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Fc-Engineered Anti-CTLA-4 Monoclonal Antibody in Advanced Cancer

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ClinicalTrials.gov Identifier: NCT03860272
Recruitment Status : Recruiting
First Posted : March 1, 2019
Last Update Posted : October 9, 2019
Sponsor:
Information provided by (Responsible Party):
Agenus Inc.

Brief Summary:
This study is an open-label, Phase 1, multicenter study to evaluate the safety, tolerability, PK, and PD profiles of a novel Fc-engineered IgG1 anti-CTLA-4 human monoclonal antibody (AGEN1181), and to assess the maximum tolerated dose (MTD) in subjects with advanced solid tumors. This study will also determine the RP2D of AGEN1181 monotherapy.

Condition or disease Intervention/treatment Phase
Advanced Cancer Drug: AGEN1181 Phase 1

Detailed Description:

This Phase 1 study will enroll up to approximately 36 evaluable adult subjects with refractory, advanced cancer (solid tumors) regardless of diagnosis and prior therapies. Subjects can be replaced for any reason other than DLT. The biopharmacological properties of the antibody suggest that this proposed dose range (0.1, 0.3, 1, 2, and 4 mg/kg) will be safe and potentially active. Toxicity will be graded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

The dose escalation includes open-label monotherapy dose escalation consisting of a standard 3+3 dose escalation scheme with the following escalating dose levels and schedules of AGEN1181: 0.1, 0.3, 1, 2, and 4 mg/kg administered every 3 weeks. Each subject will stay on the dose level and schedule assigned at trial entry. Subjects will receive AGEN1181 for ≤2 years or until PD, unacceptable toxicity, or any criterion for stopping the study drug or withdrawal from the trial occurs.

The treatment phase is divided into 3-week treatment cycles, with associated evaluations and procedures at specific timepoints. Each 3-week cycle begins with administration of AGEN1181.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 36 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Dose escalation
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Study of AGEN1181, an Fc-Engineered Anti-CTLA-4 Monoclonal Antibody in Subjects With Advanced Cancer
Actual Study Start Date : March 20, 2019
Estimated Primary Completion Date : March 2022
Estimated Study Completion Date : March 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Open Label
3+3 Dose escalation of AGEN1181, every 3 weeks, starting at dose level 0.1 mg/kg up to 4 mg/kg administered by IV.
Drug: AGEN1181
an Fc-Engineered Anti-CTLA-4 Monoclonal Antibody
Other Name: Anti-CTLA-4




Primary Outcome Measures :
  1. Incidence of Adverse Events according to NCI CTCAE version 5.0 [ Time Frame: Screening to 90 days from last dose. ]
    AEs, including AESIs, irAE, ADRs, according to NCI CTCAE version 5.0

  2. Dose Limiting Toxicity [ Time Frame: First 28 days of treatment ]
    Any Grade 2 or greater drug related toxicity for all dose groups, according to NCI CTCAE version 5.0 with described protocol exceptions.

  3. Recommended Phase II Dose (RP2D) [ Time Frame: First dose to 90 days from last dose. ]
    Maximum Tolerated Dose (MTD) based on DLT occurrence at DLT period and all AEs seen during safety period


Secondary Outcome Measures :
  1. Response rate according to RECIST 1.1 [ Time Frame: Evaluated throughout the protocol, up to 2 years ]
    Confirmed objective response rate (ORR) in analysis population

  2. Response rate according to RECIST 1.1 [ Time Frame: First observation of documented DP (or death within 12 weeks of last tumor assessment) ]
    Duration of Response (DOR)

  3. Response rate according to RECIST 1.1 [ Time Frame: 24 weeks of first dose ]
    Disease Control (DCR) including CR, PR and SD for at least 12 weeks

  4. Response rate according to RECIST 1.1 [ Time Frame: First treatment administration to first observation of documented disease progression (or death within 12 weeks of last tumor assessment) ]
    Progression Free Survival (PFS) time

  5. Overall survival time [ Time Frame: Up to 1 year after discontinuation. ]
    Duration of survival

  6. Maximum observed concentration at steady-state (Cmax-ss) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  7. Minimum observed concentration at steady-state (Cmin-ss) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  8. Area under the concentration-time curve within time span t1 to t2 at steady-state (AUC(τ1-τ2)-ss) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  9. Area under the concentration-time curve from time zero to infinity (AUC(0-∞) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  10. Time to maximum observed concentration (tmax) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  11. Terminal disposition rate constant (λz) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  12. Terminal elimination half-life (t1/2) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  13. Systemic clearance (CL) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  14. Volume of distribution (Vd) [ Time Frame: Pre-dose through 3 months after last dose. ]
    AGEN1181 blood levels measured throughout the study.

