Clinical trial NCT04262388: A Multi-Cancer, Multi-State, Platform Study of Durvalumab (MEDI4736) and Oleclumab (MEDI9447) in Pancreatic Adenocarcinoma, Non-Small Cell Lung Cancer and Squamous Cell Carcinoma of the Head and Neck to Correlate Clinical, Molecular and Immunologic Parameters With DNA Methylation
Official title: A Multi-Cancer, Multi-State, Platform Study of Durvalumab (MEDI4736) and Oleclumab (MEDI9447) in Pancreatic Adenocarcinoma, Non-Small Cell Lung Cancer and Squamous Cell Carcinoma of the Head and Neck to Correlate Clinical, Molecular and Immunologic Parameters With DNA Methylation (DOME)
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: PHASE2
Conditions: Pancreatic Ductal Adenocarcinoma
Non-small Cell Lung Cancer
Squamous Cell Carcinoma of Head and Neck
Lead sponsor: University Health Network, Toronto
Sponsor class: OTHER
Collaborators: name: AstraZeneca
First posted: 2020-02-10
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a phase II, single center, open label, multi-cohort platform study to identify a signature in tumor tissues, blood or stool that might help identify participants who are more likely to experience tumor shrinkage or side effects from the combination of the study drugs durvalumab and oleclumab. In addition, this study will see if participants with certain types of advanced cancer benefit from the experimental drug combination of durvalumab and oleclumab, will evaluate the safety and tolerability of durvalumab and oleclumab, and to understand the effects that durvalumab and oleclumab have at a molecular level in tumor cells and their effects on the immune system. This study will look at subjects with locally advanced or recurrent/metastatic pancreatic ductal adenocarcinoma (PDAC), non-small-cell carcinoma (NSCLC) and squamous cell carcinoma of head and neck (SCCHN).

Within each cancer type, 40 patients will be enrolled (for a total of 120 patients on study): 20 patients will be enrolled with locally advanced disease ("window") and treated with durvalumab 1500 mg given by IV x 1 dose and oleclumab 3000 mg x 2 doses every 2 weeks prior to definitive therapy (e.g. surgery), and 20 patients will be enrolled with recurrent/metastatic ("metastatic") disease and treated with durvalumab 1500 mg given by IV every 4 weeks and oleclumab 3000 mg given by IV every 2 weeks x 4 doses then IV every 4 weeks till disease progression, toxicity, withdrawal of subject consent, or another discontinuation reason. For locally advanced PDAC patients, approximately 10 of the 20 subjects may receive 6-8 cycles of modified FOLFIRINOX (mFFX) prior to the administration of durvalumab and oleclumab.

Detailed description: The study hypothesis is that the combination of oleclumab (anti-cluster of differentiation \[CD\]73) with durvalumab (anti programmed cell death ligand 1 \[PD-L1\]) will demonstrate adequate safety, tolerability, and antitumor activity in subjects with locally advanced or recurrent/metastatic: pancreatic ductal adenocarcinoma (PDAC), non-small-cell lung cancer (NSCLC) and squamous cell carcinoma of head and neck (SCCHN), and that circulating free methylated DNA immunoprecipitation and high-throughput sequencing (cfMeDIP-seq) can yield cancer type-agnostic predictive biomarker(s) of response and/or toxicity in subjects receiving this combination.

Eligibility criteria: Inclusion Criteria:

1. Age ≥ 18 years at the time of screening or age of consent
2. Written informed consent and any locally required authorization (eg, data privacy) obtained from the subject prior to performing any protocol-related procedures, including screening evaluations
3. ECOG of 0 or 1
4. Weight ≥ 35 kg
5. Must have a life expectancy of at least 12 weeeks
6. Histological or cytological confirmation
7. At least 1 measurable lesion according to RECIST version 1.1
8. Archival tumor formalin-fixed, paraffin-embedded (FFPE) specimens for correlative biomarker studies are required (1 H\&E and 15 unstained slides) unless no such sample is available or insufficient sample exists. Subjects with insufficient archived tumor samples are still eligible
9. Adequate organ and marrow function
10. Females of childbearing potential who are sexually active with a nonsterilized male partner must use at least one highly effective method of contraception from screening to 180 days after the final dose of study treatment
11. Nonsterilized male subjects who are sexually active with a female partner of childbearing potential must use a male condom with spermicide from screening to 180 days after receipt of the final dose of study treatment

Exclusion Criteria:

1. Receipt of any conventional or investigational anticancer therapy within 21 days or palliative radiotherapy within 14 days prior to the scheduled first dose of study treatment.
2. Prior receipt of any immune-mediated therapy
3. Concurrent enrollment in another therapeutic clinical study. Enrollment in observational studies will be allowed
4. Any toxicity (excluding alopecia) from prior standard therapy that has not been completely resolved to baseline at the time of consent
5. Subjects with a history of Grade 3 or greater thromboembolic events in the prior 12 months or thromboembolic event of any grade with ongoing symptoms
6. Subjects with prior history of myocardial infarction, transient ischemic attack, congestive heart failure ≥ Class 3 based on New York Heart Association Functional Classification or stroke within the past 3 months prior to the scheduled first dose of study treatment
7. Active or prior documented autoimmune disorders within the past 3 years prior to the scheduled first dose of study treatment
8. HIV, Hep A, B, or C
9. History of primary immunodeficiency, solid organ transplantation, or active tuberculosis
10. Other invasive malignancy within 2 years
11. Known allergy or hypersensitivity to investigational product formulations
12. History of more than one event of infusion related reactions (IRR) requiring permanent discontinuation of IV drug treatment
13. Active grade 3 or greater edema
14. Uncontrolled intercurrent illness
15. Any history of leptomeningeal disease or cord compression
16. Untreated CNS metastatic disease.
17. Current or prior use of immunosuppressive medication within 14 days prior to the scheduled first dose of study treatment.
18. Receipt of live, attenuated vaccine within 30 days prior to the scheduled first dose of study treatment
19. Major surgery within 28 days prior to scheduled first dose of study treatment or still recovering from prior surgery
20. Females who are pregnant, lactating, or intend to become pregnant during their participation in the study
21. Subjects who are involuntarily incarcerated or are unable to willingly provide consent or are unable to comply with the protocol procedures
22. Any condition that, in the opinion of the investigator, would interfere with safe administration or evaluation of the investigational products or interpretation of subject safety or study results

Primary outcomes:
measure: cfMeDIP-seq-based assays of blood samples collected serially on study. Association between cfMeDIP and Toxicity (defined as ≥ Grade 2 immune- adverse event (AE) as per CTCAE 5.0)
timeFrame: 2 years
measure: Objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
timeFrame: 2 years
measure: Disease control rate (DCR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
timeFrame: 2 years
measure: Duration of response (DoR)
timeFrame: 2 years
Secondary outcomes:
measure: Incidence of treatment-emergent adverse events (AEs)
timeFrame: 2 years
measure: Overall survival (OS)
timeFrame: 2 years
measure: Relapse-free survival (RFS)
timeFrame: 2 years
measure: Progression-free survival (PFS)
timeFrame: 2 years
measure: Pathological response rate in "Window" cohorts
timeFrame: 2 years
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: Princess Margaret Cancer Centre
state: Ontario
Study officials:
affiliation: Princess Margaret Cancer Centre
name: Lillian Siu, MD
role: PRINCIPAL_INVESTIGATOR
References: