Clinical trial NCT02906670: Sym013 (Pan-HER) in Patients With Advanced Epithelial Malignancies
Official title: An Open-label, Multicenter, Phase 1a/2a Trial Investigating the Safety, Tolerability and Antitumor Activity of Multiple Doses of Sym013, a mAb Mixture Targeting EGFR, HER2 and HER3, in Patients With Advanced Epithelial Malignancies
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE1
PHASE2
Conditions: Oncology
Keywords: Epithelial malignancies
Lead sponsor: Symphogen A/S
Sponsor class: INDUSTRY
First posted: 2016-09-20
Enrollment: 32
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 the first study to test Sym013 (Pan-HER) in humans. The primary purpose of this study is to see if Sym013 is safe and effective for patients with advanced epithelial malignancies without available therapeutic options.

Detailed description: This is an open-label, multicenter trial composed of 2 parts in which Sym013 will be evaluated when administered by intravenous infusion in patients with advanced epithelial malignancies without available therapeutic options.

Part 1 is a Phase 1a dose-escalation evaluating weekly (Q1W) and every second week (Q2W) schedules of administration in separate dose-escalation cohorts to determine the recommended phase 2 dose (RP2D) and regimen of Sym013.

Part 2 is a Phase 2a dose-expansion at the RP2D and regimen. Four (4) dose-expansion cohorts will be evaluated in this part of the trial and will be selected based upon findings from Part 1, additional preclinical data, and additional clinical data available at that time from other agents inhibiting these targets. Patients will be entered, depending upon either a defined molecular profile or profiles, or their underlying malignancy, to 1 of 4 corresponding expansion cohorts: Cohort A, Cohort B, Cohort C, or Cohort D.

Eligibility criteria: Inclusion Criteria:

Main inclusion criteria all patients, Part 1 and Part 2:

* Male or female, at least 18 years of age at the time of informed consent
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1
* Life expectancy \>3 months assessed during Screening
* Documented (histologically- or cytologically-proven) epithelial malignancy that is locally advanced or metastatic, having received all therapy known to confer clinical benefit

Additional inclusion criteria applicable to Part 2 ONLY:

* Epithelial malignancy (tumor types to be determined), measurable according to RECIST v1.1 that has been confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) within 4 weeks prior to C1/D1
* Willingness to undergo a pre-and post-dosing biopsy (total of 2 biopsies) from primary or metastatic tumor site(s) considered safe for biopsy

Exclusion Criteria:

* Any antineoplastic agent for the primary malignancy (standard or investigational) without delayed toxicity within 4 weeks or 5 plasma half-lives (whichever is shortest) prior to C1/D1, except nitrosoureas and mitomycin C within 6 weeks prior to C1/D1.
* Part 2 ONLY: Radiotherapy against target lesions within 4 weeks prior to C1/D1, unless there is documented progression of the lesion following radiotherapy
* Immunosuppressive or systemic hormonal therapy (\>10 mg daily prednisone equivalent) within 2 weeks prior to C1/D1 with exceptions
* Use of hematopoietic growth factors within 2 weeks prior to C1/D1
* Active second malignancy or history of another malignancy within the last 3 years, with allowed exceptions
* Central nervous system (CNS) malignancies including:

  1. Primary malignancies of the CNS
  2. Known, untreated CNS or leptomeningeal metastases, or spinal cord compression; patients with any of these not controlled by prior surgery or radiotherapy, or symptoms suggesting CNS metastatic involvement for which treatment is required
* Inadequate recovery from an acute toxicity associated with any prior antineoplastic therapy
* Major surgical procedure within 4 weeks prior to C1/D1 or inadequate recovery from any prior surgical procedure
* Non-healing wounds on any part of the body
* Active thrombosis, or a history of deep vein thrombosis or pulmonary embolism, within 4 weeks prior to C1/D1, unless adequately treated and stable
* Active uncontrolled bleeding or a known bleeding diathesis
* Significant gastrointestinal abnormalities
* Significant cardiovascular disease or condition
* Abnormal hematologic, renal or hepatic function

Primary outcomes:
measure: Part 1: Assess the Safety and Tolerability of Sym013 When Administered Either Q1W or Q2W to Separate Dose-escalation Cohorts of Patients.
timeFrame: 24 months
measure: Part 2: Evaluate the Antitumor Effect of Sym013 When Administered at the RP2D and Regimen to Patients.
timeFrame: 24 months
Secondary outcomes:
measure: Part 1: Determine the RP2D and Regimen of Sym013.
timeFrame: 24 months
measure: Parts 1 and 2: Evaluate the Immunogenicity of Sym013.
timeFrame: 42 months
measure: Parts 1 and 2: Area Under the Concentration-time Curve Extrapolated to Infinity (AUC).
timeFrame: 0, 2, 4, 8, 24, 48, 168 hours and 336 hours if Q2W
measure: Parts 1 and 2: Maximum Concentration (Cmax) and Trough Concentration (Ctrough) - Mean Values.
timeFrame: 0, 2, 4, 8, 24, 48, 168 hours and 336 hours if Q2W
measure: Parts 1 and 2: Time to Reach Maximum Concentration (Tmax).
timeFrame: 0, 2, 4, 8, 24, 48, 168 hours and 336 hours if Q2W
measure: Parts 1 and 2: Elimination Half-life (T½).
timeFrame: 0, 2, 4, 8, 24, 48, 168 hours and 336 hours if Q2W
measure: Parts 1 and 2: Clearance (CL).
timeFrame: 0, 2, 4, 8, 24, 48, 168 hours and 336 hours if Q2W
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Vanderbilt University Medical Center
state: Tennessee
city: San Antonio
country: United States
facility: South Texas Accelerated Research Therapeutics, LLC
state: Texas
city: San Antonio
country: United States
facility: NEXT Oncology
state: Texas
Study officials:
affiliation: Vanderbilt University Medical Center
name: Jordan Berlin, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Berlin J, Tolcher AW, Ding C, Whisenant JG, Horak ID, Wood DL, Nadler PI, Hansen UH, Lantto J, Skartved NJO, Pedersen MW, Patnaik A. First-in-human trial exploring safety, antitumor activity, and pharmacokinetics of Sym013, a recombinant pan-HER antibody mixture, in advanced epithelial malignancies. Invest New Drugs. 2022 Jun;40(3):586-595. doi: 10.1007/s10637-022-01217-7. Epub 2022 Feb 3.