Clinical trial NCT05070247: A Study of TAK-500 With or Without Pembrolizumab in Adults With Select Locally Advanced or Metastatic Solid Tumors
Official title: An Open-label, Dose Escalation and Expansion, Phase 1/2 Study to Evaluate the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Preliminary Antitumor Activity of TAK-500, a Novel Stimulator of Interferon Genes Agonist, as a Single Agent and in Combination With Pembrolizumab in Adult Patients With Select Locally Advanced or Metastatic Solid Tumors
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE1
PHASE2
Conditions: Pancreatic Cancer
Hepatocellular Cancer
Mesothelioma
Breast Cancer
Gastric Cancer
Esophageal Cancer
Nasopharyngeal Cancer
Kidney Cancer
Squamous Cell Cancer of Head and Neck (SCCHN)
Non-small Cell Lung Cancer (NSCLC), Non-squamous
Keywords: Drug Therapy
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2021-10-07
Enrollment: 61
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 study is about TAK-500, given either alone or with pembrolizumab, in adults with select locally advanced or metastatic solid tumors.

The aims of the study are:

* to assess the safety profile of TAK-500 when given alone and when given with pembrolizumab.
* to assess the anti-tumor effects of TAK-500, when given alone and when given with pembrolizumab, in adults with locally advanced or metastatic solid tumors.

Participants may receive TAK-500 for up to 1 year. Participants may continue with their treatment if they have continuing benefit and if this is approved by their study doctor. Participants who are receiving TAK-500 either alone or with pembrolizumab will continue with their treatment until their disease progresses or until they or their study doctor decide they should stop this treatment.

Detailed description: The drug being tested in this study is called TAK-500. The study will evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics, and preliminary antitumor activity of TAK-500 when used as a single agent (SA) and in combination with pembrolizumab in participants with locally advanced or metastatic solid tumors.

The study will be conducted in 2 phases: Dose Escalation and Dose Expansion Phase. The study will enroll approximately 313 participants (approximately 82 in the Dose Escalation Phase and approximately 231 in Dose Expansion Phase). The dose escalation phase will determine the recommended dose of TAK-500 along with the combination agents for the dose expansion phase. All the participants will be assigned to one of the 9 arms:

* Dose Escalation: TAK-500 Single Agent (SA)
* Dose Escalation: TAK-500 + Pembrolizumab
* Dose Expansion: 2L NSCLC: TAK-500 recommended dose 1 for expansion (RDE 1) + Pembrolizumab
* Dose Expansion: 2L NSCLC: TAK-500 recommended dose 2 for expansion (RDE 2) + Pembrolizumab
* Dose Expansion: 3L NSCLC: TAK-500 (RDE 1) SA
* Dose Expansion: 3L NSCLC: TAK-500 (RDE 2) SA
* Dose Expansion: 2L Pancreatic Adenocarcinoma: TAK-500 (RDE 1) + Pembrolizumab
* Dose Expansion: 2L Pancreatic Adeno: TAK-500 (RDE 1) SA
* Dose Expansion: 3L RCC: TAK-500 (RDE 1) + Pembrolizumab

This multi-center trial will be conducted globally. Participants with demonstrated clinical benefit may continue treatment beyond 1 year if approved by the sponsor.

Eligibility criteria: Inclusion Criteria:

1. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 1.
2. Individuals with the following pathologically confirmed (cytological diagnosis is adequate) select locally advanced or metastatic solid tumors, whose disease has progressed on or are intolerant to standard therapy:

   1. Gastroesophageal (esophageal, gastroesophageal junction, and gastric) adenocarcinoma, pancreatic adenocarcinoma, hepatocellular carcinoma (HCC), nonsquamous non-small cell lung cancer (NSCLC), squamous cell carcinoma of the head and neck (SCCHN), mesothelioma, triple-negative breast cancer (TNBC), renal clear cell carcinoma (RCC) and nasopharyngeal carcinoma (NPC). Participants who are intolerant to all standard therapies are those who have developed clinical or laboratory abnormalities that prevent continued drug administration as evaluated by the principal investigator at the time of screening.
   2. For dose expansion in 2L nonsquamous NSCLC (TAK-500 plus pembrolizumab):

      * Participants with pathologically confirmed (cytological diagnosis is adequate) locally advanced or metastatic nonsquamous NSCLC.
      * Participants may not have a known targetable driver mutation, rearrangement or amplification (eg, EGFR, ALK, MET, ROS1, BRAF, KRASG12C, etc.).
      * Must have had disease progression while on or following 1 prior line of therapy:

