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LINNOVATE: Lurbinectedin, Ipilimumab and Nivolumab for Soft Tissue Sarcoma (LINNOVATE)

Primary Purpose

Advanced Soft-tissue Sarcoma

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Lurbinectedin
Sponsored by
ERLINDA M GORDON
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced Soft-tissue Sarcoma

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Individuals must meet all of the inclusion criteria in order to be eligible to participate in the study, as follows: Male or Female ≥ 18 years of age Pathologically confirmed diagnosis of locally advanced unresectable or metastatic soft tissue sarcoma For the Phase 1 Part of Study, only previously treated participants will be enrolled. For the Phase 2 Part of Study, previously untreated participants will be enrolled. Ability to understand the purposes and risks of the study and has signed and dated a written informed consent form approved by the principal investigator's IRB/Ethics Committee Willingness to comply with all study procedures and availability for the duration of the study. Measurable disease by RECIST v1.1 ECOG performance status ≤ 1 Life expectancy of at least 3 months Acceptable liver function: Bilirubin < 1.5 times upper limit of normal (ULN; except subjects with Gilbert Syndrome who must have a total bilirubin level < 3.0 ULN); AST (SGOT), ALT (SGPT) and alkaline phosphatase < 3 x ULN (< 5 x ULN if liver metastases) Acceptable renal function: Creatinine < 1.5 times ULN or > 60 mL/min (using the Cockcroft Gault formula) Acceptable hematologic status (without hematologic support e.g. growth factors or transfusion within 21 days of first dose of study agents): ANC >= 1500 cells/μL; Platelet count >= 100,000/μL; Hemoglobin >= 9.0 g/dL; Normal PT, PTT, INR All women of childbearing potential must have a negative pregnancy test and all subjects must agree to use highly effective means of contraception (surgical sterilization or the use of barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel or an IUD) with their partner from entry into the study through 5 months for women and 7 months for men after the last dose. Exclusion Criteria: All individuals meeting any of the exclusion criteria at baseline will be excluded from study participation, as follows: Subjects with untreated CNS metastases. Subjects are eligible if CNS metastases have been adequately treated and have neurologically returned to baseline (except for residual signs or symptoms related to the CNS treatment) for at least 2 weeks prior to treatment initiation. In addition, subjects must be either off corticosteroids, or on a stable or decreasing dose of <10 mg daily prednisone (or equivalent) for at least 2 weeks prior to treatment initiation. Subjects with carcinomatous meningitis Anticancer treatment with radiation therapy, targeted therapy or other antitumor treatment within 2 weeks prior to study entry. Anticancer treatment with chemotherapy within 21 days prior to study entry. Subjects who participated in an investigational drug or device study within 14 days prior to study entry Females who are pregnant or breast-feeding Unwillingness or inability to comply with the study protocol for any reason Concurrent or prior immunotherapy with anti-CTLA4 or anti-PD-1 inhibitors Non-oncology vaccine therapy used for prevention of infectious disease within 4 weeks of trial enrollment Autoimmune disease including rheumatoid arthritis, systemic progressive sclerosis (scleroderma), systemic lupus erythematosus, autoimmune vasculitis and motor neuropathy considered to be of autoimmune origin (e.g. Guillain-Barre Syndrome) Systemic immunosuppression, including HIV positive status with or without AIDS Skin rash (psoriasis, eczema) affecting > 25% body surface area Inflammatory bowel disease (Crohn's or ulcerative colitis) Ongoing or uncontrolled diarrhea within 4 weeks of trial enrollment Recent history of acute diverticulitis, intraabdominal abscess or gastrointestinal obstruction within 6 months of trial enrollment, which are known risk factors for bowel perforation Participants with congestive heart failure or recent cardiac event Evidence of severe or uncontrolled systemic disease or any other concurrent condition, including psychiatric, which in the principal investigator or sub-investigator's opinion makes it undesirable for the participant to participate in the trial or which would jeopardize compliance with the trial Any positive test for hepatitis B virus or hepatitis C virus indicating acute or chronic infection Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). Current, active, or previous history of heavy alcohol abuse Pituitary endocrinopathy Adrenal insufficiency or excess

Sites / Locations

  • Sarcoma Oncology Research CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Phase 1/2 study using lurbinectedin, ipilimumab and nivolumab for advanced soft tissue sarcoma

Arm Description

This is an open label, dose-seeking phase 1/2 study using escalating doses of LURBINECTEDIN administered intravenously with fixed doses of IPILIMUMAB and NIVOLUMAB administered intravenously. I. Dose Escalation Phase 1 of Study: The study will employ the standard "cohort of three" design (Storer, 1989). II.Phase 2 of Study: Following completion of dose escalation, an additional 28-34 previously untreated participants will receive LURBINECTEDIN at the MTD and fixed doses of IPILIMUMAB and NIVOLUMAB to assess overall safety and potential efficacy in a larger number of participants.

