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 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:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: EphA2 siRNA in Treating Patients With Advanced or Recurrent Solid Tumors
  • Official Title: EphA2 Gene Targeting Using Neutral Liposomal Small Interfering RNA Delivery: A Phase I Clinical Trial

Clinical Trial IDs

  • ORG STUDY ID: 2011-0216
  • SECONDARY ID: NCI-2015-00745
  • SECONDARY ID: RP120214
  • SECONDARY ID: NCI-2012-00755
  • SECONDARY ID: 2011-0216
  • SECONDARY ID: P50CA093459
  • NCT ID: NCT01591356

Conditions

  • Advanced Malignant Solid Neoplasm

Interventions

DrugSynonymsArms
EphA2-targeting DOPC-encapsulated siRNAsiRNA-EphA2-DOPCTreatment (EphA2-targeting DOPC-encapsulated siRNA)

Purpose

This phase I trial studies the side effects and best dose of EphA2 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.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the safety and tolerability (toxicity profile) of EphA2-targeting
      DOPC-encapsulated siRNA (EphA2 siRNA) delivered via neutral liposome
      (1,2-dioleoyl-sn-glycero-3-phosphatidylcholine or DOPC) administered intravenously in
      patients with advanced/recurrent malignancies.

      II. To determine the maximal tolerated dose (MTD) or maximal administered dose (MAD) using a
      modified toxicity probability interval (mTPI) design.

      SECONDARY OBJECTIVES:

      I. To determine efficacy (EphA2 expression modulation) at the MTD or MAD. II. To evaluate the
      effect of EphA2 siRNA-DOPC on tumor and endothelial cell apoptosis.

      III. To record the clinical activity (objective response, duration of response, and time to
      treatment progression) of intravenous (IV) EphA2 siRNA -DOPC.

      IV. To describe the symptom burden of patients receiving siRNA-EphA2-DOPC treatment.

      EXPLORATORY OBJECTIVES:

      I. To determine the pharmacokinetic profile of siRNA-EphA2-DOPC in blood. II. To determine
      the effect of EphA2 siRNA-DOPC on tumor perfusion, apparent diffusion, and metabolism by
      radiographic imaging (dynamic contrast-enhanced-magnetic resonance imaging [DCE-MRI],
      diffusion weighted [DW]-MRI and fludeoxyglucose F-18-positron emission tomography
      [18FDG-PET]).

      III. To determine the impact of EphA2 siRNA-DOPC on surrogate biomarkers in blood (cell-free
      deoxyribonucleic acid [DNA], plasma/serum markers [vascular endothelial growth factor (VEGF),
      caveolin 1 (CAV1), soluble EphrinA1], and exosomes).

      OUTLINE: This is a dose-escalation study.

      Patients receive EphA2-targeting DOPC-encapsulated siRNA IV over 120 minutes on days 1 and 4.
      Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up periodically.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (EphA2-targeting DOPC-encapsulated siRNA)ExperimentalPatients receive EphA2-targeting DOPC-encapsulated siRNA IV over 120 minutes on days 1 and 4. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • EphA2-targeting DOPC-encapsulated siRNA

Eligibility Criteria

        Inclusion Criteria:

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

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2

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

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

          -  For dose expansion phase: patients must have EphA2 overexpression overall H-score of 3
             or above in immunohistochemistry (IHC) evaluation; Clinical Laboratory Improvement
             Amendments (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

          -  Measurable disease is defined as at least one lesion that can be accurately measured
             in at least one dimension; at least one biopsiable lesion must be available; when
             imaging (DCE-MRI, DW-MRI and PET-computed tomography [CT] imaging) is being performed
             for secondary objectives (dose level III [or when the dose reaches at least 1,500
             ug/m^2] 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 Response Evaluation Criteria in Solid Tumors
             (RECIST); this may be one of the lesions mentioned above; tumors within a previously
             irradiated field will be designated as 'non-target' lesions

          -  Resolution of any effects of prior therapy (except alopecia) to National Cancer
             Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.03
             grade =< 1 and to baseline laboratory values as defined below

          -  Hemoglobin (HGB) >= 9 g/dL

          -  White blood cells (WBC) >= 3,000/mcL

          -  Absolute neutrophil count (ANC) >= 1,500/mcL

          -  Platelet (PLT) >= 100,000/mcL

          -  Total bilirubin less than or equal to 1.5

          -  Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate pyruvate
             transaminase (SGPT) < 2.5 x institutional upper limit of normal (ULN)

          -  Creatinine < 1.5 x ULN or creatinine clearance > 60 ml/min according to
             Cockcroft-Gault formula

          -  Neuropathy (sensory and motor) =< to CTCAE grade 1

          -  Prothrombin time (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 partial thromboplastin time (PTT) <
             1.2 times control

          -  Patients should be free of active infection requiring intravenous antibiotics

          -  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 gonadotropin-releasing hormone [GnRH] agonist), ovarian or breast
             cancer are not exclusionary

          -  Any other prior therapy directed at the malignant tumor, including immunologic agents,
             must be discontinued at least three weeks prior to first dose of study drug (6 weeks
             for nitrosoureas or mitomycin C)

          -  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

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

          -  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:

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

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to DOPC, Magnevist, or fluorodeoxyglucose (FDG)

          -  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

          -  Patients with history or evidence upon physical examination of central nervous system
             (CNS) disease, including primary brain tumor, seizures not controlled with standard
             medical therapy, any brain metastases

          -  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

          -  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

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

          -  Patients who are pregnant or nursing

          -  History of human immunodeficiency virus (HIV) or HIV-positive patients on combination
             antiretroviral therapy are ineligible

          -  Patients whose tumor is not accessible for a core biopsy

          -  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 magnetic resonance (MR) compatible; patients with a known history of
                  allergic reaction to gadolinium contrast agents; patients with a history of a
                  glomerular filtration rate (GFR) of less than 60 or acute renal disease

          -  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:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Toxicity profile of ephrin type-A receptor 2-targeting 1,2-dioleoyl-sn-glycero-3-phosphatidylcholine-encapsulated short-interfering ribonucleic acid
Time Frame:Up to 5 years
Safety Issue:
Description:Will be graded according to Common Terminology Criteria for Adverse Events version 4.0

Secondary Outcome Measures

Measure:Percent of patients with ephrin type-A receptor 2 expression modulation, defined as a 50% decrease from baseline expression
Time Frame:Up to 5 years
Safety Issue:
Description:Will be calculated along with 90% exact confidence intervals.
Measure:Changes in ephrin type-A receptor 2 expression
Time Frame:Baseline to up to day 4 of course 1
Safety Issue:
Description:Tissue effects will be assessed in core biopsy samples collected pre-treatment and course 1 day 2 or day 3 (timed with biomarker assessment).
Measure:Changes in endothelial and tumor cell apoptosis conducted by terminal deoxynucleotidyl transferase dUTP nick end labeling assay
Time Frame:Up to 5 years
Safety Issue:
Description:Analysis will be performed for both between (dose-effect) and within (changes from baseline) patient cohorts.
Measure:Objective response
Time Frame:Up to 5 years
Safety Issue:
Description:The best response recorded from the start of the treatment until disease progression/recurrence
Measure:Duration of response
Time Frame:Up to 5 years
Safety Issue:
Description:measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Measure:Time to treatment progression
Time Frame:Up to 5 years
Safety Issue:
Description:The duration of time from study entry to time of recurrence or death, whichever occurs first.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

April 29, 2021