A Study of CTX-009 in Combination With Paclitaxel in Adult Patients With Unresectable Advanced, Metastatic or Recurrent Biliary Tract Cancers

• ClinicalTrials.gov Identifier: NCT05506943
• Recruitment Status: Recruiting
• First Posted: August 18, 2022
• Last Update Posted: March 16, 2023
• Sponsor: Compass Therapeutics
• Information provided by (Responsible Party): Compass Therapeutics

Study Description

Brief Summary:

This is a multi-center, open-label, randomized, phase 2/3 trial of the bispecific antibody CTX-009 plus paclitaxel versus paclitaxel in patients with previously treated, unresectable advanced or metastatic biliary tract cancers.

Condition or disease	Intervention/treatment	Phase
Biliary Tract Cancer; Cholangiocarcinoma; Gall Bladder Cancer; Ampullary Cancer	Drug: CTX-009; Drug: Paclitaxel	Phase 2; Phase 3

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 150 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Masking Description: A blinded independent review committee will be used to assess the primary study endpoint.
• Primary Purpose: Treatment
• Official Title: A Phase 2/3 Randomized, Controlled Study of CTX-009 in Combination With Paclitaxel Versus Paclitaxel Alone in Adult Patients With Unresectable Advanced, Metastatic or Recurrent Biliary Tract Cancers Who Have Received One Prior Systemic Chemotherapy Regimen
• Actual Study Start Date: January 9, 2023
• Estimated Primary Completion Date: December 2023
• Estimated Study Completion Date: December 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: CTX-009 plus Paclitaxel	Drug: CTX-009; IV infusion on day 1 and 14 of every 28 day cycle; Drug: Paclitaxel; IV infusion on day 1, 8, and 15 of every 28 day cycle
Active Comparator: Paclitaxel	Drug: Paclitaxel; IV infusion on day 1, 8, and 15 of every 28 day cycle

Outcome Measures

Primary Outcome Measures :

1. Best Overall Response [ Time Frame: From randomization to treatment discontinuation for any reason, average 6 months ]
   Percentage of patients whose Best Overall Response (BOR) is assessed as Complete Response (CR) or Partial Response (PR) as assessed by RECIST 1.1

Secondary Outcome Measures :

1. Disease Control Rate [ Time Frame: From randomization to treatment discontinuation for any reason, average 6 months ]
   Percentage of patients whose BOR is assessed as CR, PR, or Stable Disease (SD)
2. Duration of Response [ Time Frame: From first confirmed CR or PR to confirmed PD, average 6 months ]
   The time between the date of the radiological evaluation that first confirmed CR or PR and the date of the radiation evaluation that first confirmed Progressive Disease (PD)
3. Progression Free Survival [ Time Frame: From randomization to first documented objective PD or death if PD does not occur, average 6 months ]
   Time from randomization until the date of objective PD (as assessed by RECIST 1.1) or the date of death (by any cause in the absence of disease progression)
4. Overall Survival [ Time Frame: From randomization to death from any cause, average 12 months ]
   Time from randomization until the date of death by any cause. Patients who are still alive at the time of the analysis, or who have become lost to follow-up or withdrawn consent will be censored at their last date known to be alive
5. Safety Profile of CTX-009 in Combination with Paclitaxel [ Time Frame: From randomization to 60 days after the last dose of study treatment, average 7 months ]
   Incidence of Treatment Emergent Adverse Events (TEAEs) and changes in clinical abnormalities for all randomized patients who received at least one dose of study treatment (either CTX-009 or paclitaxel)
6. Patient Reported Quality of Life [ Time Frame: From randomization to treatment discontinuation for any reason, average 6 months ]
   Assessed approximately every 2 months from patient reported data using European Organization for Research and Treatment of Cancer (EORTC) Quality of Life questionnaire (QLQ)-C30 and BIL21
7. Exposure Response by Pharmacokinetic (PK) Sampling [ Time Frame: From C1D1 to treatment discontinuation for any reason, average of 6 months ]
   Serum concentrations of CTX-009 at specified timepoints

