Description:
Approximately 36 DLT-evaluable subjects will be enrolled in this study. The locations of the
study will be in the United States, Australia, Europe and Switzerland.
The goal of this study is to evaluate the safety of intrahepatic injection (directly into the
liver) of talimogene laherparepvec in combination with intravenously administered
atezolizumab in subjects with triple negative breast cancer and colorectal cancer with liver
metastases.
Title
- Brief Title: Study of Talimogene Laherparepvec With Atezolizumab for Triple Negative Breast Cancer and Colorectal Cancer With Liver Metastases
- Official Title: A Phase 1b Study of Talimogene Laherparepvec in Combination With Atezolizumab in Subjects With Triple Negative Breast Cancer and Colorectal Cancer With Liver Metastases
Clinical Trial IDs
- ORG STUDY ID:
20140299
- NCT ID:
NCT03256344
Conditions
- Metastatic Triple Negative Breast Cancer
- Metastatic Colorectal Cancer
Interventions
Drug | Synonyms | Arms |
---|
Talimogene Laherparepvec | IMLYGIC | Talimogene Laherparepvec with Atezolizumab: Colorectal Cancer (CRC) |
Atezolizumab | MPDL3280A | Talimogene Laherparepvec with Atezolizumab: Colorectal Cancer (CRC) |
Purpose
Approximately 36 DLT-evaluable subjects will be enrolled in this study. The locations of the
study will be in the United States, Australia, Europe and Switzerland.
The goal of this study is to evaluate the safety of intrahepatic injection (directly into the
liver) of talimogene laherparepvec in combination with intravenously administered
atezolizumab in subjects with triple negative breast cancer and colorectal cancer with liver
metastases.
Detailed Description
The Screening period is 28 days prior to study enrollment. This study has 2 Cohorts. Cohort
1: Triple Negative Breast Cancer and Cohort 2: Colorectal Cancer. These cohorts will enroll
in parallel. There will be a Safety Follow-up period and a Long Term Follow-up period.
Drug Administration: The participants will receive the study drugs in cycles. If the
participants are found to be eligible to take part in this study, they will receive
talimogene laherparepvec as an injection into the hepatic (liver) metastatic sites on Day 1
of each cycle along with receiving atezolizumab by intravenous infusion on Day 1 of each
cycle. Each cycle is 21 days for 6 cycles. There is an option for an additional 6 cycles
after the first 6 intra-hepatic cycles. After the first radiographic assessment at week 10,
if all injectable liver lesions have been injected but the 4.0 mL maximum volume has not been
used, injection of clinically assessed non-hepatic cutaneous, subcutaneous, and nodal tumor
lesions with or without ultrasound guidance will be permitted. Liver lesions should be
prioritized over cutaneous, subcutaneous and nodal lesions.
Treatment will continue until a participant experiences a DLT (Dose Limiting Toxicity)
evaluated in the DLT period (which is 2 cycles from initial dose), has CR (Complete
Response), has need for an alternative anticancer therapy or experiences a safety concern.
Study Visits: Cycle 1 to Cycle 12 - The participant will have a physical exam along with
vital signs and ECOG (Eastern Cooperative Oncology Group) performance level assessment. Blood
(about 2 Tablespoons) will be drawn for routine tests and to check the immune system. Adverse
events and medications taken will be reviewed on each cycle.Biomarkers will be taken on
cycles 1, 2, 3, 6, and safety FU. Tumor Markers (special lab tests associated with the
cancer, such as particular proteins) will be completed will be take on cycles 1, 4, 7, 10,
13, every 3 cycles and SFU.
Central lab tests will be completed on cycles 1, 2, 3, and 6 and safety FU. Cycle 1 Archived
(prior stored) tumor sample will be obtained. Also, a liver tumor biopsy will be completed at
Cycles 1, 3 and 6.
Response Assessments will be completed at Screening and again at Cycles 4, 7, 10, 13 and
every 3 cycles.
Throughout the trial a swab for Herpetic tumor will be obtained within 3 days of the event.
Cycle 1 to 12- The exposure to talimogene laherparepvec by the subject's healthcare provider
and household member caregiver will be reviewed. Cycles 1, 3, 6-Liver tumor biopsy will be
completed. Cycles 4, 7, 10, 13 and every 3 cycles -Response assessments will be completed by
radiographic and clinical tumor assessment.
Length of Treatment:
A maximum for 12 cycles of talimogene laherparepvec are allowed during the study. The
participant may continue taking the study drug for as long as the doctor thinks it is in
their best interest. The participant will no longer be able to take the study drug if the
disease gets worse, or if they are unable to follow study directions.
Safety Follow-up Visit:
Safety Follow-up visit will be performed about 30 days after the last dose of study
treatment.
