Phase Ib Study of TNO155 in Combination With Spartalizumab or Ribociclib in Selected Malignancies

• ClinicalTrials.gov Identifier: NCT04000529
• Recruitment Status: Active, not recruiting
• First Posted: June 27, 2019
• Last Update Posted: April 20, 2023
• Sponsor: Novartis Pharmaceuticals
• Information provided by (Responsible Party): Novartis ( Novartis Pharmaceuticals )

Study Description

Brief Summary:

This study is a Phase Ib, multi-center, open-label study of TNO155 in combination with spartalizumab or ribociclib with a dose escalation part followed by a dose expansion part in adult subjects with advanced solid tumors.

These two treatment arms will enroll subjects in parallel to characterize the safety, tolerability, PK, PD and preliminary antitumor activity.

The study treatment will be administered until the subject experiences unacceptable toxicity, progressive disease, and/or has treatment discontinued at the discretion of the Investigator or the subject, or due to withdrawal of consent.

Condition or disease	Intervention/treatment	Phase
Non-small Cell Lung Carcinoma; Head and Neck Squamous Cell Carcinoma; Esophageal SCC; Gastrointestinal Stromal Tumors; Colorectal Cancer	Drug: TNO155; Drug: Spartalizumab; Drug: Ribociclib	Phase 1

Detailed Description:

Rationale The purpose of this study is to evaluate the safety, tolerability, and preliminary efficacy of the combination of TNO155 with spartalizumab and of TNO155 with ribociclib, and to identify dosing regimens for further study. Data from preclinical models have demonstrated anti-tumor activity for the combinations of TNO155 with spartalizumab and of TNO155 with ribociclib that is superior to the activity observed with each of the drugs as single agents. These data suggest that these combinations may provide clinical benefit to patients with advanced malignancies.

Study Design This study is a Phase Ib, multi-center, open-label study with a dose escalation part followed by a dose expansion part in adult subjects with advanced solid tumors to characterize the safety and tolerability TNO155 in combination with spartalizumab and of TNO155 in combination with ribociclib and to identify the MTD and/or recommended regimen (dose and schedule) for each combination. The study treatment will be administered until the subject experiences unacceptable toxicity, progressive disease, and/or has treatment discontinued at the discretion of the Investigator or the subject, or due to withdrawal of consent.

Objectives

Primary objective:

To characterize the safety and tolerability TNO155 in combination with spartalizumab and of TNO155 in combination with ribociclib, and to identify the MTD and/or recommended regimen (dose and schedule) for each combination.

Secondary objectives:

• To characterize the pharmacokinetic (PK) profile of TNO155, spartalizumab and ribociclib when administered as a combination of TNO155 plus spartalizumab or of TNO155 plus ribociclib.
• To evaluate the preliminary anti-tumor activity of TNO155 in combination with spartalizumab and of TNO155 in combination with ribociclib.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 122 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase Ib, Open-label, Multi-center Study to Characterize the Safety, Tolerability, and Preliminary Efficacy of TNO155 in Combination With Spartalizumab or Ribociclib in Selected Malignancies
• Actual Study Start Date: July 30, 2019
• Estimated Primary Completion Date: October 2, 2023
• Estimated Study Completion Date: October 2, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: TNO155 in combination with spartalizumab; TNO155 in combination with spartalizumab	Drug: TNO155; Capsule; Drug: Spartalizumab; Concentrate for solution for infusion; Other Name: PDR001
Experimental: TNO155 in combination with ribociclib; TNO155 in combination with ribociclib	Drug: TNO155; Capsule; Drug: Ribociclib; Capsule and tablet; Other Name: LEE011

Outcome Measures

Primary Outcome Measures :

1. DLT incidence [ Time Frame: 1 year ]
   Incidence of dose limiting toxicities (DLTs) during the first cycle of combination treatment during the dose escalation part
2. AE and SAE incidence [ Time Frame: 3 years ]
   Incidence and severity of adverse events (AEs) and serious adverse events (SAEs) as per CTCAE v5.0, by treatment
3. Dose interruptions, reductions and dose intensity, by treatment [ Time Frame: 3 years ]
   Dose tolerability

Secondary Outcome Measures :

