Phase Ib/II of TG4001 and Avelumab in HPV16 Positive R/M Cancers

HPV-Related Cervical Carcinoma Clinical Trial

Official title:

A Phase Ib/II Trial Evaluating the Combination of TG4001 and Avelumab in Patients With HPV-16 Positive Recurrent or Metastatic Malignancies.

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03260023
• Other study ID #: TG4001.12
• Status: Active, not recruiting
• Phase: Phase 1/Phase 2
• Start date: September 11, 2017
• Est. completion date: December 2025

Study information

• Verified date: April 2024
• Source: Transgene
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The study will consist of two parts : In the phase Ib: safety will be assessed in consecutive cohorts of 3 to 6 patients at increasing doses of TG4001 in combination with avelumab according to a 3+3 design. There will be no intra-patient dose escalation. In the phase II part 1, evaluation of efficacy and further evaluation of safety of the combination of TG4001 and avelumab will be performed in a single arm of patients with recurrent or metastatic HPV-16 positive advanced malignancies. In the phase II part 2, evaluation of efficacy of the combination of TG4001 and avelumab will be performed in a randomized, open-label controlled study comparing TG4001 in combination with avelumab to avelumab alone in patients with HPV-16 positive advanced malignancies. In both phases, tumor response will be evaluated on local assessment using RECIST 1.1. All patients will be followed up until disease progression, death, or unacceptable toxicity, or study withdrawal for any reason, whichever occurs first.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 150
• Est. completion date: December 2025
• Est. primary completion date: December 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Female or male patients, aged at least 18 years (no upper limit of age)
• ECOG PS 0 or 1
• Life expectancy of at least 3 months
• Patients with histologically or cytologically documented metastatic or refractory/recurrent HPV-16 + cancer: cervical, vulvar, vaginal, penile and anal.
• Disease MUST not be amenable to curative surgery resection or curative radiotherapy with documented disease progression
• Prior therapy:
• No more than one prior systemic treatment for recurrent /metastatic disease
• Prior treatment for recurrent or metastatic disease is not required for:
• Patients with recurrence/progression within 6 months after completion of prior multimodal therapy for localized or locally advanced disease
• Patients who are unsuitable for platinum-based therapy
• Patients who refuse chemotherapy or other standard therapies for the treatment of metastatic or recurrent disease
• Limited hepatic disease for patients with liver metastases at baseline
• Availability of tumor tissue from biopsy
• At least one measurable lesion by CT scan according to RECIST 1.1.
• Adequate hematological, hepatic and renal function
• Negative blood pregnancy test at screening for women of childbearing potential
• Highly effective contraception for both male and female patients if the risk of conception exists during the study period and for 3 months after the last study treatment administration

Exclusion Criteria:

• Prior exposure to cancer immunotherapy including cancer vaccines, any antibody/drug targeting T cell co-regulatory proteins (immune checkpoints)
• Patients under chronic treatment with systemic corticosteroids or other immunosuppressive drugs for a period of at least 4 weeks and whose treatment was not stopped 2 weeks prior to the first study treatment, with the exception of patients with adrenal insufficiency who may continue corticosteroids at physiological replacement dose, equivalent to = 10 mg prednisone daily. Steroids with no or minimal systemic effect (topical, inhalation) are allowed
• Patients with CNS metastases except those with brain metastases treated locally and clinically stable during 4 weeks prior to start of study treatment, and those without ongoing neurological symptoms that are related to the brain localization of the disease
• Other active malignancy requiring concurrent systemic intervention
• Patients with previous malignancies other than the target malignancy to be investigated in this trial (except non-melanoma skin cancers, and the following in situ cancers: bladder, gastric, colon, endometrial, cervical/dysplasia, melanoma, or breast) are excluded unless a complete remission was achieved at least 2 years prior to study entry AND no additional therapy is required during the study period
• Patient with any organ transplantation, including allogeneic stem cell transplantation
• Known severe hypersensitivity reactions to monoclonal antibodies (Grade = 3 NCI-CTC), any history of anaphylaxis, or uncontrolled asthma
• Any known allergy or reaction to eggs, gentamycin or attributed to compounds of similar chemical or biological composition to therapeutic vaccines/immunotherapeutic products
• Any known allergy or reaction to any component of anti-PD-L1/PD-1 or its excipients
• Patients with known history or any evidence of active interstitial lung disease / pneumonitis
• Patients with active, known, or suspected auto-immune disease or immunodeficiency, except type I diabetes mellitus, hypothyroidism only requiring hormone replacement or skin disorders (such as vitiligo, psoriasis) not requiring systemic treatment
• Clinically significant (that is, active) cardiovascular disease: cerebral vascular accident/stroke or myocardial infarction (< 6 months prior to enrollment), unstable angina pectoris, congestive heart failure (New York Heart Association Classification Class = II), or serious uncontrolled cardiac arrhythmia requiring medication/active intervention, history of myocarditis
• History of uncontrolled intercurrent illness including but not limited to:
• Hypertension uncontrolled by standard therapies (not stabilized to 150/90 mmHg or lower)
• Uncontrolled diabetes (e.g., hemoglobin A1c = 8%)
• Uncontrolled infection

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Squamous Cell
• HPV-Related Anal Squamous Cell Carcinoma
• HPV-Related Carcinoma
• HPV-Related Cervical Carcinoma
• HPV-Related Penile Squamous Cell Carcinoma
• HPV-Related Vulvar Squamous Cell Carcinoma

Intervention

Biological:
• TG4001
PhIb: Dose escalation PhII: Established RP2D for TG4001

Drug:
• Avelumab
Anti PD-L1

Locations

Country	Name	City	State
France	I.C.O. Paul Papin	Angers
France	CHU Besançon	Besançon
France	Hôpital Saint André - CHU de Bordeaux	Bordeaux
France	Hôpitaux Civils de Colmar - Hôpital Pasteur	Colmar
France	CLCC Georges-François Leclerc	Dijon
France	Centre Léon Bérard	Lyon
France	Hopital de la Timone	Marseille
France	Institut Curie	Paris
France	I.C.O. Gauducheau	Saint-Herblain
France	Centre Paul Strauss - ICANS - Institut de cancérologie Strasbourg Europe	Strasbourg
France	Institut Claudius Regaud - IUCT - Oncopole	Toulouse
France	Institut Gustave Roussy	Villejuif
Spain	ICO Badalona - Hospital Germans Trias i Pujol	Badalona
Spain	Hospital Virgen de las Nieves	Granada
Spain	Fundación de Investigación biomédica H. 12 de Octubre	Madrid
Spain	Fundación de Investigación Biomédica Hospital Clínico San Carlos	Madrid
Spain	Hospital Virgen de La Victoria	Malaga
Spain	Hospital General de Valencia	Valencia
United States	Mayo Clinic	Jacksonville	Florida
United States	Mayo Clinic	Rochester	Minnesota

Sponsors (4)

Lead Sponsor	Collaborator
Transgene	EMD Serono Research & Development Institute, Inc., Merck KGaA, Darmstadt, Germany, Pfizer

Countries where clinical trial is conducted

United States,  France,  Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Phase Ib: To evaluate the safety and tolerability of the combination of TG4001 plus avelumab in patients with recurrent or metastatic HPV-16 positive advanced malignancies	Dose limiting toxicities (DLTs) includes the following: Grade = 3 drug related adverse event (AEs). However, fatigue, nausea/vomiting adequately treated with anti-emetics, endocrinopathies adequately controlled with one physiologic hormone replacement, skin toxicity and single laboratory values out of normal range without any clinical correlate, asymptomatic grade =3 lipase or amylase elevation, tumor flare defined as local pain, irritation, or rash localized at sites of known or suspected tumor or a transient Grade 3 infusion adverse event are excluded.; Liver function test abnormality: AST or ALT > 5 x ULN; Total bilirubin > 3 x ULN; Concurrent AST or ALT > 3 x ULN and total bilirubin > 2 x ULN; Drug related AE requiring treatment interruption for more than 2 weeks	Day 28
Primary	Phase II part 1: Overall Response Rate (ORR) by RECIST 1.1	Percentage of patients whose best overall response is either a Complete Response or a Partial Response according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria over the the total number of evaluable patients.	Every 6 weeks for the first 9 months, then every 12 weeks up to 3 years
Primary	Phase II part 2: Progression Free Survival (PFS) by RECISIT 1.1	Time from the date of randomization to death due to any cause, whichever occurs first.	Every 6 weeks for the first 9 months, then every 12 weeks up to 3 years
Secondary	Overall Response Rate (ORR) by using RECIST 1.1 (phase Ib, phase II part 2)	Percentage of patients whose best overall response is either a Complete Response or a Partial Response according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria over the the total number of evaluable patients	Every 6 weeks for the first 9 months, then every 12 weeks up to 3 years
Secondary	Progression Free Survival (PFS) (phase Ib, Phase II part 1)	Time from the date of first study treatment administration (Phase IB, Phase II Part1) to the date of first documented tumor progression or death due to any cause, whichever occurs first.	Every 6 weeks for the first 9 months, then every 12 weeks up to 3 years
Secondary	Overall Survival (OS)	Time from the date of first study treatment administration (Phase Ib, Phase II part 1) or time from the date of randomization (Phase II part 2) to the date of death due to any cause.	Every 3 months and up to 3 years
Secondary	Duration of overall Response (DoR)	Time from first documented response (CR or PR) until documented disease progression or death, whichever occurs first.	Every 6 weeks for the first 9 months, then every 12 weeks up to 3 years
Secondary	Disease control rate (DCR)	Proportion of patients whose best overall response is either CR, PR, or SD.	Every 6 weeks for the first 9 months, then every 12 weeks up to 3 years
Secondary	Incidence of Adverse Event reported per CTCAE v4.03		up to 90 days after last study treatment administration