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Dose Escalation and Efficacy Study of mRNA 2416 for Intratumoral Injection Alone and in Combination With Durvalumab for Patients With Advanced Malignancies

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ClinicalTrials.gov Identifier: NCT03323398
Recruitment Status : Recruiting
First Posted : October 27, 2017
Last Update Posted : September 6, 2019
Sponsor:
Information provided by (Responsible Party):
ModernaTX, Inc.

Brief Summary:
This clinical study will assess the safety and tolerability of escalating intratumoral doses of mRNA-2416 alone and in combination with intravenously administered flat doses of durvalumab in patients with relapsed/refractory solid tumor malignancies or lymphoma, as well as the objective response rate (ORR) of mRNA-2416 alone or in combination with durvalumab in ovarian cancer based on Response Evaluation Criteria in Solid Tumors (RECIST) v1.1

Condition or disease Intervention/treatment Phase
Relapsed/Refractory Solid Tumor Malignancies or Lymphoma Ovarian Cancer Biological: mRNA-2416 Biological: Durvalumab Phase 1 Phase 2

Detailed Description:
This is a first-in-human, Phase 1, open-label, multicenter, dose escalation and efficacy study designed to determine the safety and tolerability of repeated intratumoral injections of mRNA-2416 alone (Arm A) and in combination with intravenously administered durvalumab (Arm B) in patients with advanced relapsed/refractory solid tumor malignancies or lymphoma and to assess the ORR of mRNA-2416 alone and in combination with durvalumab in ovarian cancer based on RECIST v1.1. The study includes 2 treatment arms (mRNA-2416 monotherapy (Arm A),and mRNA-2416 + durvalumab (Arm B)), each arm of the study consists of a Dose Escalation period in non-visceral lesions followed by a Dose Confirmation period in visceral lesions and an Expansion period in patients with ovarian cancer at the MTD/RDE as determined by the Dose Escalation period. Once the expected MTD/RDE has been cleared in Dose Escalation for Arm A, Dose Escalation for Arm B will begin with mRNA-2416 at 1 dose level lower than the Arm A MTD/RDE.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 117 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1/2, Open-Label, Multicenter, Dose Escalation and Efficacy Study of mRNA 2416, a Lipid Nanoparticle Encapsulated mRNA Encoding Human OX40L, for Intratumoral Injection Alone or in Combination With Durvalumab for Patients With Advanced Malignancies
Actual Study Start Date : August 9, 2017
Estimated Primary Completion Date : September 2021
Estimated Study Completion Date : March 2022


Arm Intervention/treatment
Experimental: Arm A: mRNA-2416 alone
mRNA-2416 escalating dose levels; expansion cohort
Biological: mRNA-2416
mRNA encoding human OX40L

Experimental: Arm B: mRNA-2416 in combination with durvalumab
mRNA-2416 in combination with durvalumab escalating dose levels; expansion cohort
Biological: mRNA-2416
mRNA encoding human OX40L

Biological: Durvalumab
PD-L1 inhibitor




Primary Outcome Measures :
  1. Percentage of subjects with dose limiting toxicities (DLTs) with mRNA-2416 alone [ Time Frame: Days 1-28 ]
  2. Percentage of subjects with dose limiting toxicities (DLTs) with mRNA-2416 in combination with durvalumab [ Time Frame: Days 1-28 ]
  3. Percentage of subjects with adverse events (AEs) for mRNA-2416 alone [ Time Frame: Baseline through 3 months after the last dose of study treatment ]
  4. Percentage of subjects with adverse events (AEs) for mRNA-2416 in combination with durvalumab [ Time Frame: Baseline through 3 months after the last dose of study treatment ]
  5. In Phase II dose expansion: objective response rate (ORR) of mRNA-2416 alone and in combination with durvalumab in patients with ovarian cancer based on RECIST v1.1 [ Time Frame: Baseline through 6 months after the last dose of study treatment, or until disease progression, whichever occurs first ]

Secondary Outcome Measures :
  1. Percentage of subjects with anti-OX40L antibodies [ Time Frame: Pre-dose through 14 days after last dose of study treatment ]
  2. Maximum Observed Serum Concentration (Cmax) of mRNA-2416 [ Time Frame: Pre-dose through 29 days after initial mRNA-2416 dose ]
  3. Maximum Observed Serum Concentration (Cmax) of mRNA-2416 alone [ Time Frame: Pre-dose through 29 days after initial dose of study treatment ]
  4. Area under the serum concentration-time curve (AUC) of mRNA-2416 alone [ Time Frame: Pre-dose through 29 days after initial dose of study treatment ]
  5. Area under the serum concentration-time curve (AUC) of mRNA-2416 in combination with durvalumab [ Time Frame: Pre-dose through 29 days after initial dose of study treatment ]
  6. In Phase I only: ORR based on RECIST v1.1 or Cheson 2014 criteria (lymphomas) [ Time Frame: Baseline through 6 months after last mRNA-2416 monotherapy dose ]
  7. In Phase I only: duration of response based on RECIST v1.1 or Cheson 2014 criteria (lymphomas) [ Time Frame: Baseline through 6 months after last mRNA-2416 monotherapy dose ]
  8. In Phase I only: progression-free survival based on RECIST v1.1 or Cheson 2014 criteria (lymphomas) [ Time Frame: Baseline through 6 months after last mRNA-2416 monotherapy dose ]
  9. Disease control rate in patients with ovarian cancer (RECIST v1.1) [ Time Frame: Baseline through 6 months after last mRNA-2416 dose ]
  10. In Phase II: disease control rate in patients with ovarian cancer (RECIST v1.1) [ Time Frame: Baseline through 6 months after last dose of study treatment ]
  11. In Phase II: duration of response in patients with ovarian cancer (RECIST v1.1) [ Time Frame: Baseline through 6 months after last dose of study treatment ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Written informed consent prior to completing any study-specific procedure
  • Dose Escalation and Dose Confirmation Periods: Histologically- or cytologically-confirmed advanced/metastatic solid tumor or lymphoma by pathology report and who has received, or been intolerant to, all approved therapies
  • Dose Expansion Period: Histologically or cytologically confirmed diagnosis of: epithelial cancer of the ovary, fallopian tube, or peritoneum which is platinum resistant or platinum refractory. Patients must have received at least 2 prior lines of therapy. Patients with known BRCA mutation positive must have been treated with and progressed on at least 1 prior PARPi (poly(ADP-ribose) polymerase inhibitor)
  • Lesions for intratumoral injection and biopsies:

    • Dose Escalation: A minimum of one lesion that is easily accessible for injection where easily accessible is defined as a cutaneous or subcutaneous mass that is palpable and/or visualizable by ultrasound
    • Dose Confirmation: A minimum of one visceral lesion injectable with ultrasound or computer tomography (CT) guidance and that is not encasing or abutting major vascular structures or are in a location that are considered high risk for AEs by the enrolling physician
    • Dose Expansion: A minimum of one lesion amenable to injection (either non-visceral or visceral). Patients must have a tumor lesion amenable to biopsy and consent to a pre-treatment and an on-treatment biopsy. For patients with only one lesion amenable to injection, biopsy, and RECIST assessment, the lesion must be ≥ 2 cm
    • Biopsy Cohort Enrichment: Patients must have a tumor lesion amenable to biopsy and consent to a pre-treatment and an on-treatment biopsy
  • All lesion(s) targeted for the initial injection must be ≥ 0.5 cm on longest diameter, be at least 5 mm thick, and have distinct borders based on exam or imaging, not close to critical structures such as major vessels, nerves, or airways
  • Patients must have measurable disease as determined by RECIST v1.1 (solid tumors) or Cheson 2014 criteria (lymphomas).

    - Dose Expansion: Patients must have at least 1 measurable lesion per RECIST v1.1 which has not been previously irradiated

  • Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 1
  • Adequate hematological and biological function
  • Adequate thyroid function: Thyroid-stimulating hormone within normal range.
  • Female patients of childbearing potential must have a negative serum pregnancy test during screening.
  • Male and female patients must agree to use a highly reliable method of birth control.
  • Must have life expectancy of at least 12 weeks
  • Body weight > 30 kg

Exclusion Criteria:

  • Active central nervous system tumors or metastases
  • Treatment with chemotherapy, radiation (local radiation for palliative care is permitted), hormonal anti-cancer treatment, or biologic therapy < 14 days prior to the first day of study treatment (Cycle 1 Day 1 [C1D1]). Treatment with any other investigational agent or treatment with any anti-cancer monoclonal antibody, immunostimulant, or vaccine < 28 days prior to C1D1
  • Any unresolved toxicity NCI CTCAE Grade ≥ 2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria

    • Patients with Grade ≥ 2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician
    • Patients with irreversible toxicity not reasonably expected to be exacerbated by the treatment with durvalumab may be included only after consultation with the Study Physician
  • Has active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [eg, colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion:

    • Patients with vitiligo or alopecia
    • Patients with hypothyroidism (eg, following Hashimoto syndrome) stable on hormone replacement
    • Patients with any chronic skin condition that does not require systemic therapy
    • Patients without active disease in the last 5 years may be included but only after consultation with the Moderna medical monitor
    • Patients with celiac disease controlled by diet alone
  • Has a history of primary immunodeficiency, allogenic solid organ transplantation, or tuberculosis
  • Receipt of live attenuated vaccine within 30 days prior to the first dose of study treatment. Note: Patients, if enrolled, should not receive live vaccine whilst receiving study treatment and up to 30 days after the last dose of study treatment.
  • History of human immunodeficiency virus infection
  • Active/chronic hepatitis B or C
  • Any of the following cardiac abnormalities:

    • Medically uncontrolled hypertension
    • New York Heart Association Class III or IV cardiac disease
    • Myocardial infarction within prior 6 months
    • Unstable angina
    • Unstable arrhythmias or mean QT interval corrected for heart rate using Fridericia's formula (QTcF) ≥ 470 ms calculated from 3 ECGs (within 15 minutes at 5 minutes apart)
  • History of another primary malignancy except for:

    • Malignancy treated with curative intent and with no known active disease ≥ 5 years before the first dose of IP and of low potential risk for recurrence
    • Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
    • Adequately treated carcinoma in situ without evidence of disease
  • Females who are pregnant or breastfeeding
  • Any other unstable or clinically significant concurrent medical condition (eg, substance abuse, psychiatric illness/social situations, uncontrolled intercurrent illness including active infection, arterial thrombosis, symptomatic pulmonary embolism, active interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, etc.) that would, in the opinion of the investigator, jeopardize the safety of a patient, impact their expected survival through the end of the study participation, and/or impact their ability to give written informed consent or comply with the protocol
  • For patients who have received prior anti-PD-1 or anti PD-L1 therapy, a patient must not have experienced any of the following:

    • Must not have experienced a toxicity that led to permanent discontinuation of prior immunotherapy.
    • All AEs while receiving prior immunotherapy must have completely resolved or resolved to baseline prior to screening for this study.
  • Must not have experienced a ≥ Grade 3 immune related AE or an immune related neurologic or ocular AE of any grade while receiving prior immunotherapy. Note: Patients with endocrine AEs of ≤ Grade 2 are permitted to enroll if they are stable while maintained on appropriate replacement therapy and are asymptomatic.
  • Must not have required the use of additional immunosuppression other than corticosteroids for the management of an AE, not have experienced recurrence of an AE if re-challenged, and not currently require maintenance doses of > 10 mg prednisone or equivalent per day.
  • Has an active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis testing in line with local practice), hepatitis B (known positive HBV surface antigen [HBsAg] result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
  • Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
  • Has a history of leptomeningeal carcinomatosis.
  • Has involvement in the planning and/or conduct of the study.
  • Must not plan to donate blood or blood components while participating in this study and through 90 days after the last dose of study treatment

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03323398


Contacts
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Contact: Moderna Clinical Trials 855-663-6762 clinicaltrials@modernatx.com

Locations
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United States, Colorado
University of Colorado Hospital Recruiting
Aurora, Colorado, United States, 80045
Contact: Kristen Califano, RN, BSN,OCN    720-848-0592    Kristen.Califano@cuanschutz.edu   
United States, Massachusetts
Massachusetts General Hospital Recruiting
Boston, Massachusetts, United States, 02114
Contact: Ryan Sullivan, MD    877-726-5130    rsullivan7@partners.org   
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02215
Contact: Andrew Wolanski, DNP       Andrew_Wolanksi@dfci.harvard.edu   
United States, Michigan
Henry Ford Hospital Recruiting
Detroit, Michigan, United States, 48202
Contact: : Kalindi Naik, M.Dc, MS    313-916-9249      
United States, Minnesota
University of Minnesota Medical Center Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Amy Carlsen, RN    612-626-6541    carl1125@umn.edu   
United States, Tennessee
Sarah Cannon Research Institute Recruiting
Nashville, Tennessee, United States, 37203
Contact: Todd Bauer, MD    615-329-7478    Cann.ResearchReferrals@scresearch.net   
United States, Utah
Huntsman Cancer Institute Recruiting
Salt Lake City, Utah, United States, 84112
Contact: Cherie Peterson    801-587-5598    Cherie.Peterson@hci.utah.edu   
Sponsors and Collaborators
ModernaTX, Inc.

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Responsible Party: ModernaTX, Inc.
ClinicalTrials.gov Identifier: NCT03323398     History of Changes
Other Study ID Numbers: mRNA-2416-P101
First Posted: October 27, 2017    Key Record Dates
Last Update Posted: September 6, 2019
Last Verified: September 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by ModernaTX, Inc.:
mRNA-2416
OX40 ligand
OX40L
Moderna
Additional relevant MeSH terms:
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Neoplasms
Durvalumab
Antibodies, Monoclonal
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs