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X4P-001 and Pembrolizumab in Patients With Advanced Melanoma (X4P-001-MELA)

Primary Purpose

Melanoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
X4P-001
Pembrolizumab
Sponsored by
X4 Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Melanoma focused on measuring Advance malignancy

Eligibility Criteria

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

Inclusion Criteria:

To be eligible for this study, a patient must meet all of the following inclusion criteria:

  1. Be at least 18 years of age.
  2. Has signed the current approved informed consent form.
  3. Has a histologically confirmed diagnosis of malignant melanoma.
  4. Has at least two separate cutaneous lesions suitable for punch biopsies (at least 3 mm diameter).
  5. For women of childbearing potential and men, agree to use a highly effective method of contraceptive from screening, through the study, and for at least 4 weeks after the last dose of study drug.
  6. For women of childbearing potential, must have a negative pregnancy test (serum or urine) on Day 1 prior to initiating study treatment, and are not nursing.
  7. Be willing and able to comply with the schedule, treatment, and biopsies specified by this protocol.

Exclusion Criteria:

Patients with any of the following will be excluded from participation in the study:

  1. Has performance status Grade 2 or higher (Eastern Cooperative Oncology Group [ECOG] criteria).
  2. Has ongoing acute clinical adverse events NCI CTCAE Grade 2 or greater resulting from prior cancer therapies (except alopecia).
  3. Has had within the past 6 months the occurrence or persistence of one or more of the following medical conditions that could not be controlled with usual medical care (e.g., required emergency care or hospitalization): angina, congestive heart failure, diabetes, seizure disorder.
  4. Has had within the past 6 months the occurrence of one or more of the following events: myocardial infarction, cerebrovascular accident, hemorrhage (CTC Grade 3 or 4), chronic liver disease (meeting criteria for Child-Pugh Class B or C), a second active malignancy requiring ongoing treatment during the trial, organ transplantation.
  5. Has had within the 4 weeks prior to initiation of study drug, or is expected to have during the study period, surgery requiring general anesthesia
  6. Has, at screening, serologic laboratory tests meeting one or more of the following criteria:

    • An indeterminate or positive test for antibody to human immunodeficiency virus (HIV-1 or -2).
    • An indeterminate or positive test for antibody to hepatitis C virus (HCV), unless documented to have no detectable viral load on two independent samples.
    • A positive test for hepatitis B surface antigen (HBsAg).
  7. Has, at screening, safety laboratory tests meeting one or more of the following criteria:

    • Hemoglobin <9.0 g/dL
    • Absolute neutrophil count (ANC) <1,500/μL
    • Platelets <100,000/μL
    • Creatinine >2.0x ULN
    • Serum aspartate transaminase (AST) >3x ULN
    • Serum alanine transaminase (ALT) >3x ULN
    • Total bilirubin >1.5x ULN (unless due to Gilbert's Syndrome)
    • International normalized ratio (INR) >1.5x ULN (unless on therapeutic anti-coagulation).
  8. Has been previously treated with approved or investigational immunotherapy including oncolytic viruses, or agents directed at CTLA-4, PD-1, or PD-L1 ("checkpoint inhibitors").
  9. Has previously received other anti-cancer therapy within 2 weeks prior to Day 1, including radiation therapy or chemotherapy. For investigational anti-cancer therapies, the interval will be determined in consultation with the Medical Monitor.
  10. Has, within 2 weeks prior to Day 1, been regularly taking a medication prohibited based on CYP3A4 interaction.
  11. Has, at the planned initiation of study drug, an uncontrolled infection.
  12. Has any other medical or personal condition that, in the opinion of the Investigator, may potentially compromise the safety or compliance of the patient, or may preclude the patient's successful completion of the clinical trial.

Sites / Locations

  • Clinical Site
  • Clinical Site
  • Clinical Site
  • Clinical Site

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

X4P-001 + Pembrolizumab

Arm Description

X4P-001 alone, then adding pembrolizumab

Outcomes

Primary Outcome Measures

Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Histology Characterization in Sequential Biopsies of Melanoma Lesions

Secondary Outcome Measures

Blood Biomarker Changes
Minimum Plasma Concentration (Cmin)
Clinical Tumor Response

Full Information

First Posted
July 1, 2016
Last Updated
July 1, 2020
Sponsor
X4 Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02823405
Brief Title
X4P-001 and Pembrolizumab in Patients With Advanced Melanoma
Acronym
X4P-001-MELA
Official Title
A Phase 1b Trial of X4P-001 Alone and With Pembrolizumab in Patients With Advanced Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
September 15, 2016 (Actual)
Primary Completion Date
March 15, 2018 (Actual)
Study Completion Date
March 15, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
X4 Pharmaceuticals

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 goals of this protocol are 1) to investigate the safety and tolerability of X4P-001 in combination with Keytruda® (pembrolizumab) in patients with advanced melanoma, and 2) to assess serial biopsies of melanoma tumor lesions obtained throughout the study for inflammatory and tumor cell infiltrates. After completion of study treatment, participants with resectable disease will undergo surgery, unresectable participants may continue on pembrolizumab as standard of care.
Detailed Description
X4P-001 is an orally bioavailable CXCR4 antagonist that has demonstrated activity in various tumor models. CXCR4 (C-X-C chemokine receptor type 4) is the receptor for CXCL12 (C-X-C chemokine ligand type 12). CXCL12 has potent chemotactic activity for lymphocytes and MDSCs (myeloid-derived suppressor cells), and is important in homing of hematopoietic stem cells to the bone marrow. CXCR4 is also expressed and active on multiple types of human cancers, including melanoma, ccRCC, and ovarian cancer. Additionally, increased expression of CXCR4 on tumor cells has been associated with significantly decreased overall participant survival. In animal cancer models, interference with CXCR4 function has been demonstrated to disrupt the tumor microenvironment (TME) and unmask the tumor to immune attack by multiple mechanisms, including: Decreasing the infiltration of MDSCs Increasing the ratio of CD8+ T cells to Treg cells Eliminating tumor re-vascularization Pembrolizumab is a humanized IgG4 kappa monoclonal antibody that blocks the interaction between PD-1 and its ligands, PD-L1 and PD-L2. Pembrolizumab is currently approved for the treatment of unresectable or metastatic melanoma. Analysis of tumor samples before and during treatment in an earlier study demonstrated that a clinical response was associated with an increase in the density of CD8+ T cells in the tumor parenchyma (center), while disease progression was associated with persistent low levels of those cells. In an autochthonous murine model of pancreatic adenocarcinoma, persistent tumor growth despite administration of anti-PD-L1 was similarly associated with failure of tumor-specific cytotoxic T cells to enter the TME despite their presence in the peripheral circulation. This immunosuppressed phenotype was associated with CXCL12 production by cancer-associated fibroblasts. Moreover, administration of a CXCR4 antagonist (AMD3100) induced rapid T-cell accumulation among the cancer cells and, in combination with anti-PD-L1, synergistically decreased tumor growth. Based on these observations, the hypothesis is that effective CXCR4 antagonism by X4P-001 would be of potential benefit in participants with advanced melanoma and other cancers by multiple mechanisms, resulting in increased anti-tumor immune attack.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Melanoma
Keywords
Advance malignancy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
X4P-001 + Pembrolizumab
Arm Type
Experimental
Arm Description
X4P-001 alone, then adding pembrolizumab
Intervention Type
Drug
Intervention Name(s)
X4P-001
Other Intervention Name(s)
AMD11070
Intervention Description
X4P-001 100 mg capsules, administered orally, continuous daily dosing
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
Keytruda
Intervention Description
Pembrolizumab 2 mg/kg, administered by IV infusion every 3 weeks
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Time Frame
Up to 13 weeks, from time of enrollment through study completion or early termination.
Title
Histology Characterization in Sequential Biopsies of Melanoma Lesions
Time Frame
