Primary objective: To evaluate the safety and tolerability of GSK1795091 when administered in combination with either GSK3174998, GSK3359609, orpembrolizumab.Secondary objectives: * To evaluate the antitumor activity of GSK1795091 when administered…
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
Advanced Solid Tumors
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
AEs, SAEs, DLTs, withdrawals due to AEs, dose reductions or delays, and changes
in safety assessments (e.g., laboratory parameters, vital signs, and cardiac
parameters).
Secondary outcome
-Objective response rate (ORR) and disease control rate (DCR)
(complete response [CR]+ partial response [PR]+ stable disease [SD] *
12 weeks), time to response, duration of response, progression-free
survival (PFS), and overall survival.
- GSK1795091 concentrations in plasma and assessment of PK
parameters (e.g., maximum observed concentration [Cmax], AUC(0-*)
and trough plasma concentration [Ctrough]) if data permit.
- Number and percentage of participants who develop detectable antidrug
antibodies against GSK3174998, GSK3359609, or pembrolizumab.
Background summary
The combination of two or more immunotherapies holds promise in treating
patients with cancer. One model of a *cancer-immune cycle* describes a series
of feed- forward steps by which the immune system recognizes and kills tumor
cells, a cycle which is counterbalanced by tumor and host derived factors which
suppress anti-tumor immune activation [Chen, 2013; Chen, 2017]. These steps
include:
- Release of cancer cell antigens
- Cancer antigen presentation
- Priming and activation
- Trafficking of T-cells to tumors
- Infiltration of T-cells into tumors
- Recognition of cancer cells by T-cells
- Killing of cancer cells
Rational combination strategies, such as immunotherapies acting at different
steps in the immune cycle, could produce meaningful and synergistic activity
compared to monotherapies [Hoos, 2016]. Combining a TLR4 agonist with a
checkpoint modulator, such as an OX40 agonist, targets two complementary steps
in the cancer-immunity cycle; TLR engagement results in the production of
various inflammatory cytokines/chemokines such as tumor necrosis factor
(TNF)alpha, interleukin (IL) 6, granulocyte colony-stimulating factor (G-CSF),
and type I interferons (i.e., IFNalpha, IFN beta) and enhanced uptake,
processing, and presentation of antigens. OX40 agonism is expected to increase
priming and activation of T-cells. Based on nonclinical data, the combination
of GSK1795091 (a TLR4 agonist) and GSK3174998 (an OX40 agonist) is anticipated
to have antitumor activity greater than either of the monotherapies. The
combination will be evaluated for the first time in this clinical study.
Additional combinations will be introduced by protocol amendment.
Study objective
Primary objective:
To evaluate the safety and tolerability of GSK1795091 when administered in
combination with either GSK3174998, GSK3359609, or
pembrolizumab.
Secondary objectives:
* To evaluate the antitumor activity of GSK1795091 when administered in
combination with either GSK3174998, GSK3359609, or
pembrolizumab.
* To characterize the pharmacokinetics (PK) of GSK1795091 when administered in
combination with either GSK3174998, GSK3359609, or
pembrolizumab.
* To evaluate the immunogenicity of GSK3174998, GSK3359609, or pembrolizumab
when administered in combination with GSK1795091.
Study design
This is a Phase I, open-label, non-randomized, multicenter and multi-country
study designed to evaluate the safety, tolerability, PK, pharmacodynamic, and
preliminary clinical activity of GSK1795091 administered in combination with
other immunotherapies to participants with advanced solid tumors.
In Part 1, the safety and tolerability of escalating doses of GSK1795091 and
GSK3174998, GSK3359609, or
pembrolizumab. will be evaluated in participants with advanced solid tumor
cancers according to an Neuenschwander-Continual Reassessment Method (N-CRM)
design to identify doses for evaluation in Part 2 [Neuenschwander, 2008]. Part
1 will include a GSK1795091 run-in period of 2 weeks (i.e., GSK1795091
administration on Days 1 and 8) prior to administration of the combination
beginning at Day 15. Approximately 5 dose levels of GSK1795091 in combination
with a single dose level of GSK3174998, GSK3359609, or
pembrolizumab are planned to be evaluated in Part 1. Following protocol
amendment, GSK1795091 may also be evaluated with additional immunotherapies
and/or by additional routes of administration.
In Part 2, an expansion cohort of approximately 6 to 15 participants with
squamous cell carcinoma of the head and neck will be enrolled to further
evaluate safety and activity of dose identified in Part 1. The dose of
GSK1795091 administered with GSK3174998, GSK3359609, or
pembrolizumab. will be determined based on data from Part 1. Following
protocol amendment, additional expansion cohorts in other tumor types may be
enrolled, based on emerging nonclinical and clinical data.
