Study of RM-1929 and Photoimmunotherapy in Patients With Recurrent Head and Neck Cancer
Primary Purpose
Recurrent Head and Neck Cancer
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 160 mg/m^2
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 320 mg/m^2
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 640 mg/m^2
PIT: 75 J/cm^2 for superficial lesions or 150 J/cm for interstitial lesions and Drug RM-1929: 640mg/m^2
PIT: 100 J/cm^2 for superficial lesions or 200 J/cm for interstitial lesions and Drug RM-1929: 640mg/m^2
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 640mg/m^2
Sponsored by
About this trial
This is an interventional treatment trial for Recurrent Head and Neck Cancer
Eligibility Criteria
Inclusion Criteria:
Patients must meet the following criteria to be eligible for study participation:
- Patients with recurrent squamous carcinoma of the Head and Neck, who in the opinion of their treating physician, cannot be satisfactorily treated with surgery, radiation, or platinum chemotherapy. Diagnosis must be confirmed by biopsy and histopathology.
- Patient must have received prior systemic platinum-based chemotherapy for treatment of their head and neck cancer, unless in the opinion of the medical oncologist, the use of platinum-based chemotherapy is contraindicated or not recommended, e.g., renal impairment, allergy to platinum compounds, age, liver disease, myelosuppression, neuropathy, hearing loss, etc.
- Patients must have life expectancy > 6 months based on investigator judgment.
- Male or female patients at least 18 years old. Female patients must not be pregnant or breast feeding and must be practicing a medically acceptable form of birth control, be sterile, or post-menopausal. Females of childbearing potential (FCBP) is defined as premenopausal women capable of becoming pregnant. This includes women who are post-menopausal for at least 12 months after the last menses. FCBP must agree to use a medically acceptable form of birth control during the study and for at least 6 months after discontinuation of Erbitux® or study medication. Females must agree not to breast feed during the study and for at least two months after discontinuation of Erbitux® or study medication. Male patients should be using a double barrier protection method that is a medically acceptable form of birth control during the study or be sterile.
- Patients must have an ECOG score of 0 - 2.
- Patient must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure.
Exclusion Criteria:
Patients with any of the following will be excluded from participation in the study:
- Patients with a history of significant Erbitux infusion reactions (≥ Grade 3).
- Patients on chemotherapy or Erbitux® therapy or radiation therapy within 4 weeks of enrollment.
- Tumor invading a major blood vessel (such as the carotid artery) unless the vessel has been embolized, stented or surgically ligated to prevent hemorrhage.
- Tumor is not clearly shown on a CT scan or clinically measurable.
- Location and extension of the tumor precludes an effective PIT.
- Patients with impaired hepatic function (ALP (hepatic), AST and/or ALT >3 times the upper normal limits, or total serum bilirubin > 2 mg/dL.
- Patients with impairment of renal function (serum creatinine >2 mg/dL).
- Unwilling or unable to follow protocol requirements.
- Any condition which in the Investigator's opinion deems the patient an unsuitable candidate to receive study drug.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- Patient requires examinations or treatments within 4 weeks after study drug administration where they would be exposed to significant light, e.g., eye examinations, surgical procedures, endoscopy, etc.
Sites / Locations
- UCSF Helen Diller Family Comprehensive Cancer Center
- Centura Health Research Center
- Rush University Cancer Center
- Virginia Piper Cancer Institute, part of Allina Health System
- University of Oklahoma Stephenson Cancer Center
- Thomas Jefferson University
- University of Texas MD Anderson Cancer Center
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
PART 1 - Cohort 1
PART 1 - Cohort 2
PART 1 - Cohort 3
PART 2 - Cohort 1
PART 2 - Cohort 2
PART 3
Arm Description
3-6 patients
3-6 patients
3-6 patients
Number of patients depend on Part 1
Number of patients depend on Part 1
Up to 30 patients
Outcomes
Primary Outcome Measures
Part I: Maximum Tolerated Dose (MTD) or Maximum Feasible Dose (MFD) of RM-1929, whichever is lowest
Determine the MTD or MFD of RM-1929
Part I: Adverse Event profile for each drug dose of RM-1929
Assessment of safety of the combination of drug dose with low energy localized light irradiation
Part I: Photosafety (sunburn) Testing
Determination of skin Minimal Erythema Dose (MED) following infusion of RM-1929
Part II: Maximum Tolerated Dose (MTD) or Maximum Feasible Dose (MFD) of a fixed drug dose with fixed light dose
Determination of MTD or MFD of fixed drug dose with fixed light dose
Part II: Safety with repeat dosing
Safety parameters associated with repeat dosing
Secondary Outcome Measures
Part I: Tumor response
Document tumor response using response assessment in solid tumors version 1.1 (RECIST 1.1), including additional assessment of target lesion volumetrics
Part 1: Tumor reduction/necrosis
Document tumor reduction/necrosis using Choi criteria
Part I: Pharmacokinetics of RM-1929 and for both RM-1929 and unconjugated IRDye 700DX (Cmax, T 1/2, AUC, CL and Vss)
Part I: Immunogenic response to RM-1929
To assess antibodies to RM-1929 or cetuximab
Part II: Tumor Response
Assessed using RECIST 1.1
Part II: Tumor Reduction
Evaluation by CT scans, clinical measurement, photographs, biopsies, symptom relief and ECOG performance
Part II: Immunogenic response to RM-1929
To assess antibodies to RM-1929 or cetuximab
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02422979
Brief Title
Study of RM-1929 and Photoimmunotherapy in Patients With Recurrent Head and Neck Cancer
Official Title
A Phase 1/2a Multicenter, Open-Label, Dose-Escalation, Combination Study of RM-1929 and Photoimmunotherapy in Patients With Recurrent Head and Neck Cancer, Who in the Opinion of Their Physician, Cannot Be Satisfactorily Treated With Surgery, Radiation or Platinum Chemotherapy
Study Type
Interventional
2. Study Status
Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
June 2015 (Actual)
Primary Completion Date
February 25, 2019 (Actual)
Study Completion Date
February 25, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Rakuten Medical, Inc.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is a two-part clinical study of patients with recurrent Head and Neck Cancer (HNC), who in the opinion of their physician, cannot be satisfactorily treated with surgery, radiation or platinum chemotherapy. The purpose of the study is to determine the safety and anti-cancer activity of various doses and repeated cycles of the experimental treatment using the study drug RM-1929 and fixed amounts of red light applied at the tumor site to activate the pharmacodynamics of the drug.
The part 1 of the study has been completed and consisted in a single cycle, 3+3 dose escalation safety study of the experimental drug RM-1929 using a fixed amount of 690 nm red light. The part 1 was designed to determine the safety of the treatment as set by the maximal feasible dose or the maximal tolerable dose of RM-1929. From the part 1 results, the maximal feasible dose of RM-1929 was determined.
The part 2 of the study is currently ongoing and it is evaluating the safety and anticancer efficacy of up to four repeated treatments of Photoimmunotherapy with RM-1929 at the maximal feasible dose of RM-1929 activated with a fixed amount of red light.
Detailed Description
Photoimmunotherapy (PIT) is a new cancer targeted technology invented at the National Cancer Institute, USA. This clinical study evaluates the treatment of the experimental drug RM-1929 with Photoimmunotherapy (PIT).
The experimental drug, RM-1929, is a parental formulation consisting of a chemical conjugate of the dye IR700 with the FDA approved antibody, Erbitux® (Cetuximab), that targets EGFR receptors (EGFR is a cancer expressed protein, a cancer antigen). EGFR is highly expressed in squamous cell carcinomas of the head and neck (HNSCC). It is expected that systemic administration of RM-1929 will lead to tumor accumulation and binding to EGFR expressed at cancer cells. It is expected that treatment with RM-1929 and Photoimmunotherapy can lead to the selective destruction of the HNSCC cancer cells and provide an effective therapy to manage the disease.
The treatment using RM-1929 with Photoimmunotherapy requires two steps:
(i) the administration by infusion of the drug RM-1929 targeting the cancer protein EGFR
AND
(ii) the illumination of the tumor with red light (690 nm) using sufficient energy to activate the drug and induce cancer cell killing.
Light illumination is applied at 24 h post drug infusion to enable sufficient time for the drug to distribute in the tumor after administration. Cell killing occurs only at cancer cells expressing the protein EGFR that is bound to the drug RM-1929. The requirement of binding of the drug to EGFR of cancer cells enables the selective destruction of cancer cells with minimum damage of healthy tissue surrounding the tumor cells. Preclinical pharmacology demonstrated that light-induced activation of RM-1929 elicits rapid tumor destruction of human cancer xenografts implanted in mice and that the treatment is cancer specific.
The Part 1 study has been completed and consisted of a single cycle 3+3 dose escalation study of RM-1929 to determine the safety of the treatment and the maximal feasible dose of RM-1929. From the part 1 of this study, the maximal feasible dose for treatment with RM-1929 was selected. The currently ongoing Part 2 of the clinical study is evaluating the safety and anti-cancer activity of up to 4 repeat treatment cycles of Photoimmunotherapy with RM-1929.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Head and Neck Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Actual)
8. Arms, Groups, and Interventions
Arm Title
PART 1 - Cohort 1
Arm Type
Experimental
Arm Description
3-6 patients
Arm Title
PART 1 - Cohort 2
Arm Type
Experimental
Arm Description
3-6 patients
Arm Title
PART 1 - Cohort 3
Arm Type
Experimental
Arm Description
3-6 patients
Arm Title
PART 2 - Cohort 1
Arm Type
Experimental
Arm Description
Number of patients depend on Part 1
Arm Title
PART 2 - Cohort 2
Arm Type
Experimental
Arm Description
Number of patients depend on Part 1
Arm Title
PART 3
Arm Type
Experimental
Arm Description
Up to 30 patients
Intervention Type
Combination Product
Intervention Name(s)
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 160 mg/m^2
Intervention Type
Combination Product
Intervention Name(s)
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 320 mg/m^2
Intervention Type
Combination Product
Intervention Name(s)
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 640 mg/m^2
Intervention Type
Combination Product
Intervention Name(s)
PIT: 75 J/cm^2 for superficial lesions or 150 J/cm for interstitial lesions and Drug RM-1929: 640mg/m^2
Intervention Type
Combination Product
Intervention Name(s)
PIT: 100 J/cm^2 for superficial lesions or 200 J/cm for interstitial lesions and Drug RM-1929: 640mg/m^2
Intervention Type
Combination Product
Intervention Name(s)
PIT: 50 J/cm^2 for superficial lesions or 100 J/cm for interstitial lesions and Drug RM-1929: 640mg/m^2
Primary Outcome Measure Information:
Title
Part I: Maximum Tolerated Dose (MTD) or Maximum Feasible Dose (MFD) of RM-1929, whichever is lowest
Description
Determine the MTD or MFD of RM-1929
Time Frame
1 month
Title
Part I: Adverse Event profile for each drug dose of RM-1929
Description
Assessment of safety of the combination of drug dose with low energy localized light irradiation
Time Frame
1 month
Title
Part I: Photosafety (sunburn) Testing
Description
Determination of skin Minimal Erythema Dose (MED) following infusion of RM-1929
Time Frame
1 month
Title
Part II: Maximum Tolerated Dose (MTD) or Maximum Feasible Dose (MFD) of a fixed drug dose with fixed light dose
Description
Determination of MTD or MFD of fixed drug dose with fixed light dose
Time Frame
1 month
Title
Part II: Safety with repeat dosing
Description
Safety parameters associated with repeat dosing
Time Frame
2 years or until death
Secondary Outcome Measure Information:
Title
Part I: Tumor response
Description
Document tumor response using response assessment in solid tumors version 1.1 (RECIST 1.1), including additional assessment of target lesion volumetrics
Time Frame
2 months
Title
Part 1: Tumor reduction/necrosis
Description
Document tumor reduction/necrosis using Choi criteria
Time Frame
2 month
Title
Part I: Pharmacokinetics of RM-1929 and for both RM-1929 and unconjugated IRDye 700DX (Cmax, T 1/2, AUC, CL and Vss)
Time Frame
1 month
Title
Part I: Immunogenic response to RM-1929
Description
To assess antibodies to RM-1929 or cetuximab
Time Frame
2 month
Title
Part II: Tumor Response
Description
Assessed using RECIST 1.1
Time Frame
2 months
Title
Part II: Tumor Reduction
Description
Evaluation by CT scans, clinical measurement, photographs, biopsies, symptom relief and ECOG performance
Time Frame
2 months
Title
Part II: Immunogenic response to RM-1929
Description
To assess antibodies to RM-1929 or cetuximab
Time Frame
2 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients must meet the following criteria to be eligible for study participation:
Patients with recurrent squamous carcinoma of the Head and Neck, who in the opinion of their treating physician, cannot be satisfactorily treated with surgery, radiation, or platinum chemotherapy. Diagnosis must be confirmed by biopsy and histopathology.
