Nivolumab and Lenalidomide in Treating Patients with Relapsed or Refractory Non-Hodgkin or Hodgkin Lymphoma

Inclusion Criteria

• PHASE I: Histologically confirmed B-cell NHL with any of the following subtypes: DLBCL, mantle cell lymphoma (MCL), FL, marginal zone lymphoma (MZL) and lymphoplasmacytic lymphoma/Waldenstrom’s macroglobulinemia (LL/WM), Burkitt’s lymphoma (BL); patients with histological transformation to DLBCL from indolent lymphoma, primary mediastinal lymphoma and grey zone lymphoma are eligible
• PHASE I: Histologically confirmed classical or lymphocyte predominant Hodgkin’s disease that is relapsed or refractory after at least two prior chemotherapy regimens; patients who have not had prior high-dose therapy (HDT)/autologous stem cell transplant (ASCT) must be ineligible for transplant
• PHASE I: Patients with DLBCL, BL, transformed DLBCL, primary mediastinal lymphoma and grey zone lymphoma must have received at least one prior therapy; patients with MCL, FL, MZL and LL/WM must have failed at least two prior therapies; prior autologous stem cell transplant is permitted; patients with DLBCL, BL, transformed DLBCL, primary mediastinal lymphoma and grey zone lymphoma who have not had prior HDT/ASCT must be ineligible for transplant; prior lenalidomide is not permitted if patients have progressed on therapy
• PHASE IB DOSE EXPANSION: Histologically confirmed classical or lymphocyte predominant Hodgkin’s disease
• PHASE IB DOSE EXPANSION: Patients must have received at least two prior therapy regimens; prior autologous stem cell transplant is permitted; patients who have not had prior HDT/ASCT must be ineligible for transplant; prior lenalidomide is not permitted if patients have progressed on therapy
• PHASE II: Histologically confirmed DLBCL including transformed DLBCL from indolent Non-Hodgkin’s lymphoma (excludes Richter’s Syndrome). (Cases of DLBCL with MYC and BCL2 and/or BCL6 rearrangement, know referred to as High Grade B Cell Lymphoma with MYC and BCL2 and/or BCL6 rearrangement are eligible as are patients with DLBCL subtypes such as T cell histiocyte rich large B cell lymphoma)
• PHASE II: Patients with DLBCL must have received at least one prior therapy for DLBCL. Patients with DLBCL who have not had prior HDT/ASCT must be ineligible for transplant. Prior lenalidomide is not permitted if patients have progressed on therapy
• Be willing and able to provide written informed consent/assent for the trial
• Have evaluable disease by imaging, computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) evaluable imaging is acceptable
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
• Absolute neutrophil count (ANC) >= 1,000 /mcL (within 16 days of treatment initiation)
• Platelets >= 50,000 /mcL in the absence of transfusion support within 7 days of determining eligibility (within 16 days of treatment initiation)
• Hemoglobin >= 8 g/dL (within 16 days of treatment initiation)
• Serum creatinine =< 1.5 X upper limit of normal (ULN) OR measured or calculated creatinine clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance [CrCl]) >= 40 mL/min creatinine clearance (within 16 days of treatment initiation) * Creatinine clearance should be calculated per institutional standard
• Serum total bilirubin =< 1.5 X ULN OR except subjects with Gilbert syndrome, who can have total bilirubin < 3.0 mg/dL (within 16 days of treatment initiation)
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3.0 X ULN (within 16 days of treatment initiation)
• Female subject of childbearing potential should have a negative urine or serum pregnancy at screening and within 24 hours prior to receiving the first dose of study medication; if the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
• Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication; subjects should agree to ongoing pregnancy testing during the course of the study and after the end of study therapy; female subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for at least 24 consecutive months
• Male subjects should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy; males must refrain from donating sperm during study participation and for 120 days after the last dose of study medication
• Willing and able to receive adequate prophylaxis and/or therapy for thromboembolic events
• Be >= 18 years of age on day of signing informed consent.
• Be willing and able to understand and give written informed consent and comply with all study related procedures

Exclusion Criteria

• Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 3 weeks of the first dose of treatment
• Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment; subjects may use topical or inhaled corticosteroids or low-dose steroids (=< 20 mg of prednisone or equivalent per day) as therapy for comorbid conditions; during study participation, subjects may receive systemic or enteric corticosteroids as needed for treatment-emergent comorbid conditions
• Participants who have received a live / attenuated vaccine within 30 days of first treatment
• Prohibited meds
• Has a known history of active TB (Bacillus Tuberculosis)
• Hypersensitivity to nivolumab or lenalidomide or any of their excipients
• Has had a prior anti-cancer monoclonal antibody (mAb) within 2 weeks prior to study day 1 or who has not recovered (i.e., =< grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier
• Has had prior chemotherapy or radiation therapy within 2 weeks prior to study day 1 or who has not recovered (i.e., =< grade 1 or at baseline) from adverse events due to a previously administered agent * Note: subjects with =< grade 2 neuropathy are an exception to this criterion and may qualify for the study * Note: if subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy; patients must be 4 weeks out from major procedures
• Has a known additional malignancy that is progressing or requires active treatment; exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer
• Has known active central nervous system (CNS) lymphoma
• Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs); replacement therapy (thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment; conditions expected to not recur in the absence of an external trigger
• Has an active infection requiring intravenous systemic therapy
• Is unable to swallow capsules or malabsorption syndrome, disease or condition significantly affecting gastrointestinal function
• Clinically significant cardiovascular disease with uncontrolled arrhythmia, New York Association class 3 or 4 congestive heart failure, history of myocardial infarction within 6 months, or prolonged corrected QT (QTc) > 500 msec
• Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 5 months for women, 7 months for men after the last dose of trial treatment
• Has progressed on prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent
• Has progressed on prior therapy with lenalidomide
• Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies)
• Has known active hepatitis B (e.g., hepatitis B surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected)
• Has a history of deep venous thrombosis/embolism, threatening thromboembolism or known thrombophilia or are at a high risk for a thromboembolic event in the opinion of the investigator and who are not willing/able to take venous thromboembolic event prophylaxis during the entire treatment period
• History of prior allogeneic hematopoietic cell transplant with prior or active graft versus host disease (GVHD) or currently receiving immunosuppression