Study of AZD0754 in Participants With Metastatic Prostate Cancer

Metastatic Prostate Cancer Clinical Trial

— APOLLO  

Official title:

A Phase I/II Open Label Study to Evaluate the Safety, Cellular Kinetics, and Efficacy of AZD0754, a Chimeric Antigen Receptor (CAR) T-cell Therapy Directed Against STEAP2, in Adult Participants With Metastatic Prostate Cancer: APOLLO

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06267729
• Other study ID #: D9660C00001
• Status: Recruiting
• Phase: Phase 1/Phase 2
• Start date: March 12, 2024
• Est. completion date: May 24, 2027

Study information

• Verified date: May 2024
• Source: AstraZeneca
• Contact: AstraZeneca Clinical Study Information Center
• Phone: 1-877-240-9479
• Email: information.center[@]astrazeneca.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate the safety, tolerability, and antitumour activity of AZD0754 CAR T-cell therapy in participants with metastatic prostate cancer.

Description:

This is a first-time in human, multi-center, open label, Phase I/II study of AZD0754 autologous CAR T-cell therapy administered intravenously to participants with metastatic prostate cancer. The study is intended to assess the safety, cellular kinetics, pharmacodynamics, preliminary efficacy, and feasibility of manufacturing AZD0754 for patients with metastatic prostate cancer.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 60
• Est. completion date: May 24, 2027
• Est. primary completion date: May 24, 2027
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years to 130 Years

Eligibility

Inclusion Criteria:

Age

1. Participant must be 18 years or older at the time of signing the informed consent form.

Type of Participant and Disease Characteristics

2. Participants with:

1. A histologically confirmed diagnosis of metastatic adenocarcinoma of the prostate without known neuroendocrine differentiation or small cell features.

2. Castration-resistant prostate cancer as defined by disease progression despite castration by orchiectomy or ongoing luteinising hormone-releasing hormone analogue. Participants receiving medical castration therapy with gonadotropin releasing hormone analogues should continue this treatment during the study.

3. Measurable PSA >/=1 ng/mL AND

4. Evidence of progression within 6 months prior to screening according to one of the following:

(i) Radiographic disease progression in soft tissue based on Response Evaluation Criteria in Solid Tumours Version 1.1 criteria with or without PSA progression as per Prostate Cancer Working Group Criteria 3 (PCWG3) (ii) Radiographic disease progression in bone defined as the appearance of 2 or more new bone lesions on bone scan as per Prostate Cancer Working Group Criteria 3 (PCWG3).

3. Participant has previously received a NHA (ie, abiraterone, enzalutamide, apalutamide, darolutamide) and taxane as part of their treatment for prostate cancer (whether before or in the metastatic castration-resistant setting) or be ineligible for or refuse taxanes.

4. For participants with HRR deficiency disease or breast cancer gene mutated disease, they disease must also have received a PARP inhibitor or be intolerant of this therapy.

5. For participants who have high microsatellite instability or deficient DNA mismatch repair they must also have received at least one line of checkpoint inhibitors (ie, pembrolizumab), not be eligible for, or be intolerant to therapy as per NCCN or local treatment guidelines.

6. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 prior to apheresis.

7. Minimum life expectancy of > 12 weeks prior to apheresis in the opinion of the Investigator

8. Adequate organ and marrow function.

9. Consent and provision of tumour material to assess STEAP2 expression and other correlative biomarkers retrospectively with pre- and post-treatment biopsies. Fresh baseline and on-treatment biopsies are required unless these are deemed medically unfeasible. If the participant is unable to undergo fresh biopsy, an archival tumour sample will be required (age of biopsy cannot be greater than 10 years).

Exclusion Criteria:

1. Participants with weight less than 42 kg

2. History of another primary malignancy except for malignancy treated with curative intent with no known active disease (= 2 years) before the first dose of study intervention and of low potential risk for recurrence. Such exceptions include non-melanoma cancer of the skin that has undergone curative therapy or adequately treated carcinoma in situ without evidence of disease.

