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A Study Investigating the Safety and Tolerability of an Immune Treatment in Cancer Patients With Lesions to the Skin

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04059588
Recruitment Status : Recruiting
First Posted : August 16, 2019
Last Update Posted : February 17, 2020
Sponsor:
Information provided by (Responsible Party):
Rockefeller University

Brief Summary:

The purpose of this study is to test the safety and tolerability of 2141-V11 in people who have cancer that does not respond to standard treatment and who have skin lesions (skin tumors) associated with their cancer. The study will also test how the body processes and responds to 2141-V11, and if the study drug has cancer fighting activity in people. The study drug activates a naturally occurring protein called CD40. By activating CD40, cells of the immune system are better able to identify and kill cancer cells.

We are testing if injection of 2141-V11 into metastasis to the skin will be safe and well tolerated, and may result in immune activation in patients with solid tumors that have metastasis to the skin.


Condition or disease Intervention/treatment Phase
Cancer Solid Tumor Cancer of Skin Drug: 2141 V-11 Phase 1

Detailed Description:

This is a Phase 1 open label, dose-escalation study evaluating the safety, pharmacokinetics, pharmacodynamics, immunogenicity, and efficacy of the Fc-engineered variant 2141-V11 in patients with previously treated relapsed or refractory solid tumors and locally advanced or metastatic solid tumors to the skin amenable to intratumoral injection.

There are two parts to the study: a dose-finding stage (Part I), and a dose expansion stage (Part II). Both Part I and Part II of the study will include patients with locally advanced or metastatic cancers of the skin which are not amenable to standard treatment.

A traditional 3 + 3 dose escalation design will be used (Part I). Successive cohorts of participants (3 participants/cohort) will be started on a fixed dose intratumoral injection of 2141V11 at the dose assigned to their cohort. The study drug, 2141-V11, will be dosed once every 3 weeks. The study drug is administered in cycles.

The first group of study participants in Part I will receive the lowest dose of study drug. The next group of study participants will receive the next higher dose. This dosing scheme continues until the maximum tolerated dose is determined. The maximum tolerated dose (MTD) will be defined as 1 dose level below the dose in which DLTs are observed in >33% of the participants.

Participants in Part II of the study will receive the MTD determined from Part 1 (dose escalation) of the study. Part II participants in the study will also receive two vaccinations (KLH and tetanus) to allow monitoring of their immune function.

Participants in both Part I and II can continue to receive cycles of study drug at their assigned dose if they do not experience progression of disease, a serious adverse event, and the study is ongoing.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 28 participants
Intervention Model: Sequential Assignment
Intervention Model Description: Cohorts of 3 to 6 subjects will be sequentially enrolled at progressively higher dose levels of 2141-V 11 using a standard 3+3 dose-escalation design.
Masking: None (Open Label)
Primary Purpose: Other
Official Title: A Phase I, Dose-escalation Study Investigating the Safety and Tolerability of Intratumoral Injection of an Fc-engineered Anti-CD40 Monoclonal Antibody (2141-V11) in Patients With Cancer
Actual Study Start Date : January 16, 2020
Estimated Primary Completion Date : July 31, 2021
Estimated Study Completion Date : July 31, 2023

Arm Intervention/treatment
Experimental: Injection of 2141-V11
Open label study drug 2141-V11 at escalating doses until MTD is determined, and expansion utilizing the MTD.
Drug: 2141 V-11
intratumoral injection of 2141-V11




Primary Outcome Measures :
  1. Number of patients with treatment-emergent adverse events assessed by NCI CTCAE v4.03 [ Time Frame: through study completion, an average of 2 years ]
  2. Incidence and severity of DLTs reported and their relationship to 2141-V11 administration assessed by NCI CTCAE v4.03 [ Time Frame: through study completion, an average of 2 years ]
  3. Change from baseline laboratory assessments and toxicities over time in abnormal Complete Blood Count labs and Complete Metabolic Panel labs assessed by SI laboratory reference ranges [ Time Frame: through study completion, an average of 2 years ]
  4. Changes from baseline in anti-drug antibody (ADA) responses to 2141-V11 exposure over time [ Time Frame: through study completion, an average of 2 years ]