In addition, a PK/Pharmacodynamic cohort will be opened to enrollment during
Part 1 to obtain additional PK and pharmacodynamic data, with an emphasis to
obtain insight on the potential impact of the combination treatments on the
immune cells and status of the tumor microenvironment, in conjunction with PK
and pharmacodynamic markers obtained from blood. Tumor biopsies are required
for enrollment to the PK/Pharmacodynamic cohort, whereas biopsies are strongly
encouraged but not mandatory for Part 1 dose escalation cohorts. Participants
in the PK/Pharmacodynamic cohort may be enrolled to any dose level which has
already been completed and supported by adequate safety and tolerability from
dose escalation. Up to approximately
3 participants per dose level may be enrolled into the PK/Pharmacodynamic
cohort.
Intervention
Patients will be treated with study medicines for up to 2 years. They will
receive study treatment every week from Week 1 through Week 12 (in Part 1) or
till Week 13 (in Part 2) and then every 3 weeks after that.
Furthermore their data of Medical history and demographic data will be
collected They must undergo physical and vital signs examinations. An 12-lead
ECG, Echocardiogram and MRI or CT scans will be made. Tissue samples, blood
and urine will be collected.
Study burden and risks
This is an open-label, dose escalation study and the first study of the
combination of GSK1795091 and GSK3174998, GSK3359609, or
pembrolizumab. conducted in humans; this study will enroll participants with
advanced solid tumors. There is biologic rationale to study this combination
for the treatment of cancer based on complementary modes of action on the
immune system, and GSK1795091 and GSK3174998, GSK3359609, or
pembrolizumab. have antitumor activity when used in combination that exceeds
either agent*s monotherapy activity in preclinical models. However, it is
unknown if the combination will have clinical activity for patients with cancer.
Based on nonclinical in vivo and ex vivo combination evaluations and clinical
experience to date, and the conservative starting dose of GSK1795091, the
safety profile of the combination is not expected to exceed that of monotherapy
GSK3174998 and monotherapy GSK1795091. In contrast to experience to date with
GSK3174998, GSK3359609, or
pembrolizumab. , it is expected that increasing the dose of GSK1795091 past a
certain threshold will be associated with DLTs given the TLR4 agonist mechanism
of action and experience with other TLR agonists including LPS. Consistent
with other Phase 1 trials for the treatment of cancer, a target DLT frequency
has been set as 16-33%, and a Bayesian adaptive dose escalation design is
employed to efficiently determine the dose(s) associated with this DLT
frequency. In addition, it is possible that infrequent events unrelated to
dose, such as increases in hepatic laboratory values, might be observed. This
risk will, in part, be mitigated by a run-in period for GSK1795091 prior to the
initiation of combination study treatment. Overall, the benefit:risk is typical
of a Phase I study of participants with advanced cancer.
Iron Bridge Road, Stockley Park West 1-3
Uxbridge, Middlesex UB11 1BU
GB
Iron Bridge Road, Stockley Park West 1-3
Uxbridge, Middlesex UB11 1BU
GB
Listed location countries
Age
Inclusion criteria
1. Participant must be *18 years of at the time of signing the informed consent.
2. Histological documentation of advanced solid tumor, other than TNBC (defined per ASCO/CAP guidelines) [Hammond, 2010; Wolff, 2013].
3. Archival tumor tissue obtained at any time from the initial diagnosis to study entry. Although a fresh biopsy obtained during screening is preferred, archival tumor specimen is acceptable if it is not feasible to obtain a fresh biopsy.
Note: Participants enrolled in a PK/Pharmacodynamic Cohort must provide a fresh biopsy of a tumour lesion not previously irradiated during the screening period and must agree to provide at least one additional on-treatment biopsy.
4. Disease that has progressed after standard therapies or for which standard therapy is otherwise unsuitable (e.g., intolerance).
5. Measurable disease, i.e., presenting with at least 1 measurable lesion per Response Evaluation Criteria in Solid Tumors (RECIST version 1.1).
6. Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1.
7. Life expectancy of at least 12 weeks.
8. Adequate organ function
9. applicable for France only
10. Male or female
a. Female participants:
A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least 1 of the following conditions applies:
i. Not a woman of childbearing potential (WOCBP)
OR
ii. A WOCBP who agrees to follow the contraceptive guidance
during the treatment period and for at least 120 days after the last dose of study treatment.
11. Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
Additional Inclusion Criteria for Patients in Part 2
12. Histological or cytological documentation of SCCHN (oral cavity, oropharynx, hypopharynx, or larynx) that is recurrent, locally advanced, or metastatic and is not amenable to curative treatment options, surgery or definitive chemoradiation therapy.
13. Received or ineligible for platinum-based therapy and PD-1/PD-L1 therapy.
14. Received no more than 3 prior lines of systemic therapy for metastatic disease.
Exclusion criteria
1. Malignancy other than disease under study with the exception of those from which the participant has been disease-free for more than 2 years and not expected to affect the safety of the participant or the endpoints of the trial.
