Clinical trial NCT03761017: MGD019 DART® Protein in Unresectable/Metastatic Cancer
Official title: A Phase 1, First-in-Human, Open-Label, Dose Escalation and Cohort Expansion Study of MGD019, a Bispecific DART® Protein Binding PD-1 and CTLA-4 in Patients With Unresectable or Metastatic Neoplasms
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Squamous Cell Non Small Cell Lung Cancer
Prostate Cancer Metastatic
Cutaneous Melanoma
Colorectal Cancer
Advanced Cancer
Solid Tumor, Adult
Lead sponsor: MacroGenics
Sponsor class: INDUSTRY
First posted: 2018-12-03
Enrollment: 162
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: The purpose of this study is to evaluate the safety and tolerability, pharmacokinetics (PK) pharmacodynamics and preliminary antitumor activity of lorigerlimab.

This Phase 1, open-label study will characterize safety, dose-limiting toxicities (DLTs), and maximum tolerated/administered dose (MTD/MAD) of MGD019. Dose escalation will occur in a 3+3+3 design in patients with advanced solid tumors of any histology. Once the MTD/MAD is determined, a Cohort Expansion Phase will be enrolled to further characterize safety and initial anti-tumor activity in patients with specific tumor types anticipated to be sensitive to dual checkpoint blockade.


Eligibility criteria: Inclusion Criteria:

* Dose escalation: Patients with histologically proven, unresectable, locally advanced or metastatic solid tumors for whom no approved therapy with demonstrated clinical benefit is available or patients who are intolerant to standard therapy.
* Cohort Expansion Phase:
* Checkpoint inhibitor-naïve squamous cell NSCLC, including:

  1. Patients that have progressed during or following treatment with platinum-based chemotherapy for advanced disease. Patients harboring an activating epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) rearrangement must have progressed following at least one available EGFR or ALK targeted therapy. ROS1 rearrangement or BRAF mutation must have progressed following at least 1 available EGFR (including osimertinib for EGFR T790M-mutated NSCLC), ALK, ROS1 or BRAF targeted therapy, respectively
  2. Patients that have progressed during or following treatment with platinum-based chemotherapy for advanced disease and patients with previously untreated squamous cell NSCLC without activating mutations for whom checkpoint inhibitor therapy is not approved or available.
* Advanced non-microsatellite instability-high colorectal cancer (CRC) with recurrence, progression, or intolerance to standard therapy consisting of at least 2 prior standard regimens. CRC harboring an activating EGFR mutation must have progressed during or following at least one available EGFR targeted therapy. Patients who are inappropriate candidates for or have refused treatment with these regimens are also eligible. Patients should have received no more than 4 prior lines of systemic therapy.
* Checkpoint inhibitor-naïve mCRPC that has progressed during or following no more than 2 prior lines of an androgen receptor antagonist or androgen synthesis inhibitor (e.g., enzalutamide or abiraterone, respectively), if approved and available, with a PSA value of at least 2 ng/mL and meeting at least one of the following:
* Progression in measurable disease (RECIST v1.1).
* Appearance of 2 or more new bone lesions according to Prostate Cancer Working Group 2 (PCWG-2).
* Rising PSA defined as at least two sequential rises in PSA.
* Eligible patients may have received prior chemotherapy (i.e. docetaxel), and patients with known homologous recombination (HRR) pathway gene alterations must have received the applicable approved therapy (e.g. olaparib).
* Cutaneous melanoma that has progressed during or following systemic treatment for unresectable, locally advanced, or metastatic disease. Patients will have received PD-(L)1 and/or CTLA-4 pathway inhibitors where available and indicated.
* Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
* Life expectancy ≥ 12 weeks.
* Measurable disease as per RECIST 1.1 for the purpose of response assessment must either (a) not reside in a field that has been subjected to prior radiotherapy or (b) have demonstrated clear evidence of radiographic progression since the completion of prior radiotherapy and prior to study enrollment.
* All patients must have an identified formalin-fixed, paraffin embedded (FFPE) tumor specimen (up to 20 slides or a block) for immunohistochemical evaluation of pharmacodynamic markers of interest. Patients may undergo a fresh tumor biopsy during the screening period if a tumor sample is not available. Patients in the mCRPC expansion cohort with bone only disease not amenable to fresh biopsy may be eligible in consultation with the Sponsor.
* Acceptable laboratory parameters and adequate organ reserve.

