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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

NCT03929666

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).

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Biliary Tract Carcinoma
  • Colorectal Carcinoma
  • Esophageal Adenocarcinoma
  • Extrahepatic Cholangiocarcinoma
  • Gallbladder Carcinoma
  • Gastric Adenocarcinoma
  • Intrahepatic Cholangiocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

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

DrugSynonymsArms
ZW25 (Zanidatamab)ZW25 + FP
CapecitabineZW25 + XELOX
CisplatinZW25 + CisGem
FluorouracilZW25 + FP
LeucovorinZW25 + mFOLFOX6
OxaliplatinZW25 + XELOX
BevacizumabZW25 + mFOLFOX6 with bevacizumab
GemcitabineZW25 + 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

NameTypeDescriptionInterventions
ZW25 + FPExperimentalZW25 plus fluorouracil (5-FU) and cisplatin
  • ZW25 (Zanidatamab)
  • Cisplatin
  • Fluorouracil
ZW25 + mFOLFOX6ExperimentalZW25 plus 5-FU, leucovorin, and oxaliplatin
  • ZW25 (Zanidatamab)
  • Fluorouracil
  • Leucovorin
  • Oxaliplatin
ZW25 + XELOXExperimentalZW25 plus capecitabine and oxaliplatin
  • ZW25 (Zanidatamab)
  • Capecitabine
  • Oxaliplatin
ZW25 + mFOLFOX6 with bevacizumabExperimentalZW25 plus 5-FU, leucovorin, oxaliplatin, and bevacizumab
  • ZW25 (Zanidatamab)
  • Fluorouracil
  • Leucovorin
  • Oxaliplatin
  • Bevacizumab
ZW25 + CisGemExperimentalZW25 plus cisplatin and gemcitabine
  • Cisplatin
  • 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