  15. Evaluate the immunogenicity of AGEN1181 as monotherapy [ Time Frame: Pre-dose through 3 months after last dose ]
    Anti Drug Antibody (ADA) measurements throughout the study.



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:

For inclusion in the trial, all of the following inclusion criteria must be fulfilled, as no waivers will be permitted:

  1. Voluntarily agree to participate by giving written informed consent. Participation in pharmacogenomics testing is optional.
  2. ≥18 years of age.
  3. Histologically or cytologically confirmed diagnosis of metastatic or locally advanced solid tumor for which no standard therapy is available or standard therapy has failed.
  4. Measurable disease on imaging based on RECIST 1.1.
  5. Life expectancy of ≥3 months and ECOG performance status of 0 or 1.
  6. Adequate organ function, as indicated by the following laboratory values:

    a. Adequate hematological function, defined as absolute neutrophil count (ANC) ≥1500/mcl, platelet count ≥100,000/mcl, and hemoglobin ≥8 g/dL without recent transfusion (defined as a transfusion that has occurred within 2 weeks of the Hgb measurement).Adequate hepatic function, defined as total bilirubin level ≤1.5 x institutional upper limit of normal (IULN), aspartate aminotransferase (AST) ≤2.5 x IULN, alanine aminotransferase (ALT) ≤2.5 x IULN, and alkaline phosphatase (AP) ≤2.5 x IULN. Adequate renal function defined as creatinine ≤1.5 x IULN OR calculated creatinine clearance ≥40 mL/min for subjects with creatinine levels >1.5 x IULN (if no local guideline is available, creatinine clearance should be calculated using the Cockcroft-Gault method). Adequate coagulation, defined as international normalized ratio (INR) or prothrombin time ≤1.5 x IULN and activated partial thromboplastin time (aPTT) ≤1.5 x IULN (unless subject receiving anticoagulant therapy).

  7. No history of prior or concomitant malignancy, with the exception of resected basal cell carcinoma of the skin, superficial bladder cancer, squamous cell carcinoma of the skin, and in situ cervical cancer or other malignancies that have undergone potentially curative therapy with no evidence of disease recurrence for 5 years since initiation of that therapy.
  8. Sufficient and adequate formalin-fixed tumor tissue sample, preferably from biopsy of tumor lesion either at time of or after diagnosis of advanced or metastatic disease has been made, and from a site not previously irradiated.
  9. Female subjects of childbearing potential must have a negative serum pregnancy test at screening (within 72 hours of first dose of study medication). Non-childbearing potential is defined as 1 of the following:

    1. ≥45 years of age and has not had menses for >1 year.
    2. Amenorrheic for >2 years without a hysterectomy and/or oophorectomy and follicle-stimulating hormone value in the postmenopausal range upon pretrial (screening) evaluation.
    3. Status is post-hysterectomy, -oophorectomy, or -tubal ligation.
  10. Female subjects of childbearing potential must be willing to use highly effective contraceptive measures starting with the screening visit through 120 days after last dose of study treatment.

    Note: Abstinence is acceptable if this is the established and preferred contraception for the subject.

  11. Male subjects with a female partner(s) of childbearing potential must agree to use highly effective contraceptive measures throughout the trial starting with the screening visit through 120 days after the last dose of study treatment is received. Males with pregnant partners must agree to use a condom; no additional method of contraception is required for the pregnant partner.

    Note: Abstinence is acceptable if this is the established and preferred contraception method for the subject.

  12. Willing and able to comply with the requirements of the protocol.

Exclusion Criteria:

For inclusion in the trial, subject must meet none of the following exclusion criteria, as no waivers will be permitted:

  1. Currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigation device within 3 weeks of first dose of current study drug.
  2. Received prior systemic cytotoxic chemotherapy, biological therapy, or major surgery within 3 weeks prior to first dose of study drug. A 1-week washout is permitted for palliative radiation to non-CNS disease, with sponsor approval.
  3. Received prior therapy with an anti-CTLA-4 antibody or drug.
  4. Persistent toxicity of NCI CTCAE version 5.0 Grade >1 severity that is related to prior therapy.

    Note: Sensory neuropathy or alopecia of grade ≤2 is acceptable.

