Trial of X4P-001 in Patients With Advanced Renal Cell Carcinoma
Primary Purpose
Clear Cell Renal Cell Carcinoma
Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
X4P-001
axitinib
Sponsored by
About this trial
This is an interventional treatment trial for Clear Cell Renal Cell Carcinoma
Eligibility Criteria
Inclusion Criteria:
- Have a histologically confirmed diagnosis of predominant clear cell (conventional) Renal Cell Carcinoma (ccRCC).
- Have received at least one prior course of treatment for ccRCC. Part C only: Prior treatment must include at least 1 course of VEGF-directed therapy.
- Have on CT imaging done within 28 days of Day 1 findings consistent with advanced ccRCC, including at least one extra-renal measurable target lesion meeting the criteria of RECIST version 1.1.
- For women of childbearing potential and men, agree to use effective contraceptive methods from screening, through the study, and for at least 4 weeks after the last dose of study drug.
- For women of childbearing potential, have a negative pregnancy test (serum or urine) on Day 1 prior to initiating study treatment.
- Be willing and able to comply with the protocol
Exclusion Criteria:
- Has life expectancy of less than 3 months.
- Has performance status Grade >2 (Eastern Cooperative Oncology Group [ECOG] criteria).
- Has NYHA Class III or IV heart failure or uncontrolled hypertension (SBP ≥160 mm Hg; DBP ≥100 mm Hg).
- Has previously received X4P-001.
- Parts A and B only: Has received a prior course of axitinib.
- Parts A and B only: Has received mTOR inhibitor(s) as their only prior treatment for ccRCC.
Has a prior history or current evidence of intracranial (CNS) metastatic RCC, except for
≤3 lesions treated by CyberKnife or excisional surgery, clinically stable for at least 4 weeks, and without evidence of recurrence on MRI imaging at screening.
- Has ongoing acute clinical adverse events NCI CTCAE Grade >1 resulting from prior cancer therapies (except alopecia, TKI-related hand-foot syndrome, or thyroid dysfunction).
- Has had within the past 6 months the occurrence or persistence of one or more of the following medical conditions that could not be controlled with usual medical care (e.g., required emergency care or hospitalization): hypertension, angina, congestive heart failure, diabetes, seizure disorder.
- Has had within the past 6 months the occurrence of one or more of the following events: myocardial infarction, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, hemorrhage (CTC Grade 3 or 4), chronic liver disease (meeting criteria for Child-Pugh Class B or C), a second active malignancy (excluding basal cell carcinoma and cervical carcinoma in situ), organ transplantation.
- Has had within the 4 weeks prior to initiation of study drug, or is expected to have during the study period, surgery requiring general anesthesia.
- Has, at screening, serologic laboratory tests meeting one or more of the following criteria:
- An indeterminate or positive test for antibody to human immunodeficiency virus (HIV-1 or -2).
- An indeterminate or positive test for antibody to hepatitis C virus (HCV), unless documented to have no detectable viral load on two independent samples.
- A positive test for hepatitis B surface antigen (HBsAg).
- Has, at screening, safety laboratory tests meeting one or more of the following criteria:
- Hemoglobin <8.0 g/dL
- Absolute neutrophil count (ANC) <1,500/μL
- Platelets <75,000/μL
- Creatinine >2.0x ULN
- Serum aspartate transaminase (AST) >2.5x ULN
- Serum alanine transaminase (ALT) >2.5x ULN
- Total bilirubin >1.5x ULN (unless due to Gilbert's Syndrome)
- International normalized ratio (INR) >1.5x ULN
- Has received other anti-cancer therapy within the following specified intervals prior to Day 1:
- Tyrosine Kinase Inhibitor (TKI) within 2 weeks.
- Radiation therapy within 2 weeks.
- Bevacizumab within 4 weeks.
- Other chemotherapy (e.g., mitomycin-C, nitrosourea) or immunotherapy (e.g., antibody, cytokine) within 4 weeks
- For investigational anti-cancer therapies, the interval will be determined in consultation with the Medical Monitor.
- Has, within 2 weeks prior to Day 1, received a medication prohibited based on CYP3A4 interaction
- Has, within 2 weeks prior to Day 1, received systemic corticosteroids exceeding prednisone 10 mg per day or equivalent; for other immunosuppressive agents, the exclusionary dose and duration will be determined in consultation with the Medical Monitor.
- Is, within 2 weeks prior to Day 1, nursing.
- Has, at the planned initiation of study drug, an uncontrolled infection.
- Has any other medical or personal condition that, in the opinion of the Investigator, may potentially compromise the safety or compliance of the patient, or may preclude the patient's successful completion of the clinical trial.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Experimental
Arm Label
Part A
Part B
Part C
Arm Description
X4P-001 + axitinib dose escalation
Randomized assignment to one of two regimens: X4P-001 at the Part A maximum tolerated dose (MTD), in combination with axitinib X4P-001 at 0.5x Part A MTD, in combination with axitinib
X4P-001 monotherapy
Outcomes
Primary Outcome Measures
Incidence of Treatment-Emergent Adverse Events (Safety and tolerability)
Safety assessments including vital signs, physical exams, laboratory tests, and adverse event monitoring
Secondary Outcome Measures
Objective Response Rate
The treatment effect of X4P-001, as single agent and in combination with axitinib, will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 to determine tumor response.
Disease Control Rate
The treatment effect of X4P-001, as single agent and in combination with axitinib, will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 to determine the disease control rate.
Progression Free Survival
The treatment effect of X4P-001, as single agent and in combination with axitinib, will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 to determine progression free survival time.
Maximum Plasma Concentration (Cmax)
Cmax data will be collected to determine the pharmacokinetics of escalating dose levels of X4P-001 administered orally.
Area Under the Curve (AUC)
AUC data will be collected to determine the pharmacokinetics of escalating dose levels of X4P-001 administered orally.
Minimum Plasma Concentration (Cmin)
Cmin data will be collected to determine the pharmacokinetics of escalating dose levels of X4P-001 administered orally.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02667886
Brief Title
Trial of X4P-001 in Patients With Advanced Renal Cell Carcinoma
Official Title
A Phase 1/2 Trial of X4P-001 as Single Agent and in Combination With Axitinib in Patients With Advanced Renal Cell Carcinoma
Study Type
Interventional
2. Study Status
Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
January 2016 (Actual)
Primary Completion Date
March 2022 (Actual)
Study Completion Date
March 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
X4 Pharmaceuticals
4. Oversight
5. Study Description
Brief Summary
The purpose of the study is to test different doses of X4P-001 given alone and in combination with axitinib in patients diagnosed with advanced renal cell carcinoma. The goals of the study are to determine the safety and tolerability of X4P-001, as well as the potential effect it may have on the body and the cancer tumor.
Detailed Description
X4P-001 is an orally bioavailable CXCR4 antagonist that has demonstrated activity in various tumor models. CXCR4 (C-X-C chemokine receptor type 4) is the receptor for CXCL12 (C-X-C chemokine ligand type 12). CXCL12 has potent chemotactic activity for lymphocytes and MDSCs (myeloid-derived suppressor cells), and is important in homing of hematopoietic stem cells to the bone marrow. CXCR4 is also expressed and active on multiple types of human cancers, including ccRCC, ovarian cancer, and melanoma, and increased expression of CXCR4 on tumor cells has been associated with significantly decreased overall patient survival.
Multiple observations implicate the CXCL12/CXCR4 axis in contributing to the lack (or loss) of tumor responsiveness to angiogenesis inhibitors (also referred to as "angiogenic escape"). In animal cancer models, interference with CXCR4 function has been demonstrated to disrupt the tumor microenvironment and unmask the tumor to immune attack by multiple mechanisms, including:
Eliminating tumor re-vascularization
Decreasing the infiltration of MDSCs
Increasing the ratio of CD8+ T cells to Treg cells
The hypothesis is that effective CXCR4 antagonism by X4P-001 would be of potential benefit in patients with advanced ccRCC and other cancers by multiple mechanisms:
Decreased recruitment of MDSCs, resulting in increased anti-tumor immune attack
Sustained decrease in neoangiogenesis and tumor vascular supply
Interference with the autocrine effect of increased expression by ccRCC of both CXCR4 and CXCL12, its only ligand, thereby, potentially reducing cancer cell metastasis
This initial clinical trial in patients with advanced ccRCC will evaluate X4P-001 both as a single agent (monotherapy) and also in combination with axitinib, a small molecule TKI (tyrosine kinase inhibitor) approved for second-line treatment of patients with ccRCC. This combination has the potential to further improve outcomes by reducing the angiogenic escape that typically occurs with TKI therapy.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Clear Cell Renal Cell Carcinoma
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
74 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Part A
Arm Type
Experimental
Arm Description
X4P-001 + axitinib dose escalation
Arm Title
Part B
Arm Type
Experimental
Arm Description
Randomized assignment to one of two regimens:
X4P-001 at the Part A maximum tolerated dose (MTD), in combination with axitinib
X4P-001 at 0.5x Part A MTD, in combination with axitinib
Arm Title
Part C
Arm Type
Experimental
Arm Description
X4P-001 monotherapy
Intervention Type
Drug
Intervention Name(s)
X4P-001
Intervention Description
Continuous, oral, once-daily dosing
Intervention Type
Drug
Intervention Name(s)
axitinib
Other Intervention Name(s)
Inlyta
Intervention Description
Continuous, oral, twice-daily dosing
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events (Safety and tolerability)
Description
Safety assessments including vital signs, physical exams, laboratory tests, and adverse event monitoring
Time Frame
Up to 80 weeks, from time of enrollment through study completion or early termination
Secondary Outcome Measure Information:
Title
Objective Response Rate
Description
The treatment effect of X4P-001, as single agent and in combination with axitinib, will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 to determine tumor response.
Time Frame
Up to 80 weeks, from time of enrollment through study completion or early termination
Title
Disease Control Rate
Description
The treatment effect of X4P-001, as single agent and in combination with axitinib, will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 to determine the disease control rate.
Time Frame
Up to 80 weeks, from time of enrollment through study completion or early termination
Title
Progression Free Survival
Description
The treatment effect of X4P-001, as single agent and in combination with axitinib, will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 to determine progression free survival time.
Time Frame
Up to 80 weeks, from time of enrollment through study completion or early termination
Title
Maximum Plasma Concentration (Cmax)
Description
Cmax data will be collected to determine the pharmacokinetics of escalating dose levels of X4P-001 administered orally.
Time Frame
Up to 8 hrs post-dose
Title
Area Under the Curve (AUC)
Description
AUC data will be collected to determine the pharmacokinetics of escalating dose levels of X4P-001 administered orally.
Time Frame
Up to 8 hrs post-dose
Title
Minimum Plasma Concentration (Cmin)
Description
Cmin data will be collected to determine the pharmacokinetics of escalating dose levels of X4P-001 administered orally.
Time Frame
Up to 7 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Have a histologically confirmed diagnosis of predominant clear cell (conventional) Renal Cell Carcinoma (ccRCC).
Have received at least one prior course of treatment for ccRCC. Part C only: Prior treatment must include at least 1 course of VEGF-directed therapy.
Have on CT imaging done within 28 days of Day 1 findings consistent with advanced ccRCC, including at least one extra-renal measurable target lesion meeting the criteria of RECIST version 1.1.
For women of childbearing potential and men, agree to use effective contraceptive methods from screening, through the study, and for at least 4 weeks after the last dose of study drug.
For women of childbearing potential, have a negative pregnancy test (serum or urine) on Day 1 prior to initiating study treatment.
Be willing and able to comply with the protocol
Exclusion Criteria:
Has life expectancy of less than 3 months.
Has performance status Grade >2 (Eastern Cooperative Oncology Group [ECOG] criteria).
Has NYHA Class III or IV heart failure or uncontrolled hypertension (SBP ≥160 mm Hg; DBP ≥100 mm Hg).
Has previously received X4P-001.
Parts A and B only: Has received a prior course of axitinib.
