Clinical trial NCT03495882: Subjects With Metastatic or Locally Advanced Solid Tumors, and Expansion Into Select Solid Tumors (Cervical)
Official title: A Phase 1 / 2, Open-Label, Multi-Arm Trial to Investigate the Safety, Tolerability, Pharmacokinetics, Biological, and Clinical Activity of AGEN1884 in Combination With AGEN2034 in Subjects With Metastatic or Locally Advanced Solid Tumors, and Expansion Into Select Solid Tumors
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Cervical Cancer
Lead sponsor: Agenus Inc.
Sponsor class: INDUSTRY
First posted: 2018-04-12
Enrollment: 154
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This is a Phase 1/2, open-label study of AGEN1884 in combination with AGEN2034 in subjects with locally advanced, recurrent and/or metastatic solid tumors including cervical cancer. AGEN2034 is a novel, fully human monoclonal immunoglobulin G4 (IgG4) antibody, designed to block program cell death-1 (PD-1). AGEN1884 is a novel, fully human monoclonal immunoglobulin G1 (IgG1) antibody, designed to block cytotoxic T-lymphocyte antigen-4 (CTLA-4).

Detailed description: The trial consists of 2 phases:

* Phase 1: Dose escalation
* Phase 2: Expansion in advanced cervical cancer

Phase 1: Dose Escalation:

The enrollment to the Phase 1 portion of the study is completed. The trial will consist of a 3+3 dose escalation that will evaluate different combination dose levels (CDL) of AGEN1884 and AGEN2034 in subjects with locally advanced, recurrent and/or metastatic solid tumors.

Subjects may be enrolled to the following CDL cohorts:

* CDL1 - AGEN1884 1 mg/kg every 6 weeks + AGEN2034 1 mg/kg every 2 weeks (starting CDL)
* CDL2 - AGEN1884 1 mg/kg every 6 weeks + AGEN2034 3 mg/kg every 2 weeks (maximum planned CDL)
* CDL-1 - AGEN1884 0.3 mg/kg every 6 weeks + AGEN2034 1 mg/kg every 2 weeks (potential de-escalation CDL)

Combination Dose Level 1 (CDL1) will be the first to be tested. Dose escalation will continue until the maximum planned CDL (CDL2) is shown to be safe or the maximum tolerated dose (MTD) is reached. The MTD is defined as the CDL below which ≥ 33% of subjects develop dose-limiting toxicities (DLT). The decision to escalate to the next cohort will be made by a Safety Monitoring Committee (SMC), based on safety assessments after all subjects of a cohort reached the end of the DLT observation period of 21 days. Should ≥2 DLTs be observed in CDL1, the SMC may open enrollment to CDL-1. The SMC will also select the CDL for Phase 2.

Each subject will receive the combination treatment for a maximum of 24 months or until confirmed disease progression, unacceptable toxicity, or any criterion for withdrawal from the trial or the investigational medicinal products (IMPs) occur. Subjects who do not complete the DLT observation period of 21 days after the first dose, for reasons other than a DLT will be replaced. Additional subjects will be backfilled, concurrently with the 3+3 dose escalation schema at the lower cleared CDL, to ensure that each cohort enrolls at least 10 subjects. These additional subjects at each dose level will have the purpose of generating additional safety, PK, and receptor occupancy (RO) data, and will not undergo formal DLT observation.

The SMC selected CDL2 (AGEN1884 1 mg/kg every 6 weeks + AGEN2034 3 mg/kg every 2 weeks) as the Recommended Phase 2 dose (RP2D).

Phase 2: Expansion in Select Tumors

To further characterize safety and efficacy, the following expansion cohort will be enrolled:

Advanced cervical cancer In Phase 2, the RP2D of AGEN2034 and AGEN1884 will be administered for a maximum of 2 years or until confirmed progression, unacceptable toxicity, or any criterion for stopping the study drugs or withdrawal from the trial occurs.

For the Phase 2 portion of the trial, an Independent Data Monitoring Committee (IDMC) will be established to evaluate safety and efficacy and an IERC will be established to adjudicate tumor response.

