A Single-arm Clinical Trial of IMGN853 in Chinese Adult Patients With Platinum-resistant, Epithelial Ovarian Cancer

Fallopian Tube Cancer Clinical Trial

Official title:

A Single-arm, Phase III Clinical Trial of IMGN853 in Chinese Adult Patients With Platinum-resistant, Advanced High-grade Epithelial Ovarian, Primary Peritoneal or Fallopian Tube Cancer With High Expression of Folate Receptor-α

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05622890
• Other study ID #: IMGN853-301
• Secondary ID: CTR20220190
• Status: Recruiting
• Phase: Phase 3
• Start date: August 18, 2022
• Est. completion date: December 31, 2023

Study information

• Verified date: October 2022
• Source: Hangzhou Zhongmei Huadong Pharmaceutical Co., Ltd.
• Contact: Xu Sun, Master
• Phone: +8613645153601
• Email: sunxu[@]eastchinapharm.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This Phase III single-arm study is to evaluate the efficacy and safety of IMGN853 in Chinese adult patients with platinum-resistant high-grade epithelial ovarian, primary peritoneal, or fallopian tube cancers (hereafter referred to as PROC) with high FRα expression.

Description:

This is a single-arm, phase III clinical trial of IMGN853 in Chinese adult patients with platinum-resistant, advanced high-grade epithelial ovarian, primary peritoneal or fallopian tube cancer with high expression of folate receptor-α. The objective of this study is to determine the efficacy of IMGN853 in platinum-resistant ovarian cancer (PROC) patients with high folate receptor alpha (FRα) expression. A total of 35 patients will be enrolled. All patients must have measurable disease (per Response Evaluation Criteria in Solid Tumors version 1.1, RECIST v1.1) at baseline and be eligible for receiving IMGN853. All patients will be treated with the IMGN853 monotherapy with a dose at adjusted ideal body weight (AIBW) of 6 mg/kg on Day 1 of every 3-week cycle (Q3W).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 35
• Est. completion date: December 31, 2023
• Est. primary completion date: April 30, 2023
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Female patients = 18 years of age

2. Patients must have a histopathologically confirmed diagnosis of high-grade serous EOC.

3. Patients must have platinum-resistant disease:

1. Patients must have had a response (CR or PR) after previous 1 line of platinum-based therapy for at least 4 cycles of treatment, and then progressed between > 3 months and = 6 months after the date for last dose of platinum.

2. Patients who relapsed after > 6 months since the last platinum-based treatment with at least 4 cycles of one line platinum-based therapy: 1) continued to receive at least 4 cycles of 2 or 3 lines of platinum-based treatment and must have had PD within 6 months from the last dose of platinum; or 2) had PD during treatment with 2 or 3 lines of platinum-containing chemotherapy. Note: PD should be calculated from the date of the last dose of platinum-containing therapy to the date of PD indicated by radiographic imaging. Note: Patients who are platinum-refractory during 1 line treatment are excluded (see exclusion criterion 3).

4. Patients must have radiological PD on or after the most recent anti-cancer therapy.

5. Patients must be willing to provide the archival tumor tissue slides or undergo low-risk routine medical procedures to collect new biopsy samples for immunohistochemistry (IHC) confirmation of FRa positivity.

6. Per VENTANA FOLR1 (FOLR-2.1) Assay criteria, patient's tumor must be positive for FRa expression by a central laboratory.

7. Patients must have at least one lesion that meets the definition of measurable disease by RECIST v1.1 (radiologically assessed by the investigator).

8. Patients must have received at least 1 but no more than 3 lines of prior systemic anti-cancer therapy, including at least 1 line of therapy containing bevacizumab, and

for whom monotherapy is appropriate for the next line of treatment:

1. Neoadjuvant ± adjuvant is considered as 1 line of therapy;

2. Maintenance therapy (eg, bevacizumab, PARP inhibitors) will be considered as part of the prior line of therapy (ie, not counted independently);

3. Therapy changed due to toxicity in the absence of PD will be considered as part of the same line (ie, not counted independently);

4. Hormonal therapy (except as maintenance therapy) will be considered as a separate line of therapy.

9. Patients must have an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1.

10. Patients must have completed prior therapy within the following specified times:

1. Systemic anti-tumor therapy (the last prior systemic anti-tumor therapy should be at least 5 half-lives or 4 weeks from the initiation of the investigational drug, whichever is shorter);

2. Focal radiotherapy: previous focal radiotherapy should be at least 2 weeks from the initiation of investigational drug.

11. All toxicities (except alopecia) associated with prior therapy must be stable or resolved (Grade 1 or normal).

12. Any major surgery that a patient has undergone must have been completed at least 4 weeks prior to the first dose of IMGN853 and the postoperative complications of prior surgical treatment have resolved or are stable.

13. Patients must have adequate hematologic, hepatic, and renal functions as defined by the following parameters (without G-CSF [a 20-day drug washout period for long-acting growth factors], human albumin injection and other corrective treatment drugs are not

allowed within 14 days before obtaining laboratory test values):

1. Absolute neutrophil count (ANC) = 1.5 × 10^9/L (1,500 µL);

2. Platelet count = 100 × 10^9/L (100,000/µL) without platelet transfusion in the prior 10 days;

3. Hemoglobin = 9.0 g/dL without packed red blood cell (PRBC) transfusion in the prior 21 days;

4. Serum creatinine = 1.5 × upper limit of normal (ULN);

5. Both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) = 3.0 × ULN;

6. Serum bilirubin = 1.5 × ULN (patients with Gilbert syndrome may be enrolled if total bilirubin is < 3.0 × ULN);

7. Serum albumin = 2 g/dL.

14. Patients or their legally authorized representatives must be willing and able to sign the ICF and comply with the requirements of the protocol.

15. Women of child bearing potential (WCBP), defined as a sexually mature woman who have not undergone surgical sterilization or who have not been naturally postmenopausal for at least 12 consecutive months (ie, who have had menses any time in the preceding 12 consecutive months) must agree to use effective contraceptive methods; examples included oral, parenteral, or implantable hormonal contraceptive, intrauterine device, barrier contraceptive with spermicide, partner's latex condom or vasectomy) while on study treatment and for at least 12 weeks after the last dose of investigational drug.

16. WCBP must have a negative pregnancy test within 4 days prior to the first dose of IMGN853.

17. The expected survival of the subject is at least 12 weeks as assessed by the investigator.

Exclusion Criteria:

1. Male patients.

2. Patients with endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma, or sarcoma tissue, mixed tumor containing any of the above histologies, or low grade/borderline ovarian tumor.

3. Patients with primary platinum-refractory disease, defined as disease that did not respond to (CR or PR) or has progressed within 3 months of the last dose of first-line platinum-containing chemotherapy.

4. Patients who have received prior wide-field radiotherapy (RT) with at least 20% of the bone marrow affected.

5. Patients with > Grade 1 peripheral neuropathy per Common Terminology Criteria for Adverse Events (CTCAE).

6. Patients with active or chronic corneal disorders, history of corneal transplant, or active ocular conditions requiring ongoing treatment/monitoring such as uncontrolled glaucoma, wet age-related macular degeneration requiring treatment with intravitreal injections, active diabetic retinopathy with macular edema, macular degeneration, presence of papilloedema, and /or monocular vision.

7. Patients with serious concurrent illness or clinically relevant active infection,

including, but not limited to the following:

1. Known acute or chronic active hepatitis B (HBsAg positive and HBV DNA viral load = 2500 copies/mL or > 500 IU/mL, if necessary, patients may receive nucleoside prophylactic anti-hepatitis B virus therapy) or acute or chronic active hepatitis C (HCV antibody positive and HCV RNA positive);

2. Human immunodeficiency virus (HIV) infection;

3. Active cytomegalovirus infection;

4. Any other concurrent infectious disease requiring systematic treatment within 2 weeks prior to the first dose of IMGN853.

