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NCT04068194 | RECRUITING | Locally Advanced Malignant Solid Neoplasm

Testing the Combination of New Anti-cancer Drug Peposertib With Avelumab and Radiation Therapy for Advanced/Metastatic Solid Tumors and Hepatobiliary Malignancies
Sponsor:

National Cancer Institute (NCI)

Brief Summary:

This phase I/II trial studies the best dose and side effects of peposertib and to see how well it works with avelumab and hypofractionated radiation therapy in treating patients with solid tumors and hepatobiliary malignancies that have spread to other places in the body (advanced/metastatic). Peposertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as avelumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Hypofractionated radiation therapy delivers higher doses of radiation therapy over a shorter period of time and may kill more tumor cells and have fewer side effects. Giving peposertib in combination with avelumab and hypofractionated radiation therapy may work better than other standard chemotherapy, hormonal, targeted, or immunotherapy medicines available in treating patients with solid tumors and hepatobiliary malignancies.

Condition or disease

Locally Advanced Malignant Solid Neoplasm

Locally Advanced Unresectable Cholangiocarcinoma

Locally Advanced Unresectable Gallbladder Carcinoma

Locally Advanced Unresectable Malignant Solid Neoplasm

Metastatic Cholangiocarcinoma

Metastatic Gallbladder Carcinoma

Metastatic Malignant Solid Neoplasm

Stage III Gallbladder Cancer Ajcc v8

Stage IV Gallbladder CANCER AJC V8

Unresectable Malignant Solid Neoplasm

Intervention/treatment

Avelumab

Biopsy Procedure

Biospecimen Collection

Computed Tomography

Hypofractionated Radiation Therapy

Peposertib

Phase

PHASE1

PHASE2

Detailed Description:

PRIMARY OBJECTIVES: I. To determine the safety and tolerability and recommended phase 2 dose (RP2D) of peposertib (M3814) in combination with hypofractionated radiation and avelumab in patients with advanced/metastatic solid tumors. (Phase I) II. To determine the efficacy of the combination of hypofractionated radiation, peposertib (M3814), and avelumab as compared to the combination of hypofractionated radiation and avelumab in patients with advanced/metastatic hepatobiliary tumors by objective response rate (ORR) in non-irradiated lesions. (Phase II) SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity. (Phase I) II. To characterize the pharmacokinetic (PK) profile of peposertib (M3814) in combination with avelumab. (Phase I) III. To determine the efficacy and safety of the combination of hypofractionated radiation, peposertib (M3814), and avelumab as compared to hypofractionated radiation and avelumab by measurement of disease control rate (DCR), duration of response (DOR), progression free survival (PFS), PFS outside the irradiated field, and overall survival (OS) in patients with advanced/metastatic hepatobiliary tumors. (Phase II) IV. To determine if baseline deoxyribonucleic acid (DNA) repair defects inherent to some cholangiocarcinomas correlate with a more dramatic response to radiation compared to those without as measured by gamma H2AX, phosphorylated (p)NBS1 and pKAP1 immunofluorescence (IFA) with beta CATN segmentation assay. (Phase II) V. To characterize the pharmacokinetic (PK) profiles of peposertib (M3814) and avelumab. (Phase II) EXPLORATORY OBJECTIVES: I. To perform molecular profiling assays on malignant and normal tissues, including, but not limited to, whole exome sequencing (WES), ribonucleic acid (RNA) sequencing (RNAseq), mass cytometry (CyTOF), multiplexed ion beam imaging (MIBI), and T cell receptor sequencing in order to: Ia. To determine if baseline tumor mutation burden and pattern, and neoantigen burden correlate with response. Ib. To determine if combination therapy results in changes in the immune landscape in both the tumor and the host that correlate with response. Ic. To determine if baseline defects in deoxyribonucleic acid (DNA) damage repair in some cholangiocarcinomas correlate with an increased response. OUTLINE: This is a phase I, dose-escalation study of peposertib followed by a phase II study. PHASE I: Patients with advanced/metastatic malignant solid tumors undergo 8 fractions of hypofractionated radiation therapy (RT) every day (QD) on days -17 to -7. Patients also receive peposertib orally (PO) twice daily (BID) on days 1-28, and avelumab intravenously (IV) over 60 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT), biopsy, and collection of blood samples during screening and on study. PHASE II: Patients advanced/metastatic cholangiocarcinoma/gallbladder cancer are randomized to 1 of 2 arms. ARM A: Patients undergo 8 fractions of hypofractionated RT QD on days -17 to -7. Patients also receive avelumab IV over 60 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo CT, biopsy, and collection of blood samples during screening and on study. ARM B: Patients undergo 8 fractions of hypofractionated RT QD on days -17 to -7. Patients also receive peposertib PO BID on days 1-28, and avelumab IV over 60 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo C), biopsy, and collection of blood samples during screening and on study After completion of study treatment, patients are followed up at 30 days, every 3 months for 1 year, every 6 months for year 2, then annually thereafter.