Outcomes

Primary Outcome Measures

Maximum tolerated dose
The maximum tolerated dose (MTD) is defined as the highest safely tolerated dose of lurbinectedin, where not more than one participant experienced a dose limiting toxicity (DLT), with the next higher dose level having at least two participants who experienced DLT.

Secondary Outcome Measures

Objective response rate
The number of patients achieving a complete response and partial response divided by the number of patients who completed at least one treatment cycle and had a follow up computerized tomography (CT) scan
Progression free survival at 6 months
The length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse.
Overall survival
The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. I
Correlation of response with circulating tumor DNA
Correlation of response with circulating tumor DNA

Full Information

First Posted
May 17, 2023
Last Updated
June 7, 2023
Sponsor
ERLINDA M GORDON
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1. Study Identification

Unique Protocol Identification Number
NCT05876715
Brief Title
LINNOVATE: Lurbinectedin, Ipilimumab and Nivolumab for Soft Tissue Sarcoma
Acronym
LINNOVATE
Official Title
LINNOVATE: A Phase 1/2 Study of Safety/Efficacy Using LURBINECTEDIN, Combined With IPILIMUMAB, and NIVOLUMAB for Advanced Soft Tissue Sarcomas
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 7, 2023 (Actual)
Primary Completion Date
June 30, 2026 (Anticipated)
Study Completion Date
September 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
ERLINDA M GORDON

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is an open label, dose-seeking phase 1/2 study using escalating doses of LURBINECTEDIN administered intravenously with fixed doses of IPILIMUMAB and NIVOLUMAB administered intravenously.
Detailed Description
This is an open label, dose-seeking phase 1/2 study using escalating doses of LURBINECTEDIN administered intravenously with fixed doses of IPILIMUMAB and NIVOLUMAB administered intravenously. I. Dose Escalation Phase 1 of Study: The study will employ the standard "cohort of three" design (Storer, 1989). Three participants are treated at each of the 2 ascending dose levels. An additional 3 participants will be enrolled if a DLT is observed in one of the three initially-enrolled participants at each dose level. If no DLT occurs after the third participant in a dose level is on study for 6 weeks, enrollment will be opened for escalation to the next highest planned dose level. The DLT window is a total of 6 weeks. The MTD is defined as the highest safely tolerated dose of lurbinectedin, where not more than one participant experienced a DLT, with the next higher dose level having at least two participants who experienced DLT. Participants in the dose escalation study may continue treatment at their designated dose levels until disease progression or unacceptable toxicity occurs or up to a maximum of one year of therapy (up to a maximum of 18 doses of LURBINECTEDIN, 26 doses of NIVOLUMAB, and 5 doses of IPILIMUMAB). No intra-participant dose escalation will take place. Dose of IPILIMUMAB: 1 mg/kg IV over 30 min. q 12 weeks, beginning 2 weeks after the first dose of LURBINECTEDIN, until disease progression or unacceptable toxicity, up to a maximum of 5 doses Dose of NIVOLUMAB: 3 mg/kg over 30 min. q 2 weeks, beginning 2 weeks after first dose of LURBINECTEDIN, until disease progression or unacceptable toxicity, up to a maximum of 26 doses Dose of LURBINECTEDIN: Escalating doses of LURBINECTEDIN IV over 60 minutes q 3 weeks up to a maximum of 18 doses: LURBINECTEDIN # Pts. Dose Level Dose,mg/m2 Max.Volume/24 hrs Every 3 weeks 3-6 I 2.6 1000 ml Every 3 weeks 3-6 II 3.2 1000 ml No dose-escalation will be performed until all the subjects have completed the DLT period of 6 weeks and evaluation of all clinical and laboratory data has been conducted. The phase 2 part of the study will not proceed until either the maximum tolerated dose (MTD) or maximum administered dose (MAD) has been determined. Participants who do not complete the DLT period for reasons other than study drug-related toxicity will be replaced in the same dose cohort. At the discretion of the principal investigator/sponsor, dose escalation may be stopped before an MTD is reached. In this case, the MAD may be chosen based on the standard dose of LURBINECTEDIN of 3.2 mg/m2.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced Soft-tissue Sarcoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
This is an open label, dose-seeking phase 1/2 study using escalating doses of LURBINECTEDIN administered intravenously with fixed doses of IPILIMUMAB and NIVOLUMAB administered intravenously.
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Phase 1/2 study using lurbinectedin, ipilimumab and nivolumab for advanced soft tissue sarcoma
Arm Type
Experimental
Arm Description
This is an open label, dose-seeking phase 1/2 study using escalating doses of LURBINECTEDIN administered intravenously with fixed doses of IPILIMUMAB and NIVOLUMAB administered intravenously. I. Dose Escalation Phase 1 of Study: The study will employ the standard "cohort of three" design (Storer, 1989). II.Phase 2 of Study: Following completion of dose escalation, an additional 28-34 previously untreated participants will receive LURBINECTEDIN at the MTD and fixed doses of IPILIMUMAB and NIVOLUMAB to assess overall safety and potential efficacy in a larger number of participants.
Intervention Type
Drug
Intervention Name(s)
Lurbinectedin
Other Intervention Name(s)
Ipilimumab, Nivolumab
Intervention Description
This is an open label, dose-seeking phase 1/2 study using escalating doses of LURBINECTEDIN administered intravenously with fixed doses of IPILIMUMAB and NIVOLUMAB administered intravenously.
Primary Outcome Measure Information:
Title
Maximum tolerated dose
Description
The maximum tolerated dose (MTD) is defined as the highest safely tolerated dose of lurbinectedin, where not more than one participant experienced a dose limiting toxicity (DLT), with the next higher dose level having at least two participants who experienced DLT.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Objective response rate
Description
The number of patients achieving a complete response and partial response divided by the number of patients who completed at least one treatment cycle and had a follow up computerized tomography (CT) scan
Time Frame
24 months
Title
Progression free survival at 6 months
Description
The length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse.
Time Frame
12 months
Title
Overall survival
Description
The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. I
Time Frame
36 months
Title
Correlation of response with circulating tumor DNA
Description
Correlation of response with circulating tumor DNA
Time Frame
36 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Individuals must meet all of the inclusion criteria in order to be eligible to participate in the study, as follows: Male or Female ≥ 18 years of age Pathologically confirmed diagnosis of locally advanced unresectable or metastatic soft tissue sarcoma For the Phase 1 Part of Study, only previously treated participants will be enrolled. For the Phase 2 Part of Study, previously untreated participants will be enrolled. Ability to understand the purposes and risks of the study and has signed and dated a written informed consent form approved by the principal investigator's IRB/Ethics Committee Willingness to comply with all study procedures and availability for the duration of the study. Measurable disease by RECIST v1.1 ECOG performance status ≤ 1 Life expectancy of at least 3 months Acceptable liver function: Bilirubin < 1.5 times upper limit of normal (ULN; except subjects with Gilbert Syndrome who must have a total bilirubin level < 3.0 ULN); AST (SGOT), ALT (SGPT) and alkaline phosphatase < 3 x ULN (< 5 x ULN if liver metastases) Acceptable renal function: Creatinine < 1.5 times ULN or > 60 mL/min (using the Cockcroft Gault formula) Acceptable hematologic status (without hematologic support e.g. growth factors or transfusion within 21 days of first dose of study agents): ANC >= 1500 cells/μL; Platelet count >= 100,000/μL; Hemoglobin >= 9.0 g/dL; Normal PT, PTT, INR All women of childbearing potential must have a negative pregnancy test and all subjects must agree to use highly effective means of contraception (surgical sterilization or the use of barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel or an IUD) with their partner from entry into the study through 5 months for women and 7 months for men after the last dose. Exclusion Criteria: All individuals meeting any of the exclusion criteria at baseline will be excluded from study participation, as follows: Subjects with untreated CNS metastases. Subjects are eligible if CNS metastases have been adequately treated and have neurologically returned to baseline (except for residual signs or symptoms related to the CNS treatment) for at least 2 weeks prior to treatment initiation. In addition, subjects must be either off corticosteroids, or on a stable or decreasing dose of <10 mg daily prednisone (or equivalent) for at least 2 weeks prior to treatment initiation. Subjects with carcinomatous meningitis Anticancer treatment with radiation therapy, targeted therapy or other antitumor treatment within 2 weeks prior to study entry. Anticancer treatment with chemotherapy within 21 days prior to study entry. Subjects who participated in an investigational drug or device study within 14 days prior to study entry Females who are pregnant or breast-feeding Unwillingness or inability to comply with the study protocol for any reason Concurrent or prior immunotherapy with anti-CTLA4 or anti-PD-1 inhibitors Non-oncology vaccine therapy used for prevention of infectious disease within 4 weeks of trial enrollment Autoimmune disease including rheumatoid arthritis, systemic progressive sclerosis (scleroderma), systemic lupus erythematosus, autoimmune vasculitis and motor neuropathy considered to be of autoimmune origin (e.g. Guillain-Barre Syndrome) Systemic immunosuppression, including HIV positive status with or without AIDS Skin rash (psoriasis, eczema) affecting > 25% body surface area Inflammatory bowel disease (Crohn's or ulcerative colitis) Ongoing or uncontrolled diarrhea within 4 weeks of trial enrollment Recent history of acute diverticulitis, intraabdominal abscess or gastrointestinal obstruction within 6 months of trial enrollment, which are known risk factors for bowel perforation Participants with congestive heart failure or recent cardiac event Evidence of severe or uncontrolled systemic disease or any other concurrent condition, including psychiatric, which in the principal investigator or sub-investigator's opinion makes it undesirable for the participant to participate in the trial or which would jeopardize compliance with the trial Any positive test for hepatitis B virus or hepatitis C virus indicating acute or chronic infection Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). Current, active, or previous history of heavy alcohol abuse Pituitary endocrinopathy Adrenal insufficiency or excess
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Erlinda M Gordon, MD
Phone
310-552-9999
Email
egordon@sarcomaoncology.com
First Name & Middle Initial & Last Name or Official Title & Degree
Victoria Chua-Alcala, MD
Phone
310-552-9999
Email
vchua@sarcomaoncology.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Erlinda M Gordon, MD
Organizational Affiliation
Sarcoma Oncology Research Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sarcoma Oncology Research Center
City
Santa Monica
State/Province
California
ZIP/Postal Code
90403
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
ERLINDA M GORDON, MD
Phone
310-552-9999
Email
egordon@sarcomaoncology.com
First Name & Middle Initial & Last Name & Degree
Victoria Chua, MD
Phone
310-552-9999
First Name & Middle Initial & Last Name & Degree
Erlinda M Gordon, MD
First Name & Middle Initial & Last Name & Degree
Sant P Chawla, MD
First Name & Middle Initial & Last Name & Degree
Doris Quon, MD
First Name & Middle Initial & Last Name & Degree
Steven Wong, MD
First Name & Middle Initial & Last Name & Degree
Ania Moradkhani, NP

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
We have no plan to make individual participant data available to other researchers other than the Sarcoma Oncology Research Center team.
Citations:
PubMed Identifier
36765863
Citation
Gordon EM, Chawla SP, Tellez WA, Younesi E, Thomas S, Chua-Alcala VS, Chomoyan H, Valencia C, Brigham DA, Moradkhani A, Quon D, Srikureja A, Wong SG, Tseng W, Federman N. SAINT: A Phase I/Expanded Phase II Study Using Safe Amounts of Ipilimumab, Nivolumab and Trabectedin as First-Line Treatment of Advanced Soft Tissue Sarcoma. Cancers (Basel). 2023 Jan 31;15(3):906. doi: 10.3390/cancers15030906.
Results Reference
background
PubMed Identifier
27234989
Citation
Gordon EM, Sankhala KK, Chawla N, Chawla SP. Trabectedin for Soft Tissue Sarcoma: Current Status and Future Perspectives. Adv Ther. 2016 Jul;33(7):1055-71. doi: 10.1007/s12325-016-0344-3. Epub 2016 May 27.
Results Reference
background
PubMed Identifier
28683469
Citation
Belgiovine C, Bello E, Liguori M, Craparotta I, Mannarino L, Paracchini L, Beltrame L, Marchini S, Galmarini CM, Mantovani A, Frapolli R, Allavena P, D'Incalci M. Lurbinectedin reduces tumour-associated macrophages and the inflammatory tumour microenvironment in preclinical models. Br J Cancer. 2017 Aug 22;117(5):628-638. doi: 10.1038/bjc.2017.205. Epub 2017 Jul 6.
Results Reference
background
PubMed Identifier
27780828
Citation
Cespedes MV, Guillen MJ, Lopez-Casas PP, Sarno F, Gallardo A, Alamo P, Cuevas C, Hidalgo M, Galmarini CM, Allavena P, Aviles P, Mangues R. Lurbinectedin induces depletion of tumor-associated macrophages, an essential component of its in vivo synergism with gemcitabine, in pancreatic adenocarcinoma mouse models. Dis Model Mech. 2016 Dec 1;9(12):1461-1471. doi: 10.1242/dmm.026369. Epub 2016 Oct 20.
Results Reference
background

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LINNOVATE: Lurbinectedin, Ipilimumab and Nivolumab for Soft Tissue Sarcoma

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