Exclusion Criteria:

* In patients who have previously received an immune checkpoint inhibitor (e.g., anti-PD-L1, anti-PD-1, anti-CTLA-4), toxicities related to the checkpoint inhibitor must have resolved to ≤ Grade 1 or baseline. Patients with well controlled immune endocrinopathies secondary to prior checkpoint therapy are eligible.
* Patients with symptomatic CNS metastases. Patients with history of prior CNS metastasis must have been treated, must be asymptomatic, and must not have concurrent treatment for the CNS disease, progression of CNS metastases on magnetic resonance imaging (MRI) or computed tomography (CT) for at least 14 days after last day of prior therapy for the CNS metastases, or concurrent leptomeningeal disease or cord compression.
* Patients who sustained the following Grade 3 immune checkpoint inhibitor related AEs are ineligible: Ocular AE, changes in liver function tests that met the criteria for Hy's law (\> 3 × ULN of either ALT or AST with concurrent \> 2 × ULN of total bilirubin and without alternate etiology), neurologic toxicity, colitis, renal toxicity, pneumonitis.
* Patients who have received prior therapy with a combination of monoclonal antibodies against PD-1/PD-L1 and CTLA-4 will be excluded in the Cohort Expansion (this does not apply to the melanoma expansion cohort).
* Patients with any history of known or suspected autoimmune disease with certain exceptions
* History of prior allogeneic bone marrow, stem-cell, or solid organ transplantation.
* History of trauma or major surgical procedure within 4 weeks prior to initiation of study drug administration.
* Systemic antineoplastic therapy, or investigational therapy (for all tumor types) or androgen receptor antagonist/androgen synthesis inhibitor for mCRPC (e.g., enzalutamide or abiraterone, respectively) within the 4 weeks prior to initiation of study drug administration.
* Treatment with radiation therapy within 2 weeks prior to initiation of study drug administration.
* Radioligand (e.g., radium-223) within 6 months prior to initiation of study drug administration for mCRPC in the Cohort Expansion Phase.
* Serum testosterone \> 50 ng/dl or \> 1.7 nmol/L for mCRPC in the Cohort Expansion Phase.
* Confirmed or presumed COVID-19/SARS-CoV-2 infection. While SARS-CoV-2 testing is not mandatory for study entry, testing should follow local clinical practice guidelines/standards. Patients with a positive test result for SARS-CoV-2 infection, known asymptomatic infection, or presumed infection are excluded. Patients may be considered eligible after a resolved SARS-CoV-2 infection once he or she remains afebrile for at least 72 hours and after other SARS-CoV-2-related symptoms have fully recovered to baseline for a minimum of 72 hours