Study Type : INTERVENTIONAL
Estimated Enrollment : 103 participants
Masking : NONE
Primary Purpose : TREATMENT
Official Title : A Phase I/II Study of Peposertib (M3814) and Avelumab in Combination With Hypofractionated Radiation in Patients With Advanced/Metastatic Solid Tumors and Hepatobiliary Malignancies
Actual Study Start Date : 2020-04-07
Estimated Primary Completion Date : 2025-12-31
Estimated Study Completion Date : 2025-12-31

Information not available for Arms and Intervention/treatment

Ages Eligible for Study: 18 Years
Sexes Eligible for Study: ALL
Accepts Healthy Volunteers:
Criteria
Inclusion Criteria
  • * PHASE 1: Patients must have a histologically confirmed metastatic or locally advanced unresectable solid tumor that has progressed on or after available standard of care therapy or for which no acceptable standard of care therapy exists, or in which the patient declines standard of care therapy (each patient that declines standard of care therapy will be documented in the case report form)
  • * PHASE 2: Patients must have a histologically confirmed metastatic or locally advanced unresectable cholangiocarcinoma/gallbladder carcinoma that has progressed on gemcitabine, cisplatin, and durvalumab/pembrolizumab.
  • * Age \>= 18 years
  • * Because no dosing or adverse event data are currently available on the use of peposertib (M3814) in combination with avelumab in patients \< 18 years of age
  • * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (Karnofsky \>= 60%)
  • * Patients with at least 1 index lesion to irradiate for whom palliative radiation treatment is indicated (including but not limited to pain and/or symptom control, prevention of disease -related complications, and preservation of organ function). Lung and liver lesions are preferred, though alternate lesions may be considered after discussion with trial principal investigator (PI). Up to 2 lesions may be considered for irradiation provided at least 1 lesion will receive the study treatment of total of 60 Gy and all prescribed irradiation will be completed within the radiation window
  • * Patients with at least 1 Response Evaluation Criteria in Solid Tumors (RECIST) measurable lesion (to be unirradiated) (defined as those accurately measured in at least one dimension, with the longest diameter to be recorded for non-nodal lesions and the shortest diameter for nodal lesions). Measurable is defined as at least 10 mm in longest diameter for solid tumors, at least 15 mm in shortest diameter for lymph nodes
  • * Patients must be willing to undergo fresh biopsies at baseline (as opposed to using archival tissue), in the event their baseline tissue was obtained \> 12 months prior to study consent and/or they are randomized to the gamma H2AX, pNBS1 and pKAP1 IFA with beta CATN segmentation assay
  • * Absolute neutrophil count (ANC) \>= 1,500/mcL
  • * Platelet count \>= 100,000/mcL
  • * Hemoglobin \>= 9.0 g/dL
  • * Serum creatinine =\< 1.5 x upper limit of normal (ULN) OR calculated serum creatinine clearance (glomerular filtration rate \[GFR\] can be used in place of creatinine or creatinine clearance) \>= 60 mL/min for participants with creatinine levels \> 1.5 x institutional ULN
  • * Calculate serum creatinine clearance using the standard Cockcroft-Gault formula
  • * Serum total bilirubin =\< 1.5 x ULN or direct bilirubin =\< ULN for participants with total bilirubin \> 1.5 x ULN
  • * Patients with known Gilbert disease with serum bilirubin level =\< 3 x ULN are eligible
  • * Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 2.5 x ULN or =\< 5.0 x ULN for patients with hepatobiliary tumors/liver metastases
  • * Albumin \>= 2.8 g/L
  • * International normalized ratio (INR) or prothrombin time (PT) or activated partial thromboplastin time (aPTT) =\< 1.5 x ULN
  • * This applies only to patients not receiving therapeutic anticoagulation; patients receiving therapeutic anticoagulation should be on a stable dose
  • * Participants must have the ability to swallow and retain oral medication and not have any clinically significant gastrointestinal abnormalities that might alter absorption
  • * Female patients of childbearing potential must have a negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required. The effects of peposertib (M3814) and avelumab on the developing human fetus are unknown and there is the potential for teratogenic or abortifacient effects. For this reason, women and men of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study treatment, and for 6 months after completion of peposertib (M3814) and avelumab administration. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with peposertib (M3814) and avelumab, breastfeeding should be discontinued if the mother is treated with peposertib (M3814) and avelumab
  • * Ability to understand and the willingness to sign a written informed consent document. Participants with impaired decision-making capacity (IDMC) who have a close caregiver or legally authorized representative (LAR) and/or family member available will also be eligible
Exclusion Criteria
  • * PHASE I: Patients who have received prior anti-CTLA-4, anti-PD-1, anti-PD-L1 or other immune checkpoint inhibitor therapeutic antibodies or pathway-targeting agents
  • * PHASE II: Patients who have received prior anti-CTLA-4, anti-PD-1, anti-PD-L1 or other immune checkpoint inhibitor therapeutic antibodies or pathway-targeting agents with the following exceptions
    • * Patients who have only received previous durvalumab (anti-PD-L1) in combination with gemcitabine +/- cisplatin as part of first line therapy (TOPAZ-1 regimen) are eligible
    • * Patients who have only received previous pembrolizumab (anti-PD-1) in combination with gemcitabine +/- cisplatin as part of first line therapy (KEYNOTE-966 regimen) are eligible
    • * Patients who have had chemotherapy, definitive radiation, biological cancer therapy, or investigational agent/device within 21 days of first planned dose of study therapy (within 14 days for palliative radiation). Previously irradiated lesions may be re-irradiated provided there is disease progression in the irradiated lesion and the prescribed radiation dosage can safely be re- administered
    • * Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities \> Common Terminology Criteria for Adverse Events \[CTCAE\] grade 1) with the exception of alopecia
    • * Patients with untreated/uncontrolled central nervous system (CNS)/leptomeningeal disease. Patients with asymptomatic, treated CNS disease are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first cycle of therapy and the following criteria are met
      • * Radiographic demonstration of clinical stability upon the completion of CNS-directed therapy and no evidence of interim progression between the completion of CNS-directed therapy and the screening radiographic study done \>= 4 weeks from completion of radiotherapy and \>= 2 weeks from discontinuation of corticosteroids
      • * No stereotactic radiation or whole-brain radiation within 28 days prior to randomization
      • * Patients with active autoimmune disease requiring systemic corticosteroids greater than the equivalent of prednisone 10 mg daily including but not limited to: systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, colitis, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjogren's syndrome, Bell's palsy, Guillain-Barre syndrome, multiple sclerosis, autoimmune thyroid disease, vasculitis, or glomerulonephritis, with the following exceptions
        • * Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone are eligible
        • * Patients with controlled type 1 diabetes mellitus on a stable insulin regimen are eligible
        • * Patients with eczema, psoriasis, lichen simplex chronicus of vitiligo with dermatologic manifestations only who require only low potency topical steroids (e.g., hydrocortisone 2.5%, hydrocortisone butyrate 0.1%, fluocinolone 0.01%, desonide 0.05%, alclometasone dipropionate 0.05%) are eligible
        • * Patients receiving treatment with systemic immunosuppressive medications (including, but not limited to, prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor \[TNF\] agents) within 6 weeks must discontinue these medications prior to starting peposertib (M3814) and avelumab on day 7, with the exception of
          • * Patients with active autoimmune disease managed with systemic corticosteroids less than the equivalent of prednisone 10 mg daily
          • * Patients who have received acute, low dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea)
          • * The use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension and adrenocortical insufficiency
          • * Patients who have undergone prior solid organ or bone marrow transplant with the exception of patients with prior renal transplant for whom dialysis may be employed in the event of graft rejection
          • * Patients with uncontrolled intercurrent illness (e.g., including but not limited to uncontrolled hypertension \[HTN\] \[systolic blood pressure (BP) \> 150, diastolic BP \> 100\], symptomatic congestive heart failure \[CHF\], unstable angina pectoris, ischemic myocardial infarction \[MI\] within 6 months, cardiac arrhythmia, recent transient ischemic attack \[TIA or cerebrovascular accident (CVA)\]) within 6 months
