Intratumoral Injection of IP-001 Following Thermal Ablation in Patients With Advanced Solid Tumors.

Advanced Solid Tumors Clinical Trial

Official title:

Intratumoral Injection of IP-001 Following Thermal Ablation in Patients With Advanced Solid Tumors. A Multicenter Phase Ib/IIa Trial With Expansion Cohorts in Melanoma and Soft Tissue Sarcoma Patients.

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT03972436
• Other study ID #: SAKK 66/17
• Status: Not yet recruiting
• Phase: Phase 1/Phase 2
• Start date: August 1, 2019
• Est. completion date: December 31, 2023

Study information

• Verified date: May 2019
• Source: Swiss Group for Clinical Cancer Research
• Contact: Katrin Eckhardt, PhD
• Phone: +41 31 389 91 91
• Email: trials[@]sakk.ch
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The therapeutic approach taken by trial SAKK 66/17 is different from those already used in clinical practice and possibly offers patients a therapeutic benefit after failure of standard chemotherapy and immunotherapy.

Patients with laser ablation-accessible solid tumors are treated by thermal ablation followed immediately by an injection of IP-001. IP-001 is intended to trigger a tumor-specific systemic immune response when exposed to thermally liberated tumor antigens. There is strong preclinical and early clinical evidence that combining thermal ablation with IP-001 might be able to turn 'cold' tumors into 'hot' tumors, inducing a systemic immune response and resulting in shrinkage of the treated tumor including long-term response mediated by the patient's immunological defense system against any remaining tumor cells (residual primary and metastatic tumor cells) even those that are outside or distant from the treated area.

This trial will provide information on the safety and tolerability of thermal ablation followed immediately by an intratumoral IP-001 injection (Ablation + IP-001) in patients with laser ablation-accessible solid tumors ('all comers', Part 1 - safety run in). Further information on safety and tolerability and as well preliminary antitumor activity will be evaluated in patients with soft tissue sarcoma (Part 2, Cohort1) and addition, in melanoma patients the anti-tumor activity will be defined as a primary objective (Part 2, Cohort 2).

The trial treatment consists of an Ablation + IP-001 in 4-week intervals for up to six scheduled treatments. Thermal ablation will be performed according to the instruction of the medical device and IMP IP-001 will be administered in different dose levels according to the trial design. A follow up of all patients until progression of disease or until start of a subsequent treatment is part of the trial.

Description:

Despite constant progress in the treatment of patients with advanced solid tumors failing standard systemic treatment, there is still a high unmet medical need to develop new active anticancer drugs or therapies. Although patients with advanced melanoma have benefitted substantially from the new checkpoint inhibitors, monoclonal antibodies, etc., those patients progressing after such treatment are still in high need of additional treatment options. In the field of advanced sarcoma, little to no progress has been made in the last years, and chemotherapy is still standard treatment for these patients. The therapeutic approach taken by trial SAKK 66/17 is different from those already used in clinical practice and possibly offers patients a therapeutic benefit after failure of standard chemotherapy and immunotherapy. There is strong preclinical and early clinical evidence that combining thermal ablation with IP-001 might be able to turn 'cold' tumors into 'hot' tumors, inducing a systemic immune response and resulting in shrinkage of the treated tumor including long-term response mediated by the patient's immunological defense system against any remaining tumor cells (residual primary and metastatic tumor cells) even those that are outside or distant from the treated area.

The primary objective of Part 1 is to determine the safety and tolerability of thermal ablation followed immediately by an intratumoral IP-001 injection (Ablation + IP-001) in patients with laser ablation-accessible solid tumors ('all comers').

The primary objective of Part 2 - Cohort 1 (STS) is to further determine the safety and tolerability of thermal ablation followed immediately by an intratumoral IP-001 injection (Ablation + IP-001) in the dose established in Part 1 of the trial.

The primary objective of Part 2 - Cohort 2 (melanoma) of the trial is to define anti-tumor acitivity of thermal ablation followed immediately by an intratumoral IP-001 injection (Ablation + IP-001) utilizing the dose established in Part 1 of the trial.

The secondary objective of the trial is

• to further determine the safety and tolerability of IP-001 (Part 2, Cohort 1 and 2)

• to assess the preliminary anti-tumor activity in STS patients (Part 2, Cohort 1)

• to observe further signs of clinical preliminary anti-tumor activity in patients with melanoma (Part 2, Cohort 2).

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 39
• Est. completion date: December 31, 2023
• Est. primary completion date: June 30, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Written informed consent according to Swiss law and ICH/GCP regulations before registration.

• Part 1: - 'All comer' Patients with either histologically or cytologically confirmed advanced or recurrent solid tumor cancer who failed standard therapy, are not eligible for standard therapy, or for whom no effective standard therapy is available and not requiring fast responses.

• Part 2, Cohort 1 - Sarcoma cohort: Patients with either histologically or cytologically confirmed advanced or recurrent soft tissue sarcoma who failed standard therapy, are not eligible for standard therapy or for whom no effective standard therapy is available.

• Part 2, Cohort 2 - Melanoma cohort: Patients with either histologically or cytologically confirmed advanced or recurrent melanoma who failed standard therapy (including a BRAF inhibitor for BRAF-mutant patients), are not eligible for standard therapy or for whom no effective standard therapy is available and have LDH < ULN.

• Presence of at least one tumor lesion that is laser ablation-accessible, with a minimum size of 1.0 cm and located (typically subcutaneously) that it can be treated with Ablation + IP-001 without risk of skin necrosis or serious damage to other adjacent vital and healthy tissue. This tumor lesion may either belong to the skin, lymph nodes, muscles or subcutaneous tissue.

• Measurable or evaluable disease, determined with the most suitable imaging method (CT, PET-CT or MRI), according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.

• No evidence of CNS progression for at least 4 weeks after completion of CNS-directed therapy as ascertained by clinical examination and brain imaging (MRI or CT) during the screening period.

• Age = 18 years

• WHO performance status 0-2

• Bone marrow function: neutrophil count = 1.5 x 109/L, platelet count = 100 x 109/L, hemoglobin = 90 g/L

• Hepatic function: bilirubin = 1.5 x ULN, aspartate transaminase (AST) and alanine transaminase ALT = 2.5 x ULN (or = 5 x ULN in presence of liver metastasis)

• Renal function: estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73m2 (according to Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) formula)

• Women with child-bearing potential are using effective contraception, are not pregnant or lactating and agree not to become pregnant during trial treatment and for an additional 90 days after the last dose of investigational drug. Women of childbearing potential must have a negative serum human chorionic gonadotropin (hCG) pregnancy test before inclusion.

• Men agree not to donate sperm or to father a child during trial treatment and until 90 days after the last dose of investigational drug.

Exclusion criteria

• Malignant primary brain tumors, or clinically unstable symptoms from brain metastases or leptomeningeal disease, indicative of active disease.

• Patients who have received chemotherapy, radiotherapy, immunotherapy, or concurrent or recent treatment with any other investigational agents within 21 days (7 days for single fraction of palliative radiotherapy, 42 days for nitrosoureas or mitomycin C) prior to registration.

• Patients who have not recovered to = CTCAE grade 1 from all side effects of prior therapies except for residual toxicities, such as alopecia, which do not pose an ongoing medical risk.

• Patients with a previously treated malignancy, when the risk of the prior malignancy interfering with either safety or efficacy endpoints is not very low.

• Patients with prostate cancer must have discontinued anti-androgens (e.g., bicalutamide, nilutamide) for at least 6 weeks prior to registration; chemical castration with luteinizing hormone-releasing hormone analogues must be continued or patients must be surgically castrated.

• Concomitant treatment with systemic corticosteroids (daily dose of 10 mg prednisolone or equivalent is allowed) or other immunosuppressive therapy (e.g. methotrexate).

• Oral anti-coagulation with vitamin K antagonists (e.g. phenprocoumon, warfarin) and heparin, including therapeutically dosed low molecular weight heparins (LMWH) which cannot be stopped 24 hours prior to trial treatment (low dose aspirin allowed) and bleeding diathesis

• Severe or uncontrolled cardiovascular disease (congestive heart failure New York Heart Association classificationIII or IV), unstable angina pectoris, history of myocardial infarction within the last six months, serious arrhythmias requiring medication (with exception of atrial fibrillation or paroxysmal supraventricular tachycardia), significant QT-prolongation, uncontrolled hypertension .

• Known history of human immunodeficiency virus (HIV) or active chronic Hepatitis C or Hepatitis B Viral infection or any uncontrolled active systemic infection (> CTCAE grade 2) requiring intravenous (iv) antimicrobial treatment

• Serious autoimmune disease (e.g. systemic lupus erythematodes) which is judged to reduce an anti-tumor immune response.

• Known allergic reaction to shellfish, crabs, crustaceans, or any trial components, including medical device, used in trial treatment.

• Any other serious underlying medical, psychological, familial or geographical condition, which in the judgment of the investigator may limit compliance with the planned staging, treatment and follow-up, or place the patient at high risk from treatment-related complications.

Related Conditions & MeSH terms

• Advanced Solid Tumors

Intervention

Drug:
• IP-001
Dose and route: Immediately (within 15 - 30 min) after thermal ablation, IP-001 will be injected in and around the ablated lesion. The amount of IP-001 injected depends on the dose level.

Device:
• Thermal Ablation
The medical device includes a laser unit with unique monitoring capabilities. The system continuously measures the temperature of the tissue, guiding the user to perform precise and safe treatments. Treatment time: 30 min

Locations

Country	Name	City	State
Switzerland	Kantonsspital Graubünden	Chur
Switzerland	Centre hospitalier universitaire vaudois CHUV	Lausanne
Switzerland	Kantonsspital St. Gallen	St. Gallen

Sponsors (1)