3. Participants with known brain metastases.

4. Prior solid organ transplantation.

5. Active or prior documented autoimmune or inflammatory disorders (including but not limited to inflammatory bowel disease [eg, colitis, Crohn's disease], diverticulitis, systemic lupus erythematosus, Wegener's syndrome, myasthenia gravis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, autoimmune pneumonitis, autoimmune nephritis, or nephropathy, etc). The following are exceptions to this criterion:

1. Participants with vitiligo or autoimmune alopecia.

2. Participants with autoimmune hypothyroidism (eg, following Hashimoto thyroiditis) stable on hormone replacement.

3. Any chronic inflammatory or autoimmune skin condition that does not require systemic therapy.

4. Participants without active disease in the last 5 years may be included, but only after consultation with the Sponsor.

5. Participants with coeliac disease controlled by diet alone.

6. Stroke, intracranial haemorrhage, or seizure within 6 months of apheresis.

7. Cardiac arrhythmias, (such as multifocal premature ventricular contractions, bigeminy, trigeminy, ventricular tachycardia), which are symptomatic or require treatment (Common Terminology Criteria for Adverse Events [CTCAE] Grade 3) unless controlled by pacemaker (discussion with the Study Physician required); symptomatic or uncontrolled atrial fibrillation despite treatment, or asymptomatic sustained ventricular tachycardia.

8. Investigator judgement of one or more of the following:

1. Mean resting corrected QT interval > 470 ms, obtained from triplicate electrocardiograms (ECGs) performed at screening.

2. History of QT prolongation associated with other medications that required discontinuation of that medication, or any current concomitant medication known to prolong the QT interval.

3. Congenital long QT syndrome, family history of long QT syndrome, or unexplained sudden death under 40 years of age in first-degree relatives.

9. Uncontrolled intercurrent illness including, but not limited to, ongoing or active known infection, cardiomyopathy of any aetiology, symptomatic congestive heart failure defined by New York Heart Association class = 3), interstitial lung disease, uncontrolled hypertension, uncontrolled diabetes mellitus, unstable angina pectoris, history of myocardial infarction within the past 6 months prior to apheresis.

10. Active, uncontrolled epilepsy. Participants without active/uncontrolled epilepsy in the last 5 years may be included.

11. Persistent toxicities (CTCAE Grade = 2) caused by previous anticancer therapy, excluding alopecia. Participants with irreversible toxicity that is not reasonably expected to be exacerbated by study intervention may be included (eg, hearing loss) after consultation with the Study Physician or Medical Monitor. Participants with Grade 2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician or Medical Monitor.

12. Seropositive for human immunodeficiency virus (HIV).

13. Active hepatitis C infection (HCV). Participants testing positive for HCV antibody are eligible only if the polymerase chain reaction is negative for HCV RNA.

14. Participants with hepatitis B virus (HBV) may be included under the following circumstances:

1. Negative for hepatitis B surface antigen (HbsAg) and positive for anti-HBc antibody

2. Positive for HbsAg, but for > 6 months have had normal transaminases and HBV DNA levels between 0 - 2000 IU/mL (inactive carrier state) and willing to start and maintain antiviral treatment for at least the duration of the study.

3. HBV DNA levels > 2000 IU/mL but on prophylactic antiviral treatment for the past 3 months and will maintain the antiviral treatment during the study.

15. Local requirements for the testing for infectious diseases and exclusions of applicable participants should be followed per local regulations.

Prior/Concomitant Therapy

16. Participants may not receive full-dose long acting oral or parenteral anticoagulants or thrombolytic agents for therapeutic (as opposed to prophylactic) purpose from the time of informed consent to 28-days post infusion of AZD0754. Use of short acting direct oral anticoagulants for therapeutic and prophylactic purposes are permitted.

17. Any concomitant medications known to be associated with Torsades de Points within 14 days prior and 28 days after AZD0754 infusion.

