A Study of TransCon TLR7/8 Agonist With or Without Pembrolizumab in Patients With Advanced or Metastatic Solid Tumors

Advanced Solid Tumor Clinical Trial

Official title:

Phase 1/2, Open-label, Dose Escalation and Dose Expansion Study of TransCon TLR7/8 Agonist Alone or in Combination With Pembrolizumab in Participants With Locally Advanced or Metastatic Solid Tumor Malignancies

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04799054
• Other study ID #: TCTLR-101
• Secondary ID: transcendIT-101
• Status: Recruiting
• Phase: Phase 1/Phase 2
• Start date: March 18, 2021
• Est. completion date: March 2026

Study information

• Verified date: May 2024
• Source: Ascendis Pharma A/S
• Contact: Janet Connolly-Giwa
• Phone: +1 650-512-2153
• Email: jcgt[@]ascendispharma.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

TransCon TLR7/8 Agonist is an investigational drug being developed for treatment of locally advanced or metastatic solid tumors. This Phase 1/2 study will evaluate TransCon TLR7/8 Agonist as monotherapy or in combination with pembrolizumab in dose escalation and dose expansion. Participants will receive intratumoral (IT) injection of TransCon TLR7/8 Agonist every cycle. The primary objectives are to evaluate safety and tolerability, and define the Maximum Tolerated Dose (MTD) and Recommended Phase 2 Dose (RP2D) of TransCon TLR7/8 Agonist alone or in combination with pembrolizumab.

Description:

Toll-like receptors (TLRs) are a class of proteins that play a key role in innate immune cell recognition of foreign pathogens, stimulating innate and adaptive immune responses. TransCon TLR7/8 Agonist is designed as a long-acting localized delivery prodrug of resiquimod, a potent toll-like receptor (TLR) 7/8 agonist, with the potential to prolong high local concentrations of resiquimod and promote potent anti-tumoral responses while reducing systemic drug exposure and related adverse events. TransCon TLR7/8 Agonist is expected to stimulate innate and adaptive immune response in the tumor microenvironment and enhance the activity of checkpoint inhibitors like pembrolizumab.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 220
• Est. completion date: March 2026
• Est. primary completion date: May 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• At least 18 years of age.

• Participants must have histologically confirmed locally advanced, recurrent or metastatic solid tumor malignancies that cannot be treated with curative intent (surgery or radiotherapy).

• Participants must have progressed on or be intolerant of available standard of care treatment options or have disease for which there is no standard of care treatment available, with the exception of participants enrolling to the neoadjuvant cohorts.

• At least 2 lesions of measurable disease, unless specified otherwise in the selection criteria.

• Willingness to undergo biopsies.

• Demonstrated adequate organ function within 28 days of Cycle 1 Day 1 (C1D1).

• Life expectancy >12 weeks as determined by the Investigator.

• Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2.

• Participants who have undergone treatment with anti-PD-1, anti-PD-L1, or antiCTLA 4 antibody must have at least 4 weeks from the last dose of antibody and evidence of disease progression per investigator assessment before enrollment.

• Participants who have previously received an immune checkpoint inhibitor prior to enrollment must have any immune related toxicities resolved to =Grade 1 or baseline (prior to the checkpoint inhibitor) to be eligible.

• Female and male participants of childbearing potential who are sexually active must agree to use highly effective methods of contraception.

Exclusion Criteria:

• Participants who have been previously treated with a TLR agonist (excluding topical agents for unrelated disease) are not eligible.

• Other active malignancies within the last 2 years are excluded.

• Active autoimmune diseases, regardless of need for immunosuppressive treatment at the time of screening, with the exception of patients well controlled on physiologic endocrine replacement.

• Systemic immunosuppressive treatment with the exception for patients on corticosteroid taper (for example, for chronic obstructive pulmonary disease exacerbation). Participants cannot start dosing on study until steroid dose is at or lower than 10 mg per day prednisone or equivalent.

• Women who are breastfeeding or have a positive serum pregnancy test during screening or within 72 hours prior to C1D1 are not eligible.

• Vaccination with live, attenuated vaccines within 4 weeks of enrollment.

• Symptomatic central nervous system metastases.

• Known bleeding disorder that is deemed to place the patient at unacceptable risk for bleeding complications from intratumoral injections or biopsies.