          • * Patients with serious active infection (e.g. requiring hospitalization and/or intravenous \[IV\] antibiotics) within 4 weeks prior to starting peposertib (M3814) and avelumab, or signs/symptoms of infection or receiving oral or IV antibiotics for the treatment of active systemic infection within 2 weeks prior to starting peposertib (M3814) and avelumab. Patients receiving prophylactic antibiotics are eligible
          • * Patients with known chronic hepatitis B virus (HBV) infection must have an undetectable viral load on suppressive therapy if indicated. Patients with known chronic hepatitis C (HCV) infection must have been treated and cured. Patients who are currently on curative treatment are eligible if they have an undetectable HCV viral load
          • * Patients with known human immunodeficiency virus (HIV) are allowed on study provided they have
            • * A stable regimen of highly active anti-retroviral therapy (HAART)
            • * No requirement for concurrent antibiotics or antifungal agents for the prevention of opportunistic infection
            • * A CD4 count above 250 cells/mcL
            • * An undetectable HIV viral load on standard polymerase chain reaction (PCR)-based testing
            • * Patients with history of idiopathic pulmonary fibrosis, pneumonitis (including drug induced), organizing pneumonia (e.g., bronchiolitis obliterans, cryptogenic organizing pneumonia), or evidence of active pneumonitis on screening chest computed tomography (CT) scan
            • * Patients with known concurrent malignancy that is expected to require active treatment within two years, or may interfere with the interpretation of the efficacy and safety outcomes of this study in the opinion of the treating investigator. Superficial bladder cancer, nonmelanoma skin cancers, and low-grade prostate cancer not requiring cytotoxic therapy should not exclude participation in this trial. Patients with chronic lymphocytic leukemia (CLL) may be enrolled if they do not require active chemotherapy and their hematologic, renal and hepatic function meets criteria previously mentioned
            • * Patients with psychiatric illness/social situations that would limit compliance with study requirements
            • * History of allergic reactions attributed to compounds of similar chemical or biologic composition to peposertib (M3814) or avelumab
            • * Patients unable to discontinue medications or substances that are potent inhibitors, inducers or sensitive substrates of CYP3A4/5 or CYP2C19 prior to starting peposertib (M3814) and avelumab are ineligible. Medications or substances that are strong inhibitors of CYP3A4/5 or CYP2C19 must be discontinued at least 1 week prior to first peposertib (M3814) dose. Strong inducers of CYP3A4/5 or CYP2C19 must be stopped at least 3 weeks prior to the first dose. Drugs mainly metabolized by CYP3A with a narrow therapeutic index as judged by the investigator must stop at least 1 day prior to first peposertib (M3814) dose. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product. The primary elimination mechanism of avelumab is proteolytic degradation, thus there are no contraindicated medications with respect to avelumab
            • * Patients who cannot discontinue concomitant proton-pump inhibitors (PPIs) prior to starting peposertib (M3814) and avelumab. These must be discontinued \>= 5 days prior to starting peposertib (M3814) and avelumab. Patients do not need to discontinue calcium carbonate. H2 blockers are allowed provided they are taken at least 2 hours after peposertib (M3814) dose
            • * Patients receiving sorivudine or any chemically related analogues (such as brivudine) and not able to discontinue prior to starting peposertib (M3814) and avelumab are excluded
            • * Pregnant and lactating women are excluded from this study because peposertib (M3814) and avelumab are agents with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with peposertib (M3814) and avelumab, breastfeeding should be discontinued if the mother is treated with peposertib (M3814) and avelumab
            • * Patients who have received live vaccination within 30 days before starting peposertib (M3814) and avelumab
Testing the Combination of New Anti-cancer Drug Peposertib With Avelumab and Radiation Therapy for Advanced/Metastatic Solid Tumors and Hepatobiliary Malignancies

