Intra-tumoral Mitazalimab (CD40 Antibody) With Irreversible Electroporation (IRE) in Locally Advanced Pancreas Cancer

Pancreatic Cancer Clinical Trial

Official title:

Phase 1 Clinical Trial of Intra-tumoral Mitazalimab (CD40 Antibody) With Irreversible Electroporation (IRE) in Locally Advanced Pancreas Cancer

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06205849
• Other study ID #: 807630
• Secondary ID: 1R01CA282439
• Status: Not yet recruiting
• Phase: Phase 1
• Start date: June 1, 2024
• Est. completion date: August 2029

Study information

• Verified date: May 2024
• Source: University of California, San Diego
• Contact: Shakeela Dad
• Phone: 858-822-5376
• Email: sdad[@]health.ucsd.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a phase I study of an agonistic CD40 antibody (mitazalimab) injected intratumorally at the time of surgical IRE in patients with locally advanced pancreatic cancer. Intratumoral delivery has potential to be more effective than systemic (intravenous) delivery while decreasing the systemic side effects of immunotherapy. We hypothesize that local delivery of mitazalimab at the time of IRE in patients with locally advanced pancreatic cancer will be safe, augment the immune effects of IRE, and decrease the risk of recurrence.

Description:

Irreversible electroporation (IRE) is a form of non-thermal ablation (tissue destruction) that is being used to treat locally advanced pancreatic cancers. Locally advanced pancreatic cancers are tumors that have not spread (metastasized to distant locations) but cannot be surgically resected. There is evidence that IRE can help to generate anti-tumor immune responses by releasing tumor antigens in the setting of inflammation. CD40 is an immune receptor that helps to stimulate antigen presentation to the immune system. Preclinical data from the PI's laboratory have shown that combination of IRE with an antibody that stimulates the CD40 receptor improves responses to IRE and inhibits metastatic tumor growth.

This is a phase I study of an agonistic CD40 antibody (mitazalimab) injected intratumorally at the time of surgical IRE in patients with locally advanced pancreatic cancer. Intratumoral delivery has potential to be more effective than systemic (intravenous) delivery while decreasing the systemic side effects of immunotherapy. We hypothesize that local delivery of mitazalimab at the time of IRE in patients with locally advanced pancreatic cancer will be safe, augment the immune effects of IRE, and decrease the risk of recurrence.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 18
• Est. completion date: August 2029
• Est. primary completion date: August 2027
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Provision of signed and dated informed consent form

• Stated willingness to comply with all study procedures and availability for the duration of the study

• Histologically/cytologically-confirmed pancreatic ductal adenocarcinoma (PDAC)

• Persons, aged > 18 years of age, as PDAC is extremely rare in pediatric populations.

• Locally advanced disease that is not amenable to surgical resection. Locally advanced PDAC cases will be identified per the definition developed by the Alliance for Clinical Trials in Oncology[53]. Per this definition, locally advanced PDAC is defined as presence of any one or more of the following on CT:

• Occlusion of the superior mesenteric vein (SMV) and/or portal vein (PV) that is not amenable to resection and venous reconstruction

• Interface between tumor and hepatic artery that is not amenable to resection and reconstruction

• Interface between the tumor and superior mesenteric artery (SMA) measuring > 180º of the circumference of the vessel wall

• Interface between the tumor and celiac axis measuring > 180º of the circumference of the vessel wall that is not amenable to resection

• ECOG Performance Status of 0-2

• Have adequate organ function per criteria below:

• Absolute neutrophil count (ANC) = 1.5x109/L

• Platelets = 100x109/L

• Hemoglobin =9 g/dL

• Serum creatinine =1.5 x ULN OR creatinine clearance =40 mL/min (as calculated by Modified Cockcroft-Gault formula)

• Serum total bilirubin = 1.5 X ULN

• AST (SGOT) and ALT (SGPT) = 2.5 X ULN

• A minimum of 4 months of FOLFIRINOX-based systemic chemotherapy

• High quality imaging triphasic CT scan contrast-enhanced dynamic MRI of abdomen and either contrast-enhanced or non-contrast CT of chest and pelvis that demonstrate no evidence of metastatic disease within 30 days of enrollment

• FDG-PET imaging (skullbase-midthigh) at any timepoint between diagnosis and study intervention to determine whether tumor is PET-avid and evaluate for extra-pancreatic metastatic disease, as suggested by NCCN guidelines for high-risk patients.

• Tumor amenable to "in situ" (complete) ablation with maximum primary tumor dimension < 4.0 cm

• For participants able to become pregnant: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method until the study intervention and for an additional 1 month after the study intervention.

• For participants able to cause a pregnancy: use of condoms or other methods to ensure effective contraception with partner for 1 month after study intervention.

Exclusion Criteria:

• Pregnancy or lactation

• Known allergic reactions to components of the mitazalimab solution (L-Histidine, trehalose, or polysorbate 20)

• Fever > 38 degrees C within 14 days of study intervention

• Treatment with another investigational drug or other intervention within 30 days of enrollment

• Prior treatment with a CD40 antibody

• History of severe auto-immune disease

• The presence of metal fiducials or embolization coils within the tumor.

• Prior receipt of radiation therapy to the pancreas

• The presence of implanted metallic cardiac stimulation devices within the chest

• Uncontrolled cardiac arrhythmias that prevent synchronization of pulse delivery with the refractory period of the cardiac cycle

• Immunosuppressive doses of systemic medications, such as corticosteroids or absorbed topical corticosteroids (doses > 10 mg/day prednisone or equivalent) must be discontinued at least 2 weeks (14 days) before study treatment administration. Physiologic doses of corticosteroids (= 10 mg/day of prednisone or its equivalent) or short pulses of corticosteroids (= 3 days) may be permitted.

• Any medical condition that precludes major abdominal surgery under general anesthesia

• Presence of distant metastatic disease (including positive peritoneal cytology) on staging laparoscopy and/or exploratory laparotomy at any timepoint.

Related Conditions & MeSH terms

• Pancreatic Cancer
• Pancreatic Neoplasms

Intervention

Drug:
• IRE + intratumoral mitazalimab (CD40 antibody) injection
Surgical IRE will be performed using the NanoKnife System with intraoperative ultrasound guidance via laparotomy under general anesthesia. Mitazalimab (CD40 antibody) will be administered 5 minutes after completion of IRE by slow injection into the center of the ablated zone using a small needle. Core needle biopsies of the tumor will be obtained immediately prior to IRE for identification of candidate tumor antigens. Peripheral blood will be obtained immediately prior to and 12 weeks after the study intervention for analysis of systemic immune effects.

Device:
• NanoKnife
Non-thermal tumor ablation using short pulses of high voltage electrical current delivered using 19-gauge needles placed via laparotomy using ultrasound guidance

Locations

Country	Name	City	State
United States	UCSD Moores Cancer Center	La Jolla	California

Sponsors (3)

Lead Sponsor	Collaborator
University of California, San Diego	National Cancer Institute (NCI), University of California, Los Angeles

Country where clinical trial is conducted

United States, 

References & Publications (2)

Irenaeus SMM, Nielsen D, Ellmark P, Yachnin J, Deronic A, Nilsson A, Norlen P, Veitonmaki N, Wennersten CS, Ullenhag GJ. First-in-human study with intratumoral administration of a CD40 agonistic antibody, ADC-1013, in advanced solid malignancies. Int J Cancer. 2019 Sep 1;145(5):1189-1199. doi: 10.1002/ijc.32141. Epub 2019 Mar 8. — View Citation

Shankara Narayanan JS, Hayashi T, Erdem S, McArdle S, Tiriac H, Ray P, Pu M, Mikulski Z, Miller A, Messer K, Carson D, Schoenberger S, White RR. Treatment of pancreatic cancer with irreversible electroporation and intratumoral CD40 antibody stimulates systemic immune responses that inhibit liver metastasis in an orthotopic model. J Immunother Cancer. 2023 Jan;11(1):e006133. doi: 10.1136/jitc-2022-006133. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety and tolerability	Rates of dose-limiting toxicities (DLTs) and treatment-related adverse events (AEs). AE's will be graded by CTCAE v4, including grading for cytokine release syndrome. A DLT will be defined as any treatment emergent Grade 3 or higher AE that is potentially attributable to mitazalimab or the combination of IRE and mitazalimab. Exceptions will include AE's attributable to normal disease progression.	12 weeks
Secondary	Progression-free survival	Progression-free survival (PFS), defined as the time from the date of IRE and mitazalimab administration to date of first observed disease progression or death from any cause	5 years
Secondary	Overall survival	Overall survival (OS), defined as the time from the date of IRE and mitazalimab administration to death from any cause.	5 years
Secondary	Systemic immune effects	Neoantigen-specific T-cell responses will be compared between peripheral blood samples obtained pre- and 12 weeks post-IRE using neoantigens identified from tumor biopsies.	12 weeks