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GNR-084 Safety and Pharmacological Characteristics in Refractory or Relapse B-cell Precursor ALL

Primary Purpose

B-precursor Acute Lymphoblastic Leukemia, ALL, GNR-084

Status
Recruiting
Phase
Phase 1
Locations
Russian Federation
Study Type
Interventional
Intervention
Cohort 1, GNR-084
Cohort 2, GNR-084
Cohort 3, GNR-084
Cohort 4, GNR-084
Cohort 5, GNR-084
Cohort 6, GNR-084
Sponsored by
AO GENERIUM
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for B-precursor Acute Lymphoblastic Leukemia focused on measuring Leukemia, GNR-084, ALL, Blood Diseases, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Lymphoid, Neoplasms by Histologic Type, Neoplasms, Lymphoproliferative Disorders, Lymphatic Diseases, Immunoproliferative Disorders, Immune System Diseases, Neoplastic Processes, Pathologic Processes, Antineoplastic Agents

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Voluntarily signed informed consent form to participate in the study;
  2. Men and women between aged 18 to 45 inclusive;
  3. Patients with incurable morphologically / immunophenotypically confirmed refractory/ relapse of B-cell precursors CD19-positive acute lymphoblastic leukemia from (Ph "-" or Ph "+").
  4. Two or more previous lines of anti-leucosis therapy.
  5. 5-50% of bone marrow blast cells at screening;
  6. Functional status on the scale of the Eastern Cooperative Oncology Group (ECOG) 0-2 points at the screening;
  7. Life expectancy ≥ 60 days;

Exclusion Criteria:

  1. Hematopoietic stem cells transplantation within 12 weeks prior to study inclusion;
  2. Active and widespread chronic graft versus host (GVHD) reaction (grade II-IV), including taking immunosuppressants for the prevention and treatment of GVHD within 2 weeks prior the GNR-084 infusion;
  3. Investigator and / or sponsor has doubts that patient will complete the study due to rapid disease progression;
  4. Chemotherapeutic agent using within 14 days prior the first GNR-084 infusion;

    Exceptions:

    • Emergency leukapheresis;
    • Emergency hydroxyurea using due to hyperleukocytosis for ≤ 7 days;
    • Other supportive care, including antibiotics, at Investigator's discretion
  5. Biochemical blood test:

    • The level of total bilirubin> 1.5 upper limit of norm;
    • Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)> 3 upper limit of norm;
    • Glomerular filtration rate (GFR) level ≤30 (СKD-EPI)
  6. Medical history of blinatumomab and other bispecific antibodies using;
  7. Persistent toxicity event of 3rd and 4th severity degrees (CTCAE ver 5.0) due to previous treatment;
  8. HIV-positive status and / or detection of any hepatitis B and / or hepatitis C blood markers;
  9. Severe cardiovascular diseases: uncontrolled arterial hypertension, New York Heart Association (NYHA) functional class III or IV chronic heart failure, unstable angina pectoris, stroke, myocardial infarction, transient ischemic attack, coronary artery bypass grafting and coronary revascularization within last 12 months, or signs of pericardial effusion;
  10. Individual sensitivity to:

    • GNR-084 components / excipients;
    • human or humanized investigational drug antibodies;
  11. Major surgical interventions, accompanied by hospitalization and anesthesia application within 30 days before the patient is included in the study (biopsy is not a significant surgical intervention);
  12. Any other malignant neoplasm presence at the present time or within 5 years prior to inclusion in the study;
  13. Known suspected Central Nervous System (CNS) lesion by any genesis now or in medical history, including, but not limited to: neuroleukemia, epilepsy, ischemic or hemorrhagic stroke, severe traumatic brain injury, dementia, Parkinson's disease, organic brain damage, cerebellar disorders, psychosis;
  14. Extramedullary lesion of any localization;
  15. Other clinical trials participation within 30 days before screening;
  16. Mental, physical and other reasons hindering patient to adequately assess their behavior and correctly comply with the conditions of the research protocol;
  17. Pregnancy and / or lactation;
  18. Male and female patients refusal to use adequate methods of contraception throughout the study;
  19. Drug addiction;
  20. Alcohol addiction.

Sites / Locations

  • Federal State Budget Funded Institution National Medical Research Center of Hematology, Ministry of Health of the Russian Federation (MoH of Russia)Recruiting
  • Almazov National Medical Research CentreRecruiting
  • Pavlov First Saint Petersburg State Medical UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

GNR-084, dose level 1

GNR-084, dose level 2

GNR-084, dose level 3

GNR-084, dose level 4

GNR-084, dose level 5

GNR-084, dose level 6

Arm Description

Anti-CD19/CD3 antibody

Anti-CD19/CD3 antibody

Anti-CD19/CD3 antibody

Anti-CD19/CD3 antibody

Anti-CD19/CD3 antibody

Anti-CD19/CD3 antibody

Outcomes

Primary Outcome Measures

GNR-084 safety and tolerability.
The GNR-084 safety and tolerability will be assessed based on an analysis of the frequency of adverse events (AEs) over the period of treatment and observation of patients

Secondary Outcome Measures

The frequency of specific toxicity events
GNR-084 Peak Plasma Concentration (Cmax)
GNR-084 area under the plasma concentration versus time curve (AUC)
GNR-84 half-life (T1/2)
GNR-084 elimination rate constant (Kel)
GNR-084 mean retention time (MRT)
GNR-084 overall clearance (Cl)
GNR-084 kinetic volume of distribution (Vz)
Peripheral blood B-lymphocyte depletion (CD19, CD20).
CD45+ peripheral cell count
Peripheral T-lymphocytes count (CD3, CD4, CD8)
Peripheral T-memory cells (CD45RA+, CD28+, CCR7+) count
Peripheral B-cells/T-cells ratio
Cytokine dynamics
Immunogenicity
Objective response rate (ORR)
Complete clinical and hematological remission rate (CR)
Frequency of complete remission with incomplete restoration of blood cellularity (CRi)
Duration of an objective response (DoR)
Relapse-free survival (RFS)
Event-free survival (EFS)
Overall survival (OS)
Minimal residual disease (MRD) (-) rate in CR-patient

Full Information

First Posted
October 13, 2020
Last Updated
February 27, 2023
Sponsor
AO GENERIUM
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1. Study Identification

Unique Protocol Identification Number
NCT04601584
Brief Title
GNR-084 Safety and Pharmacological Characteristics in Refractory or Relapse B-cell Precursor ALL
Official Title
Dose-escalation Sequention Cohort Study of Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of GNR-084 in Patients With Refractory or Relapse Acute Lymphoblastic B-cell Precursor Leukemia.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 15, 2020 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
June 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AO GENERIUM

4. Oversight

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

5. Study Description

Brief Summary
It is an open-label dose-escalating study in sequential cohorts to assess safety and pharmacokinetics of GNR-084.
Detailed Description
Acute lymphoblastic leukemias (ALL) are a heterogeneous group of malignant clonal diseases of the blood system originating from precursor cells of hematopoiesis, predominantly of lymphoid differentiation. More than 7,200 new cases of ALL are diagnosed annually in the European Union (EU), with approximately 40% (approximately 3,000 cases) occurring in adults The main reason for the failure of treatment of acute B-cell lymphoblastic leukemias (B-ALL) is the primary refractoriness to chemical exposure and relapses of the disease, which actually occur in 40-50% of adult patients with ALL. The prognosis in these cases is regarded as extremely unfavorable. Escalation of the chemotherapeutic approach is associated with the development of severe toxic infectious and hemorrhagic complications. The active substance of the preparation GNR-084 is a bispecific antibody to CD19 / CD3 in the BiMS format (bispecific IgG-like molecules).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
B-precursor Acute Lymphoblastic Leukemia, ALL, GNR-084
Keywords
Leukemia, GNR-084, ALL, Blood Diseases, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Lymphoid, Neoplasms by Histologic Type, Neoplasms, Lymphoproliferative Disorders, Lymphatic Diseases, Immunoproliferative Disorders, Immune System Diseases, Neoplastic Processes, Pathologic Processes, Antineoplastic Agents

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Sequential dose-escalation cohorts in B-ALL patients
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
36 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
GNR-084, dose level 1
Arm Type
Experimental
Arm Description
Anti-CD19/CD3 antibody
Arm Title
GNR-084, dose level 2
Arm Type
Experimental
Arm Description
Anti-CD19/CD3 antibody
Arm Title
GNR-084, dose level 3
Arm Type
Experimental
Arm Description
Anti-CD19/CD3 antibody
Arm Title
GNR-084, dose level 4
Arm Type
Experimental
Arm Description
Anti-CD19/CD3 antibody
Arm Title
GNR-084, dose level 5
Arm Type
Experimental
Arm Description
Anti-CD19/CD3 antibody
Arm Title
GNR-084, dose level 6
Arm Type
Experimental
Arm Description
Anti-CD19/CD3 antibody
Intervention Type
Biological
Intervention Name(s)
Cohort 1, GNR-084
Other Intervention Name(s)
Anti-CD19/CD3 antibody
Intervention Description
0.01 ng/kg 6-hours intravenous infusion once a week; 4 doses per cycle, up to 5 cycles
Intervention Type
Biological
Intervention Name(s)
Cohort 2, GNR-084
Other Intervention Name(s)
Anti-CD19/CD3 antibody
Intervention Description
0.1 ng/kg 6-hours intravenous infusion once a week; 4 doses per cycle, up to 5 cycles
Intervention Type
Biological
Intervention Name(s)
Cohort 3, GNR-084
Other Intervention Name(s)
Anti-CD19/CD3 antibody
Intervention Description
1 ng/kg 6-hours intravenous infusion once a week; 4 doses per cycle, up to 5 cycles
Intervention Type
Biological
Intervention Name(s)
Cohort 4, GNR-084
Other Intervention Name(s)
Anti-CD19/CD3 antibody
Intervention Description
4 ng/kg 6-hours intravenous infusion once a week; 4 doses per cycle, up to 5 cycles
Intervention Type
Biological
Intervention Name(s)
Cohort 5, GNR-084
Other Intervention Name(s)
Anti-CD19/CD3 antibody
Intervention Description
10 ng/kg 6-hours intravenous infusion once a week; 4 doses per cycle, up to 5 cycles
Intervention Type
Biological
Intervention Name(s)
Cohort 6, GNR-084
Other Intervention Name(s)
Anti-CD19/CD3 antibody
Intervention Description
20 ng/kg 6-hours intravenous infusion once a week; 4 doses per cycle, up to 5 cycles
Primary Outcome Measure Information:
Title
GNR-084 safety and tolerability.
Description
The GNR-084 safety and tolerability will be assessed based on an analysis of the frequency of adverse events (AEs) over the period of treatment and observation of patients
Time Frame
Week 10
Secondary Outcome Measure Information:
Title
The frequency of specific toxicity events
Time Frame
Week 104
Title
GNR-084 Peak Plasma Concentration (Cmax)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
GNR-084 area under the plasma concentration versus time curve (AUC)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
GNR-84 half-life (T1/2)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
GNR-084 elimination rate constant (Kel)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
GNR-084 mean retention time (MRT)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
GNR-084 overall clearance (Cl)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
GNR-084 kinetic volume of distribution (Vz)
Time Frame
First infusion: 5 minutes before administration, immediately after infusion, 30 minutes, 1, 3, 6, 12, 18, 24, 48, 72, 96 hours after infusion.
Title
Peripheral blood B-lymphocyte depletion (CD19, CD20).
Time Frame
First infusion: 5 minutes before administration, 30 minutes, 1, 24, 48, 96 and 144 hours after infusion. Other infusions: 5 minutes before administration and 1 hour after infusion
Title
CD45+ peripheral cell count
Time Frame
First infusion: 5 minutes before administration, 30 minutes, 1, 24, 48, 96 and 144 hours after infusion. Other infusions: 5 minutes before administration and 1 hour after infusion
Title
Peripheral T-lymphocytes count (CD3, CD4, CD8)
Time Frame
First infusion: 5 minutes before administration, 30 minutes, 1, 24, 48, 96 and 144 hours after infusion. Other infusions: 5 minutes before administration and 1 hour after infusion
Title
Peripheral T-memory cells (CD45RA+, CD28+, CCR7+) count
Time Frame
First infusion: 5 minutes before administration, 30 minutes, 1, 24, 48, 96 and 144 hours after infusion. Other infusions: 5 minutes before administration and 1 hour after infusion
Title
Peripheral B-cells/T-cells ratio
Time Frame
First infusion: 5 minutes before administration, 30 minutes, 1, 24, 48, 96 and 144 hours after infusion. Other infusions: 5 minutes before administration and 1 hour after infusion
Title
Cytokine dynamics
Time Frame
First infusion: 5 minutes before administration, 30 minutes, 1, 24, 48, 96 and 144 hours after infusion. Other infusions: 5 minutes before administration and 1 hour after infusion
Title
Immunogenicity
Time Frame
Week 33
Title
Objective response rate (ORR)
Time Frame
After 2 and 5 GNR-084 cycles (each cycle is 28 days)
Title
Complete clinical and hematological remission rate (CR)
Time Frame
After 2 and 5 GNR-084 cycles (each cycle is 28 days)
Title
Frequency of complete remission with incomplete restoration of blood cellularity (CRi)
Time Frame
After 2 and 5 GNR-084 cycles (each cycle is 28 days)
Title
Duration of an objective response (DoR)
Time Frame
Week 104
Title
Relapse-free survival (RFS)
Time Frame
Week 104
Title
Event-free survival (EFS)
Time Frame
Week 104
Title
Overall survival (OS)
Time Frame
Week 104
Title
Minimal residual disease (MRD) (-) rate in CR-patient
Time Frame
After 5 GNR-084 cycles (each cycle is 28 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Voluntarily signed informed consent form to participate in the study; Men and women between aged 18 to 45 inclusive; Patients with incurable morphologically / immunophenotypically confirmed refractory/ relapse of B-cell precursors CD19-positive acute lymphoblastic leukemia from (Ph "-" or Ph "+"). Two or more previous lines of anti-leucosis therapy. 5-50% of bone marrow blast cells at screening; Functional status on the scale of the Eastern Cooperative Oncology Group (ECOG) 0-2 points at the screening; Life expectancy ≥ 60 days; Exclusion Criteria: Hematopoietic stem cells transplantation within 12 weeks prior to study inclusion; Active and widespread chronic graft versus host (GVHD) reaction (grade II-IV), including taking immunosuppressants for the prevention and treatment of GVHD within 2 weeks prior the GNR-084 infusion; Investigator and / or sponsor has doubts that patient will complete the study due to rapid disease progression; Chemotherapeutic agent using within 14 days prior the first GNR-084 infusion; Exceptions: Emergency leukapheresis; Emergency hydroxyurea using due to hyperleukocytosis for ≤ 7 days; Other supportive care, including antibiotics, at Investigator's discretion Biochemical blood test: The level of total bilirubin> 1.5 upper limit of norm; Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)> 3 upper limit of norm; Glomerular filtration rate (GFR) level ≤30 (СKD-EPI) Medical history of blinatumomab and other bispecific antibodies using; Persistent toxicity event of 3rd and 4th severity degrees (CTCAE ver 5.0) due to previous treatment; HIV-positive status and / or detection of any hepatitis B and / or hepatitis C blood markers; Severe cardiovascular diseases: uncontrolled arterial hypertension, New York Heart Association (NYHA) functional class III or IV chronic heart failure, unstable angina pectoris, stroke, myocardial infarction, transient ischemic attack, coronary artery bypass grafting and coronary revascularization within last 12 months, or signs of pericardial effusion; Individual sensitivity to: GNR-084 components / excipients; human or humanized investigational drug antibodies; Major surgical interventions, accompanied by hospitalization and anesthesia application within 30 days before the patient is included in the study (biopsy is not a significant surgical intervention); Any other malignant neoplasm presence at the present time or within 5 years prior to inclusion in the study; Known suspected Central Nervous System (CNS) lesion by any genesis now or in medical history, including, but not limited to: neuroleukemia, epilepsy, ischemic or hemorrhagic stroke, severe traumatic brain injury, dementia, Parkinson's disease, organic brain damage, cerebellar disorders, psychosis; Extramedullary lesion of any localization; Other clinical trials participation within 30 days before screening; Mental, physical and other reasons hindering patient to adequately assess their behavior and correctly comply with the conditions of the research protocol; Pregnancy and / or lactation; Male and female patients refusal to use adequate methods of contraception throughout the study; Drug addiction; Alcohol addiction.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Eugene V. Zuev, MD
Phone
+7 9166419698
Email
evzuev@generium.ru
First Name & Middle Initial & Last Name or Official Title & Degree
Oksana A. Markova, MD
Phone
+7 9854418959
Email
oamarkova@generium.ru
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Oksana A. Markova, MD
Organizational Affiliation
AO GENERIUM
Official's Role
Study Chair
Facility Information:
Facility Name
Federal State Budget Funded Institution National Medical Research Center of Hematology, Ministry of Health of the Russian Federation (MoH of Russia)
City
Moscow
ZIP/Postal Code
125167
Country
Russian Federation
Individual Site Status
Recruiting
Facility Name
Almazov National Medical Research Centre
City
Saint Petersburg
ZIP/Postal Code
191014
Country
Russian Federation
Individual Site Status
Recruiting
Facility Name
Pavlov First Saint Petersburg State Medical University
City
Saint Petersburg
ZIP/Postal Code
197022
Country
Russian Federation
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35622074
Citation
Shi Z, Zhu Y, Zhang J, Chen B. Monoclonal antibodies: new chance in the management of B-cell acute lymphoblastic leukemia. Hematology. 2022 Dec;27(1):642-652. doi: 10.1080/16078454.2022.2074704.
Results Reference
derived
Links:
URL
https://grls.rosminzdrav.ru/CIPermissionMini.aspx?CIStatementGUID=130bc5af-076e-46a8-b8c4-3391f5688540&CIPermGUID=46966D05-6364-48D8-A949-75E71F78EADC
Description
Clinical trial registry, Ministry of Health of Russian Federation

Learn more about this trial

GNR-084 Safety and Pharmacological Characteristics in Refractory or Relapse B-cell Precursor ALL

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