        - Disease progression while on or following at least 6 weeks of 1 prior anti-PD-(L)1 therapy in the recurrent locally advanced or metastatic setting. OR Disease progression/recurrence within 6 months of the completion of anti-PD-(L)1 therapy if administered in the adjuvant/neoadjuvant setting. Prior anti-PD-(L)1 therapy may have been given with or without an anti-CTLA4 antibody and/or chemotherapy (eg, carboplatin and pemetrexed).
      * Participants are eligible regardless of PD-L1 status.
   3. For dose expansion in 3L nonsquamous NSCLC (TAK-500 SA):

      * Participants with pathologically confirmed (cytological diagnosis is adequate) locally advanced or metastatic nonsquamous NSCLC.
      * Participants may not have a known targetable driver mutation, rearrangement or amplification (eg, EGFR, ALK, MET, ROS1, BRAF, KRASG12C, etc.).
      * Must have had disease progression while on or following 2 prior lines of therapy:

        * Disease progression while on or following at least 6 weeks of 1 prior anti-PD-(L)1 therapy in the recurrent locally advanced or metastatic setting OR Disease progression/recurrence within 6 months of the completion of 1 prior anti-PD-(L)1 therapy if administered in the adjuvant/neoadjuvant setting. Prior anti-PD-(L)1 therapy may have been given with or without an anti-CTLA4 antibody and/or chemotherapy (eg, carboplatin and pemetrexed).
        * Participants must have had disease progression while on or after 1 or 2 lines of chemotherapy in the recurrent locally advanced or metastatic setting. If the anti-PD-(L)1 therapy is given in combination with chemotherapy, participant must have progressed on an additional line of chemotherapy.
      * Participants are eligible regardless of PD-L1 status.
   4. For dose expansion in 2L pancreatic adenocarcinoma (TAK-500 SA and TAK-500 plus pembrolizumab):

      * Participants with pathologically confirmed (cytological diagnosis is adequate) locally advanced or metastatic pancreatic adenocarcinoma.
      * Must have had disease progression while on or following 1 prior line of therapy:

        - One prior line of fluorouracil- or gemcitabine-based chemotherapy (eg, FOLFIRINOX, FOLFOX, FOLFIRI, gemcitabine/nab-paclitaxel) in the metastatic/recurrent locally advanced setting. Prior chemotherapy in the neoadjuvant/adjuvant setting does not qualify unless the participant had progression of disease within 6 months of completion of neoadjuvant/adjuvant chemotherapy.
      * Must not have had prior exposure to anti-PD-(L)1 therapy.
      * Participants with MSI-H/dMMR disease are not eligible.
      * Participants are eligible regardless of PD-L1 status.
   5. For dose expansion in 3L RCC (TAK-500 plus pembrolizumab):

      * Participants with pathologically confirmed (cytological diagnosis is adequate) locally advanced or metastatic RCC.
      * Must have had disease progression while on or following 2 prior lines of therapy:

        * Disease progression while on or following at least 6 weeks of 1 prior anti-PD-(L)1 therapy in the recurrent locally advanced or metastatic setting. OR Disease progression/recurrence within 6 months of the completion of anti-PD-(L)1 therapy if administered in the adjuvant/neoadjuvant setting. Prior anti-PD-(L)1 therapy may have been given with or without an anti-CTLA4 antibody and/or an anti-VEGFR TKI.
        * Participants must have had prior therapy with 1 or 2 lines of VEGFR TKIs in the metastatic/recurrent locally advanced setting. If anti-PD-(L)1 therapy was given in combination with a VEGFR TKI, the participant must have had progressive disease on an additional line of therapy (eg, VEGFR TKI or VEGFR TKI-containing combination).
      * Participants are eligible regardless of PD-L1 status.
3. Must have at least 1 RECIST version 1.1 measurable lesion. Lesions in previously irradiated areas (or other local therapy) should not be selected as measurable/target lesions unless there has been demonstrated radiographic progression in that lesion. RECIST v1.1 target lesions must include at least 1 lesion that was not previously irradiated.
4. Adequate bone marrow, renal, and hepatic functions, as determined by the following laboratory parameters:

   1. Absolute neutrophil count (ANC) greater than or equal to (\>=) 1000/ microliter (mcL), platelet count \>=75,000/mcL, and hemoglobin \>= 8.0 grams per deciliter (g/dL) without growth factor support for ANC or transfusion support
   2. Total bilirubin \<=1.5 times the institutional upper limit of normal (ULN). For participants with Gilbert's disease or HCC, \<=3 milligrams per deciliter (mg/dL).
   3. Serum alanine aminotransferase and aspartate aminotransferase \<=3.0\*ULN or \<=5.0\*ULN with liver metastases or HCC.
   4. Albumin \>=3.0 g/dL.
   5. Calculated creatinine clearance using the Cockcroft-Gault formula \>=30 mL/minute.
5. Left ventricular ejection fraction (LVEF) \>50%, as measured by echocardiogram or multiple gated acquisition scan (MUGA) within 4 weeks before receiving the first dose of study drug.
6. For participants with HCC only: Child-Pugh score less than or equal to 7 (Child-Pugh A or B7).
7. Clinically significant toxic effects of previous therapy have recovered to Grade 1 (per National Cancer Institute Common Terminology Criteria for Adverse Events \[NCI CTCAE\] Version 5.0) or baseline, except for alopecia, Grade 2 peripheral neuropathy, and/or autoimmune endocrinopathies with stable endocrine replacement therapy.
8. Participants previously treated with fully human/humanized antineoplastic monoclonal antibodies must not have received treatment with such antibodies for at least 4 weeks or the time period equal to the dosing interval, whichever is shorter. No washout period is required for prior treatment with pembrolizumab or other anti-programmed cell death protein 1 (PD-1) antibodies, although the first study dose of these drugs must not occur at an interval less than standard of care (that is, 3 weeks for 200 mg of IV pembrolizumab).

Exclusion Criteria:

1. History of any of the following \<=6 months before first dose of study drug(s): congestive heart failure New York Heart Association Grade III or IV, unstable angina, myocardial infarction, persistent hypertension \>=160/100 millimeters of mercury (mmHg) despite optimal medical therapy, ongoing cardiac arrhythmias of Grade \>2 (including atrial flutter/ fibrillation or intermittent ventricular tachycardia), other ongoing serious cardiac conditions (example, Grade 3 pericardial effusion or Grade 3 restrictive cardiomyopathy), or symptomatic cerebrovascular events. Chronic, stable atrial fibrillation on stable anticoagulation therapy, including low molecular-weight heparin, is allowed.
2. QT interval with Fridericia correction method \>450 milliseconds (men) or \>475 milliseconds (women) on a 12- lead ECG during the screening period.
3. Grade \>=2 hypotension (that is, hypotension for which nonurgent intervention is required) at screening or during C1D1 predose assessment.
4. Oxygen saturation \<92% on room air at screening or during C1D1 predose assessment.
5. Treatment with other STING agonists/antagonists, Toll-like receptor agonists or CCR2 agonist/antagonist within the past 6 months.
6. Active diagnosis of pneumonitis, interstitial lung disease, severe chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, other restrictive lung diseases, acute pulmonary embolism, or Grade \>=2 pleural effusion not controlled by tap or requiring indwelling catheters.
7. Grade \>=2 fever of malignant origin.
8. Chronic, active hepatitis (example, participants with known hepatitis B surface antigen seropositive and/or detectable hepatitis C virus \[HCV\] RNA).
9. History of hepatic encephalopathy.
10. Prior or current clinically significant ascites, as measured by physical examination, that requires active paracentesis for control.
11. Treatment with any investigational products or other anticancer therapy (including chemotherapy, targeted agents, and immunotherapy), within 14 days or 5 half-lives, whichever is shorter, before C1D1 of study drug(s).
12. Radiation therapy within 14 days (42 days for radiation to the lungs) and/ or systemic treatment with radionuclides within 42 days before C1D1 of study drug(s). Participants with clinically relevant ongoing pulmonary complications from prior radiation therapy are not eligible.
13. Use of systemic corticosteroids or other immunosuppressive therapy, concurrently or within 14 days of C1D1 of study drug(s), with the following exceptions:

    * Topical, intranasal, inhaled, ocular, intra-articular, and/or other nonsystemic corticosteroids.
    * Physiological doses of replacement steroid therapy (example, for adrenal insufficiency), not to exceed the equivalent of 10 mg prednisone daily.
14. Recipients of allogeneic or autologous stem cell transplantation or organ transplantation.

Additional criteria specific for participants in TAK-500 and pembrolizumab combination arm only:

* Contraindication to the administration of a pembrolizumab or prior intolerance to pembrolizumab or other anti-PD-1 or anti-programmed cell death protein ligand 1 antibody.
* History of intolerance to any component of the study treatment agents or known serious or severe hypersensitivity reaction to any of the study drugs or their excipients. (Pembrolizumab is formulated with L-histidine, polysorbate 80, and sucrose.

