Description:
Background:
Immunotherapy drugs help the body to fight cancer. Scientists think that combining some of
these drugs will make them work better than when used alone. This may be true for many types
of cancer, including castration-resistant prostate cancer (CRPC).
Objective:
To test if the combination of the drugs BN-brachyury, M7824, N-803, and Epacadostat is safe
and shrinks tumors.
Eligibility:
People ages 18 and older with CRPC or another metastatic cancer
Design:
Participants will be screened with:
- Medical history
- Physical exam
- CT or MRI scans
- Possible bone imaging
- Blood, urine, and heart tests
- Possible tumor biopsy
Participants will be treated with a 2-, 3- or 4-drug combinations of the following study
drugs in 2-week cycles:
- Participants will receive M7824 by IV once every 2 weeks.
- Participants will receive N-803 by injection once every 2 weeks. They will record any
skin changes at the injection site in a diary.
- Participants will receive BN-brachyury as 4 injections to different limbs. They will get
the first 3 doses 2 weeks apart. Then they will get doses every 4 weeks for 6 months,
then every 3 months for 2 years, then every 6 months.
- Participants will take Epacadostat orally every 12 hours. They will keep a pill diary.
Participants will have physical exams and blood and urine tests at the start of each cycle.
They may have scans every 12 weeks.
Participants will continue treatment until their disease gets worse or they cannot tolerate
the side effects.
Participants will have a follow-up visit 4-5 weeks after they stop treatment. They will have
a physical exam and blood tests. They may be asked to return for scans every 3 months.
Title
- Brief Title: Phase I/II Study of Immunotherapy Combination BN-Brachyury Vaccine, M7824, N-803 and Epacadostat (QuEST1)
- Official Title: A Phase I/II Study of Immunotherapy Combination BN-Brachyury Vaccine, M7824, N-803 and Epacadostat (QuEST1)
Clinical Trial IDs
- ORG STUDY ID:
180078
- SECONDARY ID:
18-C-0078
- NCT ID:
NCT03493945
Conditions
- Metastatic Prostate Cancer
- Prostate Cancer
- Prostate Neoplasm
- Advanced Solid Tumors
- Solid Tumor
Interventions
Drug | Synonyms | Arms |
---|
M7824 | | Arm 1.1 |
N-803 | | Arm 1.1 |
MVA-BN-Brachyury | | Arm 2.1A |
FPV-Brachyury | | Arm 2.1A |
Epacadostat | | Arm 2.3A |
Purpose
Background:
Immunotherapy drugs help the body to fight cancer. Scientists think that combining some of
these drugs will make them work better than when used alone. This may be true for many types
of cancer, including castration-resistant prostate cancer (CRPC).
Objective:
To test if the combination of the drugs BN-brachyury, M7824, N-803, and Epacadostat is safe
and shrinks tumors.
Eligibility:
People ages 18 and older with CRPC or another metastatic cancer
Design:
Participants will be screened with:
- Medical history
- Physical exam
- CT or MRI scans
- Possible bone imaging
- Blood, urine, and heart tests
- Possible tumor biopsy
Participants will be treated with a 2-, 3- or 4-drug combinations of the following study
drugs in 2-week cycles:
- Participants will receive M7824 by IV once every 2 weeks.
- Participants will receive N-803 by injection once every 2 weeks. They will record any
skin changes at the injection site in a diary.
- Participants will receive BN-brachyury as 4 injections to different limbs. They will get
the first 3 doses 2 weeks apart. Then they will get doses every 4 weeks for 6 months,
then every 3 months for 2 years, then every 6 months.
- Participants will take Epacadostat orally every 12 hours. They will keep a pill diary.
Participants will have physical exams and blood and urine tests at the start of each cycle.
They may have scans every 12 weeks.
Participants will continue treatment until their disease gets worse or they cannot tolerate
the side effects.
Participants will have a follow-up visit 4-5 weeks after they stop treatment. They will have
a physical exam and blood tests. They may be asked to return for scans every 3 months.