Location Details

NCT04068194

Please Choose a site

How to Participate

Want to participate in this study, select a site at your convenience, send yourself email to get contact details and prescreening steps.

Locations

RECRUITING

United States, California

UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care

Irvine, California, United States, 92612

RECRUITING

United States, California

UC San Diego Moores Cancer Center

THE JOLLA, California, United States, 92093

RECRUITING

United States, California

UC Irvine Health/Chao Family Comprehensive Cancer Center

Orange, California, United States, 92868

SUSPENDED

United States, California

University of California Davis Comprehensive Cancer Center

Sacramento, California, United States, 95817

RECRUITING

United States, Colorado

UCHealth University of Colorado Hospital

Aurora, Colorado, United States, 80045

RECRUITING

United States, Connecticut

Smilow Cancer Hospital-Derby Care Center

Derby, Connecticut, United States, 06418

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center-Fairfield

Fairfield, Connecticut, United States, 06824

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center at Glastonbury

Glastonbury, Connecticut, United States, 06033

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center at Greenwich

Greenwich, Connecticut, United States, 06830

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center - Guilford

Guilford, Connecticut, United States, 06437

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center at Saint Francis

Hartford, Connecticut, United States, 06105

RECRUITING

United States, Connecticut

Smilow Cancer Center/Yale-New Haven Hospital

New Haven, Connecticut, United States, 06510

RECRUITING

United States, Connecticut

Yale University

New Haven, Connecticut, United States, 06520

RECRUITING

United States, Connecticut

Yale-New Haven Hospital North Haven Medical Center

North Haven, Connecticut, United States, 06473

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center at Long Ridge

Stamford, Connecticut, United States, 06902

RECRUITING

United States, Connecticut

Smilow Cancer Hospital-Torrington Care Center

Torrington, Connecticut, United States, 06790

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center-Trumbull

Trumbull, Connecticut, United States, 06611

RECRUITING

United States, Connecticut

Smilow Cancer Hospital-Waterbury Care Center

Waterbury, Connecticut, United States, 06708

RECRUITING

United States, Connecticut

Smilow Cancer Hospital Care Center - Waterford

Waterford, Connecticut, United States, 06385

RECRUITING

United States, District of Columbia

MedStar Georgetown University Hospital

Washington, District of Columbia, United States, 20007

RECRUITING

United States, District of Columbia

Sibley Memorial Hospital

Washington, District of Columbia, United States, 20016

RECRUITING

United States, Florida

UM Sylvester Comprehensive Cancer Center at Aventura

Aventura, Florida, United States, 33180

RECRUITING

United States, Florida

UM Sylvester Comprehensive Cancer Center at Coral Gables

Coral Gables, Florida, United States, 33146

RECRUITING

United States, Florida

UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Deerfield Beach, Florida, United States, 33442

RECRUITING

United States, Florida

University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida, United States, 33136

RECRUITING

United States, Florida

UM Sylvester Comprehensive Cancer Center at Kendall

Miami, Florida, United States, 33176

RECRUITING

United States, Florida

UM Sylvester Comprehensive Cancer Center at Plantation

Plantation, Florida, United States, 33324

RECRUITING

United States, Georgia

Emory University Hospital Midtown

Atlanta, Georgia, United States, 30308

RECRUITING

United States, Georgia

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, United States, 30322

RECRUITING

United States, Georgia

Emory Saint Joseph's Hospital

Atlanta, Georgia, United States, 30342

RECRUITING

United States, Illinois

Northwestern University

Chicago, Illinois, United States, 60611

ACTIVE NOT RECRUITING

United States, Road cancer

Wayne State University/Karmanos Cancer Institute

Detroit, Road cancer, United States, 48201

ACTIVE NOT RECRUITING

United States, Road cancer

Weisberg Cancer Treatment Center

Farmington Hills, Road cancer, United States, 48334

RECRUITING

United States, New Jersey

Rutgers Cancer Institute of New Jersey

New Brunswick, New Jersey, United States, 08903

RECRUITING

United States, New York

Bellevue Hospital Center

New York, New York, United States, 10016

RECRUITING

United States, New York

Laura and Isaac Perlmutter Cancer Center at NYU Langone

New York, New York, United States, 10016

RECRUITING

United States, New York

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York, United States, 10032

RECRUITING

United States, New York

NYP/Weill Cornell Medical Center

New York, New York, United States, 10065

RECRUITING

United States, Pennsylvania

University of Pittsburgh Cancer Institute (UPCI)

Pittsburgh, Pennsylvania, United States, 15232

RECRUITING

United States, Rhode Island

Smilow Cancer Hospital Care Center - Westerly

Westerly, Rhode Island, United States, 02891

RECRUITING

United States, Utah

Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah, United States, 84112

RECRUITING

United States, Virginia

Virginia Commonwealth University/Massey Cancer Center

Richmond, Virginia, United States, 23298

RECRUITING

United States, Wisconsin

University of Wisconsin Carbone Cancer Center - Eastpark Medical Center

Madison, Wisconsin, United States, 53718

RECRUITING

United States, Wisconsin

University of Wisconsin Carbone Cancer Center - University Hospital

Madison, Wisconsin, United States, 53792