CID-103 (Anti-CD38 Antibody) in Previously Treated Relapsed or Refractory Multiple Myeloma

Study Overview
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Brief Summary
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Patients with relapsed/refractory multiple myeloma will be enrolled in a dose-escalation phase receiving monotherapy CID-103. Once the recommended CID-103 dose and infusion duration is known, additional patients will be enrolled in an expansion phase consisting of two cohorts (anti-CD38 pretreated, and anti-CD38 treatment naïve). Patients will be treated until disease progression or unacceptable toxicities.

Detailed Description
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Dose escalation/infusion duration phase: During the CID-103 dose escalation/infusion duration phase, only patients diagnosed with multiple myeloma who have relapsed or are refractory to at least two prior lines of therapy including a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 antibody will be enrolled. Patients will receive monotherapy CID-103. Dose escalation decisions will be based on dose-limiting toxicities; infusion duration decisions will be based on infusion-related reactions. The dose taken forward into the expansion phase will be the RP2D determined in the dose escalation phase. Expansion phase: The expansion phase consists of two specific cohorts of patients with relapsed/refractory multiple myeloma: 1) Pretreated cohort having received previous treatment with an anti-CD38 antibody and 2) Naïve cohort in patients for whom an anti-CD38 antibody is unavailable. Eight patients will be enrolled into each cohort, and if one or more responses is observed, that cohort will be expanded to a total of 14 patients to further assess efficacy. Patients must have had at least two prior systemic therapies (mono or combo), including a proteasome inhibitor and an immunomodulatory agent. Patients will be treated until disease progression or unacceptable toxicities.

Official Title
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A Phase 1 Dose Escalation and Expansion Study of CID-103, an Anti-CD38 Antibody, in Patients With Previously Treated Relapsed or Refractory Multiple Myeloma

Conditions
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Multiple Myeloma

Intervention / Treatment
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* Drug: CID-103


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Able and willing to sign the ICF and comply with the protocol Male or female ≥ 18 years of age Eastern Cooperative Oncology Group (ECOG) performance status 0-1 Agrees to bone marrow aspirates Must have pathologically confirmed multiple myeloma Has relapsed or refractory myeloma At least 2 prior systemic anti-cancer therapies for relapsed or refractory multiple myeloma, including an immunomodulatory agent and a proteasome inhibitor Meets all IMWG 2014 criteria at diagnosis or at time of current relapse Measurable disease If female, must be of non-childbearing potential, or have a negative pregnancy test at screening and use highly adequate contraception throughout study until 90 days after last dose If male with partner of childbearing potential, be vasectomized or female partner must use highly adequate contraception throughout study until 180 days after last dose All previous therapy-related adverse events should have resolved, prior to Day 1, to Grade 1 or baseline value with the exception of alopecia (includes effects of radiotherapy) Adequate organ function as indicated by neutrophils, platelets, hemoglobin, eGFR, serum total and direct bilirubin, AST, ALT, INR, aPTT Exclusion Criteria: Received small molecule or tyrosine kinase inhibitor within two weeks or five half-lives (whichever is longer) prior to the first dose of study drug; chemotherapy or biological cell-based cancer therapy within four weeks prior to the first dose of study drug; nitrosourea or radioisotope within six weeks prior to first dose of study drug, non-recovery to the CTCAE v5 Grade 1 or better from the adverse events due to cancer therapeutics administered more than four weeks earlier. Received an anti-CD38 therapy within four months from first dose of study drug Inability to perform study baseline RBC type and cross-match, phenotype, genotype (if applicable) or lack of available baseline data on RBC phenotype or genotype (if applicable) Receiving other concurrent investigational therapies or have received investigational therapies within four weeks of the first dose of study drug or five half-lives, if known, whichever is shorter Currently receiving systemic steroids unless equivalent to 10 mg/day of prednisone or less for adrenal replacement only. At least two weeks since last dose of steroid therapy intended for the treatment of myeloma and the first dose of study drug. Non-secretory myeloma unless measurable plasmacytoma Known hypersensitivity to CID-103 excipients or prior severe hypersensitivity to a monoclonal antibody Baseline interval between Q and T wave on electrocardiogram > 480 msec using Fridericia's formula (QTcF) Requires renal dialysis Sensory or motor neuropathy ≥ Grade 3 Known/clinically significant amyloidosis Known active central nervous system disease or leptomeningeal plasmacytoma. Presence of any other active malignancy requiring systemic therapy other than the disease under study Active infection requiring systemic therapy Active infection with human immunodeficiency virus and CD4+ T-cell count < 350/μL Active infection with hepatitis B (surface antigen); or infection with hepatitis C in absence of sustained virologic response Therapeutic anticoagulation, meaning any thromboembolic event within the last six months prior to first dose of study drug or anticoagulation with therapeutic (non-prophylactic) intent A history or evidence of cardiovascular risk History or clinical evidence of any surgical or medical condition which the investigator judges as likely to interfere with the results of the study or pose an additional risk in participating, particularly any pre-existing condition that would put the patient at additional risk should they experience an infusion-related reaction At the time of signing informed consent is a regular user (including recreational/medical use) of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol)

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: Sequential Assignment
Interventional Model Description: Single arm dose escalation, followed by dose expansion arm (2 cohorts)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dose escalation cohort<br>Monotherapy CID-103. Priming dose will be given for first dose. Dose and duration of infusion dependent on dose cohort and tolerability. | Drug: CID-103<br>* anti-CD38 antibody<br>|
| Experimental: Dose expansion cohort - pretreated<br>CID-103 monotherapy at the recommended phase 2 dose | Drug: CID-103<br>* anti-CD38 antibody<br>|
| Experimental: Dose expansion cohort - Naïve<br>CID-103 monotherapy at the recommended phase 2 dose | Drug: CID-103<br>* anti-CD38 antibody<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events | CTCAE v5 coded using the current Medical Dictionary for Regulatory Activities (MedDRA) version | approximately 18 months after study start | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recommended Phase 2 dose | Based primarily on dose-limiting toxicities | approximately 18 months after study start | 
| Optimal pre- and post-medication regimens | Type, incidence, severity, timing, seriousness, and relatedness of AEs and laboratory abnormalities will be compared before and after the changes in pre/post medications are made, with specific focus on IRRs and their symptoms | approximately 18 months after study start | 
| Target engagement assays and ex vivo testing | Extent of RBC binding and cross-match confounding | approximately 18 months after study start | 
| PK - AUC of CID-103 | AUC of CID-103 in serum | approximately 18 months and 3 years after study start | 
| PK - Cmax of CID-103 | Cmax of CID-103 in serum | approximately 18 months and 3 years after study start | 
| PK - t1/2 of CID-103 | half-life of CID-103 in serum | approximately 18 months and 3 years after study start | 
| PK - Vd of CID-103 | volume of distribution of CID-103 in serum | approximately 18 months and 3 years after study start | 
| PK - accumulation of CID-103 | accumulation of CID-103 in serum | approximately 18 months and 3 years after study start | 
| Objective response rate | Based on IMWG | approximately 3 years after study start | 
| Duration of response | Calculated using a Kaplan-Meier method overall and for appropriate subgroups and cohorts, based on IMWG | approximately 3 years after study start | 
| Progression-free survival | Calculated using a Kaplan-Meier method overall and for appropriate subgroups and cohorts, based on IMWG | approximately 3 years after study start | 
| Overall survival | Calculated using a Kaplan-Meier method overall and for appropriate subgroups and cohorts, based on IMWG | approximately 3 years after study start | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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multiple myeloma, CID-103, anti-CD38 antibody