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XB2001 in Combination With ONIVYDE + 5-FU/LV (+Folinic Acid) in Advanced Pancreatic Cancer (1-BETTER)

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ClinicalTrials.gov Identifier: NCT04825288
Recruitment Status : Recruiting
First Posted : April 1, 2021
Last Update Posted : August 5, 2021
Sponsor:
Information provided by (Responsible Party):
XBiotech, Inc.

Brief Summary:

This trial will include 2 portions (phase 1 and phase 2).

The first portion will be a Phase I, open label, dose escalation study to establish the maximum tolerated dose (MTD) of XB2001 as measured by Dose-Limiting Toxicity (DLT), in combination with ONIVYDE + LV + 5-FU chemotherapy regimen in patients with advanced pancreatic cancer and to determine the recommended dose for the subsequent Phase 2 study.

The phase 2 portion will be implemented with the maximum established tolerated dose (MTD) of XB2001. The target enrollment in the phase 2 portion is 60 patients which will be randomized on a 1:1 basis to XB2001 plus ONIVYDE + LV + 5-FU (Arm 1) or placebo plus ONIVYDE + LV + 5-FU (Arm 2).


Condition or disease Intervention/treatment Phase
Pancreatic Cancer Biological: XB2001 or Placebo Phase 1 Phase 2

Detailed Description:

Study Title: A Phase I/II randomized, double-blind, placebo-controlled trial (1-BETTER) examining XB2001 (anti-IL-1⍺ True Human antibody) in combination with ONIVYDE + 5-FU/LV (+folinic acid) in advanced pancreatic cancer

Sponsor: XBiotech USA, Inc.

Study Chair: Shubham Pant, M.D.

Sample Size: Approximately 69 patients will be enrolled in the USA (at least 9 patients in the open label phase 1 portion and 60 patients in the randomized phase 2 portion)

Approximate Duration:

This trial will include 2 phases. The first portion will be a Phase I, open label, dose escalation study evaluating the safety, tolerability and establishing the Maximum Tolerated Dose (MTD) of XB2001 in at least nine patients with metastatic pancreatic adenocarcinoma who are receiving ONIVYDE + Leucovorin l + d racemic + 5-Fluorouracil chemotherapy treatment. The duration for each patient in the Phase I portion will be 14 days (1 treatment cycle) in which they will be given one intravenous dose of XB2001 prior to receiving ONIVYDE + Leucovorin l + d racemic + 5-Fluorouracil chemotherapy treatment and assessed for Dose Limited Toxicities (DLT). The Phase II portion will be implemented following the completion of the Phase I portion and declaration of the MTD. The duration of subject participation in the randomized, double-blind, placebo-controlled Phase II portion of the trial is approximately 28 weeks: including a screening period of up to 30 days, and 24-week treatment period. All study subjects can continue treatment with XB2001 in an open label extension, for as long as they are judged to be benefitting clinically and have had no unacceptable toxicities.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 69 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Subjects in phase II portion will be randomized on a 1:1 basis to XB2001 plus ONIVYDE + LV + 5-FU (Arm 1) or placebo plus ONIVYDE + LV + 5-FU (Arm 2).
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: Double-blinded study
Primary Purpose: Treatment
Official Title: A Phase I/II Randomized, Double-blind, Placebo-controlled Trial (1-BETTER) Examining XB2001 (Anti-IL-1⍺ True Human Antibody) in Combination With ONIVYDE + 5-FU/LV (+Folinic Acid) in Advanced Pancreatic Cancer
Actual Study Start Date : May 27, 2021
Estimated Primary Completion Date : April 19, 2022
Estimated Study Completion Date : October 19, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Arm 1

XB2001 + ONIVYDE + 5-FU + LV combination therapy administered for 12 cycles of treatment

• Arm 1 Treatment Cycle: Patients randomized to this arm will receive the following treatments every 2 weeks: XB2001 MTD as an intravenous infusion over up to 60 minutes, followed by ONIVYDE 70 mg/m2 intravenously over 90 minutes, followed by leucovorin l + d racemic 400 mg/m2 intravenously over 30 minutes, followed by 5-Fluorouracil 2400mg/m2 intravenously over 46 hours. Therapy will be administered every 2 weeks (2 weeks = 1 cycle).