Detailed Description
Background:
- PD-1/PD-L1 signaling appears to be a major inhibitor of activated T cell anti-tumor
immune responses. The rapid, deep and durable responses seen in various malignancies
with PD-1/PD-L1 targeted agents demonstrate that blockade of this axis is key to
facilitating immune responses within the tumor microenvironment (TME).
- Prostate cancer is poorly recognized by T cells. Lack of an immune response is one
explanation for the lower response rates (<15%) observed with anti-PD-1/PD-L1 therapies
for prostate cancer.
- Increasing response rates will likely require therapeutic nullification of multiple
immune deficits by combining immunotherapies that generate tumor-specific T cells
(vaccine), dampen the inhibitory milieu of the TME, and enhance T and NK cell activity
within the TME.
- A quick efficacy seeking trial, utilizing sequential arms offers a means to identify
signals of activity for combinations of immunotherapy, added sequentially, in castration
resistant prostate cancer (CRPC) participants.
- BN-Brachyury is a novel recombinant vector-based therapeutic cancer vaccine designed to
induce an enhanced immune response against brachyury, which is overexpressed in many
solid tumor types, including prostate adenocarcinoma. BN-Brachyury collectively refers
to the priming doses (MVA-BN-Brachyury) and the boost doses (FPV-Brachyury) of the
vaccine platform.
- M7824 is a bifunctional fusion protein consisting of an anti-programmed death ligand 1
(PD-L1) antibody and the extracellular domain of transforming growth factor beta (TGF-
beta) receptor type 2, a TGF-beta trap. M7824 can also mediate antibody-dependent
cellular cytotoxicity in vitro.
- N-803 is an IL-15/IL-15R alpha superagonist complex that can enhance NK cell mediated
ADCC and T-cell cytotoxicity.
- Synergistic anti-tumor effects have been observed in vitro when combining M7824 and
N-803, and in vivo when combining these agents with tumor vaccine in animal models.
- IDO1 is overexpressed in many solid tumors and can contribute to immune escape by tumor
cells. INCB024360 (Epacadostat) is an IDO1 inhibitor under investigation in combination
with different immunotherapies in treatment of various malignancies.
- In treating of CRPC, we hypothesize that these agents and their effects will be
complementary. Tumor-specific T cells generated by vaccine may become more functional in
a TME following treatment with M7824 and Epacadostat. N-803 can further enhance the
activity of antigen-specific T cells as well as NK cells.
Objective:
-To determine if there is clinical benefit to any of a set of 3 possible treatments for
participants with CRPC:
- BN-Brachyury + M7824
- BN-Brachyury + M7824 + N-803
- BN-Brachyury + M7824 + N-803 + Epacadostat
Eligibility:
- Adults with histologically proven CRPC, or metastatic solid tumor of any type for which
there is no standard treatment or standard treatment has failed.
- Adequate organ function as defined by liver, kidney, and hematologic laboratory testing.
- Participants with acquired immune defects, active systemic autoimmune disease, history
of organ transplant, history of chronic infections, or history of active inflammatory
bowel disease are excluded.
Design:
Open label Phase I/II trial with following randomization during the expansion.
Phase I: Cohort 1, Arm 1.1
-Up to 18 participants with any solid tumor will be enrolled in dose escalation Cohort 1 for
treatment in Arm 1.1 (flat dose of M7824 + different dose levels of N-803).
Phase IIA: expansion with sequential enrollment into Cohort 2A, Arms 2.1A, 2.2A and 2.3 A
- Concurrently with the enrollment to Arm 1.1, 13 participants with CRPC will start
enrollment in Cohort 2A for treatment in Arm 2.1A (M7824 + BN-Brachyury).
- When safe dosing of N-803 is identified during Phase I, 13 participants have enrolled in
arm 2.1A and the first 6 participants, treated in Arm 2.1A, have met safety
requirements, 13 participants with CRPC will start enrollment in Cohort 2A for treatment
in Arm 2.2A (M7824 + BN-Brachyury + N-803).
