV) infection must have been
treated and cured. For patients with HCV infection who are currently on
treatment, they are eligible if they have an undetectable HCV viral load.
- Pregnant or lactating patients.