A Study of Raludotatug Deruxtecan (R-DXd) in Subjects With Platinum-resistant, High Grade Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

Study Overview
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Brief Summary
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This study will evaluate the safety and efficacy of R-DXd therapy in participants with ovarian, peritoneal, or fallopian tube cancer

Detailed Description
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This study will focus on R-DXd in participants with platinum-resistant, high-grade ovarian, primary peritoneal, or fallopian tube cancer. R-DXd is an antibody-drug conjugate that specifically binds to CDH6, which is overexpressed in tumor cells. The Phase 2 dose-optimization part of the study (Part A) intends to define the recommended dose based on safety and efficacy, while the Phase 3 (Part B) part of the study will compare R-DXd with Investigator's choice of chemotherapy and further evaluate efficacy.

Official Title
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A Phase 2/3, Multicenter, Randomized Study of Raludotatug Deruxtecan (R-DXd), a CDH6-directed Antibody-drug Conjugate, in Subjects With Platinum-resistant, High Grade Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

Conditions
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Solid Cancer

Intervention / Treatment
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* Drug: R-DXd
* Drug: Gemcitabine
* Drug: Paclitaxel
* Drug: Topotecan
* Drug: PLD


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Sign and date the informed consent form prior to the start of any study-specific qualification procedures. Age ≥18 years or the minimum legal adult age (whichever is greater) at the time the informed consent form is signed. Participants with histologically or cytologically documented high-grade serous ovarian cancer (OVC), high-grade endometrioid OVC, primary peritoneal cancer, or fallopian tube cancer. Participants must have at least 1 lesion, not previously irradiated, amenable to biopsy, and must consent to provide a pretreatment biopsy and on-treatment biopsy tissue sample (on-treatment biopsy sample not required for the Phase 3 part of the study). Has received at least 1 but no more than 3 prior systemic lines of anticancer therapy. Has platinum-resistant disease. If a subject had only 1 line of platinum therapy, must have received at least 4 cycles of platinum, must have had a best response of not PD, and then progressed between >90 and ≤180 days after the date of the last dose of platinum If a subject had 2 or 3 lines of platinum therapy, must have received at least 2 cycles of platinum and have progressed on or within 180 days after the date of the last dose of platinum. Has had prior poly-ADP ribose polymerase (PARP) inhibitors for participants with documented breast cancer gene mutation (germline and/or somatic), unless the participant is not eligible for treatment with a PARP inhibitor. Has had prior treatment with mirvetuximab soravtansine for participants with documented high-folate receptor alpha expression, unless the participant is not eligible for treatment with mirvetuximab soravtansine due to precautions/intolerance, or if the treatment is not approved or available locally. Has at least 1 measurable lesion evaluated by computed tomography or magnetic resonance imaging according to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) per investigator assessment. Eastern Cooperative Oncology Group performance status of 0 or 1. Required baseline local laboratory data (within 7 days before start of study drug administration). If the participant is a female of childbearing potential, she must have a negative serum pregnancy test at 72 hours before the first dose of study drug and must be willing to use highly effective birth control upon enrollment, during the Treatment Period, and for 7 months following the last dose of study drug. Female participants must not donate, or retrieve for their own use, ova from the time of screening and throughout the study treatment period, and for at least 7 months after the final study drug administration. Is willing and able to comply with scheduled visits, drug administration plan, laboratory tests, other study procedures, and study restrictions. For Phase 3 (Part B) only: Participants must be eligible for one of the treatments included in the Investigator's choice of chemotherapy arm and must not have received it previously for OVC. Exclusion Criteria Has clear cell, mucinous, or sarcomatous histology; mixed tumors containing any histology; or low-grade/borderline OVC. Clinically active brain metastases, spinal cord compression, or leptomeningeal carcinomatosis, defined as untreated or symptomatic, or requiring therapy with steroids or anticonvulsants to control associated symptoms. Any of the following within the past 6 months prior to randomization: cerebrovascular accident, transient ischemic attack, or other arterial thromboembolic event. Uncontrolled or significant cardiovascular disease Has a history of (noninfectious) interstitial lung disease (ILD)/pneumonitis that required corticosteroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening. Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses including, but not limited to, any underlying pulmonary disorder and any autoimmune, connective tissue, or inflammatory disorders with potential pulmonary involvement or prior pneumonectomy. Chronic steroid treatment (>10 mg/day) History of malignancy other than epithelial OVC, primary peritoneal cancer, or fallopian tube cancer within 3 years prior to enrollment Unresolved toxicities from previous anticancer therapy, defined as toxicities (other than alopecia) not yet resolved to National Cancer Institute Common Terminology Criteria for Adverse Events Version 5.0 Grade ≤1 or baseline. Prior exposure to other CDH6-targeted agents or an antibody-drug conjugate that consists of an exatecan derivative that is a topoisomerase I inhibitor (eg, trastuzumab deruxtecan or datopotamab deruxtecan). History of hypersensitivity to any excipients in the R-DXd or any known contraindication to treatment with, including hypersensitivity to, the study drug(s). Has a known human immunodeficiency virus (HIV) infection that is not well controlled. Participants must be tested for HIV viral load during the Screening Period if acceptable by local regulations or institutional review boards/ethics committees. Has any evidence of severe or uncontrolled systemic diseases (including active bleeding diatheses or active infection, substance abuse) or other factors that, in the investigator's opinion, makes it undesirable for the participant to participate in the study or which would jeopardize compliance with the protocol. Has an active or uncontrolled hepatitis B and/or hepatitis C infection. Participants must be tested for hepatitis B (hepatitis B surface antigen [HBsAg] and anti-hepatitis B core antigen) and hepatitis C (hepatitis C virus [HCV] antibody) during the Screening Period. Participants are eligible if they meet the following conditions. Female who is pregnant or breastfeeding or intends to become pregnant during the study. Psychological, social, familial, or geographical factors that would prevent regular follow-up. Prior or ongoing clinically relevant illness, medical condition, surgical history, physical finding, or laboratory abnormality that, in the investigator's opinion, could affect the safety of the participants ; alter the absorption, distribution, metabolism, or excretion of the study drug; or confound the assessment of study results. Has a history of receiving live-attenuated vaccine (messenger RNA [mRNA] and replication-deficient adenoviral vaccines are not considered attenuated live vaccines) within 30 days prior to the first exposure to study intervention. For Phase 3 (Part B) only: Participants are ineligible if they have a history of any contraindication included in the approved local label for the control group treatment.