The participant will have a physical exam, have vital signs taken, assessment of ECOG status
and have weight measured. Adverse events will be assessed as well as the concominant
medications. Routine bloodwork and tumor markers will be taken.
Exposure to talimogene laherparepvec by the healthcare providers of the participant and/or
close contacts will be assessed.
Long-Term Follow-up Visits: Participants will be followed for survival every 12 weeks from
the date of the safety follow-up visit until approximately 24 months after the last subject
is enrolled. Subsequent cancer treatments will be collected as part of the long-term
follow-up survival assessment. This is an investigational study. The study doctor can explain
how the study drugs are designed to work.
Trial Arms
Name | Type | Description | Interventions |
---|
Talimogene Laherparepvec with Atezolizumab: Triple Negative Breast Cancer (TNBC) | Experimental | Participants with TNBC with liver metastases administered intrahepatic injection of talimogene laherparepvec into liver metastases via guided injection (either ultrasound or computerized tomography) on Day 1 of each cycle for a maximum of 12 cycles, where each cycle is 21 days. Participants administered 10^6 plaque-forming units/milliliter (PFU/mL) on Day 1 of Cycle 1 and 10^8 PFU/mL on Day 1 of each cycle thereafter. Participants also administered 1200 mg atezolizumab via intravenous injection on Day 1 of each cycle. | - Talimogene Laherparepvec
- Atezolizumab
|
Talimogene Laherparepvec with Atezolizumab: Colorectal Cancer (CRC) | Experimental | Participants with CRC with liver metastases administered intrahepatic injection of talimogene laherparepvec into liver metastases via guided injection (either ultrasound or computerized tomography) on Day 1 of each cycle for a maximum of 12 cycles, where each cycle is 21 days. Participants administered 10^6 PFU/mL on Day 1 of Cycle 1 and 10^8 PFU/mL on Day 1 of each cycle thereafter. Participants also administered 1200 mg atezolizumab via intravenous injection on Day 1 of each cycle. | - Talimogene Laherparepvec
- Atezolizumab
|
Eligibility Criteria
Inclusion Criteria:
- Criteria1, Participant provided informed consent prior to any study-specific
activities/procedures.
- Criteria 2, Confirmation of triple negative breast cancer or colorectal cancer with
liver metastases by laboratory testing.
- Criteria 3, Subjects with triple negative breast cancer with liver metastases, or
subjects with colorectal cancer with liver metastases are eligible if they have had
disease progression during or after one or more prior standard of care systemic
anti-cancer therapy (eg,chemotherapy, targeted therapy) for metastatic disease or if
they progress during or within 6 months of receiving adjuvant therapy. If subjects, in
the opinion of the investigator, are deemed not appropriate candidates for systemic
anti-cancer therapy for metastatic disease or if they refuse systemic anti-cancer
therapy for metastatic disease, they may be eligible after investigator discussion
with Sponsor medical monitor for approval.
- Criteria 4, Participants have measurable disease which is equal to one or more
metastatic liver lesions that can be accurately and serially measured that are greater
than or equal to 1 cm dimension and for which the longest diameter is greater or equal
to 1 cm as measured by CT (Computed Tomography) scan or magnetic resonance imaging.
The metastatic liver lesion(s) must not be in an area that received prior localized
therapies.
- Criteria 5, Metastatic liver lesions for injection must be without necrosis (dead
tissue )and must be be located where any tumor swelling will not lead to gall bladder
tract obstruction or lead to bleeding risk.
- Criteria 6, Eastern Cooperative Oncology Group performance status (ECOG PS) 0 or 1.
- Criteria 7, Life expectancy greater than or equal to 5 months.
- Criteria 8, Adequate organ function within 4 weeks prior to enrollment. This includes
hematology, renal, hepatic and blood-clotting functions as defined by protocol.
- Criteria 9, Female subjects of childbearing potential should have a negative serum
pregnancy test within 1 week prior to enrollment.
- Criteria 10, Other Inclusion Criteria May Apply.
Exclusion criteria:
- Criteria 1, Participant is a candidate for hepatic surgery or local regional therapy
of liver metastases with curative intent.
- Criteria 2, More than one third of the liver is estimated to be involved with
metastases.
- Criteria 3, There is invasion by cancer into the main blood vessels such as the portal
vein, hepatic vein or the vena cava.
- Criteria 4, Participant is currently receiving or has received liver
metastatic-directed therapy ( eg: radiation, ablation, embolization) less than 4 wks
prior to enrollment or hepatic surgery.
- Criteria 5, History of other malignancy within the past 5 years prior to enrollment
with some exceptions, as outlined in the protocol.
