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Sym021 Monotherapy, in Combination With Sym022 or Sym023, and in Combination With Both Sym022 and Sym023 in Patients With Advanced Solid Tumor Malignancies or Lymphomas

Primary Purpose

Metastatic Cancer, Solid Tumor, Lymphoma

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Sym021
Sym022
Sym023
Sponsored by
Symphogen A/S
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Cancer focused on measuring Locally advanced/unresectable, Metastatic solid tumor, Lymphoma, Anti-PD-1, PD-1, PD1, Anti-LAG-3, LAG-3, LAG3, Anti-TIM-3, TIM-3, TIM3

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female patients, ≥ 18 years of age at the time of obtaining informed consent.
  • Documented (histologically- or cytologically-proven) solid tumor malignancy that is locally advanced or metastatic; patients with documented lymphoma.
  • Malignancy (solid tumor or lymphoma) that is currently not amenable to surgical intervention due to either medical contraindications or non-resectability of the tumor.
  • Refractory to or intolerant of existing therapy(ies) known to provide clinical benefit.
  • Measurable or non-measurable disease according to RECIST v1.1 or RECIL 2017.
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1.
  • Persons of childbearing potential agreeing to use a highly effective method of contraception during the study beginning within 2 weeks prior to the first dose and continuing until 6 months after the last dose of study drug(s); men agreeing to refrain from sperm donation during this period.

Exclusion Criteria:

  • Women who are pregnant or intending to become pregnant before, during, or within 6 months after the last dose of study drug; women who are breastfeeding; persons of childbearing potential and not willing to use a highly effective method of contraception.
  • Central nervous system (CNS) malignancies; patients with known, untreated CNS or leptomeningeal metastases, or spinal cord compression, patients with any of the above not controlled by prior surgery or radiotherapy, or patients with symptoms suggesting CNS involvement for which treatment is required.
  • Hematologic malignancies other than lymphoma.
  • Active thrombosis, or a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) within 4 weeks prior to Cycle 1/Day 1 (C1/D1) unless adequately treated and considered stable.
  • Active uncontrolled bleeding or a known bleeding diathesis.
  • Clinically significant cardiovascular disease or condition.
  • Significant ocular disease or condition, including history of an autoimmune or inflammatory disorder.
  • Significant pulmonary disease or condition.
  • Current or recent (within 6 months) significant gastrointestinal (GI) disease or condition.
  • An active, known, or suspected autoimmune disease, or a documented history of autoimmune disease or syndrome, requiring systemic steroids or other immunosuppressive medications.
  • History of organ transplantation (e.g., stem cell or solid organ transplant).
  • History of significant toxicities associated with previous administration of immune checkpoint inhibitors that necessitated permanent discontinuation of that therapy.
  • Patients with unresolved > Grade 1 toxicity associated with any prior antineoplastic therapy except for persistent Grade 2 alopecia, peripheral neuropathy, decreased hemoglobin, lymphopenia, hypomagnesemia, and/or end-organ failure being adequately managed by hormone replacement therapy.
  • Inadequate recovery from any prior surgical procedure, or having undergone any major surgical procedure within 4 weeks prior to C1/D1.
  • Known history of human immunodeficiency virus (HIV) or known active infection with hepatitis B virus (HBV) or hepatitis C virus (HCV).

Drugs and Other Treatments Exclusion Criteria:

  • Part 2 Combination Dose-Escalations ONLY: Prior therapy with:

    • Sym021 or other inhibitors of PD-1/PD-L1.
    • Sym022 or other inhibitors of LAG-3, if participating in Arm A.
    • Sym023 or other inhibitors of TIM-3, if participating in Arm B.
  • Part 3 Combination Dose-Escalations ONLY: Prior therapy with:

    • Sym022 or other inhibitors of LAG-3
    • Sym023 or other inhibitors of TIM-3
  • Any antineoplastic agent for the primary malignancy (standard or investigational) within 4 weeks or 5 plasma half-lives, whichever is shortest, prior to first study drug administration and during study, with exceptions.
  • Any other investigational treatments within 2 weeks prior to and during study; includes participation in any medical device or supportive care therapeutic intervention trials.
  • Radiotherapy, with exceptions.
  • Use of live vaccines against infectious diseases 4 weeks prior to first study drug administration and during study.
  • Immunosuppressive or systemic hormonal therapy within 2 weeks prior to first study drug administration and during study, with exceptions.
  • Prophylactic use of hematopoietic growth factors within 1 week prior to first study drug administration and during Cycle 1 of study.

Sites / Locations

  • South Texas Accelerated Research Therapeutics (START) Midwest
  • The University of Texas MD Anderson Cancer Center
  • NEXT Oncology
  • Princess Margaret Cancer Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm 9

Arm 10

Arm 11

Arm 12

Arm 13

Arm 14

Arm 15

Arm 16

Arm 17

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Sym021 Dose Level 1

Sym021 Dose Level 2

Sym021 Dose Level 3

Arm A: Sym021+Sym022 Dose Level 1

Arm A: Sym021+Sym022 Dose Level 2

Arm A: Sym021+Sym022 Dose Level 3

Arm A: Sym021+Sym022 Dose Level 4

Arm B: Sym021+Sym023 Dose Level 1

Arm B: Sym021+Sym023 Dose Level 2

Arm B: Sym021+Sym023 Dose Level 3

Arm B: Sym021+Sym023 Dose Level 4

Arm B: Sym021+Sym023 Dose Level 5

Sym021+Sym022+Sym023 Dose Level 1

Sym021+Sym022+Sym023 Dose Level 2

Sym021+Sym022+Sym023 Dose Level 3

Sym021+Sym022+Sym023 Dose Level 4

Sym021+Sym022+Sym023 Dose Level 5

Arm Description

Part 1, Sym021 monotherapy dose level 1

Part 1, Sym021 monotherapy dose level 2

Part 1, Sym021 monotherapy dose level 3

Part 2, Arm A: Sym021 RP2D in combination with dose level 1 of Sym022

Part 2, Arm A: Sym021 RP2D in combination with dose level 2 of Sym022

Part 2, Arm A: Sym021 RP2D in combination with dose level 3 of Sym022

Part 2, Arm A: Sym021 RP2D in combination with dose level 4 of Sym022

Part 2, Arm B: Sym021 RP2D in combination with dose level 1 of Sym023

Part 2, Arm B: Sym021 RP2D in combination with dose level 2 of Sym023

Part 2, Arm B: Sym021 RP2D in combination with dose level 3 of Sym023

Part 2, Arm B: Sym021 RP2D in combination with dose level 4 of Sym023

Part 2, Arm B: Sym021 RP2D in combination with dose level 5 of Sym023

Part 3, Sym021 in combination with Sym022 and Sym023

Part 3, Sym021 in combination with Sym022 and Sym023

Part 3, Sym021 in combination with Sym022 and Sym023

Part 3, Sym021 in combination with Sym022 and Sym023

Part 3, Sym021 in combination with Sym022 and Sym023

Outcomes

Primary Outcome Measures

Part 1: Assessment of treatment emergent adverse events (AEs) meeting DLT criteria.
Assess the safety and tolerability of Sym021 monotherapy on a Q2W schedule. Assessment based on the occurrence of AEs meeting DLT criteria measured during Cycle 1.
Part 2: Assessment of treatment emergent adverse events (AEs) meeting DLT criteria.
Assess the safety and tolerability of the Sym021 RP2D in combination with sequential escalating doses of Sym022 or Sym023 on a Q2W schedule. Assessment based on the occurrence of AEs meeting DLT criteria measured during Cycle 1.
Part 3: Assessment of treatment emergent adverse events (AEs) meeting DLT criteria.
Assess the safety and tolerability of the Sym021 RP2D in combination with sequential escalating doses of Sym022 and Sym023 on a Q2W schedule. Assessment based on the occurrence of AEs meeting DLT criteria measured during Cycle 1.

Secondary Outcome Measures

Evaluation of the immunogenicity of Sym021 as a single agent and in combination with Sym022 and Sym023.
Serum sampling to assess the potential for anti-drug antibody (ADA) formation.
Evaluation of objective response (OR) or stable disease (SD).
Assessed by Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1), Response Evaluation Criteria in Lymphomas 2017 (RECIL 2017), or Immunotherapeutics Response Evaluation Criteria in Solid Tumors (iRECIST), depending on tumor type.
Time to progression (TTP) of disease.
Based on time of enrollment to first evidence of progression on imaging studies, as assessed by RECIST v1.1, RECIL 2017, or iRECIST, depending on tumor type.
Area under the concentration-time curve in a dosing interval (AUC)
Will be estimated using non-compartmental methods and actual timepoints.
Maximum concentration (Cmax)
Will be derived from observed data.
Time to reach maximum concentration (Tmax)
Will be derived from observed data.
Trough concentration (Ctrough)
Will be derived from observed data.
Terminal elimination half-life (T½)
Will be estimated using non-compartmental methods and actual timepoints.
Clearance (CL)
Will be estimated using non-compartmental methods and actual timepoints.

Full Information

First Posted
October 3, 2017
Last Updated
May 25, 2023
Sponsor
Symphogen A/S
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1. Study Identification

Unique Protocol Identification Number
NCT03311412
Brief Title
Sym021 Monotherapy, in Combination With Sym022 or Sym023, and in Combination With Both Sym022 and Sym023 in Patients With Advanced Solid Tumor Malignancies or Lymphomas
Official Title
A Phase 1, Open-Label, Multicenter Trial Investigating the Safety, Tolerability, and Preliminary Antineoplastic Activity of Sym021 (Anti-PD-1) as Monotherapy, in Combination With Either Sym022 (Anti-LAG-3) or Sym023 (Anti-TIM-3), and in Combination With Both Sym022 and Sym023 in Patients With Advanced Solid Tumor Malignancies or Lymphomas
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
November 20, 2017 (Actual)
Primary Completion Date
March 23, 2022 (Actual)
Study Completion Date
March 23, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Symphogen A/S

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary purpose of this study is to see if Sym021 is safe and tolerable as monotherapy, in combination with either Sym022 or Sym023, and in Combination with both Sym022 and Sym023 for patients with locally advanced/unresectable or metastatic solid tumor malignancies or lymphomas that are refractory to available therapy or for which no standard therapy is available.
Detailed Description
Part 1 of this study will evaluate the safety, tolerability, and dose-limiting toxicities (DLTs) to establish the maximum tolerated dose (MTD) and/or the selected dose of sequential escalating doses of Sym021 when administered once every 2 weeks (Q2W) by IV infusion to patient cohorts with locally advanced/unresectable or metastatic solid tumor malignancies or lymphomas that are refractory to available therapy or for which no standard therapy is available Part 2 of the study will evaluate the safety, tolerability, and DLTs to establish the MTD and/or the selected dose of sequential escalating doses of Sym022 when administered Q2W in combination with a fixed dose of 3 mg/kg of Sym021, each by IV infusion to patient cohorts with locally advanced/unresectable or metastatic solid tumor malignancies or lymphomas that are refractory to available therapy or for which no standard therapy is available Part 3 of the study will evaluate of the safety, tolerability, and DLTs to establish the MTD and/or the selected dose of sequential escalating doses of Sym023 when administered Q2W in combination with fixed doses of 3 mg/kg of Sym021 and either 1, 3 or 5 mg/kg of Sym022, each by IV infusion to patient cohorts with locally advanced/unresectable or metastatic solid tumor malignancies or lymphomas that are refractory to available therapy or for which no standard therapy is available.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Cancer, Solid Tumor, Lymphoma
Keywords
Locally advanced/unresectable, Metastatic solid tumor, Lymphoma, Anti-PD-1, PD-1, PD1, Anti-LAG-3, LAG-3, LAG3, Anti-TIM-3, TIM-3, TIM3

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
89 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Sym021 Dose Level 1
Arm Type
Experimental
Arm Description
Part 1, Sym021 monotherapy dose level 1
Arm Title
Sym021 Dose Level 2
Arm Type
Experimental
Arm Description
Part 1, Sym021 monotherapy dose level 2
Arm Title
Sym021 Dose Level 3
Arm Type
Experimental
Arm Description
Part 1, Sym021 monotherapy dose level 3
Arm Title
Arm A: Sym021+Sym022 Dose Level 1
Arm Type
Experimental
Arm Description
Part 2, Arm A: Sym021 RP2D in combination with dose level 1 of Sym022
Arm Title
Arm A: Sym021+Sym022 Dose Level 2
Arm Type
Experimental
Arm Description
Part 2, Arm A: Sym021 RP2D in combination with dose level 2 of Sym022
Arm Title
Arm A: Sym021+Sym022 Dose Level 3
Arm Type
Experimental
Arm Description
Part 2, Arm A: Sym021 RP2D in combination with dose level 3 of Sym022
Arm Title
Arm A: Sym021+Sym022 Dose Level 4
Arm Type
Experimental
Arm Description
Part 2, Arm A: Sym021 RP2D in combination with dose level 4 of Sym022
Arm Title
Arm B: Sym021+Sym023 Dose Level 1
Arm Type
Experimental
Arm Description
Part 2, Arm B: Sym021 RP2D in combination with dose level 1 of Sym023
Arm Title
Arm B: Sym021+Sym023 Dose Level 2
Arm Type
Experimental
Arm Description
Part 2, Arm B: Sym021 RP2D in combination with dose level 2 of Sym023
Arm Title
Arm B: Sym021+Sym023 Dose Level 3
Arm Type
Experimental
Arm Description
Part 2, Arm B: Sym021 RP2D in combination with dose level 3 of Sym023
Arm Title
Arm B: Sym021+Sym023 Dose Level 4
Arm Type
Experimental
Arm Description
Part 2, Arm B: Sym021 RP2D in combination with dose level 4 of Sym023
Arm Title
Arm B: Sym021+Sym023 Dose Level 5
Arm Type
Experimental
Arm Description
Part 2, Arm B: Sym021 RP2D in combination with dose level 5 of Sym023
Arm Title
Sym021+Sym022+Sym023 Dose Level 1
Arm Type
Experimental
Arm Description
Part 3, Sym021 in combination with Sym022 and Sym023
Arm Title
Sym021+Sym022+Sym023 Dose Level 2
Arm Type
Experimental
Arm Description
Part 3, Sym021 in combination with Sym022 and Sym023
Arm Title
Sym021+Sym022+Sym023 Dose Level 3
Arm Type
Experimental
Arm Description
Part 3, Sym021 in combination with Sym022 and Sym023
Arm Title
Sym021+Sym022+Sym023 Dose Level 4
Arm Type
Experimental
Arm Description
Part 3, Sym021 in combination with Sym022 and Sym023
Arm Title
Sym021+Sym022+Sym023 Dose Level 5
Arm Type
Experimental
Arm Description
Part 3, Sym021 in combination with Sym022 and Sym023
Intervention Type
Drug
Intervention Name(s)
Sym021
Other Intervention Name(s)
Anti-PD-1
Intervention Description
Sym021 is a humanized antibody that binds PD-1 with sub-nanomolar affinity and blocks binding of the inhibitory ligands PD-L1 and PD-L2, thus releasing PD-1-mediated inhibition of the immune response.
Intervention Type
Drug
Intervention Name(s)
Sym022
Other Intervention Name(s)
Anti-LAG-3
Intervention Description
Sym022 is a recombinant, fully human antibody that binds LAG-3 and blocks the LAG-3/major histocompatibility complex class II (MHC-II) interaction, thus allowing for increased T-cell proliferation and cytokine production.
Intervention Type
Drug
Intervention Name(s)
Sym023
Other Intervention Name(s)
Anti-TIM-3
Intervention Description
Sym023 is a recombinant, fully human antibody that binds TIM-3 and induces activation of immune cells.
Primary Outcome Measure Information:
Title
Part 1: Assessment of treatment emergent adverse events (AEs) meeting DLT criteria.
Description
Assess the safety and tolerability of Sym021 monotherapy on a Q2W schedule. Assessment based on the occurrence of AEs meeting DLT criteria measured during Cycle 1.
Time Frame
12 months
Title
Part 2: Assessment of treatment emergent adverse events (AEs) meeting DLT criteria.
Description
Assess the safety and tolerability of the Sym021 RP2D in combination with sequential escalating doses of Sym022 or Sym023 on a Q2W schedule. Assessment based on the occurrence of AEs meeting DLT criteria measured during Cycle 1.
Time Frame
12 months
Title
Part 3: Assessment of treatment emergent adverse events (AEs) meeting DLT criteria.
Description
Assess the safety and tolerability of the Sym021 RP2D in combination with sequential escalating doses of Sym022 and Sym023 on a Q2W schedule. Assessment based on the occurrence of AEs meeting DLT criteria measured during Cycle 1.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Evaluation of the immunogenicity of Sym021 as a single agent and in combination with Sym022 and Sym023.
Description
Serum sampling to assess the potential for anti-drug antibody (ADA) formation.
Time Frame
24 months
Title
Evaluation of objective response (OR) or stable disease (SD).
Description
Assessed by Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1), Response Evaluation Criteria in Lymphomas 2017 (RECIL 2017), or Immunotherapeutics Response Evaluation Criteria in Solid Tumors (iRECIST), depending on tumor type.
Time Frame
24 months
Title
Time to progression (TTP) of disease.
Description
Based on time of enrollment to first evidence of progression on imaging studies, as assessed by RECIST v1.1, RECIL 2017, or iRECIST, depending on tumor type.
Time Frame
24 months
Title
Area under the concentration-time curve in a dosing interval (AUC)
Description
Will be estimated using non-compartmental methods and actual timepoints.
Time Frame
24 months
Title
Maximum concentration (Cmax)
Description
Will be derived from observed data.
Time Frame
24 months
Title
Time to reach maximum concentration (Tmax)
Description
Will be derived from observed data.
Time Frame
24 months
Title
Trough concentration (Ctrough)
Description
Will be derived from observed data.
Time Frame
24 months
Title
Terminal elimination half-life (T½)
Description
Will be estimated using non-compartmental methods and actual timepoints.
Time Frame
24 months
Title
Clearance (CL)
Description
Will be estimated using non-compartmental methods and actual timepoints.
Time Frame
24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients, ≥ 18 years of age at the time of obtaining informed consent. Documented (histologically- or cytologically-proven) solid tumor malignancy that is locally advanced or metastatic; patients with documented lymphoma. Malignancy (solid tumor or lymphoma) that is currently not amenable to surgical intervention due to either medical contraindications or non-resectability of the tumor. Refractory to or intolerant of existing therapy(ies) known to provide clinical benefit. Measurable or non-measurable disease according to RECIST v1.1 or RECIL 2017. Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1. Persons of childbearing potential agreeing to use a highly effective method of contraception during the study beginning within 2 weeks prior to the first dose and continuing until 6 months after the last dose of study drug(s); men agreeing to refrain from sperm donation during this period. Exclusion Criteria: Women who are pregnant or intending to become pregnant before, during, or within 6 months after the last dose of study drug; women who are breastfeeding; persons of childbearing potential and not willing to use a highly effective method of contraception. Central nervous system (CNS) malignancies; patients with known, untreated CNS or leptomeningeal metastases, or spinal cord compression, patients with any of the above not controlled by prior surgery or radiotherapy, or patients with symptoms suggesting CNS involvement for which treatment is required. Hematologic malignancies other than lymphoma. Active thrombosis, or a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) within 4 weeks prior to Cycle 1/Day 1 (C1/D1) unless adequately treated and considered stable. Active uncontrolled bleeding or a known bleeding diathesis. Clinically significant cardiovascular disease or condition. Significant ocular disease or condition, including history of an autoimmune or inflammatory disorder. Significant pulmonary disease or condition. Current or recent (within 6 months) significant gastrointestinal (GI) disease or condition. An active, known, or suspected autoimmune disease, or a documented history of autoimmune disease or syndrome, requiring systemic steroids or other immunosuppressive medications. History of organ transplantation (e.g., stem cell or solid organ transplant). History of significant toxicities associated with previous administration of immune checkpoint inhibitors that necessitated permanent discontinuation of that therapy. Patients with unresolved > Grade 1 toxicity associated with any prior antineoplastic therapy except for persistent Grade 2 alopecia, peripheral neuropathy, decreased hemoglobin, lymphopenia, hypomagnesemia, and/or end-organ failure being adequately managed by hormone replacement therapy. Inadequate recovery from any prior surgical procedure, or having undergone any major surgical procedure within 4 weeks prior to C1/D1. Known history of human immunodeficiency virus (HIV) or known active infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Drugs and Other Treatments Exclusion Criteria: Part 2 Combination Dose-Escalations ONLY: Prior therapy with: Sym021 or other inhibitors of PD-1/PD-L1. Sym022 or other inhibitors of LAG-3, if participating in Arm A. Sym023 or other inhibitors of TIM-3, if participating in Arm B. Part 3 Combination Dose-Escalations ONLY: Prior therapy with: Sym022 or other inhibitors of LAG-3 Sym023 or other inhibitors of TIM-3 Any antineoplastic agent for the primary malignancy (standard or investigational) within 4 weeks or 5 plasma half-lives, whichever is shortest, prior to first study drug administration and during study, with exceptions. Any other investigational treatments within 2 weeks prior to and during study; includes participation in any medical device or supportive care therapeutic intervention trials. Radiotherapy, with exceptions. Use of live vaccines against infectious diseases 4 weeks prior to first study drug administration and during study. Immunosuppressive or systemic hormonal therapy within 2 weeks prior to first study drug administration and during study, with exceptions. Prophylactic use of hematopoietic growth factors within 1 week prior to first study drug administration and during Cycle 1 of study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lillian Siu, MD, FRCPC
Organizational Affiliation
Princess Margaret Cancer Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
South Texas Accelerated Research Therapeutics (START) Midwest
City
Grand Rapids
State/Province
Michigan
ZIP/Postal Code
49503
Country
United States
Facility Name
The University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
NEXT Oncology
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78240
Country
United States
Facility Name
Princess Margaret Cancer Centre
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Sym021 Monotherapy, in Combination With Sym022 or Sym023, and in Combination With Both Sym022 and Sym023 in Patients With Advanced Solid Tumor Malignancies or Lymphomas

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