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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:

  1. Age > 18 years old
  2. Must have measurable or evaluable metastatic disease (at least more than 1 lesion) as evidenced by physical exam or imaging
  3. Must have an identifiable metastatic lesion of the skin or subcutaneous tissue amenable to intratumoral injection. This includes all solid tumors as well as metastatic melanoma and/or melanoma with in-transit metastases.
  4. ECOG performance status < 1
  5. Histologically confirmed diagnosis of refractory or relapsed metastatic disease
  6. Must have the ability to comply with the collection of tumor and skin biopsies, and tumors must be accessible for biopsy.
  7. Required values for screening laboratory tests:

    1. Absolute neutrophil count (ANC) > 1000/mm3 independent of growth factor support
    2. Platelets > 75,000/mm3
    3. Hemoglobin > 8 g/dl
    4. Creatinine clearance > 40 ml/min for the dose-escalation phase, >25 ml/min in dose expansion phase (if safety data from dose escalation indicate this is possible)
    5. AST/ALT < 3 x ULN
    6. Bilirubin < 1.5 x ULN (except for participants with Gilbert's Syndrome or of non-hepatic origin)
  8. Patients must have refractory or relapsed disease and have must have exhausted all standard-of-care therapy for their disease
  9. Must be at least 4 weeks since treatment with standard or investigational chemotherapy, biochemotherapy, surgery, radiation, cytokine therapy, and recovered from any clinically significant toxicity experienced during treatment.
  10. If sexually active male or female and participating in sexual activity that could lead to pregnancy, agrees to use two effective methods of contraception (i.e. condom with spermicide, diaphragm with spermicide, hormone-eluting IUD, hormone-based contraceptive with condom). For females, these restrictions apply for 1 month after the last dose of study drug. For males, these restrictions apply for 3 months after the last dose of study drug. Men must agree not to donate sperm during and after the study g. Female study participants of reproductive potential are defined as pre-menopausal women who have not had a sterilization procedure (e.g. hysterectomy, bilateral oophorectomy, tubal ligation or salpingectomy). Women are considered menopausal if they have not had a menses for at least 12 months and have a FSH of greater than 40 IU/L or if FSH testing is not available, they have had amenorrhea for 24 consecutive months.
  11. Women of childbearing potential must have a negative beta-human chorionic gonadotropin (hCG) pregnancy test at screening, as well as a negative pregnancy test prior to each treatment
  12. Life expectancy greater than 16 weeks (should be evaluated by a prognostic score, e.g., Roya Marsden score)
  13. Able to comply with the treatment schedule as determined by the participant and the licensed practitioner

Exclusion Criteria:

