Description:
This is a multicenter, global, Phase 2, open-label, 2-part, first-line study to investigate
the safety, tolerability, and anti-tumor activity of ZW25 (zanidatamab) plus standard
first-line combination chemotherapy regimens for selected gastrointestinal (GI) cancers.
Eligible patients include those with unresectable, locally advanced, recurrent or metastatic
HER2-expressing gastroesophageal adenocarcinoma (GEA), biliary tract cancer (BTC), or
colorectal cancer (CRC).
Title
- Brief Title: A Safety and Efficacy Study of ZW25 (Zanidatamab) Plus Combination Chemotherapy in HER2-expressing Gastrointestinal Cancers, Including Gastroesophageal Adenocarcinoma, Biliary Tract Cancer, and Colorectal Cancer
- Official Title: Phase 2 Study of ZW25 Plus First-line Combination Chemotherapy in HER2-Expressing Gastrointestinal (GI) Cancers, Including Gastroesophageal Adenocarcinoma (GEA), Biliary Tract Cancer (BTC), and Colorectal Cancer (CRC)
Clinical Trial IDs
- ORG STUDY ID:
ZWI-ZW25-201
- NCT ID:
NCT03929666
Conditions
- HER2-expressing Gastrointestinal Cancers, Including Gastroesophageal Adenocarcinoma, Biliary Tract Cancer, and Colorectal Cancer
Interventions
Drug | Synonyms | Arms |
---|
ZW25 (Zanidatamab) | | ZW25 + FP |
Capecitabine | | ZW25 + XELOX |
Cisplatin | | ZW25 + CisGem |
Fluorouracil | | ZW25 + FP |
Leucovorin | | ZW25 + mFOLFOX6 |
Oxaliplatin | | ZW25 + XELOX |
Bevacizumab | | ZW25 + mFOLFOX6 with bevacizumab |
Gemcitabine | | ZW25 + CisGem |
Purpose
This is a multicenter, global, Phase 2, open-label, 2-part, first-line study to investigate
the safety, tolerability, and anti-tumor activity of ZW25 (zanidatamab) plus standard
first-line combination chemotherapy regimens for selected gastrointestinal (GI) cancers.
Eligible patients include those with unresectable, locally advanced, recurrent or metastatic
HER2-expressing gastroesophageal adenocarcinoma (GEA), biliary tract cancer (BTC), or
colorectal cancer (CRC).
Detailed Description
Part 1 of the study will first evaluate the safety and tolerability of ZW25 plus standard
first-line combination chemotherapy (XELOX, FP, or mFOLFOX6 for GEA; mFOLFOX6 with or without
bevacizumab for CRC; and CisGem for BTC) and will confirm the recommended dosage (RD) of ZW25
when administered in combination with each of these multi-agent chemotherapy regimens. Then,
Part 2 of the study will evaluate the anti-tumor activity of ZW25 plus combination
chemotherapy in HER2-expressing GEA, BTC, and CRC.
Trial Arms
Name | Type | Description | Interventions |
---|
ZW25 + FP | Experimental | ZW25 plus fluorouracil (5-FU) and cisplatin | - ZW25 (Zanidatamab)
- Cisplatin
- Fluorouracil
|
ZW25 + mFOLFOX6 | Experimental | ZW25 plus 5-FU, leucovorin, and oxaliplatin | - ZW25 (Zanidatamab)
- Fluorouracil
- Leucovorin
- Oxaliplatin
|
ZW25 + XELOX | Experimental | ZW25 plus capecitabine and oxaliplatin | - ZW25 (Zanidatamab)
- Capecitabine
- Oxaliplatin
|
ZW25 + mFOLFOX6 with bevacizumab | Experimental | ZW25 plus 5-FU, leucovorin, oxaliplatin, and bevacizumab | - ZW25 (Zanidatamab)
- Fluorouracil
- Leucovorin
- Oxaliplatin
- Bevacizumab
|
ZW25 + CisGem | Experimental | ZW25 plus cisplatin and gemcitabine | |
Eligibility Criteria
Inclusion:
- Disease diagnosis:
- Part 1:
- GEA: Unresectable, locally advanced, recurrent or metastatic HER2-expressing GEA
(IHC 3+ or 2+ with or without gene amplification based upon local assessment or
central assessment)
- BTC: Unresectable, locally advanced, recurrent or metastatic HER2-expressing BTC
(including intrahepatic cholangiocarcinoma [ICC], extrahepatic cholangiocarcinoma
[ECC], or gallbladder cancer [GBC]) (IHC 3+ with or without gene amplification;
or IHC 0, 1+ or 2+ with gene amplification, based upon central assessment)
- CRC: Unresectable, locally advanced, recurrent or metastatic HER2-expressing CRC
(IHC 3+ with or without gene amplification; or IHC 0, 1+ or 2+ with gene
amplification, based upon central assessment). Patients will be required to be
extended RAS (KRAS and NRAS) and BRAF wild-type based upon central assessment.