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: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Part A: R-DXd 4.8mg/kg Q3W<br>Participants will be randomized to receive intravenous R-DXd administered at a dose of 4.8 mg/kg every 3 weeks (Q3W). | Drug: R-DXd<br>* R-DXd will be administered as an intravenously (IV) infusion<br>* Other names: DS-6000a;|
| Experimental: Part A: R-DXd 5.6 mg/kg Q3W<br>Participants will be randomized to receive intravenous R-DXd administered at a dose of 5.6 mg/kg every 3 weeks (Q3W). | Drug: R-DXd<br>* R-DXd will be administered as an intravenously (IV) infusion<br>* Other names: DS-6000a;|
| Experimental: Part A: R-DXd 6.4 mg/kg Q3W<br>Participants will be randomized to receive intravenous R-DXd administered at a dose of 6.4 mg/kg every 3 weeks (Q3W). | Drug: R-DXd<br>* R-DXd will be administered as an intravenously (IV) infusion<br>* Other names: DS-6000a;|
| Experimental: Part B: R-DXd RP3D Q3W<br>Participants will be randomized to receive intravenous R-DXd administered at the Recommended Phase 3 Dose (RP3D) every 3 weeks (Q3W). | Drug: R-DXd<br>* R-DXd will be administered as an intravenously (IV) infusion<br>* Other names: DS-6000a;|
| Active Comparator: Part B: Investigator's Choice<br>Participants will be randomized to receive intravenous treatment with investigator's choice of paclitaxel, pegylated liposomal doxorubicin (PLD), gemcitabine, or topotecan. | Drug: Gemcitabine<br>* Gemcitabine will be administered as an IV infusion<br>Drug: Paclitaxel<br>* Paclitaxel will be administered as an IV infusion<br>Drug: Topotecan<br>* Topotecan will be administered as an IV infusion<br>Drug: PLD<br>* PLD will be administered as an IV infusion<br>* Other names: Pegylated Liposomal Doxorubicin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants With Objective Response Rate (ORR) Based on Blinded Independent Central Review (BICR) Assessment (Part A) | The ORR was defined as the percentage of participants who achieved Best Overall Response (BOR) of confirmed Complete Response (CR) or Partial Response (PR), by BICR assessment based on RECIST version 1.1. | From date of randomization to data cut off, up to 18 months | 
| Progression-free Survival (PFS) Based on BICR Assessment (Part B) | PFS is defined as the time from the date of randomization to the date of disease progression, defined as the first documented radiological progression or death due to any cause | From date of randomization to data cut off, up to 26 months | 
| Percentage of Participants With Objective Response Rate (ORR) Based on Blinded Independent Central Review (BICR) Assessment (Part B) | The ORR was defined as the percentage of participants who achieved Best Overall Response (BOR) of confirmed Complete Response (CR) or Partial Response (PR), by BICR assessment based on RECIST version 1.1. | From date of randomization to data cut off, up to 16 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants With Objective Response Rate (ORR) Based on Investigator Assessment | The ORR was defined as the percentage of participants who achieved Best Overall Response (BOR) of confirmed Complete Response (CR) or Partial Response (PR), by Investigator assessment based on RECIST version 1.1. | From date of randomization to data cut off, up to 30 months | 