Up to 13 weeks, from time of enrollment through study completion or early termination.
Secondary Outcome Measure Information:
Title
Blood Biomarker Changes
Time Frame
Up to 17 weeks, from time of screening through study completion or early termination.
Title
Minimum Plasma Concentration (Cmin)
Time Frame
Up to 9 weeks, from time of enrollment through end of treatment.
Title
Clinical Tumor Response
Time Frame
Up to 17 weeks, from time of screening through study completion or early termination.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: To be eligible for this study, a patient must meet all of the following inclusion criteria: Be at least 18 years of age. Has signed the current approved informed consent form. Has a histologically confirmed diagnosis of malignant melanoma. Has at least two separate cutaneous lesions suitable for punch biopsies (at least 3 mm diameter). For women of childbearing potential and men, agree to use a highly effective method of contraceptive from screening, through the study, and for at least 4 weeks after the last dose of study drug. For women of childbearing potential, must have a negative pregnancy test (serum or urine) on Day 1 prior to initiating study treatment, and are not nursing. Be willing and able to comply with the schedule, treatment, and biopsies specified by this protocol. Exclusion Criteria: Patients with any of the following will be excluded from participation in the study: Has performance status Grade 2 or higher (Eastern Cooperative Oncology Group [ECOG] criteria). Has ongoing acute clinical adverse events NCI CTCAE Grade 2 or greater resulting from prior cancer therapies (except alopecia). Has had within the past 6 months the occurrence or persistence of one or more of the following medical conditions that could not be controlled with usual medical care (e.g., required emergency care or hospitalization): angina, congestive heart failure, diabetes, seizure disorder. Has had within the past 6 months the occurrence of one or more of the following events: myocardial infarction, cerebrovascular accident, hemorrhage (CTC Grade 3 or 4), chronic liver disease (meeting criteria for Child-Pugh Class B or C), a second active malignancy requiring ongoing treatment during the trial, organ transplantation. Has had within the 4 weeks prior to initiation of study drug, or is expected to have during the study period, surgery requiring general anesthesia Has, at screening, serologic laboratory tests meeting one or more of the following criteria: An indeterminate or positive test for antibody to human immunodeficiency virus (HIV-1 or -2). An indeterminate or positive test for antibody to hepatitis C virus (HCV), unless documented to have no detectable viral load on two independent samples. A positive test for hepatitis B surface antigen (HBsAg). Has, at screening, safety laboratory tests meeting one or more of the following criteria: Hemoglobin <9.0 g/dL Absolute neutrophil count (ANC) <1,500/μL Platelets <100,000/μL Creatinine >2.0x ULN Serum aspartate transaminase (AST) >3x ULN Serum alanine transaminase (ALT) >3x ULN Total bilirubin >1.5x ULN (unless due to Gilbert's Syndrome) International normalized ratio (INR) >1.5x ULN (unless on therapeutic anti-coagulation). Has been previously treated with approved or investigational immunotherapy including oncolytic viruses, or agents directed at CTLA-4, PD-1, or PD-L1 ("checkpoint inhibitors"). Has previously received other anti-cancer therapy within 2 weeks prior to Day 1, including radiation therapy or chemotherapy. For investigational anti-cancer therapies, the interval will be determined in consultation with the Medical Monitor. Has, within 2 weeks prior to Day 1, been regularly taking a medication prohibited based on CYP3A4 interaction. Has, at the planned initiation of study drug, an uncontrolled infection. Has any other medical or personal condition that, in the opinion of the Investigator, may potentially compromise the safety or compliance of the patient, or may preclude the patient's successful completion of the clinical trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lu Gan, MD, PhD
Organizational Affiliation
X4 Pharmaceuticals, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Clinical Site
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Clinical Site
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
Clinical Site
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Clinical Site
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84112
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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X4P-001 and Pembrolizumab in Patients With Advanced Melanoma

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