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L19TNFα in Patients With Advanced Solid Tumors

Primary Purpose

Solid Tumors, Colorectal Cancer

Status
Completed
Phase
Phase 1
Locations
Italy
Study Type
Interventional
Intervention
L19TNFa
Sponsored by
Philogen S.p.A.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Solid Tumors focused on measuring L19, antibody, monoclonal, tumor targeting, TNFa, colorectal cancer, Phase I: Patients with relapsed or refractory locally advanced or metastatic solid tumors not amenable to standard systemic therapy., Phase II: Patients with relapsed or refractory locally advanced or metastatic colorectal cancer not amenable to standard systemic therapy.

Eligibility Criteria

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

Inclusion Criteria:

  • Phase I: histologically or cytologically confirmed relapsed or refractory locally advanced or metastatic solid tumor of any origin, not amenable to standard therapy.
  • Phase II: histologically or cytologically confirmed relapsed or refractory locally advanced or metastatic colorectal cancer not amenable to standard therapy.
  • For both phase I and II:

    • Subjects aged ≥ 18 years.
    • ECOG performance status ≤ 2.
    • Subjects must have at least one unidimensionally measurable lesion by computed tomography as defined by RECIST criteria (see Section 8) or tumour markers parameters of disease such as PSA and CA125 for Prostate cancer and Ovarian cancer, respectively. This lesion must not have been irradiated during previous treatments.
    • Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L, platelets ≥ 100 x 10^9/L, and haemoglobin (Hb) ≥ 9.5 g/dl.
    • All acute adverse effects (excluding alopecia) of any prior therapy (including surgery, radiation therapy, chemotherapy) must have resolved to ≤ Grade 1, except elevated liver transaminases judged to be associated with tumor infiltration (see below) (graded according to National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events, version 3.0 [CTCAE, v.3.0]).
    • Alkaline phosphatase (ALP), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 x upper limit of normal (ULN), and total bilirubin ≤ 2.0 mg/gL unless liver involvement by the tumor, in which case the transaminase levels up to 5 x ULN are allowed.
    • Creatinine ≤ 1.5 ULN or 24 h creatinine clearance ≥ 60 mL/min.
    • Testing negative for acute or chronic infection with hepatitis B or C virus, or human immunodeficiency virus 1 or 2.
    • Negative pregnancy test for females of childbearing potential at the screening visit.
    • Commitment from subject to practice medically appropriate/acceptable method of birth control (e.g., hormonal, condoms or other adequate barrier controls, intrauterine contraceptive device, or sterilization) beginning at the screening visit and continuing until 3 months following the last treatment with study drug.
    • Able to provide written Informed Consent.

Exclusion Criteria:

  • Breastfeeding women.
  • Presence of active infections (e.g. requiring antimicrobial therapy) or other severe concurrent disease, which, in the opinion of the Investigator, would place the subject at undue risk or interfere with the study.
  • Known brain metastases or signs and/or symptoms suggestive of brain metastases.
  • Known cancer of other primary origin (excluding Stage I non-melanoma skin cancer) within the prior 5 years.
  • Active autoimmune disease.
  • Cardiac disease as manifested by any of the following:

    • > Grade II heart failure, graded per New York Heart Association (NYHA) criteria.
    • Unstable angina pectoris.
    • Acute or subacute coronary syndromes, including myocardial infarction, occurring with 1 year prior to study treatment.
    • Arrhythmia needing continuous treatment.
    • Ejection fraction less than the institutional lower limit of normal as assessed by multigated radionuclide angiography (MUGA) scan or echocardiogram.
  • Uncontrolled hypertension.
  • Ischemic peripheral vascular disease (Grade IIb-IV).
  • Severe diabetic retinopathy.
  • Major surgery or trauma within 4 weeks prior to start of study treatment.
  • Known history of allergy to TNFα or other intravenously administered human proteins/peptides/antibodies.
  • Chemotherapy, radiation therapy or therapy with an investigational agent within 4 weeks prior start of study treatment.
  • Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before administration of study treatment.
  • Growth factors or immunomodulatory agents within 7 days prior to the administration of the study treatment.
  • Subject requires or is taking corticosteroids or other immunosuppressant drugs on a long-term basis. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criterion.
  • Concurrent therapy with warfarin at doses greater than 1 mg/day or equivalent doses of other coumarin derivatives.
  • Participation in another interventional clinical trial during participation in this trial.
  • Expectation that the subject will not be able to complete at least 6 weeks of therapy.
  • Any conditions that in the opinion of the Investigator could hamper compliance with the study protocol.

Sites / Locations

  • A.O. UNIVERSITARIA OSPEDALI RIUNITI - OSPEDALE UMBERTO I DI ANCONA - ANCONA (Italy)
  • European Istitue of Oncology Milan (Italy)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

L19TNFa

Arm Description

Phase I: Prospective, open-label, dose escalation study. Phase II: Prospective, single-arm, open-label study, equivalent to the stage 1 of the Simon two-stage phase II design.

Outcomes

Primary Outcome Measures

Phase I: Determination of the Maximum Tolerated Dose (MTD) and Recommended Dose (RD)
Determination of the Maximum Tolerated Dose (MTD) and Recommended Dose (RD) of L19TNFα.
Phase II: Investigation of the anti-cancer activity of L19TNFα as measured by Objective Response Rate (ORR)
Investigation of the anti-cancer activity of L19TNFα as monotherapy as measured by the Objective Response Rate (ORR) at the end of cycle 2 in subjects with relapsed or refractory locally advanced or metastatic colorectal cancer not amenable to standard systemic therapy.

Secondary Outcome Measures

Investigation of serum concentrations of L19TNFα (pharmacokinetic properties)
Investigation of the induction of human anti-fusion protein antibody (HAFA)
Investigation of early signs of anti-tumor activity of L19TNFα
Investigation of early signs of anti-tumor activity of L19TNFα as measured by Objective Response Rate (ORR) at the end of cycle 2, median Progression-Free Survival (PFS) and median Overall Survival (OS).

Full Information

First Posted
December 2, 2010
Last Updated
September 22, 2011
Sponsor
Philogen S.p.A.
Collaborators
InnoPharma Inc., Eudax S.r.l.
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1. Study Identification

Unique Protocol Identification Number
NCT01253837
Brief Title
L19TNFα in Patients With Advanced Solid Tumors
Official Title
Phase I/II Study of the Tumor-targeting Human L19TNFα Monoclonal Antibody-cytokine Fusion Protein in Patients With Advanced Solid Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
September 2011
Overall Recruitment Status
Completed
Study Start Date
September 2007 (undefined)
Primary Completion Date
May 2011 (Actual)
Study Completion Date
September 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Philogen S.p.A.
Collaborators
InnoPharma Inc., Eudax S.r.l.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The recombinant human fusion protein L19TNFα was created with the intention to overcome the systemic toxicity of TNFα by directly targeting it to tumor tissues. Tumor-targeted L19TNFα would result in high and sustained intralesional bioactive TNFα concentrations.
Detailed Description
The primary purpose of this Phase I/II study is to define a safe and potentially active treatment regimen of L19TNFα as a monotherapy and to evaluate the antitumor activity of this regimen in relapsed metastatic colorectal cancer subjects, for whom standard treatment options are exhausted. L19TNFα is an investigational drug that specifically and effectively binds to ED-B, which is abundantly expressed in cancer tissue. Accordingly, treatment should result in a high and long-lasting intratumoral accumulation of biologically active rh-TNFα. Although combined therapies of TNFα with cytotoxic drugs (e.g. melphalan) seem to be strikingly more active against sarcoma and melanoma than with TNFα alone - at least for the ILP setting it seems possible that the repeated intratumoral delivery of TNFα via L19TNFα might produce additional biologic effects, such as the induction of an immunologic antitumor response or the sustained inhibition of tumor-associated angiogenesis (Lejeune, 2006), that potentially could benefit advanced cancer subjects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Solid Tumors, Colorectal Cancer
Keywords
L19, antibody, monoclonal, tumor targeting, TNFa, colorectal cancer, Phase I: Patients with relapsed or refractory locally advanced or metastatic solid tumors not amenable to standard systemic therapy., Phase II: Patients with relapsed or refractory locally advanced or metastatic colorectal cancer not amenable to standard systemic therapy.

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
34 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
L19TNFa
Arm Type
Experimental
Arm Description
Phase I: Prospective, open-label, dose escalation study. Phase II: Prospective, single-arm, open-label study, equivalent to the stage 1 of the Simon two-stage phase II design.
Intervention Type
Drug
Intervention Name(s)
L19TNFa
Intervention Description
Phase I: Sequential assignment of Patient cohorts to one of six dose levels of L19TNFa: 1.3, 2.6, 5.2, 7.8, 10.4, 13.0 µg/kg. Phase II: The Recommended Dose (RD) of 13.0 µg/kg of L19TNFα determined in Phase I. Schedule: Infusions of L19TNFα on days 1, 3 and 5 of each 21-day cycle. Patients may remain on treatment for a maximum of six 21-day cycles.
Primary Outcome Measure Information:
Title
Phase I: Determination of the Maximum Tolerated Dose (MTD) and Recommended Dose (RD)
Description
Determination of the Maximum Tolerated Dose (MTD) and Recommended Dose (RD) of L19TNFα.
Time Frame
day 1-29
Title
Phase II: Investigation of the anti-cancer activity of L19TNFα as measured by Objective Response Rate (ORR)
Description
Investigation of the anti-cancer activity of L19TNFα as monotherapy as measured by the Objective Response Rate (ORR) at the end of cycle 2 in subjects with relapsed or refractory locally advanced or metastatic colorectal cancer not amenable to standard systemic therapy.
Time Frame
within day 42
Secondary Outcome Measure Information:
Title
Investigation of serum concentrations of L19TNFα (pharmacokinetic properties)
Time Frame
day 1-5
Title
Investigation of the induction of human anti-fusion protein antibody (HAFA)
Time Frame
1-16 months
Title
Investigation of early signs of anti-tumor activity of L19TNFα
Description
Investigation of early signs of anti-tumor activity of L19TNFα as measured by Objective Response Rate (ORR) at the end of cycle 2, median Progression-Free Survival (PFS) and median Overall Survival (OS).
Time Frame
14 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Phase I: histologically or cytologically confirmed relapsed or refractory locally advanced or metastatic solid tumor of any origin, not amenable to standard therapy. Phase II: histologically or cytologically confirmed relapsed or refractory locally advanced or metastatic colorectal cancer not amenable to standard therapy. For both phase I and II: Subjects aged ≥ 18 years. ECOG performance status ≤ 2. Subjects must have at least one unidimensionally measurable lesion by computed tomography as defined by RECIST criteria (see Section 8) or tumour markers parameters of disease such as PSA and CA125 for Prostate cancer and Ovarian cancer, respectively. This lesion must not have been irradiated during previous treatments. Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L, platelets ≥ 100 x 10^9/L, and haemoglobin (Hb) ≥ 9.5 g/dl. All acute adverse effects (excluding alopecia) of any prior therapy (including surgery, radiation therapy, chemotherapy) must have resolved to ≤ Grade 1, except elevated liver transaminases judged to be associated with tumor infiltration (see below) (graded according to National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events, version 3.0 [CTCAE, v.3.0]). Alkaline phosphatase (ALP), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 x upper limit of normal (ULN), and total bilirubin ≤ 2.0 mg/gL unless liver involvement by the tumor, in which case the transaminase levels up to 5 x ULN are allowed. Creatinine ≤ 1.5 ULN or 24 h creatinine clearance ≥ 60 mL/min. Testing negative for acute or chronic infection with hepatitis B or C virus, or human immunodeficiency virus 1 or 2. Negative pregnancy test for females of childbearing potential at the screening visit. Commitment from subject to practice medically appropriate/acceptable method of birth control (e.g., hormonal, condoms or other adequate barrier controls, intrauterine contraceptive device, or sterilization) beginning at the screening visit and continuing until 3 months following the last treatment with study drug. Able to provide written Informed Consent. Exclusion Criteria: Breastfeeding women. Presence of active infections (e.g. requiring antimicrobial therapy) or other severe concurrent disease, which, in the opinion of the Investigator, would place the subject at undue risk or interfere with the study. Known brain metastases or signs and/or symptoms suggestive of brain metastases. Known cancer of other primary origin (excluding Stage I non-melanoma skin cancer) within the prior 5 years. Active autoimmune disease. Cardiac disease as manifested by any of the following: > Grade II heart failure, graded per New York Heart Association (NYHA) criteria. Unstable angina pectoris. Acute or subacute coronary syndromes, including myocardial infarction, occurring with 1 year prior to study treatment. Arrhythmia needing continuous treatment. Ejection fraction less than the institutional lower limit of normal as assessed by multigated radionuclide angiography (MUGA) scan or echocardiogram. Uncontrolled hypertension. Ischemic peripheral vascular disease (Grade IIb-IV). Severe diabetic retinopathy. Major surgery or trauma within 4 weeks prior to start of study treatment. Known history of allergy to TNFα or other intravenously administered human proteins/peptides/antibodies. Chemotherapy, radiation therapy or therapy with an investigational agent within 4 weeks prior start of study treatment. Previous in vivo exposure to monoclonal antibodies for biological therapy in the 6 weeks before administration of study treatment. Growth factors or immunomodulatory agents within 7 days prior to the administration of the study treatment. Subject requires or is taking corticosteroids or other immunosuppressant drugs on a long-term basis. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criterion. Concurrent therapy with warfarin at doses greater than 1 mg/day or equivalent doses of other coumarin derivatives. Participation in another interventional clinical trial during participation in this trial. Expectation that the subject will not be able to complete at least 6 weeks of therapy. Any conditions that in the opinion of the Investigator could hamper compliance with the study protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Filippo De Braud, Dr.
Organizational Affiliation
European Istitute of Oncology Milan (Italy)
Official's Role
Principal Investigator
Facility Information:
Facility Name
A.O. UNIVERSITARIA OSPEDALI RIUNITI - OSPEDALE UMBERTO I DI ANCONA - ANCONA (Italy)
City
Ancona
Country
Italy
Facility Name
European Istitue of Oncology Milan (Italy)
City
Milan
Country
Italy

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L19TNFα in Patients With Advanced Solid Tumors

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