A Study of CLN-619 Alone and in Combination With Pembrolizumab in Advanced Solid Tumors

Study Overview
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Brief Summary
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CLN-619-001 is a Phase 1, open-label, multi-center study of CLN-619 alone and in combination with pembrolizumab in patients with advanced solid tumors.

Official Title
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A Phase 1 Dose-Escalation Study to Investigate the Safety, Efficacy, Pharmacokinetics, and Pharmacodynamic Activity of CLN-619 (Anti-MICA/MICB Antibody) Alone and in Combination With Pembrolizumab in Patients With Advanced Solid Tumors

Conditions
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Advanced Solid Tumor

Intervention / Treatment
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* Drug: CLN-619
* Drug: Pembrolizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males or females aged ≥ 18 years. Willing and able to give written informed consent and adhere to protocol requirements; written informed consent and any locally required authorization must be obtained from the patient prior to performing any protocol-related procedures, including screening evaluations. Module A Monotherapy Dose Escalation Cohort and Module B Combination Therapy Dose Escalation Cohorts: Histologically or cytologically-confirmed metastatic or locally advanced, unresectable solid tumors. For Module B, tumor type is listed as an approved indication per the current prescribing information for pembrolizumab. Module A Cohort Expansions: Expansion A1: Histologically or cytologically-confirmed metastatic or locally advanced, unresectable NSCLC; Expansion A2: Histologically or cytologically-confirmed metastatic or locally advanced, unresectable cervical cancer. Module B Cohort Expansions: Expansion B1: Histologically or cytologically-confirmed metastatic or locally-advanced, unresectable NSCLC. Expansion B2: Histologically or cytologically-confirmed metastatic or locally-advanced, unresectable HNSCC. Expansion B3: Histologically or cytologically-confirmed metastatic or locally-advanced, unresectable urothelial carcinoma. Prior treatment history as follows: For Module A Expansion A1 (NSCLC): Progressed on or after prior treatment with checkpoint inhibitor (CPI), with a regimen containing an anti-PD-1 antibody or an anti-PDL1 antibody. Patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) genomic tumor aberrations must have progressed on or after available Food and Drug Administration (FDA) approved therapy for these aberrations; For Module A Expansion A2 (Cervical Carcinoma): Treatment with a prior CPI is neither required nor excluded; For Module B Expansions B1 (NSCLC): previously untreated for metastatic disease and ineligible for chemotherapy/PD-1/CTLA-4 blockade; Expansion B2 (HNSCC): prior therapy with platinum based chemotherapy without CPI; Expansion B3 (urothelial carcinoma): ineligible for cisplatin containing chemotherapy or with disease progression following cisplatin chemotherapy in the metastatic setting or within 12 months of administration of cisplatin chemotherapy in the adjuvant or neoadjuvant setting. For all Module A cohorts: In addition to specific prior therapy criteria as stated above, patients should have received any other approved standard therapy that is available to the patient, unless this therapy is contraindicated, intolerable to the patient, or is declined by the patient. In the case of a patient declining such therapy, documentation that the patient has been informed and declined should be documented in the medical record. Baseline measurable disease based on RECIST v1.1 for Module A escalation, Module B escalation; and, both Module A and Module B expansion cohorts. Patients are required to have one or more measurable lesions that meet RECIST v1.1 and meet the following conditions: A non-lymph node lesion that has a longest unidimensional measurement of ≥ 10 mm or a lymph node lesion that has a shortest unidimensional measurement of ≥ 15 mm; Lesions that have received previous local treatment, such as radiotherapy or ablation, can also be used as measurable target lesions if progression has been confirmed according to RECIST v1.1 prior to enrollment, and the longest unidimensional measurement is ≥ 10 mm. Performance status of 0 or 1 based on the Eastern Cooperative Oncology Group (ECOG) performance scale. Estimated life expectancy of 12 weeks or greater. Prior palliative radiotherapy must have been completed 14 days prior