Primary outcomes:
measure: Dose Escalation: Number of Participants With Grade 3 or Higher TEAEs
timeFrame: Up to approximately 50 months
measure: Dose Escalation: Number of Participants Reporting one or More Treatment-emergent Adverse Events (TEAEs)
timeFrame: Up to approximately 50 months
measure: Dose Escalation: Number of Participants With Dose Limiting Toxicities (DLTs)
timeFrame: Up to approximately 50 months
measure: Dose Escalation: Number of Participants Reporting one or More Serious Adverse Event (SAEs)
timeFrame: Up to approximately 50 months
measure: Dose Escalation: Number of Participants With one or More TEAEs Leading to Dose Modifications and Treatment Discontinuations
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Overall Response Rate (ORR)
timeFrame: Up to approximately 50 months
Secondary outcomes:
measure: Dose Escalation and Dose Expansion: Cmax: Maximum Serum Concentration for TAK-500
timeFrame: Cycle 1 Day 1, Cycle 2 Day 1, Cycle 3 Day 1 and Cycle 4 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: Tmax: Time to Reach the Maximum Serum Concentration (Cmax) for TAK-500
timeFrame: Cycle 1 Day 1, Cycle 2 Day 1, Cycle 3 Day 1 and Cycle 4 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: AUCt: Area Under the Serum Concentration-time Curve From Time 0 to Time t for TAK-500
timeFrame: Cycle 1 Day 1, and Cycle 2 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: AUCinf: Area Under the Serum Concentration-time Curve From Time 0 to Infinity for TAK-500
timeFrame: Cycle 1 Day 1, and Cycle 2 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: t1/2: Terminal Disposition Phase Half-life for TAK-500
timeFrame: Cycle 1 Day 1, and Cycle 2 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: CL: Total Clearance After Intravenous Administration for TAK-500
timeFrame: Cycle 1 Day 1, and Cycle 2 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: Vss: Volume of Distribution at Steady State After Intravenous Administration for TAK-500
timeFrame: Cycle 1 Day 1, and Cycle 2 Day 1: pre-infusion and at multiple time points (up to 21 days) post-infusion (Cycle length=21 days)
measure: Dose Escalation and Dose Expansion: Changes in Intratumoral Tumor Cell Infiltration
timeFrame: Up to 23 days after first administration of TAK-500
measure: Dose Escalation and Dose Expansion: Number of Participants With Positive Anti-drug Antibody (ADA) and Acquired Immunogenicity
timeFrame: Up to approximately 50 months
measure: Dose Escalation: Overall Response Rate (ORR)
timeFrame: Up to approximately 50 months
measure: Dose Escalation and Dose Expansion: Disease Control Rate (DCR)
timeFrame: Up to approximately 50 months
measure: Dose Escalation and Dose Expansion: Duration of Response (DOR)
timeFrame: Up to approximately 50 months
measure: Dose Escalation and Dose Expansion: Time to Response (TTR)
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Progression Free Survival (PFS)
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Overall Survival (OS)
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Number of Participants With Grade 3 or Higher TEAEs
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Number of Participants Reporting one or More Treatment-emergent Adverse Events (TEAEs)
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Number of Participants With Dose Limiting Toxicities (DLTs)
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Number of Participants Reporting one or More Serious Adverse Event (SAEs)
timeFrame: Up to approximately 50 months
measure: Dose Expansion: Number of Participants With one or More TEAEs Leading to Dose Modifications and Treatment Discontinuations
timeFrame: Up to approximately 50 months
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: Univeristy of Alabama at Birmingham
state: Alabama
city: Duarte
country: United States
facility: City of Hope Comprehensive Cancer Center
state: California
city: La Jolla
country: United States
facility: University of California San Diego
state: California
city: Aurora
country: United States
facility: University of Colorado - Anschutz Medical Campus - PPDS
state: Colorado
city: Denver
country: United States
facility: Sarah Cannon Research Institute
state: Colorado
city: Miami
country: United States
facility: Sylvester Comprehensive Cancer Center
state: Florida
city: Chicago
country: United States
facility: Northwestern
state: Illinois
city: Boston
country: United States
facility: Dana Farber Cancer Institute
state: Massachusetts
city: New York
country: United States
facility: New York University
state: New York
city: Philadelphia
country: United States
facility: Fox Chase Cancer Center
state: Pennsylvania
city: Nashville
country: United States
facility: Sarah Cannon Cancer Institute
state: Tennessee
city: San Antonio
country: United States
facility: START South Texas Accelerated Research Therapeutics
state: Texas
Study officials:
affiliation: Takeda
name: Study Director
role: STUDY_DIRECTOR
References: