Safety Study to Assess AFM11 in Patients With Relapsed or Refractory Adult B-precursor ALL
Primary Purpose
Leukemia, B-Cell
Status
Terminated
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AFM11
Sponsored by
About this trial
This is an interventional treatment trial for Leukemia, B-Cell focused on measuring acute lymphoblastic leukemia
Eligibility Criteria
Inclusion Criteria:
- Patients with CD19+ B-precursor Philadelphia-chromosome negative ALL relapsed after at least induction and consolidation or having refractory disease and who are not candidates for bone marrow transplant (including both peripheral blood and hematopoietic stem cell transplant [HSCTs]) with a curative intent at time of screening
- Patients with CD19+ Philadelphia-chromosome positive ALL who failed or were intolerant to therapy with at least 2 approved tyrosine kinase inhibitors
- More than 5% blasts in bone marrow
- In patients with high tumor burden (e.g., more than 50% blasts, or more than 15,000 blasts /µL blood, or elevated lactate dehydrogenase [LDH]) > 2 × upper limit of normal [ULN]), a pre treatment with 10 mg/m2 dexamethasone and 200 mg cyclophosphamide could be administered for up to 5 days.
- Patients of both genders, age ≥ 18
Homogenous CD19 expression on leukemic blasts must be confirmed by either:
- Prior results from a CD19+ staining or flow cytometry at the most recent available diagnostic bone marrow biopsy or aspirate, or
- Submission of a recent bone marrow biopsy for staining for CD19 positivity. The results of this testing need to be available prior to start of AFM11 treatment.
- Eastern Cooperative Oncology Group performance status ≤ 2
- Life expectancy of at least 3 months
- Ability to understand the patient information and informed consent form
- Signed and dated written informed consent
Exclusion Criteria:
- Autologous HSCT within 3 months prior to start of AFM11 treatment
- Active acute or chronic graft-versus-host disease. All graft-versus-host disease medication should be omitted for at least 4 weeks prior to start of AFM11 treatment.
- Allogeneic HSCT within 3 months prior to start of AFM11 treatment
- Prior treatment with blinatumomab or any other CD19 targeting T-cell engager, including CD19 CAR-T cells
- Treatment with donor-lymphocyte infusions within 4 weeks of start of AFM11 treatment or existing Graft versus Host Disease (GvHD)
Known or suspected central nervous system (CNS) involvement:
- Evidence for presence of malignant disease, inflammatory lesions, and/or vasculitis on cerebral magnetic resonance imaging (MRI)
- Infiltration of the cerebrospinal fluid by malignant B-cells, confirmed by lumbar puncture
- History of or current relevant CNS pathology as epilepsy, seizure, paresis, aphasia, apoplexia, severe brain injuries, cerebellar disease, organic brain syndrome, psychosis
- Cancer chemotherapy within 4 weeks prior to start of AFM11 treatment, or at least 4 times the respective half-lives, whichever is longer
- Therapy with antibody, or antibody constructs within 4 weeks prior to the start of AFM11 treatment, or at least 4 half-lives, whichever is longer
- Treatment with any investigational agent within 4 weeks prior to start of AFM11 treatment, or at least 4 times the respective half-life, whichever is longer
- Contraindication for any of the concomitant medications
- Abnormal renal or hepatic function as follows: aspartate aminotransferase (AST or SGOT) and/or alanine aminotransferase (ALT or SGPT) ≥ 2.5 × ULN; total bilirubin ≥ 1.5 × ULN; serum creatinine ≥ 2 × ULN; creatinine clearance < 50 mL/minute
- History of malignancy other than B-cell lymphoma or B-precursor ALL within 5 years prior to study entry, with the exception of basal cell carcinoma of the skin or carcinoma in situ of the cervix
- Uncontrolled infections; known bacteremia
- Any concurrent disease or medical condition that is deemed to interfere with the conduct of the study as judged by the Investigator
- Clinically relevant coronary artery disease (New York Heart Association [NYHA] functional angina classification III/IV), congestive heart failure (NYHA III/IV), high risk of or known uncontrolled arrhythmia
- Regular dose of corticosteroids during the 4 weeks prior to start of AFM11 treatment of this study or anticipated need of corticosteroids exceeding prednisone 20 mg/day or equivalent, or any other immunosuppressive therapy within 4 weeks prior to study entry. Exception is the pre treatment of rapidly progressing disease
- Known infection with human immunodeficiency virus or chronic or acute infection with hepatitis B or hepatitis C virus
- Pregnant or nursing women or women of childbearing potential not willing to use an effective form of contraception during participation in the study and at least 3 months thereafter. Male patients not willing to ensure that during the study and at least 3 months thereafter no fathering takes place. Effective methods of contraception include intrauterine device (IUD), combined (estrogen- and progesterone-containing) hormonal contraception (oral, vaginal ring or transdermal patch) with an ethinylestradiol dose of at least 30 µg, plus use of male condoms (preferably with spermicides), female condoms, a female diaphragm, or a cervical cap.
Sites / Locations
- LKH-Universitätsklinikum Graz
- Kepler Universitätsklinikum Linz
- Uniklinikum Salzburg
- University Hospital
- Rambam Medical Center
- Hadassah Medical Center
- Rabin Medical Center
- Independent Public Healthcare Municipal Hospital
- University Hospital
- Baranov Republican Hospital
- First Pavlov State Medical University
- Almazov NW Federal Medical Research Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
AFM11
Arm Description
IV (intravenous) infusion, dose escalation
Outcomes
Primary Outcome Measures
Number of participants with serious and non-serious adverse events as a measure of safety and tolerability of increasing doses and different infusion times of AFM11
Measure of occurence of adverse events (AEs), laboratory testing (chemistry and hematology), physical examination, vital signs, cardiac monitoring, and neurological assessments
Secondary Outcome Measures
Maximum Plasma Concentration of AFM11 (Cmax)
The maximum observed concentration of AFM11 in plasma will be determined.
Area Under the Curve (AUC)
The area under the concentration versus time curve from time zero to the sampling time will be determined.
Clinical efficacy of AFM11 in ALL
Measured by bone marrow assessment (complete response [CR], complete response with incomplete hematological recovery [CRh], and minimal residual disease [MRD])
Measurement of immunological markers
Immunological markers like lymphocytes and cytokine levels in serum will be measured at different time points during the 4 weeks of treatment and 30 days thereafter to assess the level of activity resulting from administration of AFM11.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02848911
Brief Title
Safety Study to Assess AFM11 in Patients With Relapsed or Refractory Adult B-precursor ALL
Official Title
A Phase I Dose-escalation Study to Assess the Safety of AFM11 (CD19 x CD3 TandAb®) in Patients With Relapsed or Refractory Adult B-precursor Acute Lymphoblastic Leukemia
Study Type
Interventional
2. Study Status
Record Verification Date
June 2019
Overall Recruitment Status
Terminated
Why Stopped
Strategic decision was made to terminate the AFM11 development
Study Start Date
October 2016 (Actual)
Primary Completion Date
September 2018 (Actual)
Study Completion Date
April 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Affimed GmbH
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of the study is to determine the maximum tolerated dose (MTD) in patients with acute lymphoblastic leukemia (ALL) and to determine the safety and tolerability of increasing doses and different infusion times of AFM11 infusion in patients with adult B-precursor ALL
Detailed Description
Acute lymphoblastic leukemia (ALL) is an aggressive type of leukemia characterized by an overproduction of lymphoblasts or lymphocytes in the bone marrow and the peripheral blood; it is frequently accompanied by suppression of normal hematopoiesis. It can spread to the lymph nodes, spleen, liver, the central nervous system (CNS), and other organs (sanctuary sites). Without treatment, ALL usually progresses quickly.
B- and T-cell lymphoblastic leukemia cells express surface antigens that parallel their respective developmental lineages. Precursor B-cell ALL cells typically express CD10, CD19, and CD34 on their surface, along with nuclear terminal deoxynucleotide transferase. About 20% of adult ALL patients have a cytogenetic abnormality that is indistinguishable from the Philadelphia chromosome (Ph1, t(9;22)), according to the National Cancer Institute (NCI).
The rationale for the use of AFM11 is based on its ability to bind to both malignant cells via its anti-CD19 domain and to T-cells via its anti-CD3 domains. This results in the formation of the "immunological synapse" and the subsequent T-cell activation on leading to killing of malignant cells. AFM11 has 2 binding sites for CD19 and 2 for CD3, its molecular weight is ~ 105kDa compared to diabodies like blinatumomab with one binding site for each target and a much lower molecular weight ~ 55kDa. In addition, preclinical experiments have shown that AFM11 has about a 100 fold higher affinity to CD3 compared to diabodies and is inducing higher cytotoxicity in vitro in the presence of low effector:target cell ratios. These differences might allow for a shortening of the infusion times and potentially higher clinical efficacy compared to blinatumomab.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, B-Cell
Keywords
acute lymphoblastic leukemia
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
17 (Actual)
8. Arms, Groups, and Interventions
Arm Title
AFM11
Arm Type
Experimental
Arm Description
IV (intravenous) infusion, dose escalation
Intervention Type
Drug
Intervention Name(s)
AFM11
Intervention Description
Accelerated-titration dose-escalation with 1 patient per dose-level, followed by standard dose-escalation (3 + 3 design), Treatment duration: 2 weeks
Primary Outcome Measure Information:
Title
Number of participants with serious and non-serious adverse events as a measure of safety and tolerability of increasing doses and different infusion times of AFM11
Description
Measure of occurence of adverse events (AEs), laboratory testing (chemistry and hematology), physical examination, vital signs, cardiac monitoring, and neurological assessments
Time Frame
From first administration of continuous infusion over 2 weeks in step 1 (or 4 weeks in step 2) followed by 2 weeks of treatment break
Secondary Outcome Measure Information:
Title
Maximum Plasma Concentration of AFM11 (Cmax)
Description
The maximum observed concentration of AFM11 in plasma will be determined.
Time Frame
Multiple time points during the 2 weeks of treatment in step 1 and 4 weeks of treatment in step 2
Title
Area Under the Curve (AUC)
Description
The area under the concentration versus time curve from time zero to the sampling time will be determined.
Time Frame
Prior to initial dose on Day 1 and at multiple time points during the 2 weeks of treatment in step 1 and 4 weeks of treatment in step 2
Title
Clinical efficacy of AFM11 in ALL
Description
Measured by bone marrow assessment (complete response [CR], complete response with incomplete hematological recovery [CRh], and minimal residual disease [MRD])
Time Frame
Baseline and after treatment (week 3 in step 1 or week 4 in step 2)
Title
Measurement of immunological markers
Description
Immunological markers like lymphocytes and cytokine levels in serum will be measured at different time points during the 4 weeks of treatment and 30 days thereafter to assess the level of activity resulting from administration of AFM11.
Time Frame
Prior to initial dose on Day 1 and at multiple time points during the 2 weeks of treatment in Step 1 and 4 weeks of treatment in Step 2
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients with CD19+ B-precursor Philadelphia-chromosome negative ALL relapsed after at least induction and consolidation or having refractory disease and who are not candidates for bone marrow transplant (including both peripheral blood and hematopoietic stem cell transplant [HSCTs]) with a curative intent at time of screening
Patients with CD19+ Philadelphia-chromosome positive ALL who failed or were intolerant to therapy with at least 2 approved tyrosine kinase inhibitors
More than 5% blasts in bone marrow
In patients with high tumor burden (e.g., more than 50% blasts, or more than 15,000 blasts /µL blood, or elevated lactate dehydrogenase [LDH]) > 2 × upper limit of normal [ULN]), a pre treatment with 10 mg/m2 dexamethasone and 200 mg cyclophosphamide could be administered for up to 5 days.
Patients of both genders, age ≥ 18
Homogenous CD19 expression on leukemic blasts must be confirmed by either:
Prior results from a CD19+ staining or flow cytometry at the most recent available diagnostic bone marrow biopsy or aspirate, or
Submission of a recent bone marrow biopsy for staining for CD19 positivity. The results of this testing need to be available prior to start of AFM11 treatment.
Eastern Cooperative Oncology Group performance status ≤ 2
Life expectancy of at least 3 months
Ability to understand the patient information and informed consent form
Signed and dated written informed consent
Exclusion Criteria:
Autologous HSCT within 3 months prior to start of AFM11 treatment
Active acute or chronic graft-versus-host disease. All graft-versus-host disease medication should be omitted for at least 4 weeks prior to start of AFM11 treatment.