18. Received the following:

1. Major surgery within 2 weeks prior to apheresis, or planned major surgery within 4 weeks of the study treatment administration (Note: participants with planned surgical procedures to be conducted under local anaesthesia may participate after discussion with the Sponsor).

2. Steroids (except inhaled steroids) or other immunomodulators (including interleukins, interferons, and thymosins) of systemic therapeutic dose, and systemic corticosteroids at doses exceeding 10 mg/day of prednisone or equivalent < 7 days prior to apheresis.

19. Receipt of the last dose of anticancer therapy (chemotherapy, immunotherapy, endocrine therapy targeted therapy, biologic therapy, tumour embolisation, or monoclonal antibodies, investigational product) within 5 half-lives or = 21 days (whichever is shorter) prior to apheresis. Radiotherapy within 14 days. However, if the radiation portal covered = 5% of the bone marrow reserve, the participant is eligible irrespective of the end date of radiotherapy. If sufficient washout time has not occurred due to the schedule or PK properties of an agent, a longer washout period will be required, as agreed by AstraZeneca and the Investigator.

20. Any concurrent anticancer treatment with the following exceptions:

1. Protocol-defined LDC

2. Hormonal therapy for non cancer-related conditions (eg, hormone replacement therapy)

3. Androgen deprivation therapy with a luteinising-hormone replacement hormone agonist/antagonist is required if needed to maintain testosterone level in the castration range (levels < 50 ng/dL) and should be continued (unless bilateral orchiectomy) throughout the trial. Following apheresis, bridging therapy is permitted (if required) as outlined in Section 6.1.2

21. Participants should not have received any live vaccines within 30 days prior to apheresis. Participants can receive coronavirus (COVID)-19 vaccines, at the discretion of the Investigator, following a benefit/risk evaluation for the individual participant and in accordance with local rules and regulations and vaccination guidelines. Note: If a COVID-19 vaccine is administered, it should ideally be done at least one week prior to LDC or after completion of the DLT period.

Prior/Concurrent Clinical Study Experience

22. Prior treatment with a CAR-T therapy directed at any target or any therapy that is targeted to STEAP2.

23. Participants with a known life-threatening allergy, hypersensitivity, or intolerance to AZD0754 or any of the excipients of the product, including dimethylsulfoxide.

Related Conditions & MeSH terms

• Metastatic Prostate Cancer
• Prostatic Neoplasms

Intervention

Biological:
• AZD0754
Subjects will undergo leukapheresis to isolate peripheral blood mononuclear cells (PBMCs) to produce AZD0754. During AZD0754 production, subjects may receive bridging therapy for disease control. Upon successful generation of AZD0754 product, subjects will receive treatment with AZD0754 therapy. Study treatment will include lymphodepleting chemotherapy followed by one dose of AZD0754 administered by intravenous (IV) infusion.

Locations

Country	Name	City	State
Australia	Research Site	East Melbourne
United States	Research Site	Atlanta	Georgia
United States	Research Site	Duarte	California
United States	Research Site	Hackensack	New Jersey
United States	Research Site	Houston	Texas
United States	Research Site	New York	New York
United States	Research Site	Philadelphia	Pennsylvania
United States	Research Site	Saint Louis	Missouri
United States	Research Site	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
AstraZeneca