Eligibility criteria: Inclusion Criteria:

To be eligible for participation in this trial the subject must:

1. Voluntarily agree to participate by giving written informed consent. (Participation in pharmacogenomics testing is optional.)
2. Be ≥18 years of age.
3. Diagnosis:

   1. Phase 1: Male or female having a histologically or cytologically confirmed diagnosis of a locally advanced, recurrent, and/or metastatic solid tumor for which no standard therapy is available or standard therapy has failed.
   2. Phase 2:

   I. Female having (1) a histologically or cytologically confirmed diagnosis of squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix, and (2) locally advanced, recurrent, and/or metastatic disease at the time of enrollment. Histologic confirmation of the original primary tumor is required via pathology report.

   Note: The following cervical tumors are not eligible: minimal deviation/adenoma malignum, gastric type adenocarcinoma, clear cell carcinoma, and mesonephric carcinoma.

   II. Has cervical cancer and has relapsed after a platinum-based treatment (first line) regimen for locally advanced, recurrent, and/or metastatic disease; Note: Subjects who only received platinum-based chemotherapy concurrently with primary radiation (e.g., weekly cisplatin) or adjuvant chemotherapy following completion of radiation therapy (e.g., paclitaxel and carboplatin for ≤4 cycles) and progressed within 6 months after treatment completion will be eligible as this systemic therapy will be considered first line.
4. Measurable Disease:

   1. Phase 1: Have objective evidence of disease; the presence of measurable disease is not required.
   2. Phase 2: Have measurable disease on imaging based on RECIST version 1.1. Note: Subjects must have at least one "target lesion" to be used to assess response, as defined by RECIST version 1.1. Tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented, or a biopsy is obtained to confirm persistence at least 90 days following completion of radiation therapy.

   Note: Measurable disease by RECIST 1.1 must be confirmed by independent central radiologic review prior to first dose. Subjects without centrally confirmed measurable disease at baseline will not be eligible for this trial.
5. Have a life expectancy of at least 3 months and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
6. Have adequate organ function as indicated by the following laboratory values:

   1. Adequate hematological function defined by absolute neutrophil count (ANC) ≥1.5 x 10\^9/L, platelet count ≥100 x 10\^9/L, and hemoglobin

      ≥8 g/dL (without transfusions within 1 week of first dose).
   2. Adequate hepatic function based on a total bilirubin level \<1.5 x the institutional upper limit of normal (IULN), aspartate aminotransferase (AST) level ≤2.5 x IULN, alanine aminotransferase (ALT) level ≤2.5 x IULN, and alkaline phosphatase ≤2.5 IULN.
   3. Adequate renal function defined as creatinine ≤1.5 x IULN OR calculated creatinine clearance ≥50 mL/min for subjects with creatinine levels \>1.5 x IULN (if no local guideline is available, creatinine clearance should be calculated using the Cockcroft-Gault Method).
   4. Adequate coagulation defined by international normalized ratio (INR) or prothrombin time ≤1.5 x IULN (unless the subject is receiving anticoagulant therapy); and activated partial thromboplastin time (aPTT) ≤1.5 x IULN (unless the subject is receiving anticoagulant therapy)
7. Other than the cancer for which the subject is enrolled, have no history of prior malignancy, with the exception of basal cell carcinoma of the skin, superficial bladder cancer, squamous-cell carcinoma of the skin, or has undergone potentially curative therapy with no evidence of that disease recurrence for 5 years since initiation of that therapy.

   Note: In Phase 2, the history and time requirement for no evidence of disease for 5 years does not apply to the cancer for which the subject is enrolled in the trial.
8. In Phase 2, subjects must provide a sufficient and adequate formalin fixed paraffin embedded (FFPE) tumor tissue sample preferably from the most recent biopsy of a tumor lesion, collected either at the time of or after the diagnosis of locally advanced, recurrent, and/or metastatic disease has been made AND from a site not previously irradiated. If no tumor tissue is available, a fresh biopsy will be required.

   Note: Tissue from needle or excisional biopsy or from resection is required.
9. Female subjects must have a negative serum pregnancy test at screening (within 72 hours of first dose of study drug) if of childbearing potential or be of non- childbearing potential. Non-childbearing potential is defined as (by other than medical reasons):

   1. ≥45 years of age and has not had menses for greater than 1 year,
   2. Amenorrheic for ≥ 2 years without a hysterectomy and oophorectomy and a follicle-stimulating hormone (FSH) value in the postmenopausal range upon pretrial (screening) evaluation,
   3. Whose status is post hysterectomy, oophorectomy, or tubal ligation.
10. If of childbearing potential, female subjects must be willing to use 2 highly effective contraceptive measures (defined in the informed consent form \[ICF\]) throughout the study, starting with the screening visit through 120 days after the last dose of study drug.