Biological: XB2001 or Placebo
XB2001 has an IgG4, heavy chain and a kappa light chain. The heavy chains are joined at their hinge regions through two disulfide linkages and each heavy chain is joined to one light chain through one disulfide linkage between their CH1 and CL domains respectively. The heavy chain CH2 domains are glycosylated primarily with the oligosaccharide structure shown in Figure 2.1, as determined by cleaved N-glycan analysis performed by ProteomeLab PA800 Plus. The glycosylated residue (Asn-295 as numbered from the N-terminus of XB2001) is in the same highly conserved N-linked glycosylation site as found in endogenous IgG4 (Asn-297 according to the generic numbering system). Similarly, the primary glycan, commonly referred to as G0F, is the same as that found in about 22% of endogenous human IgG molecules . The main isoform has a pI of about 6.47 and comprises over 60% of the total isoform population, as determined by capillary isoelectric focusing.

Placebo Comparator: Arm 2

Placebo + ONIVYDE + 5-FU + LV combination therapy administered for 12 cycles of treatment

• Arm 2 Treatment Cycle: Patients randomized to this arm will receive the following treatments every 2 weeks: Placebo as an intravenous infusion over up to 60 minutes, followed by ONIVYDE 70 mg/m2 intravenously over 90 minutes, followed by leucovorin l + d racemic 400 mg/m2 intravenously over 30 minutes, followed by 5-fluorouracil 2400 mg/m2 intravenously over 46 hours. Therapy will be administered every 2 weeks (2 weeks = 1 cycle).

Biological: XB2001 or Placebo
XB2001 has an IgG4, heavy chain and a kappa light chain. The heavy chains are joined at their hinge regions through two disulfide linkages and each heavy chain is joined to one light chain through one disulfide linkage between their CH1 and CL domains respectively. The heavy chain CH2 domains are glycosylated primarily with the oligosaccharide structure shown in Figure 2.1, as determined by cleaved N-glycan analysis performed by ProteomeLab PA800 Plus. The glycosylated residue (Asn-295 as numbered from the N-terminus of XB2001) is in the same highly conserved N-linked glycosylation site as found in endogenous IgG4 (Asn-297 according to the generic numbering system). Similarly, the primary glycan, commonly referred to as G0F, is the same as that found in about 22% of endogenous human IgG molecules . The main isoform has a pI of about 6.47 and comprises over 60% of the total isoform population, as determined by capillary isoelectric focusing.




Primary Outcome Measures :
  1. To establish the maximum tolerated dose (MTD) of XB2001 as measured by Dose-Limiting Toxicity (DLT), in combination with ONIVYDE + LV + 5-FU chemotherapy regimen in patients with advanced pancreatic cancer. [ Time Frame: 44 days ]
    Primary Endpoint for Phase I portion

  2. Incidence of Treatment-Emergent Adverse Events as assessed by CTCAE v5.0 [ Time Frame: 28 weeks ]
    Safety endpoints will be evaluated for number of subjects by monitoring treatment emergent adverse events (TEAE) from clinical and laboratory reporting as assessed by CTCAE v4.0.


Secondary Outcome Measures :
  1. Progression Free Survival [ Time Frame: From baseline until the date of first documented disease progression or date of death (from any cause), whichever come first, assessed up to 24 weeks. ]
    Progression Free Survival will be evaluated following the formal database lock, or during an interim analysis, if applicable. PFS is defined as the time from date of randomization to the date of disease progression or death (any cause). Disease progression can include clinical progression, in which it is deemed by the investigator that the patient is coming off study due to the progression of underlying disease. Clinical or radiological (RECIST 1.1) progression will suffice as disease progression.

  2. Overall Survival (OS) [ Time Frame: From baseline until the date of death (from any cause) assessed up to 24 weeks. ]
    Overall survival (OS) will be defined as the duration from the date of randomization until death. Subjects who are alive at the end of follow-up will be censored and survival time will be defined as time from randomization to censor date.

  3. Objective Response Rate [ Time Frame: Assessment every 8 weeks after initial response assessed up to 24 weeks. ]
    Objective Response Rate will be defined by the percent of patients in the study with a best overall response of CR or PR as assessed by the investigator (per RECIST 1.1).

  4. Time to Treatment Failure [ Time Frame: From baseline to treatment discontinuation (any cause) assessed up to 24 weeks ]
    Time to treatment failure is defined as a composite endpoint measuring time from randomization to discontinuation of treatment for any reason, including disease progression, treatment toxicity, or death.