- Part 2:
- GEA: Unresectable, locally advanced, recurrent or metastatic HER2-expressing GEA
(IHC 3+, or IHC 2+ and FISH+ by central assessment)
- BTC: Same as Part 1
- CRC: Same as Part 1
- Tumor measurements as per Response Evaluation Criteria in Solid Tumors (RECIST)
version 1.1:
- Part 1: Measurable or non-measurable disease
- Part 2: Measurable disease
- An Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0 or 1
- Adequate organ function
- Adequate cardiac left ventricular function, as defined by a LVEF >/= institutional
standard of normal
Exclusion:
- Prior treatment with a HER2-targeted agent
- Prior systemic anti-cancer therapy (including investigational products) except prior
adjuvant/neoadjuvant therapy, which must be completed at least 6 months prior to first
study treatment dosing. For subjects with BTC and CRC the following additional
exceptions apply:
- BTC: patients may have started therapy for advanced disease but may not have
received more than one cycle of any standard gemcitabine-based chemotherapy
regimen.
- CRC: patients may have started therapy for advanced disease but may not have
received more than one cycle of 5-FU-based chemotherapy (< 1 month of therapy).
- Patients with certain contraindications to bevacizumab cannot be enrolled on the
mFOLFOX6-2 with bevacizumab arm.
- Palliative radiotherapy is allowed if completed at least 2 weeks prior to first study
treatment dosing
- Untreated known brain metastases (patients with treated brain metastases who are off
steroids, off antiseizure medications, and stable for at least 1 month at the time of
screening are eligible)
- Clinically significant cardiac disease, such as ventricular arrhythmia requiring
therapy, uncontrolled hypertension or any history of symptomatic congestive heart
failure (CHF). Patients with known myocardial infarction or unstable angina within 6
months prior to randomization are also excluded.
- QTc Fridericia (QTcF) > 470 ms. For patients with longer QTcF on initial
electrocardiogram (ECG), follow-up ECG may be performed in triplicate to determine
eligibility
- Peripheral neuropathy > Grade 1 per NCI-CTCAE v5.0
- Clinically significant interstitial lung disease
- Prior or concurrent malignancy whose natural history or treatment has the potential to
interfere with the safety or efficacy assessment of the investigational regimen
- Active hepatitis B or hepatitis C infection or infection with Human Immunodeficiency
Virus (HIV)-1 or HIV-2 (Exception: patients with well controlled HIV [e.g., CD4 >
350/mm3 and undetectable viral load] are eligible)
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of dose-limiting toxicities (DLTs) (Part 1) |
Time Frame: | Up to 6 weeks |
Safety Issue: | |
Description: | Number of participants who experienced a DLT. DLTs include adverse events considered to be related to study treatment, including the evaluated dose level of ZW25, any component or combination of the components of a chemotherapy regimen, or the combination of ZW25 plus a chemotherapy regimen. |
Secondary Outcome Measures
Measure: | Objective response rate (ORR) (Part 1) |
Time Frame: | Up to 10 months |
Safety Issue: | |
Description: | Number of participants who achieved a best response of either CR or PR during treatment per RECIST 1.1 |
Measure: | Disease control rate (Parts 1 and 2) |
Time Frame: | Up to 10 months |
Safety Issue: | |
Description: | Number of participants who achieved a best response of CR, PR, or stable disease (SD) during treatment per RECIST 1.1 |
Measure: | Duration of response (Parts 1 and 2) |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Median duration of response (in months) and range (minimum, maximum) |
Measure: | Clinical benefit rate (Parts 1 and 2) |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Number of participants with SD for ≥ 24 weeks or a confirmed, best overall response of CR or PR per RECIST 1.1 |
Measure: | Progression-free survival (Parts 1 and 2) |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Median progression-free survival (in months) and range (minimum, maximum) |
Measure: | Overall survival (Parts 1 and 2) |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Median overall survival (in months) and range (minimum, maximum) |
Measure: | Incidence of anti-drug antibodies (ADAs) (Parts 1 and 2) |
Time Frame: | Up to 11 months |
Safety Issue: | |
Description: | Number of participants who develop ADAs |
Measure: | End of infusion concentration of ZW25 (Parts 1 and 2) |
Time Frame: | Up to 11 months |
Safety Issue: | |
Description: | |
Measure: | Maximum serum concentration of ZW25 (Parts 1 and 2) |
Time Frame: | Up to 11 months |
Safety Issue: | |
Description: | |
Measure: | Trough concentration of ZW25 (Parts 1 and 2) |
Time Frame: | Up to 11 months |
Safety Issue: | |
Description: | |
Measure: | Incidence of adverse events (Part 2) |
Time Frame: | Up to 11 months |
Safety Issue: | |
Description: | Number of participants who experienced an adverse event |
Measure: | Incidence of lab abnormalities (Part 2) |
Time Frame: | Up to 11 months |
Safety Issue: | |
Description: | Number of participants who experienced a maximum severity of Grade 3 or higher post-baseline laboratory abnormality, including either hematology and chemistry. Grades are defined using National Cancer Institute's CTCAE, version 5.0. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Zymeworks Inc. |
Trial Keywords
- HER2
- Bispecific antibody
- Biparatopic antibody
- Immunotherapy
- Gastric cancers
- Esophageal cancers
- Gastroesophageal junction (GEJ) cancers
- Chemotherapy
- FP
- mFOLFOX6
- Capecitabine
- Cisplatin
- 5-FU
- Leucovorin (folinic acid)
- Oxaliplatin
- XELOX
- Gastrointestinal cancers
- Gastroesophageal adenocarcinoma
- Biliary tract cancer
- Colorectal cancer
- Intrahepatic cholangiocarcinoma
- Extrahepatic cholangiocarcinoma
- Gall bladder
Last Updated
August 11, 2021