  5. Expected to require any other form of systemic or localized antineoplastic therapy while on trial (including maintenance therapy with another agent, radiation therapy, and/or surgical resection).
  6. Known severe (grade ≥3) hypersensitivity reactions to monoclonal antibodies, antibody, or severe reaction to immuno-oncology agents, such as colitis or pneumonitis requiring treatment with steroids; or current or history of interstitial lung disease, anaphylaxis, uncontrolled asthma (i.e., ≥3 features of partly controlled asthma), or pneumonitis that has required oral or IV corticosteroids.
  7. Receiving systemic corticosteroid therapy 1 week prior to the first dose of study drug or receiving any other form of systemic immunosuppressive medication. Corticosteroid use as a premedication for IV contrast allergies/reactions is allowed. Subjects who are receiving daily corticosteroid replacement therapy are also an exception to this rule. Daily prednisone at doses of ≤7.5 mg or equivalent hydrocortisone dose are examples of permitted replacement therapy.
  8. CNS tumor, metastasis(es), and/or carcinomatous meningitis identified either on the baseline brain imaging obtained during the screening period or identified prior to consent.

    Note: Subjects with history of brain metastases that have been treated may participate provided they show evidence of stable supra-tentorial lesions at screening (defined as 2 brain images, both of which are obtained after treatment to the brain metastases and obtained ≥4 weeks apart). In addition, any neurologic symptoms that developed either as a result of the brain metastases or their treatment must have returned to baseline or resolved. Any steroids administered as part of this therapy must be completed ≥3 days prior to first dose of trial medication.

  9. Active or history of autoimmune disease that requires systemic treatment within 2 years of the start of study drug (i.e., with use of disease-modifying agents, corticosteroids, or immunosuppressive drugs).

    Note: Subjects with diabetes type 1, vitiligo, psoriasis, or hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible.

  10. Has had an allogeneic tissue/solid organ transplant.
  11. Active infection requiring treatment.
  12. Known history of human immunodeficiency virus type 1 or 2 antibodies.
  13. Known active infection with hepatitis B and/or hepatitis C virus.
  14. Clinically significant (i.e., active) cardiovascular disease: cerebral vascular accident/stroke or myocardial infarction within 6 months of enrollment, unstable angina, congestive heart failure (New York Heart Association class ≥II), or serious uncontrolled cardiac arrhythmia requiring medication.
  15. 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.
  16. Known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the trial.
  17. Legally incapacitated or has limited legal capacity.
  18. Pregnant or breastfeeding.

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): NCT03860272


Locations
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United States, Arizona
HonorHealth Research Institute Recruiting
Scottsdale, Arizona, United States, 85258
Contact: Joyce Schaffer    480-323-1364    clinicaltrials@honorhealth.com   
Principal Investigator: Michael Gordon, MD         
United States, California
University of Southern California Norris Comprehensive Cancer Center Recruiting
Los Angeles, California, United States, 90033
Contact: Anthony El-Khoueiry, MD    323-865-3000    elkhouei@med.usc.edu   
Principal Investigator: Anthony El-Khoueiry, MD         
John Wayne Cancer Institute Recruiting
Santa Monica, California, United States, 90404
Contact: Aleksandra Dubinchik    310-582-7455    aleksandra.dubinchik@providence.org   
Principal Investigator: Steven O'Day, MD         
United States, Massachusetts
Beth Israel Deaconess Medical Center Recruiting
Boston, Massachusetts, United States, 02215
Contact: Susan Gotthardt, RN    617-975-7452    sgotthar@bidmc.harvard.edu   
Principal Investigator: Andrea Bullock, MD         
United States, Texas
The University of Texas Health Science Center at San Antonio Recruiting
San Antonio, Texas, United States, 78229
Contact: Goodwine Epp    210-450-5798    GOODWINE@uthscsa.edu   
Principal Investigator: Chethan Ramamurthy, MD         
Sponsors and Collaborators
Agenus Inc.
Investigators
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Study Director: Waldo Ortuzar, MD Agenus Inc.

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Responsible Party: Agenus Inc.
ClinicalTrials.gov Identifier: NCT03860272     History of Changes
Other Study ID Numbers: C-800-01
First Posted: March 1, 2019    Key Record Dates
Last Update Posted: October 9, 2019
Last Verified: October 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
Additional relevant MeSH terms:
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Neoplasms
Antibodies
Antibodies, Monoclonal
Immunologic Factors
Physiological Effects of Drugs