8. Patients with a history of multiple sclerosis (MS) or other demyelinating diseases and/or Lambert-Eaton syndrome (paraneoplastic syndrome).

9. Patients with clinically significant cardiac disorders, including but not limited to

any of the following:

1. Myocardial infarction = 6 months prior to the first dose;

2. Unstable angina pectoris;

3. Uncontrolled congestive cardiac failure (New York Heart Association classification > II);

4. Uncontrolled = Grade 3 hypertension (per CTCAE criteria);

5. Uncontrolled cardiac arrhythmias.

10. Patients with a history of hemorrhagic or ischemic stroke within 6 months prior to signing the ICF.

11. Patients with a history of hepatic cirrhosis (Child-Pugh B or C).

12. Patients with a previous clinical diagnosis of or currently ongoing non-infectious interstitial lung disease (ILD), including noninfectious pneumonitis, lung disorders such as pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, drug-related pulmonitis, severely impaired lung function, etc.

13. Patients requiring folic acid-containing supplements (e.g., folate deficiency).

14. Known hypersensitivity to previous monoclonal antibody therapy or maytansinoids, or to the investigational drug and/or any excipients.

15. Pregnant or lactating women.

16. Patients with prior IMGN853 or other FRa-targeted drug therapies.

17. Known active central nervous system (CNS) and/or leptomeningeal metastases. Patients with untreated but asymptomatic brain metastases, or patients who have radiographically documented progression-free status for at least 4 weeks after treatment and do not require hormonal or antiepileptic therapy for at least 2 weeks may be considered for enrollment.

18. Patients with a history of other malignancies within 3 years prior to enrollment. Note: patients with tumors with a negligible risk of metastasis or death (e.g., adequately controlled basal-cell carcinoma or squamous-cell carcinoma of the skin, or carcinoma in situ of the cervix or breast) are eligible for inclusion.

19. Patients with pleural effusion, pericardial effusion, or ascites that cannot be controlled by drainage or other means, except the small amount of effusion that without clinical symptoms or do not require clinical intervention.

20. Patients who are detained by a court or administrative decision, receiving psychiatric care against their will, adults who are under the protection of law (under tutorship/curatorship), people who are unable to give their consent, and people who are subject to a legal guardianship.

21. Participated in other clinical studies and received their investigational drugs within 4 weeks prior to the first dose.

22. Subject has other serious systemic diseases or other reasons that are not suitable for participation in this clinical study as evaluated by the investigator.

Related Conditions & MeSH terms

• Carcinoma, Ovarian Epithelial
• Epithelial Ovarian Cancer
• Fallopian Tube Cancer
• Fallopian Tube Neoplasms
• Ovarian Neoplasms
• Peritoneal Cancer

Intervention

Drug:
• Mirvetuximab Soravtansine
Mirvetuximab Soravtansine is an antibody drug conjugate designed to target folate receptor a (FRa). It consists of the humanized anti-FRa mAb M9346A attached via a cleavable disulfide linker to the cytotoxic maytansinoid, DM4.

Locations

Country	Name	City	State
China	Beijing Obstetrics and Gynecology Hospital, Capital Medical University	Beijing	Beijing
China	The First Affiliated Hospital of Bengbu Medical College	Bengbu	Anhui
China	Jilin Cancer Hospital	Changchun	Jilin
China	Hunan Cancer Hospital	Changsha	Hunan
China	West China Second Hospital of Sichuan University	Chengdu	Sichuan
China	The Second Affiliated Hospital of Dalian Medical University	Dalian	Liaoning
China	Fujian Provincial Cancer Hospital	Fuzhou	Fujian
China	Sun Yat-Sen University Cancer Hospital	Guangzhou	Guangdong
China	People's Hospital of Zhejiang Province	Hangzhou	Zhejiang
China	The Second Affiliated Hospital of Zhejiang University School of Medicine	Hangzhou	Zhejiang
China	Zhejiang Tumor Hospital	Hangzhou	Zhejiang
China	Anhui Provincial Hospital	Hefei	Anhui
China	The Second Affiliated Hospital of Anhui Medical University	Hefei	Anhui
China	The Second Affiliated Hospital of Zhengzhou University	Henan	Zhengzhou
China	Shandong Cancer Hospital	Jinan	Shandong
China	Yunnan Cancer Hospital	Kunming	Yunnan
China	Gansu Provincial Hospital	Lanzhou	Gansu
China	The First Affiliated Hospital of Nanchang University	Nanchang	Jiangxi
China	Affiliated Cancer Hospital of Guangxi Medical University	Nanning	Guangxi
China	Shanghai Tumor Hospital	Shanghai	Shanghai
China	SIMC	Shanghai	Shanghai
China	Liaoning Cancer Hospital	Shengyang	Liaoning
China	The Second Affiliated Hospital of Wenzhou Medical University	Wenzhou	Zhejiang
China	Hubei Cancer Hospital	Wuhan	Hubei
China	Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technolog	Wuhan	Hubei
China	Zhongnan Hospital Affiliated to Wuhan University	Wuhan	Hubei
China	People's Hospital of Shanxi province	Xi'an	Shanxi
China	Henan Cancer Hospital	Zhengzhou	Henan

Sponsors (1)

Lead Sponsor	Collaborator
Hangzhou Zhongmei Huadong Pharmaceutical Co., Ltd.

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Relationship between test results using the companion diagnostic reagent from MEDx Translational Medicine (Suzhou) Co., Ltd. and efficacy of IMGN853 and consistency with VENTANA FOLR1	Samples will be tested by another CDx at same time to certify the consistency with VENTANA FOLR1	Up to 2 years
Primary	Objective Response Rate (ORR)	Objective response rate (ORR), which includes best response of complete response (CR) or partial response (PR) as assessed by the BIRC.	Up to 2 years
Secondary	Duration of response (DOR)	The time interval from initial response (CR or PR) assessed by the investigator and the BIRC to progressive disease (PD) assessed by the BIRC	Up to 2 years
Secondary	ORR assessed by the investigator	The best response of CR or PR assessed by the investigator.	Up to 2 years
Secondary	DOR assessed by the investigator	The time interval from initial response (CR or PR) assessed by the investigator to PD assessed by the investigator	Up to 2 years
Secondary	Treatment-emergent adverse events (TEAEs) and Laboratory results,physical examinations, or vital signs	Adverse Events (AE's) will be evaluated according to the NCI CTCAE v5.0. AE's will be coded using the latest Medical Dictionary for Regulatory Activities (MedDRA) version and summarized per system organ class (SOC) and preferred term (PT).	Up to 2 years
Secondary	Determination of CA-125 response with GCIG criteria	GCIG CA-125 response rate will be calculated using the CA-125 Response-Evaluable population and its exact 95% CI will be estimated using the Clopper-Pearson method.	Up to 2 years
Secondary	PFS assessed by the BIRC	The time interval from the first dose of IMGN853 to radiographic PD or death assessed by the BIRC, whichever occurs first.	Up to 2 years
Secondary	PFS assessed by the investigator	The time interval from the first dose of IMGN853 to radiographic PD or death assessed by the investigator, whichever occurs first.	Up to 2 years
Secondary	Overall survival (OS)	The time interval from the first dose of IMGN853 to death	Up to 2 years
Secondary	Summary statistics of intact ADC, total Ab (TAb), DM4 and S-methyl DM4 concentration data over time	To assess the PK properties of IMGN853 and its key metabolites	Up to 2 years
Secondary	Incidence of seroconversion of ADA caused by IMGN853 and its relationship to safety and efficacy	Subjects will be evaluated for anti-drug antibody (ADA) levels. Confirmatory experiments will be conducted for positive samples. ADA titers and neutralizing antibodies (Nabs) will be further determined as appropriate after the confirmation of positivity.	Up to 2 years