Nivolumab and Ipilimumab Treatment in Prostate Cancer With an Immunogenic Signature

Prior treatment

• Patients with prior allogeneic stem cell or solid organ transplantation.
• Active invasive malignancy in the previous 2 years excluding non-melanoma skin cancer.
• Received therapeutic oral or intravenous (IV) antibiotics within 14 days prior to enrolment (Patients receiving prophylactic antibiotics (e.g., for prevention of a urinary tract infection or COPD) are eligible).
• Patients must not have had systemic corticosteroid therapy (\>10mg daily prednisone equivalent) for 14 days prior to study entry, or concomitant use of other immunosuppressive medications. The use of inhaled corticosteroids, physiologic replacement doses of glucocorticoids (i.e., for adrenal insufficiency), and mineralocorticoids (e.g., fludrocortisone) is allowed.
• Prior treatment with Sipuleucel-T, immune checkpoint targeting agents or other novel immune-oncology agents.
• Administration of a live, attenuated vaccine within 4 weeks prior to enrolment or anticipation that such a live, attenuated vaccine will be required during the study.
• Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction within 3 months prior to enrolment, unstable arrhythmias, or unstable angina.

Other illness

• Any history of autoimmune disease, with the exception of patients with a history of autoimmune-related hyperthyroidism or hypothyroidism who are in remission or on a stable dose of thyroid-replacement hormone.
• History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia (i.e. bronchiolitis obliterans, cryptogenic organizing pneumonia), or evidence of active pneumonitis on screening chest CT scan.
  • (History of radiation pneumonitis in the radiation field is permitted).
• Patients with interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected drug-related pulmonary toxicity.
• Patients with risk factors for bowel perforation.
• History of grade ≥2 peripheral neuropathy.
• Patients with uncontrolled Type 1 diabetes mellitus. Patients controlled on a stable insulin regimen are eligible.
• Patients with uncontrolled adrenal insufficiency.
• Patients with active hepatitis infection (defined as having a positive hepatitis B surface antigen \[HBsAg\] test at screening) or hepatitis C.
• Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness.

• Metastatic castrate resistant prostate cancer.
• Histologically confirmed prostate adenocarcinoma.
• Patient has archival prostate cancer tissue available or is willing to undergo a new biopsy.
• Immunogenic biomarker positive disease - see Appendix 1 NB patients will be included in the trial if they meet all other eligibility criteria. Analysis of the ImS will take place after registration. Patients who do not have ImS positive disease will be withdrawn from the trial.
• WHO performance status of 0-1.
• Adequate haematological status.
• Adequate liver and renal function.
• Has had 1 or more lines of systemic treatment for mCRPC.
• Documented prostate cancer progression within 6 months prior to screening
• Ongoing androgen deprivation with serum testosterone \<1.73 nmol/L.