• Known hypersensitivity to any component of TransCon TLR7/8 Agonist or pembrolizumab.

• Any uncontrolled bacterial, fungal, viral, or other infection.

• Treatment with any other anti-cancer systemic treatment (approved or investigational) or radiation therapy within 4 weeks of first dosing on study is not allowed.

• Significant cardiac disease

• A marked baseline prolongation of QT/QTc (corrected QT) interval (e.g., repeated demonstration of a QTc interval >480 ms (National Cancer Institute NCI) Common Terminology Criteria for Adverse Events [CTCAE] grade 1) using Fredericia's QT correction formula.

• A history of additional risk factors for Torsades de Pointes (TdP) (e.g., heart failure, clinically significant hypokalemia, family history of Long QT Syndrome).

• The use of concomitant medications that prolong the QT/QTc interval within 14 days of enrollment.

• Positive for HIV or with active hepatitis B or C infection.

Related Conditions & MeSH terms

• Advanced Solid Tumor
• Carcinoma
• Carcinoma, Squamous Cell
• HPV-associated Cancers
• Locally Advanced Solid Tumor
• Metastatic Solid Tumor
• Neoplasms
• Squamous Cell Carcinoma of Head and Neck

Intervention

Drug:
• TransCon TLR7/8 Agonist
TransCon TLR7/8 Agonist will be administered as an IT injection
• Pembrolizumab
Pembrolizumab will be administered IV

Locations

Country	Name	City	State
Australia	Ascendis Investigational Site	Bedford Park
Australia	Ascendis Pharma Investigational Site	Clayton	Victoria
Australia	Ascendis Pharma Investigational Site	Frankston	Victoria
Australia	Ascendis Pharma Investigational Site	Wollongong	New South Wales
Korea, Republic of	Ascendis Investigational Site	Dalseo-gu
Korea, Republic of	Ascendis Investigational Site	Seocho-gu
Korea, Republic of	Ascendis Investigational Site	Seogu
Korea, Republic of	Ascendis Investigational Site	Seogu
Korea, Republic of	Ascendis Investigational Site	Seongnam
Korea, Republic of	Ascendis Investigational Site	Seoul
Korea, Republic of	Ascendis Investigational Site	Seoul
Korea, Republic of	Ascendis Investigational Site	Seoul
Korea, Republic of	Ascendis Investigational Site	Suwon-si
Korea, Republic of	Ascendis Investigational Site	Suwon-si
Netherlands	Ascendis Investigational Site	Amsterdam
Netherlands	Ascendis Investigational Site	Rotterdam
Spain	Ascendis Investigational Site	Barcelona
Spain	Ascendis Investigational Site	Barcelona
Spain	Ascendis Investigational Site	Barcelona
Spain	Ascendis Investigational Site	Barcelona
Spain	Ascendis Investigational Site	Madrid
Spain	Ascendis Investigational Site	Madrid
Spain	Ascendis Investigational Site	Madrid
Spain	Ascendis Investigational Site	Madrid
Spain	Ascendis Investigational Site	Málaga
Spain	Ascendis Investigational Site	Murcia
Spain	Ascendis Investigational Site	Pamplona
Spain	Ascendis Investigational Site	Sevilla
Spain	Ascendis Investigational Site	Valencia
Taiwan	Ascendis Investigational Site	Tainan
Taiwan	Ascendis Investigational Site	Taipei City
United States	Ascendis Pharma Investigational Site	Canton	Ohio
United States	Ascendis Pharma Investigational Site	Chicago	Illinois
United States	Ascendis Pharma Investigational Site	Cincinnati	Ohio
United States	Ascendis Pharma Investigational Site	Cleveland	Ohio
United States	Ascendis Investigational Site	Dallas	Texas
United States	Ascendis Investigational Site	Dallas	Texas
United States	Ascendis Pharma Investigational Site	Duarte	California
United States	Ascendis Pharma Investigational Site	Fairfax	Virginia
United States	Ascendis Investigational Site	Houston	Texas
United States	Ascendis Investigational Site	Houston	Texas
United States	Ascendis Pharma Investigational Site	Iowa City	Iowa
United States	Ascendis Pharma Investigational Site	Knoxville	Tennessee
United States	Ascendis Investigational Site	Los Angeles	California
United States	Ascendis Pharma Investigational Site	Louisville	Kentucky
United States	Ascendis Investigational Site	Orange	California
United States	Ascendis Pharma Investigational Site	Pittsburgh	Pennsylvania
United States	Ascendis Pharma Investigational Site	San Francisco	California
United States	Ascendis Pharma Investigational Site	Stanford	California
United States	Ascendis Investigational Site	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Ascendis Pharma Oncology Division A/S

