Clinical trial NCT05496686: Targeted Alpha Particle Radiotherapy for Metastatic Uveal Melanoma
Official title: First in Human Phase I Study of 225Actinium-MTI-201 (225Ac-MTI-201) in Metastatic Uveal Melanoma
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
Conditions: Uveal Melanoma
Metastatic
Keywords: Uveal Neoplasms
Melanoma of the Uvea
Melanocortin 1 Receptor
MC1R
Peptide Receptor Radiotherapeutic
PRRT
Actinium-225-PRRT
Lead sponsor: Modulation Therapeutics, Inc.
Sponsor class: INDUSTRY
Collaborators: name: H. Lee Moffitt Cancer Center and Research Institute
First posted: 2022-08-11
Enrollment: 16
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Intervention model description: The continual reassessment method (CRM) will be used for this study. The dose escalation plan is for a doubling of the dose for doses 2 through 6, a 1.67-fold increase for doses 7 and 8, and a 1.33-fold increase for doses 9-12. This plan corresponds roughly to the modified Fibonacci dose escalation plan given by Penel and Kramar.
Primary purpose: TREATMENT

Brief summary: The primary aim of the study is to establish the maximum-tolerated dose (MTD) of 225Ac-MTI-201 in participants with metastatic uveal melanoma. The secondary aims are to describe the pharmacokinetics of 225Ac-MTI-201 and the toxic effects of 225Ac-MTI-201 in participants with metastatic uveal melanoma.

Detailed description: This study will enroll patients with metastatic uveal melanoma that have failed at least one form of therapy from a single academic medical center in the United States. All participants will be informed about the study and potential risks and required to provide written informed consent prior to undergoing study-related procedures. A continual reassessment method (CRM) design will be used for this clinical trial. The study proposes single patient cohorts with dose escalation starting at 4.7 microCi of 225Ac-MTI-201 after each cohort in the absence of safety concerns (2-fold increases for doses and lower dose increases between higher doses). Dose Limiting Toxicities will be assessed using the CTCAE version 5.0 criteria.

The participants who meet the eligibility requirements will be administered a single intravenous dose of 225Ac-MTI-201. After study treatment, the study participants will stay overnight at the study center, undergo study procedures (i.e. vital signs, physical exam, multiple blood and urine sample collections) and will be scheduled to return to the clinic at 48 hours and for additional appointments weekly clinic visits the first month and on Week 9 for health status assessments, including physical exams, complete blood chemistry, and EKG. Tumor measurements every 8 weeks in first year post-injection; extended to 12 weeks in year 2; every 16 weeks in year 3, and 24 weeks in years 4 and 5. The clinic visits will involve seeing a study doctor plus radiological tests (such as MRI and/or CT scans) to see how the metastatic uveal melanoma has responded to the study drug. The protocol and informed consent documents have been reviewed and approved by the hospital human subjects review board and the study will be performed in accordance with the Declaration of Helsinki.

Eligibility criteria: Inclusion Criteria:

* Histologically confirmed metastatic uveal melanoma.
* Progression after at least one prior line of therapy for metastatic uveal melanoma. Liver directed therapy (e.g., hepatic arterial embolization, isolated hepatic perfusion) will count as one line of therapy. Should any additional treatment(s) receive regulatory approval for metastatic uveal melanoma during the conduct of this trial, participants (if eligible for the newly approved treatment) would need to demonstrate disease progression on the additional treatment(s) before being eligible to participate in the current study. There is no limit to the number of previous treatments for metastatic disease.
* Participants must have measurable disease per RECIST 1.1.
* Adults, age 18 or over, with no upper age limit.
* ECOG (Eastern Cooperative Oncology Group) performance status of 0-1 (Karnofsky ≥ 70 percent).
* Acceptable organ and marrow function as defined below:

  * Leucocytes ≥ 3,000/μL
  * Absolute neutrophil count ≥ 1,500/μL
  * Platelets ≥ 100,000/μL
  * Aspartate aminotransferase (AST)/ Alanine aminotransferase (ALT) ≤ 2.5x institutional upper limit of normal (ULN)
  * Bilirubin ≤ 1.5x institutional upper limit of normal (ULN)
  * Creatinine clearance ≥ 60mL/min/1.73m\^2 (measured by Cockcroft-Gault equation using actual body weight in kilograms, and then adjusted for body surface area)
* Male participants who are sexually active, and female participants of childbearing potential must agree to use 2 forms of FDA approved contraceptive methods during treatment with 225Ac-MTI-201 and up to 3 months following treatment.
* Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