  1. Concurrent anticancer therapy including investigational agents. This includes topical therapeutic agents
  2. History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia (i.e. bronchiolitis obliterans, cryptogenic organizing pneumonia), risk of pulmonary toxicity, or evidence of active pneumonitis on screening chest CT scan
  3. History of radiation pneumonitis in the radiation field (fibrosis) is permitted
  4. Patients with active hepatitis B (defined as having a positive hepatitis B surface antigen (HBsAg) test at screening
  5. Patients with past/resolved hepatitis B virus (HBV) infection (defined as having a negative HBsAg and a positive antibody to hepatitis B core antigen antibody test) are eligible only if polymerase chain reaction is negative for HBV RNA. HBV DNA must be obtained in these patients prior to Cycle 1, Day 1.
  6. History of stroke or intracranial hemorrhage within 6 months prior to enrollment.
  7. Increased corrected QT (QTc) interval (QTc > 470 ms), patients with baseline resting bradycardia < 45 bpm, or baseline resting tachycardia > 100 bpm
  8. Has spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for > 2 weeks prior to screening
  9. Vaccinated with live, attenuated viral vaccines within 4 weeks of enrollment
  10. Known history of human immunodeficiency virus (HIV) or any uncontrolled active systemic infection
  11. Major surgery or a wound that has not fully healed within 4 weeks of enrollment.
  12. Treatment with an immunosuppressive regimen of corticosteroids or other immunosuppressive medication (e.g., methotrexate, rapamycin) within 30 days of study treatment. Note: patients with adrenal insufficiency may take up to 5 mg of prednisone or equivalent daily. Topical and inhaled corticosteroids in standard doses are allowed
  13. Severe infections within 4 weeks prior to Cycle 1, Day 1, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia.
  14. Signs and symptoms of infection within 2 weeks prior to Cycle 1, Day 1
  15. Any investigational therapy within 28 days prior to initiation of study treatment. This includes topical or injected agents
  16. Significant cardiovascular disease (i.e., NYHA class 3 congestive heart failure; myocardial infarction within the past 6 months; unstable angina; coronary angioplasty within the past 6 months; uncontrolled atrial or ventricular cardiac arrhythmias
  17. Autoimmune disease including systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjogren's syndrome, autoimmune thrombocytopenia, history of uveitis or other autoimmune disease if clinically significant
  18. Untreated CNS metastases as determined by CT or magnetic resonance imaging (MRI) evaluation during screening or prior radiographic assessments. Patients with radiographically stable, asymptomatic previously irradiated lesions are eligible provided patient is > 4 weeks beyond completion of cranial irradiation and > 3 weeks of corticosteroid therapy.
  19. Known history of leptomeningeal leptomeningeal disease, patients with metastases to the brain stem, midbrain, pons, or medulla, and patients with metastases with 10 mm of the optic apparatus (optic nerve and chiasm) will be excluded from the study
  20. Requires anticoagulation with warfarin or equivalent vitamin K antagonists
  21. Has had a pulmonary embolism or any other thromboembolic event within 6 months prior to study entry
  22. Any approved anti-cancer therapy, including chemotherapy, immunotherapy or hormonal therapy, within 4 weeks prior to initiation of study treatment, with the following exceptions:

    1. Hormone-replacement therapy or oral contraceptives
    2. Tyrosine kinase inhibitors (TKIs) that have been discontinued > 7 days prior to Cycle 1, Day 1; screening scans must be obtained after discontinuation of prior TKIs
  23. Prior toxicities from previous cancer therapy, including checkpoint inhibition, that have not regressed to Grade < 1 severity (NCI CTCAE v4.03, or later versions) within 28 days before Cycle 1, Day 1, with the exception of alopecia
  24. Active hepatitis C are excluded. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA
  25. Any surgical procedure within less than 14 days of the first receipt of study drug. Major surgical procedure within 28 days prior to Cycle 1, Day 1 or anticipation of the need for a major surgical procedure during the study other than for diagnosis.
  26. Pregnant or breast feeding
  27. Active infection or with a fever >38.5 degrees C within 3 days prior to the first scheduled treatment
  28. Any medical history, including laboratory results, deemed by the investigator to be likely to interfere with their participation in the study, or to interfere with the interpretation of the results, or any social condition that, in the opinion of the Investigator, might pose additional risk to the participant or confound the results of the study.

    -


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): NCT04059588


Contacts
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Contact: Recruitment Office 1-800-782-2737 RUcares@Rockefeller.edu
Contact: Joseph P Colagrecco, DNP, NP-BC jcolagreco@rockefeller.edu

Locations
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United States, New York
Rockefeller University Recruiting
New York, New York, United States, 10065
Contact: Joseph Colagreco, DNP, NP-BC    929-226-4440    jcolagreco@rockefeller.edu   
Contact: David Knorr, MD,PhD       dknorr@rockefeller.edu   
Sponsors and Collaborators
Rockefeller University
Investigators
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Principal Investigator: David A Knorr, MD, PhD Rockefeller University
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Responsible Party: Rockefeller University
ClinicalTrials.gov Identifier: NCT04059588    
Other Study ID Numbers: DKN-0993
First Posted: August 16, 2019    Key Record Dates
Last Update Posted: February 17, 2020
Last Verified: February 2020
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 Rockefeller University:
Solid Tumors
Skin lesions
Immunotherapy
CD40 antibody
Cancer
intratumoral
intralesional
metastases
metastasis
Additional relevant MeSH terms:
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Skin Neoplasms
Neoplasms by Site
Neoplasms
Skin Diseases