2. Symptomatic central nervous system (CNS) metastases or asymptomatic CNS metastases that have required steroids within 2 weeks prior to first dose of study treatment.
3. Active autoimmune disease that has required systemic disease modifying or immunosuppressive treatment within the last 2 years.
Note: Replacement therapy (e.g., thyroxine or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is permitted.
4. Concurrent medical condition requiring the use of systemic immunosuppressive treatment within 28 days before the first dose of study treatment.
5. Known human immunodeficiency virus infection.
6. Current unstable liver or biliary disease per investigator assessment defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, oesophageal or gastric varices, persistent jaundice, or cirrhosis.
NOTE: Stable chronic liver disease (including Gilbert*s syndrome or asymptomatic gallstones) or hepatobiliary involvement of malignancy is acceptable if participant otherwise meets entry criteria.
7. Presence of Hepatitis B surface antigen (HBsAg) at screening or within 3 months prior to first dose of study treatment
8. Positive Hepatitis C test result at screening or within 3 months prior to first dose of study treatment.
NOTE: Participants with positive Hepatitis C antibody due to prior resolved disease can be enrolled, only if a confirmatory negative Hepatitis C RNA test is obtained. Participants with negative Hepatitis C antibody test are not required to also undergo Hepatitis C RNA testing
9. QTcF >450 msec or QTcF >480 msec for participants with bundle branch block
The QTcF is the QT interval corrected for heart rate according to Fridericia*s formula, machine-read or manually over-read.
10. Recent history (within the past 6 months) of acute diverticulitis, inflammatory bowel disease, intra-abdominal abscess, or gastrointestinal obstruction.
11. Recent history of allergen desensitization therapy within 4 weeks of starting study treatment.
12. History of severe hypersensitivity to mAbs.
13. History or evidence of cardiovascular (CV) risk including any of the following:
* Recent (within the past 6 months) history of serious uncontrolled cardiac arrhythmia or clinically significant ECG abnormalities including second degree (Type II) or third degree atrioventricular block.
* Cardiomyopathy, myocardial infarction, acute coronary syndromes (including unstable angina pectoris), coronary angioplasty, stenting, or bypass grafting within the past 6 months before enrollment.
* Congestive heart failure (Class II, III, or IV) as defined by the New York
Heart Association functional classification system [NYHA, 1994].
* Recent (within the past 6 months) history of symptomatic pericarditis.
14. History of idiopathic pulmonary fibrosis, pneumonitis, interstitial lung disease, or organizing pneumonia, or evidence of active, non-infectious pneumonitis. Note: post-radiation changes in the lung related to prior radiotherapy and/or asymptomatic radiation-induced pneumonitis not requiring treatment may be permitted if agreed by the investigator and Sponsor.
15. Recent history (within 6 months) of uncontrolled symptomatic ascites or pleural effusions.
16. Any serious and/or unstable pre-existing medical, psychiatric disorder, or other condition that could interfere with the participant*s safety, obtaining informed consent, or compliance to the study procedures.
17. Is or has an immediate family member (e.g., spouse, parent/legal guardian,
sibling or child) who is investigational site or sponsor staff directly involved with this trial, unless prospective Institutional Review Board (IRB) approval (by chair or designee) is given allowing exception to this criterion for a specific participant.
18. Prior treatment with the following agents:
* Tumor necrosis factor receptor (TNFR) agonists, including OX40, CD27, CD137 (4-1BB), CD357 (glucocorticoid-induced TNFR family-related gene) at any time.
* TLR4 agonist at any time.
* Anticancer therapy or investigational therapy within 30 days or 5 half-lives of the drug, whichever is shorter.
* Prior radiation therapy: permissible if at least 1 non-irradiated measurable lesion is available for assessment according to RECIST version 1.1 or if a solitary measurable lesion was irradiated, objective progression is documented. A wash out of at least 14 days before start of study treatment for radiation of any intended use to the extremities for bone metastases and 28 days for radiation to the chest, brain, or visceral organs is required.
19. Prior allogeneic or autologous bone marrow transplantation or other solid organ transplantation.
20. Toxicity from previous treatment including:
* Toxicity Grade *3 related to prior immunotherapy and that lead to study treatment discontinuation.
* Toxicity related to prior treatment has not resolved to Grade *1 (except alopecia, or endocrinopathy managed with replacement therapy).
21. Received transfusion of blood products (including platelets or red blood cells) or administration of colony stimulating factors (including G-CSF, granulocyte- macrophage colony-stimulating factor, and recombinant erythropoietin) within 2 weeks before the first dose of study treatment.
22. Major surgery within 4 weeks before the first dose of study treatment. Participants must have also fully recovered from any surgery (major or minor) and/or its complications before initiating study
treatment.
23. Known drug or alcohol abuse.
24. Receipt of any live vaccine within 4 weeks.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2017-003545-23-NL |
Other | IND136203 |
CCMO | NL64368.031.18 |