Patient must have received prior systemic platinum-based chemotherapy for treatment of their head and neck cancer, unless in the opinion of the medical oncologist, the use of platinum-based chemotherapy is contraindicated or not recommended, e.g., renal impairment, allergy to platinum compounds, age, liver disease, myelosuppression, neuropathy, hearing loss, etc.
Patients must have life expectancy > 6 months based on investigator judgment.
Male or female patients at least 18 years old. Female patients must not be pregnant or breast feeding and must be practicing a medically acceptable form of birth control, be sterile, or post-menopausal. Females of childbearing potential (FCBP) is defined as premenopausal women capable of becoming pregnant. This includes women who are post-menopausal for at least 12 months after the last menses. FCBP must agree to use a medically acceptable form of birth control during the study and for at least 6 months after discontinuation of Erbitux® or study medication. Females must agree not to breast feed during the study and for at least two months after discontinuation of Erbitux® or study medication. Male patients should be using a double barrier protection method that is a medically acceptable form of birth control during the study or be sterile.
Patients must have an ECOG score of 0 - 2.
Patient must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure.
Exclusion Criteria:
Patients with any of the following will be excluded from participation in the study:
Patients with a history of significant Erbitux infusion reactions (≥ Grade 3).
Patients on chemotherapy or Erbitux® therapy or radiation therapy within 4 weeks of enrollment.
Tumor invading a major blood vessel (such as the carotid artery) unless the vessel has been embolized, stented or surgically ligated to prevent hemorrhage.
Tumor is not clearly shown on a CT scan or clinically measurable.
Location and extension of the tumor precludes an effective PIT.
Patients with impaired hepatic function (ALP (hepatic), AST and/or ALT >3 times the upper normal limits, or total serum bilirubin > 2 mg/dL.
Patients with impairment of renal function (serum creatinine >2 mg/dL).
Unwilling or unable to follow protocol requirements.
Any condition which in the Investigator's opinion deems the patient an unsuitable candidate to receive study drug.
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
Patient requires examinations or treatments within 4 weeks after study drug administration where they would be exposed to significant light, e.g., eye examinations, surgical procedures, endoscopy, etc.
Facility Information:
Facility Name
UCSF Helen Diller Family Comprehensive Cancer Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States
Facility Name
Centura Health Research Center
City
Denver
State/Province
Colorado
ZIP/Postal Code
80210
Country
United States
Facility Name
Rush University Cancer Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Virginia Piper Cancer Institute, part of Allina Health System
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55407
Country
United States
Facility Name
University of Oklahoma Stephenson Cancer Center
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73104
Country
United States
Facility Name
Thomas Jefferson University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
34626024
Citation
Cognetti DM, Johnson JM, Curry JM, Kochuparambil ST, McDonald D, Mott F, Fidler MJ, Stenson K, Vasan NR, Razaq MA, Campana J, Ha P, Mann G, Ishida K, Garcia-Guzman M, Biel M, Gillenwater AM. Phase 1/2a, open-label, multicenter study of RM-1929 photoimmunotherapy in patients with locoregional, recurrent head and neck squamous cell carcinoma. Head Neck. 2021 Dec;43(12):3875-3887. doi: 10.1002/hed.26885. Epub 2021 Oct 9.
Results Reference
derived
Learn more about this trial
Study of RM-1929 and Photoimmunotherapy in Patients With Recurrent Head and Neck Cancer
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