A Study of MRG004A in Patients With Tissue Factor Positive Advanced or Metastatic Solid Tumors

Study Overview
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Brief Summary
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The objective of this study is to evaluate the safety, efficacy, pharmacokinetics, and immunogenicity of MRG004A in patients with Tissue Factor positive advanced or metastatic solid tumors.

Detailed Description
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This study consists of two parts. Part A is a dose escalation study to determine the maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of MRG004A. Part B is a disease specific multi-cohort dose expansion study to further assess the efficacy and safety of MRG004A at confirmed RP2D.

Official Title
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An Open-Label, Multi-center, Phase I/II Dose Escalation and Expansion Study to Assess the Safety, Tolerability, Anti-Tumor Activity and Pharmacokinetics of MRG004A in Patients With Tissue Factor Positive Advanced or Metastatic Solid Tumors

Conditions
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Advanced or Metastatic Solid Tumors

Intervention / Treatment
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* Drug: MRG004A


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Understands and provides written informed consent and willing to follow the requirements specified in protocol. Age ≥18 years. Life expectancy ≥6 months. For Part B patients, documented Tissue Factor (TF) presence in tumor biopsy specimens obtained from archival or re-biopsy specimens by immunohistochemistry (IHC) protein expression. Must have histologically or cytologically confirmed unresectable or metastatic cancer with documented disease progression during prior therapy, or relapse or progression following approved standard therapy for their tumor types- Part A and Part B. Part B: Patients who have documented progression during or relapse following standard therapy, no further treatment options that are known to improve survival, and participation in a clinical trial is a reasonable therapeutic option. Patients must have measurable disease per RECIST v1.1. ECOG performance status of 0 or 1. Acceptable bone marrow, hepatic, cardiac, renal, and coagulation function. A negative serum pregnancy test if female and aged between 18-55 years old. Patients, both females and males, of reproductive potential must agree to use adequate contraception during and for 180 days after the last infusion of MRG004A. Exclusion Criteria: Archival or biopsy tumor shows TF IHC membrane or cytosolic score of zero, no TF-positive expression or no TF-positive staining in Part B patients. Toxicities (except alopecia & fatigue) due to prior antitumor therapy are greater than CTCAE v5.0 Grade 1. Toxicities due to prior radiotherapy that have not resolved to Grade ≤ 1 CTCAE v5.0 at least 21 days prior to the first treatment. Untreated, unstable or uncontrolled central nervous system (CNS) metastases. Any other type of anti-cancer therapy within 21 days of the first dose of study treatment. Use of any other type of anti-cancer treatment is prohibited throughout the study. Patients with increased bleeding risk. Presence of severe cardiac dysfunction. Pulmonary embolism or deep vein thrombosis within 3 months prior to the first dose of study drug. Concurrent malignancy within 5 years prior to entry. Uncontrolled or poorly controlled hypertension. History of ventricular tachycardia, or torsade des pointes. History of moderate to severe dyspnea at rest. Major surgery within 4 weeks of the first dose of study treatment and not fully recovered. Minor surgery within 2 weeks prior to study treatment. Known allergic reactions to any component or excipient of MRG004A or known allergic reactions to other prior anti-TF (including investigational) or other monoclonal antibody ≥ Grade 3. Patients who have any known liver disease, including chronic hepatitis B, hepatitis C, autoimmune hepatic disorders, primary biliary cirrhosis or sclerosing cholangitis; Patients who have concurrent, serious, uncontrolled infections or known infection with HIV, or have a diagnosed acquired immunodeficiency syndrome (AIDS); or an uncontrolled autoimmune disease, or have undergone organ transplant. Active uncontrolled bacterial, viral, fungal, rickettsial, or parasitic infection. Use of systemic corticosteroids within 4 weeks prior to the first dose of treatment. Use of strong CYP3A4 inhibitors or inducers with MRG004A. Other excluded medications or treatment: therapeutic anti-coagulative, or long-term anti-platelet treatment; multivitamins, calcium, vitamin D, and prophylactic anti-RANKL (denosumab) and zoledronic acid therapies for bone metastases are allowed. Any patient with a positive pregnancy or is breast-feeding. Any severe and/or uncontrolled systemic disease that at the discretion of investigator and sponsor makes it undesirable for the patient to participate in this study.

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: MRG004A<br>All patients in Part A (dose escalation) and Part B (dose expansion) will be administrated MRG004A on Day 1 of every 3 weeks (21-day cycle). | Drug: MRG004A<br>* Administrated intravenously<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Tolerated Dose (MTD) | The highest dose confirmed wherein less than 2 out of 6, or < 33% of evaluable patients in a treatment cohort experiences dose-limiting toxicity (DLT). | DLT will be evaluated during the first treatment cycle (Day 1-21) | 
| Recommended Phase II Dose (RP2D) | The dose level of MRG004A recommended for further clinical studies based on assessment of the safety, efficacy and PK data from Part A of this study. | Baseline to study completion (up to 24 months) | 
| Objective Response Rate (ORR) | The proportion of patients who achieve complete response (CR) or partial response (PR) as assessed by the Independent Central Review (ICR). | Baseline to study completion (up to 24 months) | 
| Adverse Events (AEs) | Any reaction, side effect, or untoward event that occurs during the course of the clinical trial whether or not the event is considered related to the study drug. | From signing informed consent until 45 days after the last dose of MRG004A | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of Response (DoR) | The time interval between the date of the earliest qualifying response and the date of disease progression or death for any cause, whichever occurs earlier. | Baseline to study completion (up to 24 months) | 
| Disease Control Rate (DCR) | The proportion of patients who achieve CR, PR, or stable disease (SD) ≥ 6 weeks based on RECIST v1.1. | Baseline to study completion (up to 24 months) | 
| Progression Free Survival (PFS) | The time from the date of first study dose to disease progression or death whichever occurs first. | Baseline to study completion (up to 24 months) | 
| Overall Survive (OS) | The time from start of study treatment to date of death as a result of any cause. | Baseline to study completion (up to 24 months) | 
| Pharmacokinetics (PK) Parameter of MRG004A: Cmax | Maximum observed plasma concentration. | Baseline to 30 days after the last dose of study treatment | 
| Pharmacokinetics (PK) Parameter of MRG004A: Tmax | Time to reach the maximum plasma concentration. | Baseline to 30 days after the last dose of study treatment | 
| Pharmacokinetics (PK) Parameter of MRG004A: AUClast | Area under the plasma concentration-time curve from time 0 to the time of last quantifiable concentration. | Baseline to 30 days after the last dose of study treatment | 
| Incidence of anti-drug antibody (ADA) | The proportion of patients with positive ADA immunogenicity results. | Baseline to 30 days after the last dose of study treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MRG004A, Antibody drug conjugate (ADC), Tissue factor, Solid tumors