  5. Percentage of Patients with Clinical Benefit Response [ Time Frame: Baseline to weeks 8, 16 and 24. CBR will be defined as a composite measure consisting of change in lean body mass (LBM) and change in quality of life ]
    For Phase 2 portion only. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. The CBR will be defined as a stabilization or positive (≥0 kg) change in lean body mass (LBM)-as assessed by dual-energy X-ray absorptiometry (DEXA) scan, and improvement or no worsening (≥0 score point change) on any two of the three symptom scale measures (fatigue, pain, appetite) of EORTC QLQ-C30

  6. Quality of Life assessed through the cancer-specific European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life questionnaire (QLQ)-C30 [ Time Frame: Baseline to weeks 8, 16 and 24 ]
    Score ranges from 0 to 100. A high score represents a higher response level.

  7. Number of Serious Adverse Events (SAEs) [ Time Frame: From baseline (Visit 1) (post-infusion) until two weeks after the last infusion, assessed up to 24 weeks ]
    For Phase 2 portion only

  8. Incidence of Grade 3-4 Diarrhea [ Time Frame: From Visit 1 (post-infusion) until two weeks after the last infusion, assessed up to 24 weeks ]
    For Phase 2 portion only

  9. Duration of hospitalizations [ Time Frame: Baseline to weeks 4, 8, 12, 16, 20 and 24 ]
    For Phase 2 portion only

  10. Plasma/serum concentration of XB2001 [ Time Frame: At the specified timepoints in the study calendar assessed up to 24 weeks ]
    Plasma/serum concentration of XB2001 will be measured throughout the study.

  11. Number of Treatment Cycles [ Time Frame: Throughout the study assessed up to 24 weeks ]
    For Phase 2 portion only

  12. Change in (CD14+CD16+IL-1⍺+) triple positive tumor associated monocytes in peripheral blood [ Time Frame: Baseline to week 2 (post infusion at visit 2) ]
    For Phase 2 portion only


Other Outcome Measures:
  1. Results of a symptom questionnaire will be summarized by treatment arm at various post-infusion time points and compared over time [ Time Frame: At various post-infusion time points assessed up to 22 weeks ]
    Score ranges from 12 to 48. A high score represents worse outcome.

  2. Cardiotoxicity measured by the number of required ECGs and cardiotoxicity related events summarized by treatment arm and compared over time [ Time Frame: Compared over time, assessed up to 22 weeks ]
    Exploratory Endpoint (Phase 2 portion only)



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:

  • Histologically or cytologically confirmed pancreatic adenocarcinoma of exocrine pancreas that is metastatic, unresectable, or recurrent
  • At least one measurable lesion according to Response Evaluation Criteria in Solid Tumor V1.1
  • Documented disease progression after one prior gemcitabine-based therapy OR one FOLFIRINOX and gemcitabine combination therapy
  • Eastern Cooperative Oncology Group (ECOG) performance of 0 or 1 or Karnofsky performance status (KPS) ≥ 70
  • Adequate hepatic, renal and bone marrow function

Exclusion Criteria:

  • Clinically significant decrease in performance status (medical records) within 2 weeks of intended first dose administration
  • Clinically significant GI disorders
  • Severe arterial thromboembolic events less than 6 months before inclusion
  • Prior Whole Brain Radiation Therapy (WBRT)
  • Evidence of brain metastases
  • NYHA Class III or IV congestive heart failure, ventricular arrhythmias or uncontrolled blood pressure (defined as ≥ 160/100 mm Hg)
  • Use of strong CYP3A4 inducers or inhibitors and/or UGT1A1 inhibitors within 14 days prior to Visit 1/Baseline visit.

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): NCT04825288


Contacts
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Contact: Haritha Pallapotu 5123862992 hpallapotu@xbiotech.com
Contact: Norma Gonzalez 5123862903 ngonzalez@xbiotech.com

Locations
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United States, Texas
Mary Crowley Cancer Research Recruiting
Dallas, Texas, United States, 75230
Contact: Guillermina Damian    972-566-3079    gdamian@marycrowley.org   
Contact: Mahogany Wadford    972-566-3085    Mwadford@marycrowley.org   
The University of Texas MD Anderson Cancer Center Not yet recruiting
Houston, Texas, United States, 77030
Contact: Christina Williams    713-563-4799    Cjwilliams5@mdanderson.org   
Principal Investigator: Shubham Pant, MD         
Sponsors and Collaborators
XBiotech, Inc.
Investigators
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Study Chair: Shubham Pant The University of Texas MD Anderson Cancer Center
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Responsible Party: XBiotech, Inc.
ClinicalTrials.gov Identifier: NCT04825288    
Other Study ID Numbers: 2020-PT049
First Posted: April 1, 2021    Key Record Dates
Last Update Posted: August 5, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: It is not yet known if there will be a plan to make IPD available

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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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Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases