Testing Nivolumab as a Potential Targeted Treatment in Cancers With Mismatch Repair Deficiency (MATCH-Subprotocol Z1D)
Testing Nivolumab as a Potential Targeted Treatment in Cancers With Mismatch Repair Deficiency (MATCH-Subprotocol Z1D)
This phase II MATCH treatment trial identifies the effects of nivolumab in patients whose
 cancer has a genetic change called mismatch repair deficiency. Mismatch repair deficiency
 refers to cells that have mutations (changes) in certain genes that are involved in
 correcting mistakes made when DNA is copied in a cell. Immunotherapy with monoclonal
 antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may
 interfere with the ability of cancer cells with mismatch repair deficiency to grow and
 spread. Researchers hope to learn if nivolumab will shrink this type of cancer or stop its
 growth.
PRIMARY OBJECTIVE:

 I. To evaluate the proportion of patients with objective response (OR) to targeted study
 agent(s) in patients with advanced refractory cancers/lymphomas/multiple myeloma.

 SECONDARY OBJECTIVES:

 I. To evaluate the proportion of patients alive and progression free at 6 months of treatment
 with targeted study agent in patients with advanced refractory cancers/lymphomas/multiple
 myeloma.

 II. To evaluate time until death or disease progression.

 EXPLORATORY OBJECTIVES:

 I. To identify potential predictive biomarkers beyond the genomic alteration by which
 treatment is assigned or resistance mechanisms using additional genomic, ribonucleic acid
 (RNA), protein and imaging-based assessment platforms.

 II. To assess whether radiomic phenotypes obtained from pre-treatment imaging and changes
 from pre- through post-therapy imaging can predict objective response and progression free
 survival and to evaluate the association between pre-treatment radiomic phenotypes and
 targeted gene mutation patterns of tumor biopsy specimens.

 OUTLINE:

 Patients receive nivolumab intravenously (IV) over 30-60 minutes on days 1 and 15 of cycles
 1-4 and on day 1 of subsequent cycles. Cycles repeat every 28 days in the absence of disease
 progression or unacceptable toxicity.

 After completion of study treatment, patients are followed up every 3 months if less than 2
 years from study entry, and then every 6 months for year 3 from study entry.

 THE MATCH SCREENING TRIAL:

 Please see NCT02465060 for information on the MATCH Screening Protocol and applicable
 documents.
Inclusion Criteria:

 -  Patients must have met applicable eligibility criteria in the Master MATCH Protocol
 prior to registration to treatment subprotocol

 -  Patients must have mismatch repair deficiency as determined via the MATCH Master
 Protocol

 -  Women of childbearing potential (WOCBP) receiving nivolumab must agree to use adequate
 contraception (hormonal or double barrier method of birth control; abstinence) from
 one week prior to study treatment starting, during treatment, and for a period of 5
 months after the last dose of nivolumab. Men receiving nivolumab and who are sexually
 active with WOCBP must agree to use adequate contraception (hormonal or double barrier
 method of birth control; abstinence) from one week prior to study treatment starting,
 during treatment, and for a period of 7 months after the last dose of nivolumab

 -  Patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection may be
 eligible provided they have the following:

 -  There must be no evidence of clinically significant hepatic injury from hepatitis
 virus infection

 -  For HBV, patients must be on suppressive therapy and have undetectable HBV viral
 load

 -  For HCV, patients must either be on suppressive therapy for HCV or have already
 completed therapy thought to have eradicated HCV

 Exclusion Criteria:

 -  Patients must not have known hypersensitivity to nivolumab or compounds of similar
 chemical or biologic composition

 -  No prior therapy with anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-OX-40,
 anti-CD40 or anti-CTLA-4 antibodies (or any other antibody targeting T cell
 co-regulatory pathways)

 -  Patients with cancers for which nivolumab is approved or becomes approved are excluded
 (e.g: colorectal cancer, locally advanced or metastatic urothelial carcinoma,
 unresectable or metastatic melanoma, metastatic non-small cell lung cancer, advanced
 renal cell carcinoma, classical Hodgkin lymphoma, and recurrent or metastatic squamous
 cancer of the head and neck)

 -  Must not have received any of the following therapies within four weeks prior to the
 first dose of the study drug: IL-2, interferon, or other non-study immunotherapy
 regimens or immunosuppressive agents

 -  Must not have a history of toxic epidermal necrolysis (Stevens-Johnson syndrome)

 -  Must not have received growth factors, including but not limited to granulocyte-colony
 stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF),
 erythropoietin, etc. within 2 weeks of study drug administration. Use of such agents
 while on study is also prohibited. Prior use of growth factors should be documented in
 the patient's medical history

 -  Must not have a history of any autoimmune disease: inflammatory bowel disease,
 (including ulcerative colitis and Crohn's disease), rheumatoid arthritis, systemic
 progressive sclerosis (scleroderma), systemic lupus erythematosus (SLE) autoimmune
 vasculitis (e.g., Wegener's Granulomatosis), central nervous system (CNS) or motor
 neuropathy considered to be of autoimmune origin (e.g., Guillain-Barre syndrome,
 myasthenia gravis, multiple sclerosis). Patients are permitted to enroll if they have
 vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune
 condition only requiring hormone replacement, psoriasis not requiring systemic
 treatment, or conditions not expected to recur in the absence of an external trigger
 (precipitating event). Entry of patients with autoimmune diagnoses not listed here
 must be approved by the protocol chair

 -  Must not be on supplemental home oxygen

 -  Must not have evidence of interstitial lung disease

 -  Patients with a requirement for steroid treatment or other immunosuppressive
 treatment: Patients will be excluded if they have a condition requiring systemic
 treatment with either corticosteroids (> 10 mg daily prednisone equivalents) within 14
 days of study drug administration. Inhaled or topical steroids and adrenal replacement
 doses > 10 mg daily prednisone equivalents are permitted in the absence of active
 autoimmune disease

 -  No history of severe hypersensitivity reaction to any monoclonal antibody