Eligibility Criteria

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

Criteria

Inclusion Criteria

1. 18 years of age or older
2. Histologically or cytologically confirmed unresectable advanced, metastatic, or recurrent biliary tract cancers (including intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary carcinoma)
3. Patients must have radiologically documented progression after a prior gemcitabine and platinum containing chemotherapy regimen as initial therapy for locally advanced or metastatic disease. Patients who relapse within 6 months of receiving gemcitabine and platinum containing chemotherapy regimen in the adjuvant setting are also eligible.
4. At least one lesion measurable as defined by RECIST v1.1
5. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1
6. Predicted life expectancy of at least 12 weeks

7. No evidence of ongoing infection and adequate biliary excretion or patients whose adequate biliary excretion can be confirmed with the following procedures:

   1. Patients who underwent endoscopic retrograde biliary drainage (ERBD) at least 1 week before the investigational drug treatment
   2. Patients who underwent percutaneous transhepatic biliary drainage (PTBD) at least 4 weeks before the investigational drug treatment
   3. Patients free of any signs of active or suspected uncontrolled infection after a drainage procedure
   4. Patients free of any risk of hemorrhage and with incision completely healed

8. Adequate bone marrow, hepatic, and renal function within 14 days of randomization as described below. (Patient must be free of granulocyte colony-stimulating factor (G-CSF) treatment and blood transfusion within 14 days prior to the lab test):

   1. Absolute neutrophil count (ANC) ≥ 1,500/mm3
   2. Hemoglobin ≥ 9.0 g/dL
   3. Platelet count ≥ 100,000/mm3
   4. White Blood Cell ≥ 3,000/mm3
   5. Total bilirubin ≤ 1.5 X Upper Limit of Normal (ULN)
   6. Aspartate aminotransferase (AST)/ alanine transaminase (ALT) ≤ 3.0 X ULN (≤5 X ULN in case of hepatic metastasis)
   7. Estimated creatinine clearance ≥ 30 mL/min based on Cockcroft-Gault
   8. Urine protein ≤ 1+ by Dipstick (Only when urinalysis shows a protein dipstick result of > 1 positive (+), the total protein volume (<1.0 g/24hr) can be confirmed with a 24-hour urine test.)
   9. Serum amylase and lipase level ≤ 1.5 X ULN
   10. Serum Albumin ≥ 3.0 g/dL
9. Female patients who are women of childbearing potential (WCBP) must have a negative pregnancy test (serum-human chorionic gonadotropin (hCG) or urine-hCG performed at the Investigator's discretion) within 14 days of randomization
10. Female patients must be surgically sterile (or have a monogamous partner who is surgically sterile) or be at least 2 years postmenopausal or commit to use 2 acceptable forms of birth control (defined as the use of an intrauterine device (IUD), a barrier method with spermicide, condoms, any form of hormonal contraceptives, or abstinence) for the duration of the study and for 4 months following the last dose of study treatment. Male patients must be sterile (biologically or surgically) or commit to the use of a reliable method of birth control (condoms with spermicide) for the duration of the study and for 4 months following the last dose of study treatment.
11. Signed and dated Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved Informed Consent Form (ICF) before any protocol-directed screening procedures are performed

Exclusion Criteria

1. Patients who are eligible to be treated with a molecularly targeted therapy on a labelled regimen after receiving first-line chemotherapy

2. From the time point of screening,

   1. Less than 4 weeks have elapsed since patients had a surgery or major procedure
   2. Less than 2 weeks have elapsed from the last treatment date since patients had any radiation therapy

3. Prior to the initial treatment of study drug,

   1. Less than 2 weeks have elapsed since patients had chemotherapy or hormone therapy (However, patients cannot participate when nitrosoureas or mitomycin was administered within 6 weeks)
   2. Less than 2 weeks have elapsed since patients had anticancer immunotherapy or investigational drug treatment
   3. Less than 6 weeks since cryotherapy, radiofrequency ablation, anhydrous alcohol therapy, or photodynamic therapy

