A Study of PDR001 in Combination With LCL161, Everolimus or Panobinostat

Study Overview
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Brief Summary
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The purpose of this study was to combine the PDR001 checkpoint inhibitor with several agents with immunomodulatory activity to identify the doses and schedule for combination therapy and to preliminarily assess the safety, tolerability, pharmacological and clinical activity of these combinations.

Official Title
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Phase Ib, Open-label, Multi-center Study to Characterize the Safety, Tolerability and Pharmacodynamics (PD) of PDR001 in Combination With LCL161, Everolimus (RAD001) or Panobinostat (LBH589)

Conditions
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Colorectal Cancer, Non-small Cell Lung Carcinoma (Adenocarcinoma), Triple Negative Breast Cancer, Renal Cell Carcinoma

Intervention / Treatment
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* Biological: PDR001
* Drug: LCL161
* Drug: Everolimus
* Drug: Panobinostat
* Drug: QBM076
* Drug: HDM201


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Written informed consent prior to any procedure Patients with advanced/metastatic cancer, with measurable disease as determined by RECIST version 1.1, who have progressed despite standard therapy or are intolerant to SOC, or for whom no standard therapy exists. Patients must fit into one of the following groups: • CRC •NSCLC • TNBC• RCC ECOG ≤ 2 Patient must have a site of disease for biopsy, and be a candidate for tumor biopsy according to the institution's guidelines. Patient must be willing to undergo a new tumor biopsy at screening, and again during therapy on this study. Prior therapy with PD-1/PDL-1 inhibitors is allowed provided any toxicity attributed to prior PD-1- or PD-L1-directed therapy did not lead to discontinuation of therapy. Exclusion Criteria: Presence of symptomatic central nervous system (CNS) metastases, or CNS metastases that require local CNS-directed therapy within prior 2 weeks. Patients with known hypersensitivity to any of the components of an investigational treatment will be excluded from participation in the corresponding arm but are eligible for participation in other study arm; Patients that have a history of hypersensitivity to rapamycin derivatives will be excluded from participation in the everolimus arm History of or current drug-induced interstitial lung disease or pneumonitis grade ≥2 Out of range lab values as defined in protocol Impaired cardiac function or clinically significant cardiac disease Active, known or suspected autoimmune disease Human Immunodeficiency Virus (HIV), or active Hepatitis C (HCV) virus. Escalation: active Hepatitis B (HBV); Expansion: Patients with Chronic HBV currently on medication will not be excluded. Impairment of gastrointestinal (GI) function Malignant disease, other than that being treated in this study Systemic anti-cancer therapy within 2 weeks of the first dose of study treatment. For cytotoxic agents that have major delayed toxicity and washout period is 6 weeks; prior immunotherapy - washout is 4 weeks Active infection requiring systemic antibiotic therapy. Patients requiring chronic treatment with systemic steroid therapy, other than replacement dose steroids or treatment with low, stable dose of steroid (<10 mg/day prednisone or equivalent) for stable CNS metastatic disease. Patients receiving systemic treatment with any immunosuppressive medication. Major surgery within 2 weeks of the first dose of study treatment Radiotherapy within 2 weeks of the first dose of study drug Participation in an interventional, investigational study within 2 weeks of the first dose of study treatment. Presence of ≥ CTCAE grade 2 toxicity (except alopecia, peripheral neuropathy and ototoxicity, which are excluded if ≥ CTCAE grade 3) due to prior therapy. Use of hematopoietic colony stimulating growth factors </= 3 weeks prior to first dose Additional exclusion criteria for PDR001/LCL161 Patients requiring medications metabolized through CYP3A4/5 and have a narrow therapeutic index or medications that are CYP3A4 substrates that cause QT prolongation Patients requiring treatment with strong CYP2C8 inhibitors Additional exclusion criteria for PDR001/Everolimus Patients requiring treatment with moderate CYP3A4 inhibitors Patients requiring treatment with a strong CYP3A4 inhibitor or inducer Additional exclusion criteria for PDR001/Panobinostat- Patient who received DAC inhibitors Patient needing valproic acid during the study or within 5 days prior to first dose Patients requiring medications that are sensitive CYP2D6 substrates areCYP2D6 substrates with a narrow therapeutic index or are anti-arrhythmic drugs/drugs with QT-prolongation risks Patients requiring a strong inhibitor or inducer of CYP3A4 Clinically significant, uncontrolled heart disease and/or recent cardiac event within 6 months prior to study Unresolved diarrhea ≥ CTCAE grade 2 or a medical condition associated with chronic diarrhea Taking medications with QT prolongation risk or interval or inducing Torsade de pointes Additional exclusion criteria for PDR001/QBM076- Patients requiring medications that are strong inducers or strong inhibitors of CYP3A4 Patients requiring medications with narrow therapeutic index CYP3A4 substrates Women using any form of hormonal contraception (oral, injected, implanted, transdermal) will be excluded (unless they are willing to switch to another effective form of contraception under their physician's guidance) Additional exclusion criteria for PDR001/HDM201- Prior treatment with compounds with the same mode of action as proposed for HDM201, i.e. an inhibition of the interaction of TP53 with HDM2, e.g. RG7112 or CGM097 Patients who require the following treatments moderate to strong CYP3A4 inhibitors; any substrates of CYP3A4/5 with a narrow therapeutic index Moderate to strong CYP3A4 inducers Patients having out of range values for: Absolute neutrophil count (ANC) <1500/µL; Platelets < 100 000/µL Other protocol-defined inclusion exclusion criteria may apply.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CRC - PDR001 + LCL161<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: LCL161<br> <br> |