* Prior alpha-particle therapy.
* Has known symptomatic central nervous system (CNS) metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are stable without evidence of progression by imaging for at least four weeks after definitive intervention and using no more than the equivalent of dexamethasone 2 mg/d for the management of vasogenic edema, if necessary. This exception does not include carcinomatous meningitis, which is excluded regardless of clinical stability.
* Participants with an active malignancy requiring anticancer treatment at the time of study entry that, in the judgment of the investigator could impact the results of treatment of metastatic uveal melanoma.
* Pregnant or nursing women. Women of childbearing potential (defined as having had a menstrual cycle within the past 12 months, and not having had a surgical procedure for sterilization) must have a negative pregnancy test (urine or serum) within 7 days of treatment with 225Ac-MTI-201.
* Participants with uncontrolled inter-current illness including, but not limited to, ongoing or active bacterial infection, active hepatitis B/C infection requiring antiviral therapy, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
* Immunocompromised participants may be at increased risk of toxicity. Therefore, HIV-positive participants, participants with acquired or congenital immunodeficiency conditions, those on chronic systemic corticosteroids requiring \>10 mg of prednisone or equivalent per day will be excluded from participation. (Participants with autoimmune disease who do not require corticosteroids or are maintained on ≤10 mg of prednisone or equivalent per day ARE eligible for participation; for participants with CNS metastases on steroids, exclusion criterion bullet point #2 above will apply).
* Prior external beam radiation therapy to more than 25 percent of the bone marrow.

Primary outcomes:
measure: Maximum Tolerated Dose (MTD) of 225Ac-MTI-201
timeFrame: Within 4 weeks after study drug administration
measure: Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs)
timeFrame: Within 4 weeks after study drug administration
measure: The Number of Participants Who Experienced Serious or Non-Serious Adverse Events
timeFrame: From time of signing the informed consent document until death, or lost to follow-up (approximately 3 years)
Secondary outcomes:
measure: Observed Rate of Renal Elimination of 225Ac-MTI-201
timeFrame: 3 to 24 hours post-dose
measure: Observed Rate of Elimination from Blood of 225Ac-MTI-201
timeFrame: Prior to the initial dose on day 1; 0.042, 0.083, 0.167, 0.333, 0.667, 1.333, 2.333, 24, and 48 hours; day 8; and day 15 post-dose
measure: Number of Participants Who Experienced a Complete Response (CR), Partial Response (PR), Progressive Disease (PD), or Stable Disease (SD) According to Tumor Lesion Measurement
timeFrame: From time of signing the informed consent document until death, or lost to follow-up (approximately 3 years)
Other outcomes:
Locations:
city: Tampa
country: United States
facility: H. Lee Moffitt Cancer Center and Research Institute
state: Florida
Study officials:
affiliation: Modulation Therapeutics, Inc.
name: Mark L McLaughlin
role: STUDY_DIRECTOR
affiliation: H. Lee Moffitt Cancer Center and Research Institute
name: Nikhil I Khushalani, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Tafreshi NK, Doligalski ML, Tichacek CJ, Pandya DN, Budzevich MM, El-Haddad G, Khushalani NI, Moros EG, McLaughlin ML, Wadas TJ, Morse DL. Development of Targeted Alpha Particle Therapy for Solid Tumors. Molecules. 2019 Nov 26;24(23):4314. doi: 10.3390/molecules24234314.
citation: Tafreshi NK, Tichacek CJ, Pandya DN, Doligalski ML, Budzevich MM, Kil H, Bhatt NB, Kock ND, Messina JL, Ruiz EE, Delva NC, Weaver A, Gibbons WR, Boulware DC, Khushalani NI, El-Haddad G, Triozzi PL, Moros EG, McLaughlin ML, Wadas TJ, Morse DL. Melanocortin 1 Receptor-Targeted alpha-Particle Therapy for Metastatic Uveal Melanoma. J Nucl Med. 2019 Aug;60(8):1124-1133. doi: 10.2967/jnumed.118.217240. Epub 2019 Feb 7.
citation: Tafreshi NK, Kil H, Pandya DN, Tichacek CJ, Doligalski ML, Budzevich MM, Delva NC, Langsen ML, Vallas JA, Boulware DC, Engelman RW, Gage KL, Moros EG, Wadas TJ, McLaughlin ML, Morse DL. Lipophilicity Determines Routes of Uptake and Clearance, and Toxicity of an Alpha-Particle-Emitting Peptide Receptor Radiotherapy. ACS Pharmacol Transl Sci. 2021 Mar 12;4(2):953-965. doi: 10.1021/acsptsci.1c00035. eCollection 2021 Apr 9.