Countries where clinical trial is conducted

United States,  Australia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Incidence of participants with Dose-limiting Toxicity (DLTs)/DLT-like events, Adverse Events (AEs), including Adverse Events of Special Interest (AESIs) and Serious Adverse Events (SAEs).	Determine if treatment with AZD0754 is safe and tolerable through assessment of DLTs/DLT-like events, AEs, AESIs, SAEs, and changes from baseline in laboratory parameters, vital signs, and ECGs.	Through study completion, an average of 2 years
Primary	Presence of replication-competent lentivirus (RCL) in peripheral blood samples	Number of patients with positive RCL sample	Through study completion, an average of 2 years
Secondary	Prostate-specific antigen (PSA) response rate - PSA50	PSA50 response rate is defined as the proportion of participants achieving a = 50% decrease in PSA from baseline to the lowest post-baseline PSA result, confirmed by a second consecutive PSA assessment at least 3 weeks later.	Through study completion, an average of 2 years
Secondary	PSA response rate - PSA90	PSA90 response rate is defined as the proportion of participants achieving a = 90% decrease in PSA from baseline to the lowest post-baseline PSA result, confirmed by a second consecutive PSA assessment at least 3 weeks later.	Through study completion, an average of 2 years
Secondary	Duration of PSA Response (DoPSA50, DoPSA90)	Time from the date of first documented PSA50 and PSA90 until the date of documented PSA progression or death due to any cause in the absence of PSA progression.	Through study completion, an average of 2 years
Secondary	Durable PSA Response Rate (DRRPSA50, DRRPSA90)	Percentage of participants who have a confirmed PSA50 and PSA90 response with a duration of at least 6 months.	Through study completion, an average of 2 years
Secondary	Time to PSA Response (TTPSA50, TTPSA90)	Time from AZD0754 infusion date until the date of the first documented PSA50 and PSA90 response.	Through study completion, an average of 2 years
Secondary	Time to PSA Progression (TTPSAP50, TTPSAP90)	Time from the date of first documented PSA50 and PSA90 response until the date of documented PSA progression.	Through study completion, an average of 2 years
Secondary	Best Overall Response (BOR)	Best overall radiological visit response the participant achieves per RECIST V1.1 and PCWG3.	Through study completion, an average of 2 years
Secondary	Objective Response Rate (ORR)	Percentage of participants with a confirmed Complete Response (CR) or Partial Response (PR).	Through study completion, an average of 2 years
Secondary	Time to Response (TTR)	Time from AZD0754 infusion date until date of first documented evidence of CR or PR.	Through study completion, an average of 2 years
Secondary	Duration of Response (DoR)	Time from the date of first documented evidence of CR or PR until date of first documented disease progression or death.	Through study completion, an average of 2 years
Secondary	Durable Response Rate (DRR)	Percentage of participants who have a confirmed response (CR/PR) with a duration of at least 6 months.	Through study completion, an average of 2 years
Secondary	Disease Control Rate (DCR)	Percentage of participants who have a confirmed CR, PR, or Stable Disease (SD) for at least 11 and 23 weeks after AZD0754 infusion.	12 and 24 weeks after AZD0754 infusion
Secondary	Percentage change in tumor size	Percentage change in tumor size from baseline per RECIST V1.1 and PCWG3.	Through study completion, an average of 2 years
Secondary	Radiographic Progression-free Survival (rPFS)	Time from AZD0754 infusion until date of objective disease progression according to RECIST V1.1 and PCWG3 criteria.	Through study completion, an average of 2 years
Secondary	Overall Survival (OS)	Time from AZD0754 infusion until death due to any cause	Through study completion, an average of 2 years
Secondary	Time from AZD0754 Infusion to the first Symptomatic Skeletal-related Events (SSRE)	Time from AZD0754 Infusion to the first Symptomatic Skeletal-related Event (SSRE).	Through study completion, an average of 2 years
Secondary	Pharmacokinetics - maximum observed serum concentration (Cmax) of AZD0754	Maximum observed serum concentration	Through study completion, an average of 2 years
Secondary	Pharmacokinetics - time taken to reach maximum serum concentration (Tmax) of AZD0754	Time taken to reach maximum serum concentration	Through study completion, an average of 2 years
Secondary	Pharmacokinetics - Last measurable serum concentration (Clast) of AZD0754	Last measurable serum concentration	Through study completion, an average of 2 years
Secondary	Pharmacokinetics - time of last measurable serum concentration (Tlast) of AZD0754	Time of last measurable serum concentration	Through study completion, an average of 2 years
Secondary	Pharmacokinetics - Exposure of AZD0754	Area Under the concentration time curve	Through study completion, an average of 2 years
Secondary	Biomarker - STEAP2 expression in Tumor	Investigate STEAP2 expression in tumor as measured by IHC.	Through study completion, an average of 2 years