| Experimental: NSCLC - PDR001 + LCL161<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: LCL161<br> <br> |
| Experimental: TNBC - PDR001 + LCL161<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: LCL161<br> <br> |
| Experimental: CRC - PDR001+ Everolimus<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: Everolimus<br> <br> * Other names: RAD001;|
| Experimental: NSCLC - PDR001+ Everolimus<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: Everolimus<br> <br> * Other names: RAD001;|
| Experimental: TNBC - PDR001+ Everolimus<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: Everolimus<br> <br> * Other names: RAD001;|
| Experimental: CRC - PDR001 + Panobinostat<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: Panobinostat<br> <br> * Other names: LBH589;|
| Experimental: NSCLC - PDR001 + Panobinostat<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: Panobinostat<br> <br> * Other names: LBH589;|
| Experimental: TNBC - PDR001 + Panobinostat<br>Enrollment to this combination arm is closed to further enrollment. | Biological: PDR001<br>* anti-PD1 antibody<br>Drug: Panobinostat<br> <br> * Other names: LBH589;|
| Experimental: CRC - PDR001 + QBM076<br>Enrollment to this combination arm is closed to further enrollment. | Drug: QBM076<br> <br> |
| Experimental: TNBC - PDR001 + QBM076<br>Enrollment to this combination arm is closed to further enrollment. | Drug: QBM076<br> <br> |
| Experimental: NSCLC- PDR001 + QBM076<br>Enrollment to this combination arm is closed to further enrollment. | Drug: QBM076<br> <br> |
| Experimental: CRC - PDR001 + HDM201<br>Dose escalation completed, expansion arm. | Drug: HDM201<br> <br> |
| Experimental: RCC - PDR001 + HDM201<br>Dose escalation completed, expansion arm. | Drug: HDM201<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phase 1: Incidence of dose limiting toxicities (DLTs) | During the first two cycles Cycle = 28 days | 5.5 years | 
| Frequency of dose interruptions and reductions | Through study completion, an average of 6 months | 5.5 years | 
| Frequency and severity of treatment-emergent adverse events (AEs) and serious adverse events (SAEs) | Through study completion, an average of 6 months | 6 years | 
| Changes between baseline and post-baseline laboratory parameters and vital signs | Through study completion, an average of 6 months | 6 years | 
| Dose intensities | Through study completion, an average of 6 months | 6 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes from baseline in ECG parameters in patients recieving PDR001 in combination with Panobinostat | Baseline and end of treatment, an average of 6 months | 6 years | 
| Best overall response (BOR) | per RECIST v1.1 | 6 years | 
| Time to reach max concentration (Tmax) for PDR001 |  | 6 years | 
| Presence of anti-PDR001 antibodies |  | 6 years | 
| Progression free survival (PFS) | per RECIST v1.1 | 6 years | 
| Treatment Free Survival (TFS) |  | 6 years | 
| Maximum and minimum plasma concentrations of LCL161 (Cmax and Cmin) | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Maximum and minimum Plasma concentrations of everolimus (Cmax and Cmin) | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Maximum and minimum plasma concentrations of panobinostat (Cmax and Cmin) | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Concentration of anti-PDR001 antibodies | Cycle 1 through cycle 6 in treatment period 1 and 2, an average of 6 months | 6 years | 
| Maximum and minimum serum concentration of PDR001 (Cmax and Cmin) | Cycle 1 through cycle 6 in treatment period 1 and 2, an average of 6 months | 6 years | 
| Area under the concentration-time curve calculated to the last concentration point (AUClast) for PDR001, as applicable | Cycle 1 through cycle 6 in treatment period 1 and 2, an average of 6 months | 6 years | 
| Progression free survival (PFS) per irRC |  | 6 years | 
| Area under the concentration-time curve calculated to the last concentration point (AUClast) for LCL161, as applicable | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Time to reach max concentration (Tmax) for LCL161 | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Time to reach max concentration (Tmax) for Everolimus | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Time to reach max concentration (Tmax) for Panobinostat | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Area under the concentration-time curve calculated to the last concentration point (AUClast) for Everolimus, as applicable | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Area under the concentration-time curve calculated to the last concentration point (AUClast) for Panobinostat, as applicable | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Maximum and minimum Plasma concentrations of QBM076 (Cmax and Cmin) | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Maximum and minimum Plasma concentrations of HDM201 (Cmax and Cmin) | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Time to reach max concentration (Tmax) for QBM076 | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Time to reach max concentration (Tmax) for HDM201 | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Area under the concentration-time curve calculated to the last concentration point (AUClast) for QBM076, as applicable | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 
| Area under the concentration-time curve calculated to the last concentration point (AUClast) for HDM201, as applicable | Cycle 1 through cycle 6 in treatment period 1, an average of 6 months | 6 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PDR001, CRC, TNBC, NSCLC, RCC, Immunomodulation, Biomarkers, Bayesian logistic regression model