4. A history of the following cardiovascular diseases in past 5 years:

   1. Congestive heart failure (CHF) that corresponds to Class II or a higher class (or less than 50% of left ventricular ejection fraction (LVEF)) under New York Heart Association (NYHA) classification
   2. Uncontrolled hypertension (Systolic/Diastolic Blood Pressure (SBP/DBP) >140/90 mmHg) (e.g., patient with SBP/DBP >140/90 mmHg despite the best care including optimizing the anti-hypertensive medication regimen)
   3. Patients with any history of hypertensive crisis or pre-existing hypertensive encephalopathy
   4. Pulmonary hypertension
   5. Myocardial infarction
   6. Uncontrolled arrhythmia
   7. Unstable angina
   8. Patients with any significant vascular diseases (e.g., aortic aneurysm requiring surgery or recent peripheral artery thrombosis) within 6 months prior to the initial treatment of the investigational product
5. History of hypersensitivity reactions to any components of the investigational product or other drugs of the same class (humanized/human monoclonal antibody drugs) or paclitaxel
6. Patients with contraindications to paclitaxel therapy
7. Patients with persistent, clinically significant toxicities (excluding hair loss) from previous anticancer treatment that corresponds to Grade 2 or a higher grade under NCI-CTCAE v5.0
8. Symptomatic or uncontrolled central nervous system (CNS) metastasis (However, patients with asymptomatic CNS metastasis can participate provided that systemic corticosteroid treatment was discontinued at least 4 weeks prior to screening and that the patient is radiologically and neurologically stable or improving)

9. A history of the following hemorrhage-related or gastroenterological disease:

   1. Active hemorrhage, hemorrhagic diathesis, coagulopathy or tumor in great arteries
   2. History of clinically significant gastroenterological disease, such as peptic ulcer, GI bleeding, GI or non-GI fistula, perforation, abdominal abscess, clinical symptoms, and signs of GI obstruction, need for parenteral hydration or nutrition, or inflammatory bowel disease (IBD)
10. Patients who received antiplatelet drugs (aspirin, clopidogrel, etc.) or anticoagulant drugs (warfarin, heparin, etc.) within 2 weeks prior to screening, or is expected to need those drugs during the clinical study

11. Patients requiring continuous treatment with systemic non-steroidal anti-inflammatory drugs (NSAIDs) or systemic corticosteroids (the following cases are permitted):

    1. NSAIDs: Up to 3 consecutive days' use is permitted.
    2. Corticosteroids: Topical use of corticosteroids, such as topical intra-articular injection, intranasal administration, eye drops, inhaler, etc., or temporary systemic corticosteroid use for treatment and prevention of patient's contrast media allergy, paclitaxel pre-treatment, or adverse event, is permitted
12. Severe infection requiring systemic antibiotics, antivirus drugs, etc., or other uncontrolled acute active infectious diseases
13. Patients with evidence of active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Patients with positive HBsAg and/or detectable HBV DNA are eligible only if adequately controlled on antiviral therapy according to institutional standards and liver function eligibility criteria are also met. HCV patients showing sustained viral response or patients with immunity to HBV infection may enroll.

14. Patients with other severe diseases or uncontrolled illnesses that warrant the exclusion from the study (permitted only if medically controlled) including but not limited to:

    1. Pre-existing condition of hemoptysis (≥ 1/2 teaspoon of bright red blood per episode) within 28 days prior to screening
    2. Major, unhealed injury, active ulcer, or untreated fracture
    3. Pre-existing conditions of cerebrovascular incident (ischemic or hemorrhagic stroke), transient ischemic attack or subarachnoid hemorrhage within 6 months prior to screening.
    4. Moderate to severe ascites and/or pleural effusion. However, enrollment is permitted for patients with ascitic fluid as long as paracentesis is not required to improve the condition.
    5. Interstitial lung disease or pulmonary fibrosis
15. Patients expected to require anticancer treatment other than the investigational product during the clinical study
16. Pregnant or lactating patients, or patients planning to become pregnant during the clinical study

17. A history of primary malignant tumor other than biliary tract cancer with the following exceptions:

    1. At least 3 years have passed since complete remission of primary malignant tumor (Patients who had papillary thyroid carcinoma and underwent a radical resection may participate in the clinical study even if less than 3 years have elapsed).
    2. At least 1 year has passed since complete resection of dermal basal cell carcinoma or successful treatment of cervical intraepithelial neoplasia
18. Clinically significant abnormal ECG findings or history determined as clinically significant by the Investigator
19. QT interval (Fridericia's formula) (QTcF) interval > 450msec at the time of screening

Contacts and Locations

Contacts

Contact: Marilyn Fontaine; 617-500-8099 ext 118; CTX-009-002@compasstherapeutics.com

