Clinical Trials /

EphA2 siRNA in Treating Patients With Advanced or Recurrent Solid Tumors

NCT01591356

Description:

This phase I trial studies the side effects and best dose of EphA2 siRNA (ephrin type-A receptor 2 [EphA2]-targeting 1,2-dioleoyl-sn-glycero-3-phosphatidylcholine [DOPC]-encapsulated short-interfering ribonucleic acid [siRNA]) in treating patients with solid tumors that have spread to other places in the body and usually cannot be cured or controlled with treatment (advanced) or have come back after a period of improvement (recurrent). EphA2-targeting DOPC-encapsulated siRNA may slow the growth of tumor cells by shutting down the activity of a gene that causes tumor growth.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title:EphA2 Gene Targeting Using Neutral Liposomal Small Interfering RNA Delivery
  • Official Title:EphA2 Gene Targeting Using Neutral Liposomal Small Interfering RNA Delivery (IND# 72924): A Phase I Clinical Trial

Clinical Trial IDs

  • ORG STUDY ID: 2011-0216
  • SECONDARY ID: NCI-2012-00755
  • SECONDARY ID: RP120214
  • NCT ID: NCT01591356

Trial Conditions

  • Advanced Cancers

Trial Interventions

DrugSynonymsArms
siRNA-EphA2-DOPCsiRNA-EphA2-DOPC

Trial Purpose

The goal of this clinical research study is to learn about the safety of siRNA-EphA2-DOPC when given to patients with advanced, recurrent cancer. Researchers also want to learn the highest tolerable dose of this drug that can be given.

siRNA-EphA2-DOPC is designed to shut down the activity of a genetic biomarker called EphA2. Biomarkers are found in the blood and tissue and may be related to your reaction to the study drug.

Detailed Description

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a study group based on when you join this study. Up to 5 groups of up to 6 participants will be enrolled in Part 1 of the study. Up to 10 will be enrolled in Part 2.

If you are enrolled in Part 1, the dose of siRNA-EphA2-DOPC you receive will depend on when you join this study. The first group of participants will receive the lowest dose level. Each new group will receive a higher dose than the group before it, if no intolerable side effects were seen. This will continue until the highest tolerable dose of siRNA-EphA2-DOPC is found.

If you are enrolled in Part 2, you will receive siRNA-EphA2-DOPC at the highest dose that was tolerated in Part 1.

Study Drug Administration:

You will receive siRNA-EphA2-DOPC 2 times a week (Days 1 and 4 of each week) by vein over 120 minutes (+/- 10 minutes).

You will be given standard drugs (hydrocortisone and diphenhydramine) to help decrease the risk of side effects. You may ask the study staff for information about how the drugs are given and their risks.

Cycles in this study are 3 weeks long.

Study Visits:

On Day 1 of Cycle 1, if you have not already had these procedures done within the last week:

- Any updates to your medical history will be recorded, including any drugs you may be taking and any side effects you may be having.

- You will have a physical exam, including measurement of your vital signs and weight.

- Your performance status will be recorded.

- Blood (about 4-6 teaspoons) will be drawn for routine tests. If you are able to become pregnant, this blood and/or urine will be used for a pregnancy test.

- Blood (about 2 teaspoons each time) will be drawn for pharmacokinetic (PK) testing before the study drug dose, 1 time during the dose, at the end of the dose, and 6 times during the 6 hours after the dose. PK testing measures the amount of study drug in the body at different time points.

- Blood (about 3 tablespoons) will be drawn for biomarker testing.

- If you are in the third dose level in Part 1 of if you are in Part 2, you will have a dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) scan, a diffusion weighted imaging MRI (DWI-MRI) scan, and a fluorodeoxyglucose positron emission tomography (FDG-PET) scan to check if the study drug may be able to affect the tumor.

On Day 2 of Cycle 1 (24 hours after the first study drug dose), blood (about 2 teaspoons) will be drawn for PK testing.

On Day 3 or 4 of Cycle 1:

- You will have a core biopsy at the same site(s) that may have been tested at screening to check the status of the disease. This sample will be compared to the sample collected at screening.

- If you are in the third dose level in Part 1 of if you are in Part 2, you will have an FDG-PET scan, DCE-MRI scan, and a DWI-MRI to check the status of the disease and to learn how the drug may be affecting the tumor.

On Day 4 of Cycle 1:

- Your vital signs and weight will be measured.

- You will be asked about any side effects you may be having.

- Blood (about 2 teaspoons) will be drawn for routine tests.

- Blood (about 3 tablespoons) will be drawn for biomarker testing.

- Blood (about 2 teaspoons each time) will be drawn for PK testing before and at the end of the study drug dose.

On Days 8 and 15 of Cycle 1:

- You will have a physical exam, including measurement of your vital signs and weight.