Allogeneic HSCT within 3 months prior to start of AFM11 treatment
Prior treatment with blinatumomab or any other CD19 targeting T-cell engager, including CD19 CAR-T cells
Treatment with donor-lymphocyte infusions within 4 weeks of start of AFM11 treatment or existing Graft versus Host Disease (GvHD)
Known or suspected central nervous system (CNS) involvement:
Evidence for presence of malignant disease, inflammatory lesions, and/or vasculitis on cerebral magnetic resonance imaging (MRI)
Infiltration of the cerebrospinal fluid by malignant B-cells, confirmed by lumbar puncture
History of or current relevant CNS pathology as epilepsy, seizure, paresis, aphasia, apoplexia, severe brain injuries, cerebellar disease, organic brain syndrome, psychosis
Cancer chemotherapy within 4 weeks prior to start of AFM11 treatment, or at least 4 times the respective half-lives, whichever is longer
Therapy with antibody, or antibody constructs within 4 weeks prior to the start of AFM11 treatment, or at least 4 half-lives, whichever is longer
Treatment with any investigational agent within 4 weeks prior to start of AFM11 treatment, or at least 4 times the respective half-life, whichever is longer
Contraindication for any of the concomitant medications
Abnormal renal or hepatic function as follows: aspartate aminotransferase (AST or SGOT) and/or alanine aminotransferase (ALT or SGPT) ≥ 2.5 × ULN; total bilirubin ≥ 1.5 × ULN; serum creatinine ≥ 2 × ULN; creatinine clearance < 50 mL/minute
History of malignancy other than B-cell lymphoma or B-precursor ALL within 5 years prior to study entry, with the exception of basal cell carcinoma of the skin or carcinoma in situ of the cervix
Uncontrolled infections; known bacteremia
Any concurrent disease or medical condition that is deemed to interfere with the conduct of the study as judged by the Investigator
Clinically relevant coronary artery disease (New York Heart Association [NYHA] functional angina classification III/IV), congestive heart failure (NYHA III/IV), high risk of or known uncontrolled arrhythmia
Regular dose of corticosteroids during the 4 weeks prior to start of AFM11 treatment of this study or anticipated need of corticosteroids exceeding prednisone 20 mg/day or equivalent, or any other immunosuppressive therapy within 4 weeks prior to study entry. Exception is the pre treatment of rapidly progressing disease
Known infection with human immunodeficiency virus or chronic or acute infection with hepatitis B or hepatitis C virus
Pregnant or nursing women or women of childbearing potential not willing to use an effective form of contraception during participation in the study and at least 3 months thereafter. Male patients not willing to ensure that during the study and at least 3 months thereafter no fathering takes place. Effective methods of contraception include intrauterine device (IUD), combined (estrogen- and progesterone-containing) hormonal contraception (oral, vaginal ring or transdermal patch) with an ethinylestradiol dose of at least 30 µg, plus use of male condoms (preferably with spermicides), female condoms, a female diaphragm, or a cervical cap.
Facility Information:
Facility Name
LKH-Universitätsklinikum Graz
City
Graz
Country
Austria
Facility Name
Kepler Universitätsklinikum Linz
City
Linz
Country
Austria
Facility Name
Uniklinikum Salzburg
City
Salzburg
Country
Austria
Facility Name
University Hospital
City
Brno
Country
Czechia
Facility Name
Rambam Medical Center
City
Haifa
Country
Israel
Facility Name
Hadassah Medical Center
City
Jerusalem
Country
Israel
Facility Name
Rabin Medical Center
City
Petah-Tikva
Country
Israel
Facility Name
Independent Public Healthcare Municipal Hospital
City
Chorzow
Country
Poland
Facility Name
University Hospital
City
Krakow
Country
Poland
Facility Name
Baranov Republican Hospital
City
Petrozavodsk
Country
Russian Federation
Facility Name
First Pavlov State Medical University
City
St. Petersburg
ZIP/Postal Code
197022
Country
Russian Federation
Facility Name
Almazov NW Federal Medical Research Center
City
St. Petersburg
Country
Russian Federation
12. IPD Sharing Statement
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Safety Study to Assess AFM11 in Patients With Relapsed or Refractory Adult B-precursor ALL
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