to dosing on C1D1. Toxicities related to prior study therapy should have resolved to Grade 1 or less according to criteria of NCI CTCAE v5.0, except for alopecia. Peripheral neuropathy should be clinically stable or improving and be Grade 2 or less in severity. Patients with chronic but stable Grade 2 toxicities may be allowed to enroll after agreement between the Inve2tigator and Sponsor. Have adequate liver and kidney function and hematological parameters within a normal range as defined by: Total bilirubin ≤ 1.5x ULN. This does not apply for patients with confirmed Gilbert's Syndrome, for whom total bilirubin must be less than 3.0 mg/dL with a conjugated bilirubin less than 0.5 mg/dL; AST and ALT ≤ 2.5x ULN or ≤ 5x ULN for patients with liver metastases; Serum creatinine ≤ 1.5x ULN or ≥ 50 mL/min by estimated creatinine clearance (CrCl) using Cockcroft-Gault formula; Hemoglobin ≥ 8 g/dL without blood transfusions for at least two weeks prior to dosing on C1D1; Absolute neutrophil count ≥ 1500 cells/mm3 without growth factor support, three days for filgrastim, 14 days for pegfilgrastim; Platelet count ≥ 75,000 cells/mm3. Patients in the Module A and Module B dose escalation cohorts must have archival tissue for biomarker analysis. A fresh biopsy is required if archival tissue is unavailable. Exclusion Criteria: Currently participating/previously participated in an interventional study and received an investigational drug within 28 days (or five half-lives, whichever is longer) of dosing on C1D1. Patients with concomitant second malignancies (except adequately treated non-melanomatous skin cancers, ductal carcinoma in situ, superficial bladder cancer, prostate cancer or in situ cervical cancer) are excluded unless in complete remission three years prior to study entry, and no additional therapy is required or anticipated to be required during study participation. Patients with any active autoimmune disease or a history of known or suspected autoimmune disease, or history of a syndrome that requires systemic corticosteroids or immunosuppressive medications, except for patients with vitiligo, resolved childhood asthma/atopy or autoimmune thyroid disorders on stable thyroid hormone supplementation. A serious uncontrolled medical disorder that would impair the ability of the patient to receive protocol therapy or whose control may be jeopardized by the complications of this therapy. These criteria include, but are not limited to the following: Uncontrolled airway hyper-reactivity; Type 1 diabetes mellitus. Type 2 diabetes mellitus patients are allowed if they are under stable glycemic control as per Investigator assessment; Uncontrolled, clinically significant pulmonary disease; Requirement for supplemental oxygen to maintain a pulse ox > 93%; Symptomatic congestive heart failure as per Investigator assessment or documented cardiac ejection fraction less than 45%; Ejection fraction < 45% in patients with prior history of treatment with anthracycline chemotherapy or with a prior history of cardiac ventricular dysfunction. Patients with prior history of ventricular dysfunction or anthracycline therapy are required to have an echocardiogram for assessment of baseline cardiac function; History of unstable angina or myocardial infarction within six months of dosing on C1D1; Unstable cardiac arrhythmia; History of ventricular arrhythmia; Uncontrolled hypertension: patients with sustained systolic blood pressure readings greater than 150 or diastolic blood pressure greater than 100 should have documentation by treating physician that the finding is not consistent with uncontrolled hypertension; History of stroke or cerebral hemorrhage within one year of dosing on C1D1; Poorly controlled seizure disorder; Active diverticulitis within one year prior to dosing on C1D1; Recent major surgery within three months of dosing on C1D1 or major surgery with unresolved complications that could interfere with study treatment. Treatment with systemic antiviral, antibacterial or antifungal agents for acute infection within ≤ 7 days of dosing on C1D1. Has a history of, or a positive test for, HIV1/2 primary immunodeficiency disease such as Human Immunodeficiency Virus (HIV). History of hepatitis B (with positive testing for either hepatitis B surface antigen [HBsAg] or hepatitis B core Ag) or hepatitis C (HCV) infection (with positive testing for HCV antibody and/or HCV ribonucleic acid [RNA] in serum). Acute hepatitis A (with positive testing for hepatitis A IgM). Prior organ allograft or allogeneic