Countries where clinical trial is conducted

United States,  Australia,  Korea, Republic of,  Netherlands,  Spain,  Taiwan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety and Tolerability	Treatment emergent and treatment related adverse events (assessed by CTCAE v5.0), serious adverse events (SAEs), adverse events leading to treatment discontinuation, deaths	Through study completion, expected average of 2 years
Primary	Maximum Tolerated Dose (MTD)	Determine the maximum tolerated dose by assessing the Incidence of Dose Limiting Toxicities (DLTs), treatment emergent and treatment related adverse events (assessed by CTCAE v5.0), serious adverse events (SAEs), adverse events leading to treatment discontinuation and deaths.	Cycle 1 (each cycle is 21 days) in Part 1 (monotherapy dose escalation) and Cycle 1 (the first cycle is 28 days and 21 days thereafter) in Part 2 (combination therapy dose escalation)
Primary	Recommended Phase 2 Dose (RP2D)	To determine a recommended phase 2 dose of TransCon TLR7/8 Agonist and combination regimen for further development by evaluating number of patients with treatment-related adverse events as assessed by CTCAE.	12 months
Primary	Response	Evaluate the Pathologic complete response (pCR) per local assessment for pathology review anti-tumor activity of TransCon TLR7/8 Agonist in combination with pembrolizumab in the Neoadjuvant Cohorts	9 weeks
Secondary	Overall Response Rate	Response assessed by RECIST v1.1 and itRECIST (response assessment for intratumoral immunotherapy for injected and noninjected lesions)	Average of two years
Secondary	Duration of Response	Time from first documentation of objective tumor response (CR or PR that is subsequently confirmed) to first documentation of disease progression or death due to any cause, whichever occurs first	Average of two years
Secondary	Time to Response	Time from date of first dose of study treatment to first occurrence of response (CR or PR)	Expected up to 1 year from first dose
Secondary	Progression Free Survival (PFS)	Time from date of first dose of study treatment to first documentation of disease progression or death due to any cause	Average of two years
Secondary	Event free survival (EFS) by RECIST 1.1 per investigator assessment		Average of two years
Secondary	Overall Survival (OS)	Time from date of first dose of study treatment to date of death due to any cause	Average of two years
Secondary	PK characterization - Cmax	Maximum observed plasma concentration of resiquimod, O-desethyl resiquimod (metabolite) and total resiquimod (sum of bound and unbound resiquimod) after IT administration of TransCon TLR7/8 Agonist alone or in combination with pembrolizumab	Average of two years
Secondary	PK characterization - tmax	Time to reach maximum plasma concentration of resiquimod, O-desethyl resiquimod (metabolite) and total resiquimod (sum of bound and unbound resiquimod) after IT administration of TransCon TLR7/8 Agonist alone or in combination with pembrolizumab	Average of two years
Secondary	PK characterization - AUC0-t for first dose only	Area under the plasma concentration-time curve from time zero to last sampling time at which the concentration is at or above the lower limit of quantification for resiquimod, O-desethyl resiquimod (metabolite) and total resiquimod (sum of bound and unbound resiquimod) after IT administration of TransCon TLR7/8 Agonist alone or in combination with pembrolizumab	Average of two years
Secondary	PK characterization - t1/2	Apparent terminal half-life of resiquimod, O-desethyl resiquimod (metabolite) and total resiquimod (sum of bound and unbound resiquimod) after IT administration of TransCon TLR7/8 Agonist alone or in combination with pembrolizumab	Average of two years
Secondary	PK characterization - Ctrough	Plasma concentration immediately before next dosing of resiquimod, O-desethyl resiquimod (metabolite) and total resiquimod (sum of bound and unbound resiquimod) after IT administration of TransCon TLR7/8 Agonist alone or in combination with pembrolizumab	Average of two years