- Criteria 6, Active or untreated central nervous system (CNS) metastases per CT or
magnetic resonance imagine (MRI) evaluation during screening.
- Participants with a history of CNS metastases are eligible provided they are stable
and meet the criteria details in the protocol.
- Criteria 7, Other Medical Conditions as noted in the protocol.
- Criteria 8, Other Exclusion Criteria May Apply.
Maximum Eligible Age: | 99 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of Participants Who Experienced a Dose-Limiting Toxicity (DLT) |
Time Frame: | From Day 1 up to the start of Cycle 3 (each cycle is 21 days) |
Safety Issue: | |
Description: | Toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. A DLT was considered as any of the below, if judged by the investigator to be related to either treatment:
Grade ≥ 4 neutropenia (absolute neutrophil count [ANC] < 500/μl) lasting ≥ 7 days
Grade ≥ 3 febrile neutropenia
Grade ≥ 4 thrombocytopenia
Grade ≥ 4 anemia
Grade ≥ 4 rash
Serious herpetic events
Grade ≥ 3 symptomatic hepatic toxicities that do not resolve to Grade ≤ 2 within 48 hours or Grade ≥ 3 asymptomatic hepatic toxicities that do not resolve to Grade ≤ 1 within 3 weeks of onset
Grade ≥ 3 non-hematologic, non-hepatic organ toxicity
Grade 5 toxicity (ie, death)
Any other intolerable toxicity leading to permanent discontinuation of treatment
DLTs were to occur within the DLT evaluation period, defined as the period between the initial 10^6 PFU/mL dose and 3 weeks following the initial 10^8 PFU/mL dose or the start of Cycle 3, whichever occurred first. |
Secondary Outcome Measures
Measure: | Objective Response Rate (ORR) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | ORR was defined as the incidence rate of either a complete response (CR) or partial response (PR) based on modified immune-related response criteria simulating Response Evaluation Criteria in Solid Tumors(irRC-RECIST) criteria. A CR was a complete disappearance of all lesions and a PR was a decrease in tumor burden 30% or more relative to baseline. |
Measure: | Best Overall Response (BOR) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | BOR was defined as the best visit response based on modified irRC-RECIST criteria:
CR: a complete disappearance of all lesions
PR: a decrease in tumor burden 30% or more relative to baseline
Stable disease (SD): neither sufficient shrinkage to qualify for CR or PR nor sufficient increase to qualify for progressive disease (PD)
PD: an increase in tumor burden of 20% or more and at least 5 mm absolute increase relative to nadir (minimum recorded tumor burden)
Unevaluable (UE): any lesion present at baseline which was not assessed or was unable to be evaluated leading to an inability to determine the status of that particular tumor |
Measure: | Duration of Response (DOR) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | DOR was defined as the time from the date of an initial response that is subsequently confirmed to the earlier of PD per modified irRC RECIST or death. Participants who have not ended their response at the time of analysis were censored at the last evaluable tumor assessment. |
Measure: | Lesion Level Response in Injected Tumor Lesions |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | Responses for individual tumor lesions for hepatic and non-hepatic tumors injected wtih treatment were assessed for the following responses:
Lesion complete response rate (L-CRR): Disappearance of lesion
Lesion partial response rate (L-PRR): Decrease in tumor burden 30% or more relative to baseline
Lesion objective response rate (L-ORR): Either a L-CRR or L-PRR based on modified irRC-RECIST criteria |
Measure: | Lesion Level Response in Uninjected Tumor Lesions |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | Responses for individual tumor lesions for hepatic and non-hepatic tumors that were not injected with treatment were assessed for the following responses:
L-CRR: Disappearance of lesion
L-PRR: Decrease in tumor burden 30% or more relative to baseline
L-ORR: Either a L-CRR or L-PRR based on modified irRC-RECIST criteria |
Measure: | Durable Response Rate (DRR) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | DRR was defined as the percentage of participants with an objective response with a DOR of at least 6 months. |
Measure: | Disease Control Rate (DCR) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | DCR was defined as the percentage of participants that have a best overall response in one of the following categories: CR/PR/SD. |
Measure: | Progression-free Survival (PFS) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | PFS was defined as time from first dose to the date of first of confirmed disease progression per modified irRC-RECIST criteria, or death. Results were estimated using the Kaplan-Meier method. |
Measure: | Overall Survival (OS) |
Time Frame: | Every 12 weeks (± 28 days). Maximum overall time on-study (treatment + follow up) at data cut off was 32 months (TNBC cohort) and 19 months (CRC cohort). |
Safety Issue: | |
Description: | OS was defined as the time from the date of first dose to the date of death from any cause. Results were estimated using the Kaplan-Meier method. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Amgen |
Trial Keywords
Last Updated
June 9, 2021