hematopoietic transplantation. History of the following events in conjunction with prior treatment with checkpoint inhibitor immunotherapy: Grade 3 or greater neurotoxicity, ocular toxicity, pneumonitis, myocarditis, or colitis; liver dysfunction meeting the laboratory criteria for Hy's Law. Active central nervous system metastases and/or carcinomatous meningitis. Patients with brain metastases identified at Screening may be rescreened after they have been appropriately treated. Patients with treated brain metastases should be neurologically stable for 28 days post completion of treatment and prior to enrollment, and on a stable regimen of steroid dosing (prednisone <10 mg or the equivalent) for 14 days prior to dosing on C1D1. Treatment with non-oncology vaccines for the control of infectious diseases (i.e. HPV vaccine) within 28 days of C1D1. The inactivated seasonal influenza vaccine can be given to patients before initiation of treatment, and while on study therapy without restriction. Influenza vaccines containing live virus, or other clinically indicated vaccinations for infectious diseases (i.e. pneumovax, varicella) may be permitted, but must be discussed in advance with the Sponsor Medical Monitor and may require a study drug washout period before and/or after administration of the vaccine. Covid-19 vaccines may be administered according to institutional policy. Active SARS-CoV-2 infection including history of positive SARS-CoV-2 testing without subsequent documentation of negative test results, patients with results that are pending but not yet known, or patients with suspected active infection based on clinical features. SARS-CoV-2 vaccination is permitted on treatment. Has received immunosuppressive medications including but not limited to cellcept, methotrexate, infliximab, anakinra, tocilizumab, cyclosporine or corticosteroids (≥10 mg/day of prednisone or equivalent), within 28 days of dosing on C1D1. Woman of child-bearing potential (WOCBP) who is pregnant or breast-feeding, plans to become pregnant within 120 days of last study drug administration, or declines to use an acceptable method to prevent pregnancy during study treatment and for 120 days after the last dose of study drug administration. a) A woman of childbearing potential is defined as: i) Not surgically sterile, i.e. bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy, or; ii) Not post-menopausal, defined as amenorrhea for ≥ two years without an alternative medical cause. Note: Women with amenorrhea for < two years and who are not surgically sterile i.e. tubal ligation, bilateral oophorectomy, or complete hysterectomy will only be considered not to be of reproductive potential if they have a documented follicle stimulating hormone (FSH) value in the postmenopausal range. Male patient who plans to father a child or donate sperm within 120 days or 5 half-lives of CLN-619, whichever comes later, of last study drug administration, or who has a partner who is a WOCBP, and declines to use acceptable method to prevent pregnancy during study treatment and for 120 days or 5 half-lives of CLN-619, whichever comes later, after the last dose of study drug administration. QT interval corrected for heart rate using Fridericia's formula (QTcF) of ≥ 500 milliseconds. Patient has history of drug-related anaphylactic reactions to any components of CLN-619 (Module A and Module B patients) or pembrolizumab (Module B patients only). History of Grade 4 anaphylactic reaction to any monoclonal antibody therapy. Known active alcohol or drug abuse. Inability to comply with the protocol and/or not willing or not available for follow-up assessments. Patients who are incapacitated or involuntarily incarcerated. Patients who are unsuitable for participation based on the judgement of the Investigator. Treatment with any of the following: Systemic anticancer treatment (excluding EGFR-TKIs as described above) within 14 days prior to the first dose of study drug on C1D1. Immunotherapy ≤ 28 days prior to the first dose of study drug on C1D1. Radiotherapy < 28 days and palliative radiation ≤ 14 days prior to the first dose of study drug on C1D1. If irradiated, lesions must have demonstrated clear-cut progression prior to being eligible for evaluation as target lesions. Major surgery (excluding placement of vascular access) ≤ 28 days of the first dose of study drug on C1D1. Refractory disease will be defined as progressive disease at 16 weeks after receiving at least three doses of PD-1 therapy (Expansion B2 and Expansion B3 only).