| Duration of Response (DOR) | DoR is defined as the time from the date of the first documentation of objective tumor response (CR or PR) that is subsequently confirmed to the first documentation of disease progression or death due to any cause, whichever occurs first. | From date of randomization to data cut off, up to 40 months | 
| Progression-free Survival (PFS) Based on BICR and Investigator Assessment (Part A) | PFS is defined as the time from the date of randomization to the date of disease progression, defined as the first documented radiological progression or death due to any cause. | From date of randomization to data cut off, up to 30 months | 
| Disease Control Rate (DCR) | DCR is defined as the proportion of participants who achieved a CR, PR, or stable disease maintained for ≥12 weeks, as assessed by BICR and investigator based on RECIST version 1.1 | From date of randomization to data cut off, up to 40 months | 
| Overall Survival (OS) | OS is defined as the time from the date of randomization to the date of death due to any cause. | From date of randomization to data cut off, up to 40 months | 
| Number of participants with Treatment-emergent Adverse Events (TEAEs) | TEAEs are defined as those AEs with a start or worsening date during the on-treatment period (from the first dose date to 40 days after the last dose date of study treatment). | From first dose to data cut off, up to 40 months | 
| Pharmacokinetic (PK) Analysis: Maximum Plasma Drug Concentration (Cmax) of R-DXd |  | From first dose to data cut off, up to 40 months | 
| Pharmacokinetic (PK) Analysis: Time to Reach Maximum Plasma Drug Concentration (Tmax) of R-DXP |  | From first dose to data cut off, up to 40 months | 
| Pharmacokinetic (PK) Analysis: Area Under the Concentration-Time Curve (AUC) of R-DXd |  | From first dose to data cut off, up to 40 months | 
| Pharmacokinetic (PK) Analysis: Terminal Half-Life (t1/2) of R-DXd |  | From first dose to data cut off, up to 40 months | 
| Percentage of Participants With Treatment Emergent Antidrug Antibody (ADA) |  | From baseline to data cut off, up to 40 months | 
| Percentage of Participants With Cancer Antigen 125 (CA-125) Response Rate | CA-125 response rate is defined as the percentage of participants with a reduction of 50% in CA-125 levels when compared to levels from a pretreatment sample, as assessed by blood sample based on Gynecological Cancer InterGroup criteria | From baseline to data cut off, up to 40 months | 
| Cadherin-6 (CDH6) protein expression in tumor tissue as determined by immunochemistry assay and correlation with ORR, DoR, PFS and OS | CDH6 protein expression in tumor tissue as determined by immunohistochemistry. | From baseline to data cut off, up to 40 months | 
| Change in Score in the Quality of Life (QoL) Questionnaire |  | From baseline to data cut off, up to 40 months | 
| Time to Next Treatment (TTNT) | TTNT is defined as the time from randomization to the start date of the next line of therapy | From date of randomization to data cut off, up to 40 months | 
| Progression-free Survival 2 (PFS2) Based on Investigator Assessment | PFS2 is defined as the time from randomization to the second objective disease progression or death due to any cause, whichever comes first. | From date of randomization to data cut off, up to 40 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Primary pertioneal cancer, Ovarian cancer, Fallopian tube cancer, Raludotatug Deruxtecan (R-DXd), Cadherin 6 (CDH6)