1. Pharmacokinetics (PK): Cmax [ Time Frame: 3 years ]
   Cmax for TNO155, spartalizumab, and ribociclib
2. Pharmacokinetics (PK): Tmax [ Time Frame: 3 years ]
   Tmax for TNO155, spartalizumab, and ribociclib
3. Pharmacokinetics (PK): AUClast [ Time Frame: 3 years ]
   AUClast for TNO155, spartalizumab, and ribociclib
4. Pharmacokinetics (PK): AUCtau [ Time Frame: 3 years ]
   AUCtau for TNO155, spartalizumab, and ribociclib
5. Efficacy measurements per RECIST v1.1: ORR [ Time Frame: 3 years ]
   Overall response rate (ORR) per RECIST v1.1, by treatment
6. Efficacy measurements per RECIST v1.1: DCR [ Time Frame: 3 years ]
   Disease control rate (DCR) per RECIST v1.1, by treatment
7. Efficacy measurements per RECIST v1.1: PFS [ Time Frame: 3 years ]
   Progression-free survival (PFS) per RECIST v1.1, by treatment
8. Efficacy measurements per RECIST v1.1: DOR [ Time Frame: 3 years ]
   Duration of response (DOR) per RECIST v1.1, by treatment
9. Efficacy measurements per iRECIST: ORR [ Time Frame: 3 years ]
   Overall response rate (ORR) per iRECIST for TNO155 in combination with spartalizumab
10. Efficacy measurements per iRECIST: DCR [ Time Frame: 3 years ]
    Disease control rate (DCR) per iRECIST for TNO155 in combination with spartalizumab
11. Efficacy measurements per iRECIST: PFS [ Time Frame: 3 years ]
    Progression-free survival (PFS) per iRECIST for TNO155 in combination with spartalizumab
12. Efficacy measurements per iRECIST: DOR [ Time Frame: 3 years ]
    Duration of response (DOR) per iRECIST for TNO155 in combination with spartalizumab
13. Overall Survival [ Time Frame: 3 years ]
    Overall survival (OS) by treatment

Eligibility Criteria

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

Criteria

Key Inclusion Criteria:

1. Signed informed consent must be obtained prior to participation in the study.
2. Age ≥ 18 years. For Japan only: written consent is necessary both from the patient and his/her legal representative if he/she is under the age of 20 years.
3. ECOG (Eastern Cooperative Oncology Group) performance status ≤ 1.

4. Dose escalation part: Patients with advanced solid tumors, with evaluable disease as determined by RECIST version 1.1, and fit into one of the following groups:

   a. For TNO155 plus spartalizumab combination: i. Advanced EGFR WT, ALK WT NSCLC, after progression on or intolerance to platinum-containing combination chemotherapy and after progression on anti-PD-1 or anti-PD-L1 therapy.

   ii. Advanced HNSCC or esophageal SCC, after progression on or intolerance to platinum-containing combination chemotherapy.

   iii. Advanced CRC, after progression on or intolerance to all standard-of-care (SOC) therapy per local guidelines.

   b. For TNO155 plus ribociclib combination: Advanced solid malignancies with the exception of CRC or GIST, after progression on or intolerance to all SOC therapy per local guidelines. The exclusion of CRC applies only as of Protocol Amendment 4.

5. Dose expansion part: Patients with advanced solid tumors, with at least one measurable lesion as determined by RECIST version 1.1, who fit into one of the following groups:

   a. For TNO155 plus spartalizumab combination: i. Advanced EGFR WT, ALK WT, KRAS G12C NSCLC after progression on or intolerance to platinum-containing combination chemotherapy and after progression on anti-PD-1 or anti-PD-L1 therapy.

   ii. Advanced EGFR WT, ALK WT, KRAS WT NSCLC, after progression on or intolerance to platinum-containing combination chemotherapy and after progression on anti-PD-1 or anti-PD-L1 therapy.

   iii. Advanced HNSCC, after progression on or intolerance to, platinum-containing combination chemotherapy.

   b. For TNO155 plus ribociclib combination: i. Advanced EGFR WT, ALK WT, KRAS WT NSCLC, after progression on or intolerance to platinum-containing chemotherapy and anti-PD-1 or anti-PD-L1 therapy ii. Advanced HNSCC, after progression on or intolerance to all SOC per local guidelines

6. Patients with NSCLC whose tumors harbor genomic aberrations for which SOC targeted therapies exist and are locally approved and available must have had progression on or after, or intolerance to, the SOC targeted therapy/therapies as indicated
7. Patients must have a site of disease amenable to biopsy

Key Exclusion Criteria:

1. Prior treatment with a MAPK pathway inhibitor
2. Clinically significant cardiac disease or risk factors
3. Use of any agent known to prolong the QT interval unless it can be permanently discontinued for the duration of study (see list in Section 6.2.2).
4. History or current evidence of retinal vein occlusion (RVO) or current risk factors for RVO
5. Inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease) or impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drugs
6. Symptomatic CNS metastases which are neurologically unstable

7. Insufficient bone marrow function at screening:

   1. Absolute Neutrophil Count (ANC) < 1.5 x 109/L.
   2. Hemoglobin < 9.0 g/dL.
   3. Platelets < 75 x 109/L for TNO155 plus spartalizumab combination; < 100 x 109/L for TNO155 plus ribociclib combination.