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
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Module A Dose Escalation<br>Patients with advanced solid tumors enrolled in dose escalation cohorts treated with CLN-619 | Drug: CLN-619<br>* Anti-MICA/MICB monoclonal antibody<br>|
| Experimental: Module A Cohort Expansion<br>Patients with select solid tumor types enrolled in expansion cohorts treated with CLN-619 at a dose selected from the Module A Escalation arm | Drug: CLN-619<br>* Anti-MICA/MICB monoclonal antibody<br>|
| Experimental: Module B Combination Therapy Dose Escalation<br>Patients with advanced solid tumors enrolled in dose escalation cohorts treated with CLN-619 in combination with pembrolizumab | Drug: CLN-619<br>* Anti-MICA/MICB monoclonal antibody<br>Drug: Pembrolizumab<br>* Keytruda<br>|
| Experimental: Module B Combination Therapy Cohort Expansion<br>Patients with select tumor types enrolled in expansion cohorts treated with CLN-619 at a dose selected from the Module B Escalation arm, in combination with pembrolizumab | Drug: CLN-619<br>* Anti-MICA/MICB monoclonal antibody<br>Drug: Pembrolizumab<br>* Keytruda<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dose Escalation | Number of treatment-emergent events (TEAEs) TEAE is defined as adverse events reported for the first time or worsening of a pre-existing event after the first dose of study drug. | 24 Months | 
| Dose Expansion | Best Overall Response (BOR): The % of patients having a CR or PR as determined by PI assessment of disease response per RECIST 1.1 on at least one scan. | Every 9 weeks for the first two years and then every 12 weeks until disease progression; approximately 36 months | 
| Dose Expansion | Overall Response Rate (ORR): The % of patients having a CR or PR as determined by PI assessment of disease response per RECIST 1.1. | Every 9 weeks for the first two years and then every 12 weeks until disease progression; approximately 36 months | 
| Dose Expansion | Duration of Response (DoR): The time from the earliest date of CR or PR until the earliest date of disease progression, as determined by PI assessment of disease response per RECIST 1.1 or death from any cause if occurring sooner than progression. | Every 9 weeks for the first two years and then every 12 weeks until disease progression; approximately 36 months | 
| Dose Expansion | Disease Control Rate (DCR): The % of participants having CR, PR, or SD as best on study response. | Every 9 weeks for the first two years and then every 12 weeks until disease progression; approximately 36 months | 
| Dose Expansion | Overall Survival (OS): Time from the initial date of treatment until death. | Every 9 weeks for the first two years and then every 12 weeks until disease progression; approximately 36 months | 
| Dose Expansion | Clinical Benefit Rate (CBR): The % of participants who achieve CR, PR or SD for a duration of 6 months as determined by PI assessment of disease response per RECIST 1.1. | Every 9 weeks for the first two years and then every 12 weeks until disease progression; approximately 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All Cohorts | Maximum drug concentration (Cmax) of CLN-619 | Up to 2 years | 
| All Cohorts | Area under the curve up to tau (AUCtau) of CLN-619 | Up to 2 years | 
| All Cohorts | Time to Cmax (Tmax) of CLN-619 | Up to 2 years | 
| All Cohorts | Last validated plasma concentration (Clast) of CLN-619 | Up to 2 years | 
| All Cohorts | Time to Clast (Tlast) of CLN-619 | Up to 2 years | 
| All Cohorts | Terminal Half-life (t1/2) of CLN-619 | Up to 2 years |