- When 13 participants have enrolled in Arm 2.2A and the first 6 participants, treated in
Arm 2.2A, have met safety requirements, 13 participants with CRPC will start enrollment
in Cohort 2A for treatment in Arm 2.3A (M7824 + BN-Brachyury + N-803 + Epacadostat).
Phase IIB: expansion with randomized enrollment into Cohorts 2D and 2R, Arms 2.1B, 2.2B. and
2.3B
- Each Arm in Cohorts 2D and 2R: 2.1B, 2.2B and 2.3B will be open for additional
enrollment (25 evaluable participants total) when the initial 13 participants have
accrued, safety requirements are meet and a positive signal (defined as Objective
Response by RECIST 1.1 or sustained PSA decrease >= 30% sustained for > 21 days) in >= 2
participants is shown.
- If only one arm is open for additional enrollment, participants will be directly
assigned to this arm. If 2 arms are open for additional enrollment, participants will be
randomized between these 2 open arms. If 3 arms are open for additional enrollment,
participants will be randomized among these 3 open arms.
If there are >= 6 of 25 participants with a positive signal of activity in any expansion arm,
that arm will be considered of interest for future studies.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm 1.1 | Experimental | M7824 + N-803 | |
Arm 2.1A | Experimental | M7824 + BN-Brachyury | - M7824
- MVA-BN-Brachyury
- FPV-Brachyury
|
Arm 2.1B | Experimental | M7824 + BN-Brachyury | - M7824
- MVA-BN-Brachyury
- FPV-Brachyury
|
Arm 2.2A | Experimental | M7824 + BN-Brachyury + N-803 | - M7824
- N-803
- MVA-BN-Brachyury
- FPV-Brachyury
|
Arm 2.2B | Experimental | M7824 + BN-Brachyury + N-803 | - M7824
- N-803
- MVA-BN-Brachyury
- FPV-Brachyury
|
Arm 2.3A | Experimental | M7824 + BN-Brachyury + N-803 + Epacadostat | - M7824
- N-803
- MVA-BN-Brachyury
- FPV-Brachyury
- Epacadostat
|
Arm 2.3B | Experimental | M7824 + BN-Brachyury + N-803 + Epacadostat | - M7824
- N-803
- MVA-BN-Brachyury
- FPV-Brachyury
- Epacadostat
|
Eligibility Criteria
- INCLUSION CRITERIA:
Participants must have histologically or cytologically confirmed any solid tumor (Cohort 1)
or castration-resistant prostate cancer (CRPC, Cohorts 2A, 2D and 2R). No prior treatment
other than testosterone lowering therapy for CRPC is required.
For the Cohort 1, eligible participants must have a histologically, cytologically or
radiographically proven metastatic or locally advanced solid tumor of any type, for which
there is no curative standard therapy or standard therapy has failed.
Castrate testosterone level (less than 50ng/dl or 1.7nmol /L). (Participants with a
malignancy other than prostate cancer are excluded from this criterion).
Radiological confirmation of metastatic disease, or
Progressive disease at study entry defined as one or more of the following criteria
occurring in the setting of castrate levels of testosterone:
--Radiographic progression defined as any new or enlarging bone lesions or growing lymph
node disease, consistent with prostate cancer
OR
--PSA progression defined by sequence of rising values separated by greater than 1 week (2
separate increasing values over a minimum of 1 ng/ml (PCWG3 PSA eligibility criteria). If
participants had been on flutamide, PSA progression is documented 4 weeks or more after
withdrawal. For participants on bicalutamide or nilutamide disease progression is
documented 6 or more weeks after withdrawal. The requirement for a 4-6 week withdrawal
period following discontinuation of flutamide, nilutamide or bicalutamide only applies to
participants who have been on these drugs for at least the prior 6 months. For all other
participants they must stop bicalutamide, nilutamide or flutamide the day prior to
enrollment.