Lead Sponsor	Collaborator
Swiss Group for Clinical Cancer Research

Country where clinical trial is conducted

Switzerland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Part 1 and Part 2, cohort 1 (expansion cohort - STS) Dose-limiting toxicity (DLT)	The primary endpoint is the frequency of DLTs which are relevant for the determination the tentative RP2D in Part 1 of the trial.	Day 1 to day 28
Primary	Part 2, Cohort 2 (phase IIa - melanoma) Disease control (DC) according to RECIST 1.1	DC is defined as any complete response (CR), partial response (PR) or stable disease (SD) for 12 weeks from start of treatment according to RECIST 1.1 criteria achieved during trial treatment. Any patient with CR, PR or SD (= 12 weeks) as best observed response during trial treatment will be considered as a success; otherwise they will be considered as a failure.; Patients without any response assessment during trial treatment will be regarded as having a non-evaluable response (NE) and thus will be considered as faillures for this endpoint.	up to 12 weeks from treatment start
Secondary	Objective response according to iRECIST (iOR)	iOR is defined as any complete response (CR/iCR) or partial response (PR/iPR) according to RECIST 1.1 or iRECIST criteria achieved during trial treatment until disease progression according to iRECIST, death or subsequent anticancer treatment, whichever occurs first. Any patient with CR/iCR or PR/iPR as best observed response during trial treatment until disease progression according to iRECIST, death or subsequent anticancer treatment (whichever occurs first) will be considered as a success; otherwise they will be considered as a failure.; Patients without any objective response assessment during trial treatment until disease progression according to iRECIST, death or subsequent anticancer treatment (whichever occurs first) will be regarded as having a NE and thus will be considered as faillures for this endpoint.	up to 12 weeks from treatment start
Secondary	Disease control according to iRECIST (iDC)	iDC is defined as any complete response (CR/iCR), partial response (PR/iPR) or stable disease (SD/iSD) for 12 weeks according to RECIST 1.1 or iRECIST criteria achieved during trial treatment until disease progression according to iRECIST, death or start of a subsequent anticancer treatment, whichever occurs first. Any patient with CR/iCR, PR/iPR or SD/iSD (=12 weeks) as best observed response during trial treatment until disease progression according to iRECIST, death or start of a subsequent anticancer treatment (whichever occurs first) will be considered as a success; otherwise they will be considered as a failure.; Patients without any response assessment during trial treatment until disease progression according to iRECIST, death or start of a subsequent anticancer treatment (whichever occurs first) will be regarded as having a NE and thus will be considered as faillures for this endpoint.	up to 12 weeks from treatment start
Secondary	Duration of response according to iRECIST (iDoR)	iDoR is defined as the time from the first documentation of iOR until disease progression according to iRECIST criteria (iPD) or death due to disease progression.; iPD is defined as the time point of first iUPD without subsequent iSD, iPR or iCR before trial treatment discontinuation.; Patients not experiencing an event at the time of the analysis, as well as patients starting a subsequent anticancer treatment in the absence of an event, will be censored at the date of their last available tumor assessment showing no evidence of iPD before starting a subsequent anticancer treatment, if any.	from date of response until date of disease progression according to iRECIST or death due to disease progression, whichever occurs first, assessed up to 4 years
Secondary	Progression-free survival according to iRECIST (iPFS)	iPFS is defined as the time from treatment start until disease progression according to iRECIST criteria (iPD) or death due to any reason, whichever occurs first.; iPD is defined as the time point of first iUPD without subsequent iSD, iPR or iCR before trial treatment discontinuation.; Patients not experiencing an event at the time of the analysis, as well as patients starting a subsequent anticancer treatment in the absence of an event, will be censored at the date of their last available tumor assessment before starting a subsequent anticancer treatment, if any.	from treatment start until date of disease progression according to iRECIST or death due to any reason, whichever occurs first, assessed up to 4 years
Secondary	Objective response (OR) according to RECIST 1.1	OR is defined as any complete response (CR) or partial response (PR) according to RECIST 1.1 criteria achieved during trial treatment. Any patient with CR or PR as best observed response during trial treatment will be considered as a success; otherwise they will be considered as a failure.; Patients without any objective response assessment during trial treatment will be regarded as having a NE and thus will be considered as faillures for this endpoint.	up to 24 weeks from treatment start
Secondary	Disease control (DC) according to RECIST 1.1 (only for Part 2, Cohort 1)	DC is defined as any complete response (CR), partial response (PR) or stable disease (SD) for 12 weeks from registration according to RECIST 1.1 criteria achieved during trial treatment. Any patient with CR, PR or SD (= 12 weeks) as best observed response during trial treatment will be considered as a success; otherwise they will be considered as a failure.; Patients without any response assessment during trial treatment will be regarded as having a NE and thus will be considered as faillures for this endpoint.	up to 24 weeks from treatment start
Secondary	Duration of response (DoR) according to RECIST 1.1	DoR is defined as the time from the first documentation of OR until disease progression according to RECIST 1.1 criteria or death due to disease progression, whichever occurs first.; Patients not experiencing an event at the time of the analysis, as well as patients starting a subsequent anticancer treatment in the absence of an event, will be censored at the date of their last available tumor assessment before starting a subsequent anticancer treatment, if any.	from date of response until date of disease progression according to RECIST 1.1 or death due to disease progression, whichever occurs first, assessed up to 4 years
Secondary	Progression-free survival (PFS) according to RECIST 1.1	PFS is defined as the time from treatment start until disease progression according to RECIST 1.1 criteria or death due to any reason, whichever occurs first.; Patients not experiencing an event at the time of the analysis, as well as patients starting a subsequent anticancer treatment in the absence of an event, will be censored at the date of their last available tumor assessment before starting a subsequent anticancer treatment, if any.	from treatment start until date of disease progression according to RECIST 1.1 or death due to any reason, whichever occurs first, assessed up to 4 years