Testing the Value of Adding Surgery after the Usual Treatment (Immunotherapy) for Patients with Stage I-IIIA Sarcomatoid Mesothelioma
This phase II trial evaluates the safety and effectiveness of adding surgery after the usual immunotherapy (nivolumab and ipilimumab) for controlling and treating disease in patients with stage I-IIIa sarcomatoid mesothelioma. 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. Adding surgery after usual immunotherapy may be more effective at stabilizing sarcomatoid mesothelioma.
Eligibility
Inclusion Criterea
- Sarcomatoid or sarcomatoid-dominant (> 50%) biphasic, pleural mesothelioma
- Stage: I-IIIA disease per Union for International Cancer Control (UICC) TNM Classification of Malignant Tumours 8th edition
- Measurable disease or non-measurable disease as defined
- No prior treatment which would be considered treatment for the primary neoplasm or impact the primary endpoint
- No treatment with hormones or other chemotherapeutic agents except for hormones administered for non-disease-related conditions (e.g., insulin for diabetes and or hormonal therapy for breast, prostate cancer etc.)
- Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown
* Therefore, for women of childbearing potential only, a negative pregnancy test done =< 14 days prior to registration is required
- Age >= 18 years
- Eastern Cooperative Oncology Group (ECOG) performance status == 60%
- Absolute neutrophil count (ANC) >= 1,000/mm^3
- Leukocytes >= 2,000/mm^3
- Platelet count >= 100,000/mm^3
- Creatinine == 40 mL/min
- Total bilirubin =<1.5 x ULN, except patients with Gilbert Syndrome who can have total bilirubin < 3.0 mg/dl
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3.0 x ULN
- Alkaline (alk) phosphatase (phos) =< 3.0 x ULN
- No active, known or suspected autoimmune disease except for 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
- No active systemic infection requiring therapy, as well as positive tests for hepatitis B surface antigen or hepatitis C antibody
- No history of any other condition that may require the initiation of anti-tumor necrosis factor alpha (TNFalpha) therapies or other immunosuppressant medications during the study
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
- Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better
- 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
- STEP 2 ELIGIBILITY CRITERIA: Completion of at least 1 cycle of treatment and not have an unresolved adverse event that would preclude surgery
- STEP 2 ELIGIBILITY CRITERIA: No evidence of progression that would preclude resection
- STEP 2 ELIGIBILITY CRITERIA: ECOG performance status == 60%
- STEP 2 ELIGIBILITY CRITERIA: Predicted forced expiratory volume in 1 second (FEV1) > 35% and postoperative predicted diffusion capacity of the lung for carbon monoxide (DLCO) > 35%
- STEP 2 ELIGIBILITY CRITERIA: Registration to step 2 no less than 21 days and no more than 90 days after the last dose of immunotherapy
- No patients with chest wall invasion, peritoneal spread, contralateral pleural involvement, mediastinal organ involvement, vertebral involvement, or metastases to contralateral intrathoracic lymph nodes, or any supraclavicular nodes
- No patients with a history of symptomatic interstitial lung disease
Participating Clinics
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
Carson Tahoe Regional Medical Center
Comprehensive Cancer Centers of Nevada - Henderson
Saint Mary's Regional Medical Center
Sunrise Hospital and Medical Center
Cancer and Blood Specialists-Henderson
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas Cancer Center-Henderson
GenesisCare USA - Las Vegas
Comprehensive Cancer Centers of Nevada - Central Valley
Comprehensive Cancer Centers of Nevada
Hope Cancer Care of Nevada
Radiation Oncology Centers of Nevada Central
Comprehensive Cancer Centers of Nevada-Southeast Henderson
GenesisCare USA - Henderson
OptumCare Cancer Care at MountainView
OptumCare Cancer Care at Charleston
GenesisCare USA - Vegas Tenaya
Comprehensive Cancer Centers of Nevada - Northwest
Comprehensive Cancer Centers of Nevada - Town Center
Kingman Regional Medical Center
OptumCare Cancer Care at Seven Hills
Comprehensive Cancer Centers of Nevada-Horizon Ridge
University Medical Center of Southern Nevada
Hope Cancer Care of Nevada-Pahrump
OptumCare Cancer Care at Fort Apache
Radiation Oncology Centers of Nevada Southeast
GenesisCare USA - Fort Apache
Summerlin Hospital Medical Center
Radiation Oncology Associates
Las Vegas Cancer Center-Medical Center
Renown Regional Medical Center
Comprehensive Cancer Centers of Nevada-Summerlin
Las Vegas Urology - Cathedral Rock
Urology Specialists of Nevada - Southwest
Urology Specialists of Nevada - Central
Las Vegas Urology - Green Valley
Urology Specialists of Nevada - Northwest
Las Vegas Urology - Sunset
Las Vegas Prostate Cancer Center
Las Vegas Urology - Pebble
Las Vegas Urology - Pecos
Urology Specialists of Nevada - Green Valley