Parts A and B only: Has received mTOR inhibitor(s) as their only prior treatment for ccRCC.
Has a prior history or current evidence of intracranial (CNS) metastatic RCC, except for
≤3 lesions treated by CyberKnife or excisional surgery, clinically stable for at least 4 weeks, and without evidence of recurrence on MRI imaging at screening.
Has ongoing acute clinical adverse events NCI CTCAE Grade >1 resulting from prior cancer therapies (except alopecia, TKI-related hand-foot syndrome, or thyroid dysfunction).
Has had within the past 6 months the occurrence or persistence of one or more of the following medical conditions that could not be controlled with usual medical care (e.g., required emergency care or hospitalization): hypertension, angina, congestive heart failure, diabetes, seizure disorder.
Has had within the past 6 months the occurrence of one or more of the following events: myocardial infarction, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, hemorrhage (CTC Grade 3 or 4), chronic liver disease (meeting criteria for Child-Pugh Class B or C), a second active malignancy (excluding basal cell carcinoma and cervical carcinoma in situ), organ transplantation.
Has had within the 4 weeks prior to initiation of study drug, or is expected to have during the study period, surgery requiring general anesthesia.
Has, at screening, serologic laboratory tests meeting one or more of the following criteria:
An indeterminate or positive test for antibody to human immunodeficiency virus (HIV-1 or -2).
An indeterminate or positive test for antibody to hepatitis C virus (HCV), unless documented to have no detectable viral load on two independent samples.
A positive test for hepatitis B surface antigen (HBsAg).
Has, at screening, safety laboratory tests meeting one or more of the following criteria:
Hemoglobin <8.0 g/dL
Absolute neutrophil count (ANC) <1,500/μL
Platelets <75,000/μL
Creatinine >2.0x ULN
Serum aspartate transaminase (AST) >2.5x ULN
Serum alanine transaminase (ALT) >2.5x ULN
Total bilirubin >1.5x ULN (unless due to Gilbert's Syndrome)
International normalized ratio (INR) >1.5x ULN
Has received other anti-cancer therapy within the following specified intervals prior to Day 1:
Tyrosine Kinase Inhibitor (TKI) within 2 weeks.
Radiation therapy within 2 weeks.
Bevacizumab within 4 weeks.
Other chemotherapy (e.g., mitomycin-C, nitrosourea) or immunotherapy (e.g., antibody, cytokine) within 4 weeks
For investigational anti-cancer therapies, the interval will be determined in consultation with the Medical Monitor.
Has, within 2 weeks prior to Day 1, received a medication prohibited based on CYP3A4 interaction
Has, within 2 weeks prior to Day 1, received systemic corticosteroids exceeding prednisone 10 mg per day or equivalent; for other immunosuppressive agents, the exclusionary dose and duration will be determined in consultation with the Medical Monitor.
Is, within 2 weeks prior to Day 1, nursing.
Has, at the planned initiation of study drug, an uncontrolled infection.
Has any other medical or personal condition that, in the opinion of the Investigator, may potentially compromise the safety or compliance of the patient, or may preclude the patient's successful completion of the clinical trial.
Facility Information:
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85259
Country
United States
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20057
Country
United States
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46237
Country
United States
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
City
New Orleans
State/Province
Louisiana
ZIP/Postal Code
70121
Country
United States
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
City
Saint Paul
State/Province
Minnesota
ZIP/Postal Code
55101
Country
United States
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
City
Bronx
State/Province
New York
ZIP/Postal Code
10461
Country
United States
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
City
Toledo
State/Province
Ohio
ZIP/Postal Code
43623
Country
United States
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
City
Greenville
State/Province
South Carolina
ZIP/Postal Code
29605
Country
United States
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
City
Gyeyang-gu
State/Province
Seoul
ZIP/Postal Code
06351
Country
Korea, Republic of
City
Seongdu
State/Province
Seoul
ZIP/Postal Code
03722
Country
Korea, Republic of
12. IPD Sharing Statement
Learn more about this trial
Trial of X4P-001 in Patients With Advanced Renal Cell Carcinoma
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