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Study of MT-6402 in Subjects With Advanced Solid Cancer That Expresses PD-L1

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ClinicalTrials.gov Identifier: NCT04795713
Recruitment Status : Recruiting
First Posted : March 12, 2021
Last Update Posted : July 13, 2021
Sponsor:
Information provided by (Responsible Party):
Molecular Templates, Inc.

Brief Summary:
This will be a Phase 1 Open-label, dose escalation and expansion study of MT-6402 (an Engineered Toxin Body (ETB)) in subjects with advanced solid cancer that expresses PD-L1

Condition or disease Intervention/treatment Phase
Advanced Solid Tumor Non-small Cell Lung Cancer Squamous Cell Carcinoma of Head and Neck Drug: MT-6402 Phase 1

Detailed Description:

This study will be conducted in two sequential parts:

  • Part 1 (Dose Escalation): The purpose of Part 1 is to evaluate the safety and tolerability of MT-6402 in subjects with advanced cancer (solid tumors) and to estimate the maximum tolerated dose (MTD)
  • Part 2 (Dose Expansion): The purpose of Part 2 is to confirm the recommended Phase 2 dose (RP2D) and to evaluate the efficacy of MT-6402 in subjects with advanced cancer. Part 2 will include subjects with PD-L1 positive non-small cell lung cancer (NSCLC) who received prior PD-1/PD-L1 treatment, subjects with PD-L1 positive squamous cell cancer of the head and neck (SCCHN) who are refractory to or ineligible for platinum-based therapy and received prior PD-1/PD-L1 treatment and subjects with any other relapsed or refractory PD-L1 positive solid tumor who received PD-1/PD-L1 treatment.

Up to 138 eligible subjects will be identified and treated through competitive enrollment at multiple study centers

In Parts 1 and 2, a subject may participate for the following four (4) periods:

  • Screening Period - up to 28 days before first dose of MT-6402
  • Treatment Period - active period where a subject will receive doses of MT-6402 over a 28-day treatment period
  • Short-term Follow-up Period - up to 90 days after last dose of MT-6402
  • Long-term follow-up Period - up to 24 months after last dose of MT-6402

MT-6402 will be given as an intravenous (IV) infusion over 30 minutes on the same day every week (i.e., days 1, 8, 15 and 22) of each cycle. A cycle is defined as 28 days. A subject can continue receiving MT-6402 as long as it is well-tolerated or until the subject decides they no longer want to participate in the study.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 138 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Open-label, Multicenter, Dose-ranging Study to Investigate Safety and Tolerability, Efficacy, Pharmacokinetics, Pharmacodynamics and Immunogenicity of MT-6402 in Subjects With Advanced Solid Cancer That Expresses PD-L1
Actual Study Start Date : May 27, 2021
Estimated Primary Completion Date : April 2025
Estimated Study Completion Date : May 2026

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: PD-L1 Positive NSCLC
Subjects with PD-L1 Positive Lung Carcinoma (NSCLC) who received prior PD-1/PD-L1 treatment
Drug: MT-6402
Experimental Treatment

Experimental: PD-L1 Positive SCCHN
Subjects with PD-L1 Positive Squamous Cell Carcinoma of the head and neck (SCCHN), refractory to or ineligible for platinum-based therapy, who received prior PD-1/PD-L1 treatment
Drug: MT-6402
Experimental Treatment

Experimental: Other relapsed/refractory PD-L1 positive solid tumors
Subjects with any other relapsed or refractory PD-L1 positive solid tumor who received PD-1/PD-L1 treatment.
Drug: MT-6402
Experimental Treatment

Experimental: PD-L1 positive advanced cancer
Subjects with PD-L1 positive advanced cancer (solid tumors)
Drug: MT-6402
Experimental Treatment




Primary Outcome Measures :
  1. Evaluate the safety of MT-6402 in subjects with advanced cancer (solid tumors) and to estimate the maximum tolerated dose (MTD) [ Time Frame: 28 days (Part 1) ]
    Safety as measured by number of subjects with incidence of adverse events using CTCAE v4.0

  2. Evaluate the tolerability of MT-6402 in subjects with advanced cancer (solid tumors) and to estimate the maximum tolerated dose (MTD) [ Time Frame: 28 days (Part 1) ]
    Tolerability as measured by incidence of adverse events using CTCAE v4.0 and incidence of laboratory abnormalities

  3. Confirm the recommended Phase 2 dose (RP2D) [ Time Frame: 28 days (Part 2) ]
    Incidence of Adverse Events (AEs)

  4. Evaluate efficacy of MT-6402 in subjects with advanced cancer by objective response rate (ORR) with RECIST 1.1 [ Time Frame: up to 2 years (Part 2) ]
    ORR using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria


Secondary Outcome Measures :
  1. Characterize the PK profile of MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Maximum observed plasma concentration (Cmax)

  2. Characterize the PK profile of MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Time of maximum observed plasma concentration (tmax)

  3. Characterize the PK profile of MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Area under the concentration-time curve (AUC) from time zero to the last measurable concentration (AUC0-t)

  4. Characterize the PK profile of MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Interpolated AUC to infinity (AUC0-∞)

  5. Characterize the PK profile of MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Clearance (CL)

  6. Characterize the PK profile of MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Volume of distribution of steady-state (Vss)

  7. Evaluate efficacy of MT-6402 in subjects with advanced cancer by ORR with RECIST 1.1 [ Time Frame: up to 2 years (Part 1) ]
    ORR using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria

  8. Assess additional efficacy parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Duration of response (DOR)

  9. Assess additional efficacy parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Progression-free survival (PFS)

  10. Assess additional efficacy parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Overall Survival (OS)

  11. Evaluate the immunogenicity of MT-6402 in subjects with advanced cancer [ Time Frame: 28 days (Parts 1 and 2) ]
    Anti-drug antibodies (ADA)


Other Outcome Measures:
  1. Evaluate the immunogenicity of MT-6402 in subjects with advanced cancer [ Time Frame: 28 days (Parts 1 and 2) ]
    Neutralizing antibodies (NAb)

  2. Explore efficacy of MT-6402 in subjects with advanced cancer by using ORR [ Time Frame: up to 2 years (Part 2) ]
    ORR using immune-related RECIST (irRECIST)

  3. Explore immune response to MT-6402 treatment [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Change from baseline in peripheral blood mononuclear cells and respective T cell subsets

  4. Correlate the pharmacodynamic markers of cancer under study with tumor response to MT-6402 in subjects with advanced cancer [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Intensity of programmed death-ligand (PD-L1) expression by immunohistochemistry staining in biopsied metastatic tumor tissue (tumor cells, immune cells) and in circulating tumor and immune cell markers, correlating with tumor response

  5. Explore pharmacodynamic effect of cytomegalovirus (CMV) antigen presentation [ Time Frame: Baseline to Cycle 1 Day 15 (each cycle is 28 days) (Part 1) ]
    Change of CMV activated T cells in peripheral blood from baseline to Cycle 1 Day 15

  6. Correlate pharmacodynamic effect of cytomegalovirus (CMV) antigen presentation with tumor response [ Time Frame: Baseline to Cycle 1 Day 15 (each cycle is 28 days) (Part 2), Baseline and Cycle 2 (each cycle is 28 days) (Part 2) ]
    Change of CMV activated T cells in peripheral blood from baseline to Cycle 1 Day 15, Comparison of lymphocyte infiltration from metastatic tumor biopsy at baseline and Cycle 2

  7. If warranted, evaluate the exposure-response relationship for MT-6402 via Pharmacokinetics (PK) parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Maximum observed plasma concentration (Cmax)

  8. If warranted, evaluate the exposure-response relationship for MT-6402 via Pharmacokinetics (PK) parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Time of maximum observed plasma concentration (tmax)

  9. If warranted, evaluate the exposure-response relationship for MT-6402 via Pharmacokinetics (PK) parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    The area under the concentration-time curve from time zero to the last measurable concentration (AUC0-t)

  10. If warranted, evaluate the exposure-response relationship for MT-6402 via Pharmacokinetics (PK) parameters [ Time Frame: up to 2 years (Parts 1 and 2) ]
    Interpolated AUC to infinity (AUC0-∞)

  11. Assess quality of life with MT-6402 treatment [ Time Frame: up to 2 years (Parts 1 and 2) ]
    European Organization for the Research and Treatment of Cancer-quality of life questionnaire core 30 (EORTC-QLQ-C30) (Version 3). The Euro-Quality-of-Life-questionnaire C30 (Version 3) assesses five states (mobility, self care, usual activities, pain / discomfort, and anxiety / depression) at four different levels - Not at All (1), A Little (2), Quite a Bit (3), and Very Much (4)



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:

Part A

  1. Subject must be at least 18 years old and must have histologically confirmed, unresectable, locally advanced, or metastatic PD-L1-expressing solid cancer not amenable to standard treatment, or standard treatment is not available, or in the Investigator's opinion the standard treatment would not be in the subject's best interest. Any level of PD-L1 expression assessed by using any Food and Drug Administration (FDA) approved PD-L1 immunohistochemistry (IHC) assay is accepted. The assessment should have been performed on the most recent available tissue from a site of metastatic disease (if possible).
  2. Subject must have evaluable or measurable disease.

Part B

  1. Subject must be at least 18 years old and must have histologically confirmed, unresectable, locally advanced or metastatic PD-L1-expressing solid cancer (defined below) not amenable to standard treatment, or standard treatment is not available, or in the Investigator's opinion the standard treatment would not be in the subject's best interest. PD-L1 expression must be assessed at screening by the study's central laboratory, using VENTANA SP263 PD-L1 assay on a tissue from a site of metastatic disease (if possible). For this purpose, recent archived tissue suitable for PD-L1 expression assessment by IHC (obtained after the last treatment and within 6 months) or fresh biopsy material can be used. The PD-L1 assessment must show at least 5% vCPS (visually estimated Combined Positive Score) for eligibility.

    • Arm 1: Histologically confirmed recurrent or metastatic NSCLC not amenable to standard treatment, or standard treatment is not available, or in the Investigator's opinion the standard treatment would not be in the subject's best interest. NOTE: subjects with driver mutations are only eligible if they have received all appropriate targeted therapies.
    • Arm 2: Histologically confirmed recurrent or metastatic SCCHN (oral cavity, oropharynx, hypopharynx, or larynx) not amenable to standard treatment, or standard treatment is not available, or in the Investigator's opinion the standard treatment would not be in the subject's best interest. Subjects who refuse radical resection are eligible. NOTE: squamous cell carcinoma of any other primary anatomic location in the head and neck, subjects with SCCHN of unknown primary, and subjects with skin squamous cell carcinoma (SCC) of the head and neck are not eligible for this arm. The tumor must be platinum resistant or the subject ineligible for platinum therapy due to hypersensitivity or concerns with ototoxicity.
    • Arm 3: Subjects with any other relapsed or refractory PD-L1 positive solid tumor not amenable to standard treatment, or standard treatment is not available, or in the Investigator's opinion the standard treatment would not be in the subject's best interest, who received PD-1/PD-L1 treatment. Subjects with PD-L1 positive solid tumor types, for which PD-1/PD-L1 treatment is not approved, could be enrolled at the Investigator's discretion and after discussion with the Medical Monitor.
  2. Subject must have at least 1 measurable tumor lesion according to RECIST 1.1.

    Parts A and B

  3. Subject must have Eastern Cooperative Oncology Group (ECOG) performance score of 0 or 1.
  4. Prior treatment must include a CPI (i.e., PD-1 inhibitors, PD-L1 inhibitors with or without CTLA-4 inhibitors) if there is an approved CPI for the specific cancer type. Subjects may also have received CPIs in an investigational setting. Subjects who have not received a CPI and where there is no approved CPI for the specific cancer type could be enrolled at the Investigator's discretion and after discussion with the Medical Monitor.
  5. Subject must have adequate bone marrow function (NOTE: administration of blood products and growth factors is not allowed within 2 weeks prior to screening laboratory tests):

    • absolute neutrophil count (ANC) ≥ 1,500/μL
    • platelet count ≥ 100,000/μL
    • hemoglobin ≥ 8.0 g/dL
  6. Subject must have adequate renal function, based on estimated creatinine clearance (eCrCl) ≥ 50 mL/min, calculated by the Cockcroft-Gault equation.

    NOTE: At the Investigator's discretion, the eCrCl result < 50 mL/min may be verified by measured creatinine clearance (mCrCl) based on the 24-hour urine collection. Subjects with mCrCl ≥ 50 mL/min will be eligible irrespective of the eCrCl result calculated by the Cockcroft-Gault equation.

  7. Subject must have adequate hepatic function, as determined by:

    • total bilirubin (or direct bilirubin for subjects with Gilbert's disease) < 1.5 × upper limit of normal (ULN)
    • aspartate aminotransferase (AST) ≤ 3 × ULN (or ≤ 5 × ULN if liver metastasis)
    • alanine aminotransferase (ALT) ≤ 3 × ULN (or ≤ 5 × ULN if liver metastasis)
  8. Subject must have adequate serum albumin (albumin ≥ 2.5 g/dL)
  9. Women of reproductive potential must have a negative highly sensitive pregnancy test within 72 hours before the start of treatment. Women who are postmenopausal (> 1 year since last menstrual cycle) or permanently sterilized (e.g., bilateral tubal occlusion, hysterectomy, bilateral salpingectomy) may be considered as not of reproductive potential.
  10. Subjects of reproductive potential must agree either to abstain continuously from heterosexual intercourse or to use a highly effective birth control method from signing the informed consent until 30 days after the last dose of MT-6402 for females and until 90 days after the last dose of MT-6402 for males.

Exclusion Criteria:

Part A

1. Subjects without available tissue from a site of metastatic disease or easily biopsiable lesion (biopsy sites of non significant risk, in the opinion of the Investigator) or unwilling to consent to biopsy.

Part B

  1. Subjects without easily biopsiable lesions (biopsy sites of non significant risk, in the opinion of the Investigator) or unwilling to consent to biopsy.

    Parts A and B

  2. History or current evidence of another neoplastic disease, except cervical carcinoma in situ, superficial noninvasive bladder tumors, curatively treated Stage I to II non melanoma skin cancer or any previous cancer curatively treated > 2 years before the start of treatment.
  3. Active autoimmune disease currently under treatment or required systemic treatment within 2 years (replacement therapy, e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency is allowed). Subjects who have not required systemic treatment of an auto-immune disease for at least 2 years may be enrolled if permission is provided after discussion with the Medical Monitor.
  4. Ongoing > Grade 1 immune related toxicity caused by prior CPI therapy (i.e., PD-1 inhibitors, PD-L1 inhibitors, or CTLA-4 inhibitors). Subjects with stable endocrinological AEs, e.g., hypothyroidism, adrenal insufficiency, hypopituitarism, or diabetes mellitus, must have been on a stable dose of supplemental therapy for at least 2 weeks before screening to be eligible for this study.
  5. Evidence of active noninfectious ≥ Grade 2 pneumonitis or current evidence of ≥ Grade 3 other underlying pulmonary disease.
  6. Received any of the following PD-L1 inhibitors within the following time periods prior to the first dose of MT-6402: atezolizumab - 12 months; durvalumab - 7 months; avelumab - 2 months.
  7. Any concurrent cancer treatment, apart from local treatment of non-target lesions for palliative intent (e.g., local surgery or radiotherapy).
  8. Prior radiation therapy within 4 weeks before the start of study treatment. NOTE: A lesion in a previously irradiated area can only be considered target lesion if there has been radiographical disease progression since the end of radiation therapy.
  9. Received approved or investigational treatment for the disease under study (except PD L1 inhibitors where exclusion criterion 6 applies) within 4 weeks before the start of treatment. For small molecules (MW < 0.9 kDa), the washout is 5 half-lives, but at least 2 weeks.
  10. Subjects who have had allogeneic tissue or solid organ transplantation.
  11. Current evidence of new or growing central nervous system (CNS) metastases during screening. Subjects with known asymptomatic CNS metastases will be eligible if they meet all the following criteria:

    1. Had radiotherapy or another appropriate therapy for the CNS metastases.
    2. Have stable CNS disease on the computed tomography (CT) or magnetic resonance imaging (MRI) scan within 4 weeks before screening compared with prior neuro imaging.
  12. Major surgical procedure (as defined by the Investigator) within 28 days prior to the start of study treatment.
  13. History or current evidence of significant cardiovascular disease before the start of treatment, including but not limited to the following conditions:

    1. Angina pectoris requiring anti-anginal medication, (chest pain: Common Terminology Criteria for Adverse Events [CTCAE] Grade ≥ 2)
    2. Clinically significant valvular disease.
    3. Myocardial infarction within 12 months prior to the start of treatment.
    4. Arterial thrombosis or pulmonary embolism within 3 months before the start of treatment.
    5. History of Grade ≥ 2 symptomatic congestive heart failure (CHF) or New York Heart Association (NYHA) criteria Class ≥ II.
    6. Left ventricular ejection fraction (LVEF) < 55%, assessed preferably by echocardiogram (ECHO) or multiple-gated acquisition (MUGA) scan if ECHO is not available, within 28 days before starting study treatment.
    7. High-risk uncontrolled arrhythmias (i.e., atrial tachycardia with a heart rate > 100/min at rest and upon repeated testing, significant ventricular arrhythmia (CTCAE Grade ≥ 2 [ventricular tachycardia], or higher-grade atrioventricular [AV]-block [second degree AV-block Type 2 [Mobitz 2] or third-degree AV-block]) or left ventricular bundle branch block. Subjects receiving digoxin, calcium channel blockers, or beta adrenergic blockers are eligible at the Investigator's discretion after consultation with the Medical Monitor if the dose has been stable for ≥ 2 weeks before the start of treatment with MT-6402.
    8. Any of the following within 3 months before the start of treatment: pericarditis (any CTCAE Grade), pericardial effusion (CTCAE Grade ≥ 2), non-malignant pleural effusion (CTCAE Grade ≥ 2) or malignant pleural effusion (CTCAE Grade ≥ 3) (subjects with pleural effusion that is manageable and stable > 3 months prior to study are eligible).
    9. QT interval correction for heart rate using Fridericia's formula (QTcF) ≥ 470 ms (average from 3 QTcF values on the triplicate 12-lead electrocardiogram [ECG]) at screening. In subjects with right bundle branch blocks, additional corrections will be performed to calculate the QT equivalent JT, and depending on the result the subject may be eligible with the agreement of the Medical Monitor.
  14. Current evidence of uncontrolled human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) at screening. Serology testing is not required if seronegativity is documented in the medical history, and if there are no clinical signs suggestive of HIV or hepatitis infections, or suspected exposure. The following exceptions apply for subjects with positive viral serology:

    1. Subjects with HIV and an undetectable viral load and CD4 + T-cell (CD4+) counts ≥ 350 cells/mL may be enrolled, but must be taking appropriate opportunistic infection prophylaxis, if clinically relevant.
    2. Subjects with positive HBV serology are eligible if they have an undetectable viral load and the subject will receive antiviral prophylaxis for potential HBV reactivation per institutional guidelines.
    3. Subjects with positive HCV serology are eligible if quantitative polymerase chain reaction (PCR) for plasma HCV RNA is below the lower limit of detection. Concurrent antiviral HCV treatment per institutional guidelines is allowed.
  15. Current treatment requiring systemic steroids at doses > 10 mg/day prednisone equivalent.
  16. Subjects with a history of hypersensitivity or serious toxic reactions to kanamycin or other aminoglycosides.
  17. Subjects with unintentional weight loss > 10% of their body weight over the preceding 2 months or less before screening.
  18. Female subjects who are pregnant or breastfeeding.
  19. History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the Investigator or Medical Monitor, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion.

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): NCT04795713


Contacts
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Contact: Sandra Hankins 848-666-7646 sandra.hankins@mtem.com
Contact: Kristen Quigley 862-203-7537 kristen.quigley@mtem.com

Locations
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United States, California
Cedars Sinai Medical Center Not yet recruiting
Los Angeles, California, United States, 90048
Contact: Bethany Wendel, RN, BSN    310-967-4339    bethany.wendel@cshs.org   
Principal Investigator: Alain Mita, MD         
United States, Georgia
Comprehensive Care and Research Center - Atlanta Recruiting
Newnan, Georgia, United States, 30265
Contact: Becky Slawik, MSN    770-400-7191    becky.slawik@ctca-hope.com   
Principal Investigator: Herbert Duvivier, MD         
United States, Illinois
Comprehensive Care and Research Center - Chicago Recruiting
Chicago, Illinois, United States, 60099
Contact: Karina Szymulanska-Ramamurthy, PharmD, PhD    847-731-4154    karina.szymulanska-ramamurthy@ctca-hope.com   
Principal Investigator: Eugene Ahn, MD         
United States, Missouri
Washington University School of Medicine - St. Louis Not yet recruiting
Saint Louis, Missouri, United States, 63110
Contact: Cheryl Callahan, MSW    314-286-2584    callahanc@wustl.edu   
Principal Investigator: Brian VanTine, MD         
United States, North Carolina
Carolina BioOncology Recruiting
Huntersville, North Carolina, United States, 28078
Contact: Ashley McClain, BS    980-441-1021    smcclain@carolinabiooncology.org   
Principal Investigator: John Powderly, MD         
United States, Tennessee
Tennessee Oncology, PLLC Recruiting
Nashville, Tennessee, United States, 37203
Contact: Emily Lay Petcu    615-329-7274    emily.laypetcu@sarahcannon.com   
Principal Investigator: David Spigel, MD         
United States, Texas
South Texas Accelerated Research Therapeutics, LLC Recruiting
San Antonio, Texas, United States, 78229
Contact: Isabel Jimenez, RN, MSN    210-593-5265    isabel.jimenez@startsa.com   
Principal Investigator: Drew W. Rasco, MD         
Sponsors and Collaborators
Molecular Templates, Inc.
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Responsible Party: Molecular Templates, Inc.
ClinicalTrials.gov Identifier: NCT04795713    
Other Study ID Numbers: MT-6402-001
First Posted: March 12, 2021    Key Record Dates
Last Update Posted: July 13, 2021
Last Verified: July 2021

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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 Molecular Templates, Inc.:
PD-L1 Positive
Relapsed or Refractory
Prior PD-1 or PD-L1 treatment
Additional relevant MeSH terms:
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Squamous Cell Carcinoma of Head and Neck
Neoplasms by Site
Neoplasms
Carcinoma, Squamous Cell
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Head and Neck Neoplasms