    Note: Abstinence is acceptable if this is the established and preferred contraception for the subject.
11. Male subjects with a female partner(s) of childbearing potential must agree to use 2 highly effective contraceptive measures (defined in the ICF) throughout the trial starting with the screening visit through 120 days after the last dose of study drug is received. Males with pregnant partners must agree to use a condom; no additional method of contraception is required for the pregnant partner.

    Note: Abstinence is acceptable if this is the established and preferred contraception for the subject.
12. Is willing and able to comply with the requirements of the protocol.

Exclusion Criteria

The subject must be excluded from participating in the trial if the subject:

1. Is currently participating and receiving trial therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment.
2. Has an inadequate washout period prior to first dose of study drug defined as:

   1. Received systemic cytotoxic chemotherapy or biological therapy within 3 weeks before first dose,
   2. Received radiation therapy within 3 weeks before first dose, or
   3. Had major surgery within 4 weeks before first dose.
3. Has received prior therapy with:

   1. Any antibody/drug targeting T-cell co-regulatory proteins (immune checkpoints) such as anti-PD-1, anti-PD-L1, or anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibodies
   2. For Phase 2: \>1 systemic treatment regimen for the locally advanced recurrent, and/or metastatic cervical cancer for which the subject is considered for the study. Subjects who received a systemic regimen immediately after progressing within 6 months of completing chemotherapy concurrent with primary radiation or adjuvant chemotherapy after radiation will only be considered as having 1 prior systemic regimen for the purpose of this criterion.

   Note: In Phase 1, prior treatment with a CTLA-4 antibody is permissible for subjects with metastatic melanoma.
4. Has persisting toxicity related to prior therapy of National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 (NCI-CTCAE) Grade \>1 severity.

   Note: Sensory neuropathy or alopecia of Grade ≤2 is acceptable.
5. Is expected to require any other form of systemic or localized antineoplastic therapy while on trial (including maintenance therapy with another agent, radiation therapy, and/or surgical resection).
6. Has known severe hypersensitivity reactions to fully human monoclonal antibodies (NCI-CTCAE Version 4.03 Grade ≥3), any history of anaphylaxis, or uncontrolled asthma.
7. Is receiving systemic corticosteroid therapy ≤7 days prior to first dose of study treatment or receiving any other form of systemic immunosuppressive medication (corticosteroid use on study for management of immune-related adverse events (AE), and/or a premedication for intravenous (IV) contrast allergies/reactions is allowed). Subjects who are receiving daily corticosteroid replacement therapy are an exception to this rule. Examples of permitted therapy are daily prednisone at doses of 5 to 7.5 mg or equivalent hydrocortisone dose, and steroid therapy administered by topical, intraocular, intranasal, and/or inhalation routes.
8. Has a central nervous system (CNS) tumor, metastasis(es), and/or carcinomatous meningitis identified either on the baseline brain imaging obtained during the screening period OR identified prior to consent.

   Note: Subjects with history of brain metastases that have been treated may participate provided they show evidence of stable supra-tentorial lesions at screening (based on 2 sets of brain images performed ≥4 weeks apart, and obtained after the brain metastases treatment). In addition, any neurologic symptoms that developed either as a result of the brain metastases or their treatment must have resolved or be minimal and be expected as sequelae from treated lesions. For individuals who received steroids as part of brain metastases treatment, steroids must be discontinued ≥7 days prior to first dose of study drug.
9. Has active or history of autoimmune disease that has required systemic treatment within 2 years of the start of study treatment (i.e. with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (i.e., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of immunosuppressive systemic treatment.