Locations

United States, Colorado

Rocky Mountain Cancer Centers, LLP; Recruiting

Aurora, Colorado, United States, 80012

Contact: Jennifer Hege jennifer.hege@usoncology.com

Principal Investigator: Sujatha Nallapareddy, MD

United States, Delaware

Medical Oncology Hematology Consultants, PA; Recruiting

Newark, Delaware, United States, 19713

Contact: Elizabeth MacWade elizabeth.macwade@usoncology.com

Principal Investigator: Jamal Misleh, MD

United States, Missouri

Washington University School of Medicine, Siteman Cancer Center; Not yet recruiting

Saint Louis, Missouri, United States, 63110

Principal Investigator: Olivia Aranha, MD

United States, New Jersey

Rutgers Cancer Institute; Recruiting

New Brunswick, New Jersey, United States, 08854

Contact: Lead Clinical Research Coordinator perez11@cinj.rutgers.edu

Contact: Back-Up Clinical Research Coordinator uq5@cinj.rutgers.edu

Principal Investigator: Howard Hochster, MD

United States, New Mexico

The University of New Mexico; Recruiting

Albuquerque, New Mexico, United States, 87131

Principal Investigator: Ursa Brown-Glaberman, MD

Memorial Medical Center; Recruiting

Las Cruces, New Mexico, United States, 88011

United States, New York

New York Oncology Hematology, P.C.; Recruiting

Albany, New York, United States, 12206

Contact: Josephine Faruol Josephine.Faruol@usoncology.com

Principal Investigator: Lawrence E Garbo, MD

United States, South Carolina

Prisma Health; Recruiting

Greenville, South Carolina, United States, 29605

Contact: Amber Ledwell Amber.Ledwell@Prismahealth.org

Principal Investigator: Christopher R Thomas, MD

United States, Texas

Texas Oncology - Austin; Recruiting

Austin, Texas, United States, 78705

Contact: Jennifer Rowan jennifer.rowan@usoncology.com

Principal Investigator: Vivian Cline, MD

Texas Oncology - Baylor Charles A. Sammons Cancer Center; Recruiting

Dallas, Texas, United States, 75246

Contact: Christine Terraciano Christine.terraciano@usoncology.com

Principal Investigator: Andrew Scott Paulson, MD

Texas Oncology - Dension; Recruiting

Denison, Texas, United States, 75020

Contact: Jayne Mettetal jayne.mettetal@usoncology.com

Principal Investigator: Amir Faridi, MD

Texas Oncology - McAllen; Recruiting

McAllen, Texas, United States, 78503

Contact: Nereida Salinas nereida.salinas@usoncology.com

Principal Investigator: Suresh Ratnam, MD

Texas Oncology - San Antonio; Recruiting

San Antonio, Texas, United States, 78217

Contact: Shannon Syring shannon.syring@usoncology.com

Principal Investigator: Nathan Shumway, DO

Texas Oncology - Northeast Texas; Recruiting

Tyler, Texas, United States, 75702

Contact: Shelly K Maxfield shelly.maxfield@usoncology.com

Principal Investigator: Donald A Richards, MD, PhD

United States, Washington

Northwest Cancer Specialists, P.C.; Recruiting

Vancouver, Washington, United States, 98684

Contact: Jennifer Thompson jennifer.thompson@usoncology.com

Principal Investigator: David P Cosgrove, MD

Sponsors and Collaborators

Compass Therapeutics

Investigators

• Study Director: Thomas J Schuetz, MD, PHD; Compass Therapeutics

More Information

• Responsible Party: Compass Therapeutics
• ClinicalTrials.gov Identifier: NCT05506943
• Other Study ID Numbers: CTX-009-002
• First Posted: August 18, 2022
• Last Update Posted: March 16, 2023
• Last Verified: March 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

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

Additional relevant MeSH terms:

Cholangiocarcinoma; Biliary Tract Neoplasms; Gallbladder Neoplasms; Neoplasms by Site; Neoplasms; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Digestive System Neoplasms; Biliary Tract Diseases; Digestive System Diseases; Gallbladder Diseases; Paclitaxel; Antineoplastic Agents, Phytogenic; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Molecular Mechanisms of Pharmacological Action