Primary outcomes:
measure: Incidence of treatment-emergent adverse events
timeFrame: 30 days after last dose
Secondary outcomes:
measure: Cmax
timeFrame: up to 108 weeks
measure: Tmax
timeFrame: up to 108 weeks
measure: AUC
timeFrame: up to 108 weeks
measure: Ctrough
timeFrame: up to 108 weeks
measure: CL
timeFrame: up to 108 weeks
measure: Vss
timeFrame: up to 108 weeks
measure: t1/2
timeFrame: up to 108 weeks
measure: Percent of patients with anti-drug antibodies against lorigerlimab
timeFrame: up to 108 weeks
measure: Objective response rate (ORR)
timeFrame: Every 12 weeks, up to 4 years
measure: Duration of Response (DoR)
timeFrame: Every 12 weeks until withdrawal of consent, lost to follow up, death, or end of the study, up to 4 years
measure: Progression free survival (PFS)
timeFrame: Tumor status assessed every 12 weeks. Survival status is assessed approximately every 12 weeks after the last dose of study treatment until withdrawal of consent, lost to follow up, death, or end of the study, up to 4 years
measure: Overall survival (OS)
timeFrame: OS status is assessed approximately every 12 weeks after the last dose of study treatment until withdrawal of consent, lost to follow up, death, or end of the study, up to 4 years
measure: Prostate specific antigen (PSA) response rate in mCRPC
timeFrame: Every 3 weeks on treatment, then every 3 months up to 2 years post last treatment
measure: Best PSA percent change in mCRPC
timeFrame: Every 3 weeks on treatment, then every 3 months up to 2 years post last treatment
measure: Duration of PSA response
timeFrame: Every 3 weeks on treatment, then every 3 months up to 2 years post last treatment
measure: Radiographic progression-free survival (PFS) in metastatic castration-resistant prostate cancer (mCRPC)
timeFrame: up to 2 years post last treatment
measure: Time to PSA progression in mCRPC
timeFrame: PSA is assessed every 3 weeks while on treatment, every 3 months for up to 2 years post-treatment
Other outcomes:
Locations:
city: Chicago
country: United States
facility: University of Chicago Medical Center
state: Illinois
city: Boston
country: United States
facility: Beth Israel Deaconess Medical Center
state: Massachusetts
city: Boston
country: United States
facility: Dana Farber Cancer Institute
state: Massachusetts
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
city: Grand Rapids
country: United States
facility: START Midwest
state: Michigan
city: Grand Island
country: United States
facility: Oncology Hematology West p.c. dba Nebraska Cancer Specialists
state: Nebraska
city: Omaha
country: United States
facility: Nebraska Cancer Specialists
state: Nebraska
city: Portland
country: United States
facility: Providence Portland Medical Center
state: Oregon
city: Camp Hill
country: United States
facility: UPMC Hillman Cancer Center
state: Pennsylvania
city: Carlisle
country: United States
facility: UPMC Hillman Cancer Center
state: Pennsylvania
city: Erie
country: United States
facility: UPMC Hillman Cancer Center
state: Pennsylvania
city: Harrisburg
country: United States
facility: UPMC Pinnacle Harrisburg
state: Pennsylvania
city: Harrisburg
country: United States
facility: UPMC Pinnacle - Community Osteopathic Medical Sciences Pavilion (MSP)
state: Pennsylvania
city: Mechanicsburg
country: United States
facility: UPMC Pinnacle - Ortenzio Cancer Center (OCC)
state: Pennsylvania
city: Pittsburgh
country: United States
facility: UPMC Hillman Cancer Center
state: Pennsylvania
city: York
country: United States
facility: UPMC Hillman Cancer Center at UPMC Memorial
state: Pennsylvania
city: Nashville
country: United States
facility: The Sarah Cannon Research Institute / Tennessee Oncology
state: Tennessee
city: Burgas
country: Bulgaria
facility: Complex Oncology Center - Burgas" EOOD, Department of Medical Oncology
city: Panagyurishte
country: Bulgaria
facility: Multiprofile Hospital for Active Treatment-Uni Hospital
city: Pleven
country: Bulgaria
facility: Multiprofile Hospital for Active Treatment "Heart and Brain"" EAD, Clinic of Medical Oncology
city: Ruse
country: Bulgaria
facility: Complex Oncology Center - Ruse EOOD
city: Sofia
country: Bulgaria
facility: University Mulitprofile Hospital for Active Treatment "Sv. Ivan Rilski
city: Gdańsk
country: Poland
facility: University Clinical Centre, Early Clinical Trials Unit
city: Kraków
country: Poland
facility: Pratia MCM Krakow
city: Otwock
country: Poland
facility: Europejskie Centrum Zdrowia Otwock
city: Poznań
country: Poland
facility: Med-Polonia Sp. z.o.o.
city: Warszawa
country: Poland
facility: LUX MED Onkologia Sp. z.o.o.
city: Warszawa
country: Poland
facility: Narodowy Instytut Onkologii im
city: Wieliszew
country: Poland
facility: Mazovian Onkological Hospital
city: Badalona
country: Spain
facility: ICO Badalona / Hospital Universitari Germans Trias i Pujol
state: Barcelona
city: Madrid
country: Spain
facility: Hospital Ruber Internacional
city: Madrid
country: Spain
facility: Hospital Universitario La Princesa
city: Dnipro
country: Ukraine
facility: Communal Non-profit Enterprise "City Clinical Hospital #4" of Dnipro
city: Kharkiv
country: Ukraine
facility: Communal Non-Profit Enterprise "Regional Center of Oncology", Oncosurgical Department of Head and Neck
city: Kirovohrad
country: Ukraine
facility: Communal Nonprofit Enterprise "Regional Clinical Oncology Center of Kirovohrad Regional Council"
city: Kyiv
country: Ukraine
facility: Kyiv City Clinical Oncological Centre
city: Kyiv
country: Ukraine
facility: National Cancer Institute of Ukraine
city: Sumy
country: Ukraine
facility: Sumy Clinical Oncological Hospital
city: Vinnytsia
country: Ukraine
facility: Communal Nonprofit Enterprise "Podilsky Regional Center of Oncology"
Study officials:
affiliation: MacroGenics
name: Denise Casey, MD
role: STUDY_DIRECTOR
References:
citation: Berezhnoy A, Sumrow BJ, Stahl K, Shah K, Liu D, Li J, Hao SS, De Costa A, Kaul S, Bendell J, Cote GM, Luke JJ, Sanborn RE, Sharma MR, Chen F, Li H, Diedrich G, Bonvini E, Moore PA. Development and Preliminary Clinical Activity of PD-1-Guided CTLA-4 Blocking Bispecific DART Molecule. Cell Rep Med. 2020 Dec 22;1(9):100163. doi: 10.1016/j.xcrm.2020.100163. eCollection 2020 Dec 22.