Pembrolizumab-based Therapy in Previously Treated High Grade Neuroendocrine Carcinomas

1. Has Merkel cell carcinoma, small cell lung carcinoma, or large cell NEC of lung
2. Intermediate grade neuroendocrine tumors are excluded
3. Well differentiated Grade 3 neuroendocrine tumors are excluded
4. Metastatic high-grade prostate carcinoma with evidence of focal neuroendocrine differentiation on prostate biopsy (e.g., positive chromogranin staining by immunohistochemistry) without small cell or large cell NEC morphology are excluded, as are neuroendocrine prostate cancers with phenotype intermediate between adenocarcinoma and small cell
5. Atypical and typical bronchial carcinoids and well differentiated G1 and G2 gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are excluded
6. 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 4 weeks of the first dose of treatment.
7. Has a diagnosis of immunodeficiency
8. Is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
9. Physiologic doses of steroids (e.g. < 10 mg prednisone/day or equivalent) are allowed
10. Has a known history of active Bacillus Tuberculosis (TB).
11. History of or high suspicion of Gilbert's disease (safety run-in, Part B only)
12. Hypersensitivity to pembrolizumab or any of its excipients.
13. Has had a prior anti-cancer monoclonal antibody (mAb) within 4 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.
14. Documented progression on and/or intolerance/hypersensitivity to both paclitaxel and irinotecan (Part B only)
15. . Has had prior chemotherapy, targeted small molecule therapy, 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.
16. Note: Subjects with ≤ Grade 2 neuropathy are an exception to this criterion and may qualify for the study.
17. Note: If subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy.
18. Concurrent somatostatin analog therapy is allowed (for control of hormone excess) provided patient has been on stable dose for at least two months and tumor progression has been documented
19. Continuation of androgen deprivation therapy (ADT) allowed for patients with neuroendocrine prostate cancer (in the setting of castration-resistant prostate cancer, CRPC)
20. . 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.
21. . Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.
22. . 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).
23. Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
24. . Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis
25. . Evidence for interstitial lung disease
26. . Has an active infection requiring systemic therapy.
27. . Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
28. . Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
29. . 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 120 days after the last dose of trial treatment.
30. . Has received prior therapy with an anti-Programmed Death 1 (PD-1), anti-Programmed Death Ligand 1 (PD-L1), or anti-PD-L2 agent.
31. . Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
32. . Has known active Hepatitis B virus (e.g., HBsAg reactive) or Hepatitis C virus (e.g., HCV RNA [qualitative] is detected).
33. . Has received a live vaccine within 30 days of planned start of study therapy.

Note: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live attenuated vaccines, and are not allowed.