- Your performance status will be recorded.

- Blood (about 2 teaspoons each time) will be drawn for routine tests.

- You will be asked about any side effects you may be having.

On Days 11 and 18 of Cycle 1:

- Your vital signs and weight will be measured.

- You will be asked about any side effects you may be having.

- Blood (about 2 teaspoons will be drawn for routine tests.

Before Cycle 2, if you are in the third dose level in Part 1 of if you are in Part 2, you will have an FDG-PET scan, DCE-MRI scan, and a DWI-MRI to check the status of the disease and to learn how the drug may be affecting the tumor.

On Day 1 of Cycles 2 and beyond:

- You will have a physical exam, including measurement of your vital signs, and weight.

- You will be asked about any drugs you may be taking and about any side effects you may be having.

- Your performance status will be recorded.

- Blood (about 2 teaspoons) will be drawn for routine tests.

- If you are able to become pregnant, blood (about 2 teaspoons) and/or urine will be collected for a pregnancy test.

On Days 4, 8, 11, 15, and 18 of Cycles 2 and beyond:

- Your vital signs and weight will be measured.

- You will be asked about any side effects you may be having.

- Blood (about 2 teaspoons) will be drawn for routine tests.

- In Cycle 3 only, blood (about 4 teaspoons) will be drawn for biomarker testing.

On Day 1 of every even numbered cycle (Cycles 2, 4, 6, and so on):

- You will have a CT scan or x-ray to check the status of the disease.

Length of Dosing:

You may continue taking the study drug for as long as the doctor thinks it is in your best interest. You will no longer be able to take the study drug if the disease gets worse, if intolerable side effects occur, if study drug dosing is delayed for more than 2 weeks, if the disease completely responds, or if you are unable to follow study directions.

Your participation on the study will be over once you have completed the end-of-dosing visit.

End-of-Dosing Visit:

After you have finished taking the study drug:

- You will have a physical exam, including measurement of your vital signs and weight.

- You will be asked about any drugs you may be taking.

- Your performance status will be recorded.

- Blood (about 4-6 teaspoons) will be drawn for routine tests.

- Blood (about 4 teaspoons) will be drawn for biomarker testing.

- You will have a CT scan, MRI scan, or x-ray to check the status of the disease.

- You will have an ECG.

- If you are able to become pregnant, blood (about 2 teaspoons) and/or urine will be collected for a pregnancy test.

This is an investigational study. siRNA-EphA2-DOPC is not FDA approved or commercially available. It is currently being used for research purposes only.

Up to 40 patients will be enrolled on this study. All will be enrolled at MD Anderson.

Trial Arms

NameTypeDescriptionInterventions
siRNA-EphA2-DOPCExperimentalsiRNA-EphA2-DOPC administered by vein twice weekly on Days 1 and 4 of each week for 3 weeks. One cycle equals 3 weeks of treatment (21 day schedule). Treatment will normally be administered on an outpatient basis; however, inpatient administration may be relevant in some situations. siRNA-EphA2-DOPC administered over 30 (+/- 5 minutes). Starting dose level of siRNA-EphA2-DOPC 450 ug/m2 by vein twice weekly.
  • siRNA-EphA2-DOPC

Eligibility Criteria

Inclusion Criteria:

1. All patients with histologic proof of advanced solid tumors, who are not candidates for known regimens or protocol treatments of higher efficacy or priority.

2. Subject/patient must be 18 years or older (no dosing or adverse event data are currently available on the use of EphA2 siRNA-DOPC in patients < 18 years of age).

3. ECOG performance status </=2.

4. All patients (dose escalation and dose expansion phases) must be willing to undergo pre- and post-treatment biopsies.

5. For the dose escalation phase, the trial population will be limited to solid tumor types

6. For dose expansion phase: patients must have EphA2 overexpression overall H-score of 3 or above in IHC evaluation.CLIA certified EphA2 IHC staining to be performed on formalin fixed, paraffin-embedded tissue sections using monoclonal EphA2 antibody. EphA2 expression to be assessed through a combo of % of positive cells and staining intensity. The % of positive cells will be rated: 0 points (pts), 0 to 5%; 2 pts, 6 to 50%; 3 pts, 50%. The staining intensity will be rated as follows: 1 pt, weak intensity; 2 pts, moderate intensity; 3 pts, strong intensity. Pts for expression and % of positive cells will be added; an overall score will be assigned. Tumors to be categorized into 4 groups: negative (overall score 0), 5% cells stained, regardless of intensity; weak expression (overall score 1), 1 - 2 pts; moderate expression (overall score 2), 3 - 4 pts; and strong expression (overall score 3), 5 - 6 pts. Overall H-score of 3 or above will be defined as EphA2 overexpression in tumor cells.

7. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension. At least one lesion greater than 2 cm in short axis is required to ensure serial biopsy. When imaging (DCE-MRI, DW-MRI and PET-CT imaging) is being performed for Secondary Objectives (Dose Level III and during the Expansion Phase) at least one lesion (>/=2 cm) not adjacent to the diaphragm will be required when measured by conventional techniques, including palpation, plain x-ray, CT, and MRI. A second lesion accessible for biopsy must also be present. Patients must have at least one 'target lesion' to be used to assess response on this protocol as defined by RECIST. This may be one of the lesions mentioned above. Tumors within a previously irradiated field will be designated as 'non-target' lesions.

8. Resolution of any effects of prior therapy (except alopecia) to NCI CTCAE Version 4.03 grade </= 1 and to baseline laboratory values as defined in inclusion criteria 7.

9. Patients must have adequate: Bone marrow function: HGB >/= 9 g/dL, WBC >/= 3,000/mcL, ANC >/= 1,500/mcL, PLT >/= 100,000/mcL; Hepatic function: Total bilirubin less than or equal to 1.5, SGOT and SGPT < 2.5 X institutional ULN; Renal function: Creatinine < 1.5 x ULN or creatinine clearance > 60ml/min according to Cockcroft-Gault formula; Neurologic function: Neuropathy (sensory and motor) </= to CTCAE grade 1; Blood coagulation parameters: PT such that international normalized ratio (INR) is < 1.5 (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin or low molecular weight heparin) and a PTT < 1.2 times control.

10. Patients should be free of active infection requiring intravenous antibiotics.

11. Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to registration (study enrollment). Continuation of hormone replacement therapy is permitted.Stable regimens of hormonal therapy i.e. for prostate cancer (e.g. leuprolide, a GnRH agonist), ovarian or breast cancer are not exclusionary.

12. Any other prior therapy directed at the malignant tumor, including immunologic agents, must be discontinued at least three weeks prior to registration (study enrollment) (6 weeks for nitrosoureas or mitomycin C).

13. Female subject is either post-menopausal or surgically sterilized or willing to use an acceptable method of birth control (i.e., a hormonal contraceptive, intrauterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study and for at least 3 months after completion of EphA2 siRNA-DOPC therapy.

14. Male subject agrees to use an acceptable method of contraception for the duration of the study.

15. Patients must voluntarily sign an informed consent indicating that they are aware of the investigational nature of this study in keeping with the policies of the hospital.

Exclusion Criteria:

1. Patients may not be receiving any other investigational agents and/or other therapy for their cancer.

2. History of allergic reactions attributed to compounds of similar chemical or biologic composition to DOPC, Magnevist, or FDG.

3. Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as a known bleeding disorder, coagulopathy, or tumor involving major vessels.

4. Patients with history or evidence upon physical examination of CNS disease, including primary brain tumor, seizures not controlled with standard medical therapy, any brain metastases.

5. Patients with history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within 6 months of the first date of treatment on this study.

6. Patients with clinically significant cardiovascular disease; this includes: Uncontrolled hypertension (greater than 140/90); Myocardial infarction or unstable angina within 6 months prior to registration; New York Heart Association (NYHA) Grade II or greater congestive heart failure; Serious cardiac arrhythmia requiring medication; Grade II or greater peripheral vascular disease; Patients with clinically significant peripheral artery disease, e.g., those with claudication, within 6 months of first date of treatment on this study.

7. Patients whose circumstances do not permit completion of the study or the required follow-up.

8. Patients who are pregnant or nursing. To date, no fetal studies in animals or humans have been performed with this agent.

9. History of HIV or HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with EphA2 siRNA-DOPC.

10. Patients whose tumor is not accessible for a core biopsy.

11. Exclusion criteria (MRI specific): Patients who are ineligible to undergo an MRI scan for reasons such as claustrophobia or the presence of implanted devices or metallic foreign bodies that are not MR compatible. Patients with a known history of allergic reaction to gadolinium contrast agents. Patients with a history of a GFR of less than 60 or acute renal disease.

12. Exclusion criteria (PET specific): Pregnant or nursing women. Extreme claustrophobia. Weight near or greater than 350 pounds.

Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Both
Healthy Volunteers:No

Primary Outcome Measures

Measure:Toxicity Profile of siRNA-EphA2
Time Frame:21 days
Safety Issue:Yes
Description:Dose-limiting toxicity (DLT) defined as any event during the first cycle of study treatment that is considered possibly, probably or definitely related to study drug: Hematologic toxicity or Non-hematologic toxicity.

Secondary Outcome Measures

Trial Keywords

  • Advanced Cancers
  • Advanced solid tumors
  • siRNA/EphA2