Efficacy and Safety Study of OMTX705, Monotherapy and Pembrolizumab-combined, in Subjects With Advanced Solid Tumors.

Advanced Solid Tumor Clinical Trial

Official title:

Phase 1 Dose-escalation Trial of OMTX705, an Anti-fibroblast Activation Protein Antibody-drug Conjugate, as Single Agent and in Combination With Pembrolizumab in Patients With Advanced Solid Tumors

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05547321
• Other study ID #: OMTX705-001
• Status: Recruiting
• Phase: Phase 1
• Start date: October 20, 2022
• Est. completion date: October 2024

Study information

• Verified date: October 2023
• Source: Oncomatryx Biopharma S.L.
• Contact: Ignacio García-Ribas, MD
• Phone: +34 649450384
• Email: igarcia[@]oncomatryx.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Open-label, two parallel arm, multicenter, Phase 1 dose-escalation study to evaluate the safety and tolerability of OMTX705, both as monotherapy or in combination with pembrolizumab in the treatment of patients with advanced or metastatic cancer in whom there is no available standard therapeutic option.

Description:

The study consists of 2 parts: - Part 1: Phase 1 dose-escalation with 2 parallel staggered escalation cohorts: one cohort of patients treated with OMTX705 as monotherapy and one cohort of patients receiving escalating doses of OMTX705 in combination with standard pembrolizumab. The combination arm will start once OMTX705 monotherapy safety has been evaluated. - Part 2: Up to 4 cohort expansions to confirm the safety of OMTX705 as monotherapy and in combination with pembrolizumab and will provide additional efficacy information. The classical 3+3 design will be followed to establish the maximum tolerated dose (MTD) or the provisional recommended dose for the expansion phase. Three to six patients per treatment cohort will be assigned to receive sequentially higher doses of OMTX705 on Days 1 and 8 in cycles of 21 days. The OMTX705 starting dose is 1.0 mg/kg Dose escalation will be based on a review of all parameters critical to subject safety from C1D1 to the start of C2D1. A safety report will be reviewed by the safty review committee (SRC) to determine if progression to the next planned dose level should occur or if additional subjects or lower dose levels are needed. Expansion phase (Part 2): Once MTD is identified, or if another dose is identified because observed efficacy, non-DLT safety, or because a dose is supported by the PK/PD model under development, a provisional recommended Phase 2 dose (RP2D) will be selected by the sponsor and SRC for cohort expansion. Up to 4 cohort expansions of up to 15 patients each will proceed to confirm the safety and for initial assessment of anti-tumor activity. Each expansion cohort can be enriched with patients with advanced/metastatic cancer with no therapeutic standard alternative indications in which antitumor activity has been observed during the escalation phase. The final decision on the expansion cohort enrichment will be made by the sponsor with the support of the SRC. After treatment discontinuation, patients will have the EoT visit 30 (±2) days after the last dose of any component of the treatment for the evaluation of new AEs or recovery from previous ones. EoT visit can be anticipated for patients scheduled to receive the next line of systemic treatment to the day of the start of the new therapy if this happens less than 30 days after the last dose of study treatment. Subjects who discontinue study treatment for reasons other than progressive disease (PD) will continue to attend PFS Follow-up (FU) Visits every 12 (±1) weeks from the EoT Visit until the occurrence of PD, loss to follow up, consent withdrawal, death, the start of subsequent systemic antineoplastic therapy, or study termination, whichever occurs first. Only patients enrolled in Part 2 will be followed for survival. To assess survival status, subjects will be contacted (which may be by phone or hospital visit, whichever is preferable) every 3 months from the first dose of OMTX705.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 120
• Est. completion date: October 2024
• Est. primary completion date: October 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Male and female patient aged 18 years and older.

2. Part 1 and 2, monotherapy and combination: Patients with histologically confirmed advanced (locoregionally recurrent, not amenable to curative therapy) or metastatic solid tumors that have no standard therapeutic option with a proven clinical benefit, or are intolerant to these therapies with the following selected tumor histologies: pancreatic ductal adenocarcinoma (PDAC), gastric cancer (including gastroesophageal junction tumors), head and neck squamous-cell carcinoma (HNSCC), esophageal cancer, non-small cell lung cancer (NSCLC), high grade serious ovarian cancer (HGSOC), breast cancer (BC), colorectal cancer (CRC), and leiomyosarcoma.

3. Subjects with tumors with actionable mutations should have progress to all approved targeted therapies or have them contraindicated.

4. Measurable disease by RECIST 1.1 on CT, PET/CT or MRI scan.

5. ECOG performance status 0-1

6. Serum albumin =3.0 g/dL

7. Adequate bone marrow, hepatic and renal function:

1. Total bilirubin =1.5 times upper limit of normal (ULN).

2. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =2.5 times ULN, (if liver metastases are present, then =5 times ULN is allowed).

3. For Dose escalation Phase: Estimated creatinine clearance (CrCL) using the Cockcroft-Gault formula =60 mL/minute. Patients with calculated CrCL <60 mL/min can be enrolled if measured CrCL is =60 mL/min.

4. In the expansion phase CrCL should be =30 mL/min.

5. Hemoglobin =9 g/dL (whole or partial blood transfusions not allowed in the 2 previous weeks).

6. Absolute neutrophil count (ANC) =1.5 x 109/L (growth factors like G-CSF are not allowed in the 2 previous weeks).

7. Platelet count =75 x 109/L (platelet in the 2 previous weeks transfusions not allowed)

8. Women of childbearing potential (WOCBP) and men with sexual partners who are WOCBP must be willing to adhere to contraceptive requirements as detailed in the protocol from at least 1 month prior to study entry to at least 4 months after the last dose of study treatment.

9. Suitable venous access for safe drug administration and the study-required drug concentration and pharmacodynamic sampling.

Exclusion Criteria:

1. Treatment with systemic anticancer treatments, investigational products, or major surgery within 4 weeks before the first dose of study drug or 5 half-lives, whichever is shorter. Subjects should have recovered from previous treatment toxicity to grade 1, baseline (except alopecia and peripheral neuropathy). Patients with endocrinopathies should have the replacement treatment in stable dosing.

2. History of uncontrolled brain metastasis. For asymptomatic subjects, screening brain imaging is not required.

3. Subject has received extended field radiotherapy =4 weeks before the start of treatment (=1 weeks for limited field radiation for palliation), and who has not recovered to grade 1 or better from related side effects of such therapy (except for alopecia).

4. Active infection requiring parenteral or oral antibiotics.

5. Evidence of serious uncontrolled medical disorder that, in the opinion of the investigator or medical monitor, makes it unwise for the subject to participate in the study or that might jeopardize compliance with the protocol.

6. Drainage of ascitic or pleural fluid 2 or more times in the 4 weeks prior to the first dose of study drug or permanent drain in place for ascites or pleural effusion symptom management.

7. Psychiatric illness/social circumstances that would limit compliance with study requirements and substantially increase the risk of AEs or has compromised ability to provide written informed consent.

8. Clinical evidence of an active second invasive malignancy with the exception of stable prostate cancer on watchful waiting, in situ cervical cancer, breast ductal carcinoma in situ or localized non-melanoma skin cancers.

9. Uncontrolled or significant cardiovascular disease defined as NYHA classification III or IV.

10. Baseline QTc (using the Fridericia correction calculation) > 470 msec.

11. Combination with pembrolizumab only: history of autoimmune disease requiring systemic immunosuppressive therapy (daily prednisone equivalent doses >10 mg/day).

12. Combination with pembrolizumab only: Subjects who, according to the currently approved Keytruda® (pembrolizumab) USPI/SmPC, had, with a previous checkpoint inhibitor (approved or investigational) treatment, an immune-related adverse event (irAE) for which permanent discontinuation is mandated (any grade 4 event and grade 3 events of pneumonitis, hepatitis, and nephritis). Also, subjects without formal contraindication due to previous irAE are not eligible if the AE has not resolved to grade 1 or better and/or still requires steroids (>10 mg of prednisone equivalent per day) for ongoing management.

13. Combination with pembrolizumab only: patients with a history of pneumonitis/interstitial lung disease, patients who received live vaccines within 30 days of enrollment, and patients who discontinued prior immune checkpoint inhibitors due to Grade 2 myocarditis are excluded from enrollment into pembrolizumab-containing cohorts.

14. Known hepatitis B virus surface antigen seropositive or detectable hepatitis C infection viral load.

15. Patients positive for human immunodeficiency virus (HIV) are NOT excluded from this

study, but HIV-positive patients must meet the following criteria:

1. have CD4+ T-cell (CD4+) counts =350 cells/µL.

2. have not had an opportunistic infection within the past 12 months. Patients on prophylactic antimicrobials can be included in the trial.

3. should be on established antiretroviral therapy for at least 4 weeks.

4. have an HIV viral load less than 400 copies/mL prior to enrollment.

5. known history of any other relevant congenital or acquired immunodeficiency other than HIV infection.

16. Known or suspected allergy to study treatment or related products, and specifically patients with a prior history of life-threatening reaction to polysorbate 20.

17. Women who are pregnant or breastfeeding or trying to become pregnant.

18. Male patients wishing fathering children, planning for future sperm banking, or expressing concerns about sterility.

19. Patients requiring the concomitant administration of medications that are strong inhibitors or inducers of CYP3A4, 2D6, 1A2, 2C9, 2B6, and 2C19. In case they are taking any of these drugs, they should be stopped at least 14 days prior to first dose.

Related Conditions & MeSH terms

• Advanced Solid Tumor
• Neoplasms

Intervention

Drug:
• OMTX705
The investigational product is OMTX705 administered as monotherapy.
• Pembrolizumab
The investigational product is OMTX705 administered in combination with pembrolizumab.

Locations

Country	Name	City	State
Spain	Hospital Universitari Vall d'Hebron	Barcelona
Spain	ICO L'Hospitalet	L'Hospitalet de Llobregat	Barcelona
Spain	Hospital 12 Octubre	Madrid
Spain	Hospital MD Anderson	Madrid
Spain	Clínica Universitaria de Navarra	Pamplona	Navarra
Spain	Hospital Universitario de Donostia	San Sebastián	Guipúzcoa
Spain	Onkologikoa	San Sebastián
United States	Beth Israel Deaconess Medical Center	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Oncomatryx Biopharma S.L.

Countries where clinical trial is conducted

United States,  Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Evaluation of standard cancer serum biomarkers	By measuring the change in circulating cancer blood biomarkers prior and after using OMTX705 as monotherapy and in combination with pembrolizumab	Through study completion, an average of 24 months
Other	Evaluation of OMTX705 biomarkers	By measuring the changes in circulating OMTX705 biomarkers prior and after using OMTX705 as monotherapy and in combination with pembrolizumab	Through study completion, an average of 24 months.
Other	Evaluation of OMTX705 payload metabolites	By quantifying OMTX705 payload TAM470 metabolites prior and after using OMTX705 as monotherapy and in combination with pembrolizumab.	Through study completion, an average of 24 months.
Other	Evaluation of QTc prolongation	By performing electrocardiography (ECG) pre and at the end of the drug infusion.	Through study completion, an average of 24 months.
Other	Evaluation of cancer-associated fibroblasts (CAFs).	By measuring the changes of CAFs and inmune cells in plasma samples prior and after using OMTX705 as monotherapy and in combination with pembrolizumab.	Through study completion, an average of 24 months
Other	Evaluation of clinical efficacy of OMTX705 in combination with pembrolizumab	By assessing the objective response rate (ORR) [complete response (CR) + partial response (PR)] per the Response Evaluation Criteria in Solid Tumors scale version 1.1 (RECIST 1.1)	Through study completion, an average of 24 months
Primary	Safety evaluation of OMTX705	Frequency by grade of treatment-emergent adverse events (TEAEs).	Through study completion, an average of 24 months
Secondary	Evaluation of the preliminary signs of antitumor activity of OMTX705 as monotherapy and in combination with pembrolizumab	By assessing the objective response rate (ORR) [complete response (CR) + partial response (PR)] per the Response Evaluation Criteria in Solid Tumors scale version 1.1 (RECIST 1.1)	Through study completion, an average of 24 months
Secondary	Evaluation of the OMTX705 Pharmacokinetics	By assessing plasma drug concentrations of OMTX705 as monotherapy and with pembrolizumab, with Ultra-High-Performance Liquid Chromatography (UPLC-MS/MS) and immunosorbent assay (ELISA) methods	Through study completion, an average of 24 months
Secondary	Evaluation of OMTX705 Immunogenicity	By quantifying the formation of anti-drug antibodies (ADAs) with Meso Scale Discovery (MSD) immunoassay method.	Through study completion, an average of 24 months.