8. Insufficient hepatic or renal function at screening:

   1. Serum total bilirubin > upper limit of normal (ULN) or, for TNO155 plus spartalizumab combination only, if liver metastases are present at baseline, serum total bilirubin > 1.5 x ULN. An exception for either combination is for patients with Gilbert's syndrome, who are excluded if total bilirubin > 3.0 x ULN or direct bilirubin > 1.5 x ULN
   2. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3 x ULN for TNO155 plus spartalizumab combination or > 2.5 x ULN for TNO155 plus ribociclib combination, or > 5 x ULN for either combination if liver metastases are present.
   3. Creatinine clearance < 60 mL/min (calculated using Cockcroft-Gault equation).

9. Pregnant or breast-feeding (lactating) women.

   Additional exclusion criteria for the TNO155 plus spartalizumab combination

10. History of severe hypersensitivity reactions to other mAbs.
11. Active, known or suspected autoimmune disease.
12. History of or current interstitial lung disease or pneumonitis grade ≥ 2.
13. Human Immunodeficiency Virus (HIV) infection, unless the patient is on antiviral therapy and has undetectable viral load.
14. Active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.
15. Systemic chronic steroid therapy

16. Patients who discontinued prior anti-PD-1 therapy due to an anti-PD-1-related toxicity.

    Additional exclusion criteria for the TNO155 plus ribociclib combination

17. Systolic Blood Pressure (SBP) < 90 mmHg.
18. International Normalized Ratio (INR) > 1.5 (unless the patient is receiving anticoagulants and the INR is within the therapeutic range of intended use for that anticoagulant within seven days prior to the first dose of study drug).
19. History of HIV infection (testing not mandatory)

20. Currently receiving any of the following substances and cannot be discontinued seven days prior to Cycle 1 Day 1:

    • Concomitant medications or herbal supplements, that are strong inducers or inhibitors of CYP3A4/5,
    • Medications that have a narrow therapeutic window and are predominantly metabolized through CYP3A4/5.
21. Previous treatment with a CDK4/6 inhibitor.
22. Patient is currently receiving or has received systemic corticosteroids ≤ 2 weeks prior to starting study drug, or who have not fully recovered from side effects of such treatment.

Note: The following uses of corticosteroids are permitted: single doses, topical applications (e.g., for rash), inhaled sprays (e.g., for obstructive airways diseases), eye drops or local injections (e.g., intra-articular).

Contacts and Locations

Locations

United States, Massachusetts

Massachusetts General Hospital

Boston, Massachusetts, United States, 02114

Australia, New South Wales

Novartis Investigative Site

Westmead, New South Wales, Australia, 2145

Belgium

Novartis Investigative Site

Bruxelles, Belgium, 1200

China, Sichuan

Novartis Investigative Site

Chengdu, Sichuan, China, 610041

Germany

Novartis Investigative Site

Koeln, Germany, 50937

Hong Kong

Novartis Investigative Site

Hong Kong, Hong Kong

Japan

Novartis Investigative Site

Chuo ku, Tokyo, Japan, 104 0045

Singapore

Novartis Investigative Site

Singapore, Singapore, 119228

Spain

Novartis Investigative Site

Barcelona, Catalunya, Spain, 08035

Novartis Investigative Site

Valencia, Comunidad Valenciana, Spain, 46010

Sponsors and Collaborators

Novartis Pharmaceuticals

More Information

• Responsible Party: Novartis Pharmaceuticals
• ClinicalTrials.gov Identifier: NCT04000529
• Other Study ID Numbers: CTNO155B12101
• First Posted: June 27, 2019
• Last Update Posted: April 20, 2023
• Last Verified: April 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Novartis ( Novartis Pharmaceuticals ):

TNO155, spartalizumab, ribociclib, checkpoint inhibitor, SHP2, PD-1, CDK4/6, NSCLC, CRC, HNSCC, KRAS, esophageal SCC, GIST

Additional relevant MeSH terms:

Carcinoma; Squamous Cell Carcinoma of Head and Neck; Gastrointestinal Stromal Tumors; Carcinoma, Non-Small-Cell Lung; Esophageal Squamous Cell Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Gastrointestinal Diseases; Carcinoma, Squamous Cell; Neoplasms, Squamous Cell; Head and Neck Neoplasms; Lung Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Diseases; Respiratory Tract Diseases; Neoplasms, Connective Tissue; Neoplasms, Connective and Soft Tissue; Carcinoma, Bronchogenic; Bronchial Neoplasms; Esophageal Neoplasms; Esophageal Diseases; Spartalizumab; Immune Checkpoint Inhibitors; Molecular Mechanisms of Pharmacological Action