   Note: Subjects with diabetes type 1, vitiligo, psoriasis, hypo-, or hyperthyroid disease not requiring immunosuppressive treatment are eligible.
10. Has had an allogeneic tissue/solid organ transplant.
11. Has or had interstitial lung disease (ILD) OR has had a history of pneumonitis that has required oral or IV corticosteroids.
12. Has an active infection requiring IV systemic therapy.
13. Has known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
14. Has known active Hepatitis B, Hepatitis C, or tuberculosis. Active Hepatitis B is defined as a known positive HBsAg result. Active Hepatitis C is defined by a known positive Hep C Ab result and known quantitative HCV RNA results greater than the lower limits of detection of the assay.
15. Has clinically significant (i.e., active) cardiovascular disease: cerebral vascular accident/stroke or myocardial infarction within 6 months of enrollment, unstable angina, congestive heart failure (New York Heart Association class ≥II), or serious uncontrolled cardiac arrhythmia requiring medication.
16. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
17. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
18. Is, at the time of signing informed consent, a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol).
19. Is legally incapacitated or has limited legal capacity.
20. Is pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of AGEN2034 and/or AGEN1884.

Primary outcomes:
measure: Objective Response Rate (ORR), as determined by IERC, in the analysis population
timeFrame: Evaluated throughout the protocol, up to 2 years.
Secondary outcomes:
measure: Safety and Tolerability of AGEN2034 and AGEN1884
timeFrame: From the time of the first dose to the end of follow-up (up to 2 years after the last dose).
measure: Maximum drug concentration observed postdose at steady-state (Cmax-ss)
timeFrame: Pre-dose through 3 months after last dose.
measure: Minimum observed concentration at steady-state (Cmin-ss)
timeFrame: Pre-dose through 3 months after last dose.
measure: Area under the drug concentration-time curve within time span t1 to t2 at steady-state (AUC(τ1-τ2)-ss)
timeFrame: Pre-dose through 3 months after last dose.
measure: Area under the drug concentration-time curve from time zero to time t (AUC(0-t)), area under the drug concentration-time curve from time zero to infinity (AUC(0-∞))
timeFrame: Pre-dose through 3 months after last dose.
measure: Time to maximum observed concentration (tmax)
timeFrame: Pre-dose through 3 months after last dose.
measure: Terminal disposition rate constant (λz)
timeFrame: Pre-dose through 3 months after last dose.
measure: Terminal elimination half-life (t1/2)
timeFrame: Pre-dose through 3 months after last dose.
measure: Systemic clearance (CL)
timeFrame: Pre-dose through 3 months after last dose.
measure: Volume of distribution (Vd)
timeFrame: Pre-dose through 3 months after last dose.
measure: Immunogenicity of AGEN2034 and AGEN1884
timeFrame: Pre-dose through 3 months after last dose.
measure: Objective Response Rate (ORR), as determined by investigator
timeFrame: Evaluated throughout the protocol, up to 2 years.
measure: Duration of Response (DOR)
timeFrame: Time from first observation of response to first observation of documented disease progression, up to 3 years.
measure: Disease Control Rate (DCR)
timeFrame: Duration of the trial, up to 3 years.
measure: Duration of Stable Disease (SD)
timeFrame: Duration of the trial, up to 3 years.
measure: Time to Response
timeFrame: Duration of the treatment phase of the trial, up to 2 years.
measure: Progression-free Survival (PFS)
timeFrame: Duration of the treatment phase of the trial, up to 2 years.
measure: Overall Survival Rate (OS)
timeFrame: Duration of the treatment phase of the trial, up to 2 years.
Other outcomes:
Locations:
city: Goodyear
country: United States
facility: Comprehensive Care and Research Center
state: Arizona
city: Duarte
country: United States
facility: City of Hope National Medical Center
state: California
city: Miami
country: United States
facility: University of Miami
state: Florida
city: Plantation
country: United States
facility: BRCR Medical Center, Inc
state: Florida
city: Augusta
country: United States
facility: Augusta University
state: Georgia
