Clinical trial NCT03746431: A Phase 1/2 Study of [225Ac]-FPI-1434 Injection
Official title: A Phase 1/2 Study of [225Ac]-FPI-1434 Injection in Patients With Locally Advanced or Metastatic Solid Tumours
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
PHASE2
Conditions: Advanced Solid Tumours
Endometrial Cancer
Cervical Cancer
Ovarian Cancer
Breast Cancer
Triple Negative Breast Cancer (TNBC)
HER2-negative Breast Cancer
Head and Neck Squamous Cell Carcinoma (HNSCC)
Adrenocortical Carcinoma
Uveal Melanoma
Keywords: 225-Ac Labelled Humanized Monoclonal Antibody Against IGF-1R
[225Ac]-FPI-1434
IGF-IR Targeted Alpha Therapeutic
IGF-IR Radioligand Therapy
Radiopharmaceuticals
Lead sponsor: Fusion Pharmaceuticals Inc.
Sponsor class: INDUSTRY
First posted: 2018-11-19
Enrollment: 253
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: TREATMENT

Brief summary: This is a first-in-human Phase 1/2, non-randomized, multi-centre, open-label clinical study designed to investigate safety, tolerability, PK, and preliminary anti-tumour activity of \[225Ac\]-FPI-1434 (radioimmuno-therapeutic agent) in patients with solid tumours that demonstrate uptake of \[111In\]-FPI-1547 (radioimmuno-imaging agent), and to establish the maximum tolerated dose (MTD) and/or the recommended Phase 2 dose (RP2D) of repeat doses of \[225Ac\]-FPI-1434 Injection in patients with solid tumours that demonstrate uptake of \[111In\]-FPI-1547 (radioimmuno-imaging agent).

Detailed description: This study consists of a Phase 1 portion and a Phase 2 portion.

Phase 1 includes the following cohorts: Single dose-ascending cohorts and Multi- dose ascending cohorts of \[225Ac\]-FPI-1434 and Multi- dose ascending cohorts evaluating administration of FPI-1175 (cold antibody), followed by, \[225Ac\]-FPI-1434 (cold + hot), with cycles repeating every 42 days. And Cold Antibody Sub-study evaluating administration of ascending doses of FPI-1175 followed by \[111In\]-FPI-1547.

The Phase 2 will evaluate \[111In\]-FPI-1547 and \[225Ac\]-FPI-1434 with or without FPI-1175 in tumour-specific cohorts. The decision to utilize FPI-1175 in the Phase 2 portion of the study will be determined based on Phase 1 data, including safety, tolerability, pharmacokinetic and dosimetry results.

Eligibility criteria: Inclusion Criteria:

1. Pathologically documented, definitively diagnosed, advanced solid tumour that is refractory to all standard treatment, for which no standard treatment is available, or it is contraindicated, or the patient refuses standard therapy.
2. Measurable or evaluable disease in accordance with RECIST 1.1.
3. Eastern Cooperative Oncology Group (ECOG) Performance status of 0 or 1.
4. Life expectancy of greater than 3 months as judged by the treating physician.
5. Available tumour tissue (either archival or fresh biopsy) for IGF-1R immunohistochemistry. Submission of the tissue is not required prior to enrollment.
6. Adequate heart, kidney, and liver function
7. Adequate bone marrow reserves
8. Ability to understand and the willingness to sign a written informed consent document.

   Phase 2 Specific
9. Histologically and/or cytologically documented diagnosis of locally advanced, inoperable, metastatic, or recurrent solid tumour types: endometrial, cervical, ovarian, TNBC, HER 2-negative breast, HNSCC, ACC, or uveal melanoma.
10. Have measurable disease per RECIST 1.1 Failure to respond to standard systemic therapy, or for whom standard or curative systemic therapy does not exist or is not tolerable.

    Imaging Eligibility
11. Prior to the initial \[225Ac\]-FPI-1434 cycle: Sufficient target expression in at least 1 lesion following \[111In\]-FPI-1547 and SPECT imaging.

Exclusion Criteria:

1. Systemic therapeutic radiopharmaceutical within 6 months prior to enrollment into this study.
2. Contraindications to or inability to perform the required imaging procedures in this study (e.g., inability to lay flat during scan time)
3. Uncontrolled brain metastasis, including but not limited to the need for treatment with steroids, surgery or radiation therapy.
4. Anticancer therapy (including investigational agents) or external beam radiation therapy within 14 days of the dosing of \[111In\]-FPI-1547
5. Has known additional malignancy that is progressing or has required active treatment within the past 3 years. Patients with basal cell carcinoma of the skin, squamous cell carcinoma of the skin or carcinoma in situ (e.g., breast cancer, cervical cancer, prostate) that have undergone potentially curative therapy are not excluded.
6. Residual CTCAE ≥ Grade 2 side effects of prior therapy, with the exception of residual grade 2 alopecia.
7. Prior organ transplantation, including stem cell transplantation.
8. Any prior treatment with nitrosoureas or actinomycin-D.
9. Clinically relevant levels of protein in the urine
10. Known or suspected allergies or contraindications to the Investigational Products or any component of the investigational drug formulation.
11. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, diabetes, or psychiatric illness/social situations that would limit compliance with study requirements.
12. Received \> 20 Gy prior radiation to large areas of the bone marrow

Primary outcomes:
measure: Dose Escalation: Incidence of adverse events (AEs).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Single-Dose Escalation: Incidence of dose limiting toxicities (DLTs).
timeFrame: 8 weeks.
measure: Multi-Dose Escalation: Incidence of DLTs.
timeFrame: 6 weeks.
measure: Dose Escalation: Incidence of clinically significant clinical laboratory abnormalities.
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation: Changes in electrocardiogram (ECG) parameters (PR, QRS, QT, and QTc intervals).
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Cold Antibody Sub-Study: Changes in uptake of [111In]-FPI-1547 Injection following FPI-1175 Infusion in selected regions of interest on SPECT/CT images.
timeFrame: Within two weeks of the first [111In]-FPI-1547 Injection.
measure: Cold Antibody Sub-Study: Changes in radiation dose estimates for selected tissues, organs and whole body both for [111In]-FPI-1547 and [225Ac]-FPI-1434 Injection at various dose levels following FPI-1175 Infusion.
timeFrame: Within two weeks of the first [111In]-FPI-1547 Injection.
measure: Evaluate anti-tumour activity of [225Ac]-FPI-1434 regimen
timeFrame: Approximately one year post final [225Ac]-FPI-1434 injection.
measure: Objective response rate (ORR) RECIST v1.1.
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
Secondary outcomes:
measure: Dose Escalation and Cold Antibody Sub-Study: Tumour uptake of [111In]-FPI-1547 in selected regions of interest on SPECT/CT images.
timeFrame: Dose Escalation: Within one week of the [111In]-FPI-1547 Injection. Cold-Antibody Sub-Study: Within two weeks of the first [111In]-FPI-1547 Injection.
measure: Dose Escalation: Radiation doses for selected organs and whole body both for [111In]-FPI-1547 Injection and [225Ac]-FPI-1434 Injection.
timeFrame: Within one week of the [111In]-FPI-1547 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Changes in radiation absorbed doses for tumour lesions for [225Ac]-FPI-1434.
timeFrame: Dose Escalation: Within one week of the [111In]-FPI-1547 Injection. Cold-Antibody Sub-Study: Within two weeks of the first [111In]-FPI-1547 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Clearance for radioactivity and for the targeting antibody.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Area under the curve (AUC) for radioactivity and for the targeting antibody.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Cmax for radioactivity and for the targeting antibody.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Half-life for radioactivity and for the targeting antibody.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Objective response rate (ORR) (sum of complete and partial response) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 or Prostate Cancer Working Group 3 (PCWG3) guidelines.
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation: Changes in the corrected QT (QTc) interval in milliseconds after [225Ac]-FPI-1434 treatment, compared to baseline.
timeFrame: Approximately 24 hours from the time of [225Ac]-FPI-1434 Injection administration.
measure: Dose Escalation and Cold-Antibody Sub-Study: Changes in human growth hormone (hGh) following [111In]-FPI-1547 Injection and [225Ac]-FPI-1434 Injection.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Changes in insulin-like growth factor 1 (IGF-1) following [111In]-FPI-1547 Injection and [225Ac]-FPI-1434 Injection.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Changes in insulin-like growth factor binding protein 3 (IGFBP-3) following [111In]-FPI-1547 Injection and [225Ac]-FPI-1434 Injection.
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Cold Antibody Sub-Study: Incidence of AEs.
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Cold Antibody Sub-Study: Incidence of clinically significant clinical laboratory abnormalities.
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Cold Antibody Sub-Study: Changes in ECG parameters (PR, QRS, QT, and QTc intervals).
timeFrame: 4 weeks post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Time to response (TTR).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Duration of response (DoR).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Progression free survival (PFS).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Time to Progression (TTP).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Disease control rate (DCR).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
measure: Dose Escalation and Cold-Antibody Sub-Study: Overall survival (OS).
timeFrame: Approximately one year post final [225Ac]-FPI-1434 Injection.
Other outcomes:
Locations:
city: Duarte
country: United States
facility: City of Hope
state: California
city: Boston
country: United States
facility: Dana-Farber Cancer Institute
state: Massachusetts
city: Minneapolis
country: United States
facility: Masonic Cancer Center, University of Minnesota
state: Minnesota
city: Buffalo
country: United States
facility: Roswell Park Comprehensive Cancer Center
state: New York
city: New York City
country: United States
facility: Memorial Sloan Kettering Cancer Center
state: New York
city: Philadelphia
country: United States
facility: Hospital of the University of Pennsylvania
state: Pennsylvania
city: Houston
country: United States
facility: University of Texas MD Anderson Cancer Center
state: Texas
city: Adelaide
country: Australia
facility: Royal Adelaide Hospital
state: South Australia
city: Heidelberg
country: Australia
facility: Austin Hospital
state: Victoria
city: Hamilton
country: Canada
facility: Juravinski Cancer Center - Hamilton Health
state: Ontario
city: Toronto
country: Canada
facility: Princess Margaret Cancer Centre
state: Ontario
city: Montréal
country: Canada
facility: Centre Hospitalier De I'Universite de Montreal
state: Quebec
city: Québec City
country: Canada
facility: Quebec University Hospital- Laval
state: Quebec
Study officials:
affiliation: Fusion Pharmaceuticals Inc.
name: Julia Kazakin, MD
role: STUDY_DIRECTOR
References:
citation: Martiniova L, Zielinski RJ, Lin M, DePalatis L, Ravizzini GC. The Role of Radiolabeled Monoclonal Antibodies in Cancer Imaging and ADC Treatment. Cancer J. 2022 Nov-Dec 01;28(6):446-453. doi: 10.1097/PPO.0000000000000625.