Asymptomatic or mildly symptomatic form prostate cancer; no use of regularly scheduled
opiate analgesics for prostate cancer-related pain. (Participants with a malignancy other
than prostate cancer are excluded from this criterion).
Participants must agree to continuation of androgen deprivation therapy (ADT) with a
gonadotropin-releasing hormone analogue/antagonist or bilateral orchiectomy.
(Participants with a malignancy other than prostate cancer are excluded from this
criterion).
Age greater than or equal to 18 years.
ECOG performance status less than or equal to 1
Participants must have adequate organ and marrow function as defined below:
- Absolute neutrophil count greater than or equal to 1000/mcL
- Platelets greater than or equal to 100,000/mcL
- Hemoglobin greater than or equal to 9.0 g/dL
- Total bilirubin within normal institutional limits; in participants with Gilbert s,
less than or equal to 3.0 mg/dL
- AST (AGOT)/ALT (AGPT) less than or equal to 2.5X upper limit of normal. For subjects
with liver involvement in their tumor, AST less than or equal to 3.5. (SqrRoot) ULN,
ALT less than or equal to 3.5 (SqrRoot) ULN, and bilirubin less than or equal to 3.0
is acceptable
- Creatinine within 1.5X upper limit of normal institutional limits
The effects of BN-Brachyury, M7824, N-803, and Epacadostat on the developing human fetus
are unknown. For this reason, men and women must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry, during the
study and maintain such contraception until 4 months following the last dose of any study
agent. Should a woman become pregnant or suspect she is pregnant while she or her partner
is participating in this study, she should inform her partner s treating physician
immediately.
Ability of subject to understand and the willingness to sign a written informed consent
document.
Participants with successfully treated HCV are eligible if HCV viral load is undetectable.
EXCLUSION CRITERIA:
Participants who are immunocompromised as follows:
- Human immunodeficiency virus positivity due to the potential for decreased tolerance,
and potential to be at risk for severe side effects with immunotherapies. These
concerns are relevant to all drugs, as drug-drug interactions among antiretrovirals
and immunotherapies are yet uncharacterized.
- Chronic administration (defined as daily or every other day for continued use greater
than 14 days) of systemic corticosteroids or other immune suppressive drugs, within 28
days before treatment on study. Nasal, or inhaled steroid, topical steroid creams and
eye drops for small body areas are allowed.
- Participants who have undergone allogeneic peripheral stem cell transplantation, or
solid organ transplantation requiring immunosuppression
- Active autoimmune disease, except participants with type 1 diabetes mellitus,
vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring current
immunosuppression, or with other endocrine disorders on replacement hormones or
are not excluded if the condition is well controlled.
Prostate cancer participants with a history of brain/leptomeningeal metastasis, since these
participants have a very poor prognosis and immunotherapy may take time to lead to
beneficial clinical effects. Participants with brain or CNS metastases enrolling to arm 1.1
are eligible if they are status post definitive radiotherapy or surgery, and are
asymptomatic
History of allergic reactions attributed to compounds of similar chemical or biologic
composition to study agents to be used in the cohort the subject will be enrolled into.
Known allergy to eggs, egg products, aminoglycoside antibiotics (for example, gentamicin or
tobramycin).
Any condition which, in the opinion of the investigator, would prevent full participation
in this trial (including the long-term follow-up), or would interfere with the evaluation
of the trial endpoints.
Participants with prior investigational drug, chemotherapy, immunotherapy or any prior
radiotherapy (except for palliative bone directed therapy) within the past 28 days prior to
enrollment, except if the investigator has assessed that all residual treatment-related
toxicities have resolved or are minimal and feel the participant is otherwise suitable for
enrollment.
Uncontrolled intercurrent acute or chronic illness including, but not limited to, ongoing
or active infection, symptomatic congestive heart failure (>New York Heart Association
Class I), hepatic disease, unstable angina pectoris, serious cardiac arrhythmia, requiring
medication, uncontrolled hypertension (SBP>170/ DBP>105) or psychiatric illness/social
situations within 12 months that would limit compliance with study requirements.
Use of herbal products that may decrease PSA levels (e.g. saw palmetto)
Participants who have had cytotoxic chemotherapy for metastatic castration-resistant
prostate cancer within the past year. (Participants who have had docetaxel for metastatic
castration sensitive per CHAARTED data may enroll as long as they did not have progressive
disease while on docetaxel and are 3 months removed from treatment, with all treatment
related toxicities resolving to at least grade 1.)
Participants who have undergone major surgery within 4 weeks of enrollment. A biopsy will
not preclude a participant from starting study.
Participants with a history of hepatitis B (HBV) are excluded due to potential risk for
viral reactivation and resulting liver injury in persons with latent HBV
For participants enrolling in Arm 2.3A and for participants who may be randomized to Arm
2.3B, the following additional exclusion criteria will apply:
- Subjects receiving Monoamine Oxidase Inhibitors (MAOIs) or a drug which has
significant MAOI activity (meperidine, linezolid, methylene blue) within the 21 days
before initiation of study therapy are excluded.
- Since epacadostat s metabolism may be altered by drugs that inhibit UDP-
glucuronosyltransferase UGT1A9 (see Appendix D), Participants receiving such drugs
within 21 days of initiation of study therapy are excluded.
- Participants receiving agents that are substrates of CYP1A2, CYP2C8, and CYP2C19 or
affected by OATP1B1 or OATP1B3 within 21 days of initiation of study therapy or 5 half
lives of the agent (whichever is shorter) are excluded. Participants receiving
medications that are substrates of these enzymes/transporters but are not listed in
the appendix or participants receiving substrates of CYP2B6 and CYP3A will be
evaluated on a case-by-case basis prior to enrollment. Participants who consume
caffeine are eligible but must agree to moderate consumption.
- Subjects receiving coumarin-based anticoagulants (e. Coumadin) are excluded.
- Subjects having any history of Serotonin Syndrome (SS) after receiving serotonergic
drugs are excluded.
--Participants with a QTcF interval > 480 milliseconds at the screening are excluded.
In the event that a single QTcF is > 480 milliseconds, the subject may enroll if the
average QTcF for the 3 ECGs is < 480 milliseconds. For subjects with an
intraventricular conduction delay (QRS interval > 120 milliseconds), the JTc interval
may be used in place of the QTc. The JTc must be < 340 milliseconds if JTc is used in
place of the QTc. QTc prolongation due to pacemaker may enroll if the JTc is normal.
- Subjects with left bundle branch block are excluded.
- Pregnant women are excluded from this study because investigational agents used in
this study (BN-Brachyury, M7824, N-803, and/or Epacadostat) could have 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 these
investigational agen s, breastfeeding should be discontinued if the mother is treated
with either of them.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To determine if there is clinical benefit to any of a set of 3 possibletreatments for patients with mCRPC. |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Best treatment combination for patients with mCRPC |
Secondary Outcome Measures
Measure: | Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 |
Time Frame: | 6-month |
Safety Issue: | |
Description: | Progression free survival until progression or death without progression |
Measure: | Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 + N-803 |
Time Frame: | 6-month |
Safety Issue: | |
Description: | Progression free survival until progression or death without progression |
Measure: | Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 + N-803 + Epacadostat |
Time Frame: | 6-month |
Safety Issue: | |
Description: | Progression free survival until progression or death without progression |
Measure: | To characterize the safety profile of the above combinations and M7824 + N-803 |
Time Frame: | 3 weeks DLT period |
Safety Issue: | |
Description: | Safety |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- Immunotherapy
- Combined Treatment
- PD-1/PD-L1
- Tumor-Specific T Cells
- Novel Cancer Vaccine
Last Updated
August 31, 2021