city: Zion
country: United States
facility: Cancer Treatment Centers of America
state: Illinois
city: New Orleans
country: United States
facility: Ochsner Cancer Institute
state: Louisiana
city: Kalamazoo
country: United States
facility: West Michigan Cancer Center
state: Michigan
city: Oklahoma City
country: United States
facility: University of Oklahoma
state: Oklahoma
city: Chattanooga
country: United States
facility: Chattanooga's Program In Women's Oncology
state: Tennessee
city: Baytown
country: United States
facility: CliniCore International
state: Texas
city: Aberdeen
country: United States
facility: Providence Regional Cancer System
state: Washington
city: Seattle
country: United States
facility: Swedish Cancer Institute
state: Washington
city: Perth
country: Australia
facility: Linear Clinical Research
state: Western Australia
city: South Brisbane
country: Australia
facility: Mater Research
city: South Brisbane
country: Australia
facility: Icon Cancer Care South Brisbane
city: Sydney
country: Australia
facility: Scientia Clinical Research
city: São Paulo
country: Brazil
facility: Clínica de Pesquisas e Centro de Estudos em Oncologia Ginecológica e Mamária Ltda.
city: São Paulo
country: Brazil
facility: IBCC - Instituto Brasileiro de Controle do Câncer
city: Tbilisi
country: Georgia
facility: LLC Arensia Exploratory Medicine
city: Budapest
country: Hungary
facility: Magyar Honvedseg Egeszsegugyi Kozpont
city: Budapest
country: Hungary
facility: Orszagos Onkologiai Intezet
city: Debrecen
country: Hungary
facility: Debreceni Egyetem
city: Kecskemét
country: Hungary
facility: Bacs-Kiskun Megyei Korhaz
city: Pécs
country: Hungary
facility: Pecsi Tudomanyegyetem
city: Szeged
country: Hungary
facility: Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Klinikai Kozpont
city: Szolnok
country: Hungary
facility: Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet
city: Zalaegerszeg
country: Hungary
facility: Zala Megyei Szent Rafael Korhaz
city: Chisinau
country: Moldova, Republic of
facility: ARENSIA Exploratory Medicine Unit, Institute of Oncology
city: Nadarzyn
country: Poland
facility: BioResearch Group SP. Z O.O.
city: Warszawa
country: Poland
facility: Centrum Onkologii-Instytut im.M.Sklodowskiej Curie
city: L'Hospitalet De Llobregat
country: Spain
facility: ICO l'Hospitalet - Hospital Duran i Reynals
city: Madrid
country: Spain
facility: START Madrid. Oncology Phase I
city: Madrid
country: Spain
facility: Hospital Universitario La Paz
city: Pamplona
country: Spain
facility: Clinica Universidad de Navarra
city: Sevilla
country: Spain
facility: Hospital Universitario Virgen Macarena
city: Valencia
country: Spain
facility: Hospital Universitari i Politecnic La Fe
city: Dnipro
country: Ukraine
facility: CI Dnipropetrovsk CMCH #4 of Dnipropetrovsk RC Dept of Chemotherapy SI Dnipropetrovsk MA of MOHU
city: Ivano-Frankivs'k
country: Ukraine
facility: CI Transcarpathian Cl Onc Center Dep of Surgery #1 SHEI Ivano-Frankivsk NMU
city: Kharkiv
country: Ukraine
facility: Communal Non-profit Enterprise Regional Center of Oncology
city: Kharkiv
country: Ukraine
facility: CI of Healthcare Regional Clinical Specialized Dispensary of the Radiation Protection, Department of Surgery
city: Khmelnytskyi
country: Ukraine
facility: Khmelnytskyi Regional Oncological Dispensary
city: Kiev
country: Ukraine
facility: Medical Clinic Innovacia, LLC
city: Kyiv
country: Ukraine
facility: Kyiv Сity Clinical Oncological Center
city: Kyiv
country: Ukraine
facility: Medical Center Oncolife
city: Kyiv
country: Ukraine
facility: Limited Liability Company Company Adonis
city: Luts'k
country: Ukraine
facility: Treatment-Prevention Institution Volyn Regional Oncological Dispensary
Study officials:
affiliation: Agenus Inc.
name: Medical Director
role: STUDY_DIRECTOR
References:
citation: O'Malley DM, Neffa M, Monk BJ, Melkadze T, Huang M, Kryzhanivska A, Bulat I, Meniawy TM, Bagameri A, Wang EW, Doger de Speville Uribe B, Hegg R, Ortuzar Feliu W, Ancukiewicz M, Lugowska I. Dual PD-1 and CTLA-4 Checkpoint Blockade Using Balstilimab and Zalifrelimab Combination as Second-Line Treatment for Advanced Cervical Cancer: An Open-Label Phase II Study. J Clin Oncol. 2022 Mar 1;40(7):762-771. doi: 10.1200/JCO.21.02067. Epub 2021 Dec 21.