Clinical Trials /

FT538 in Combination With Daratumumab in AML Acute Myeloid Leukemia

NCT04714372

Description:

This Phase I open-label dose escalation study is conducted in two stages with a primary endpoint to identify the maximum tolerated dose (MTD) of FT538 when administered with daratumumab in patients 12 years and older with advanced acute myeloid leukemia (AML) and related myeloid diseases.

Related Conditions:
  • Acute Myeloid Leukemia
Recruiting Status:

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: FT538 in Combination With Daratumumab in AML Acute Myeloid Leukemia
  • Official Title: Study of FT538 in Combination With Daratumumab in Acute Myeloid Leukemia

Clinical Trial IDs

  • ORG STUDY ID: 2020LS114
  • SECONDARY ID: MT2020-33
  • NCT ID: NCT04714372

Conditions

  • Acute Myeloid Leukemia
  • Myeloid Leukemia
  • Monocytic Leukemia

Interventions

DrugSynonymsArms
Daratumumab/rHuPH20DarzalexDose Level 1: FT538 at 1 x10^8 cells/dose
FT538Dose Level 1: FT538 at 1 x10^8 cells/dose
FludarabineFLUDARADose Level 1: FT538 at 1 x10^8 cells/dose
CyclophosphamideCYTOXAN, NEOSARDose Level 1: FT538 at 1 x10^8 cells/dose

Purpose

This Phase I open-label dose escalation study is conducted in two stages with a primary endpoint to identify the maximum tolerated dose (MTD) of FT538 when administered with daratumumab in patients 12 years and older with advanced acute myeloid leukemia (AML) and related myeloid diseases.

Detailed Description

      FT538 is an off the shelf product comprised of allogeneic natural killer (NK)-cell
      immunotherapy lacking CD38 and expressing hnCD16 and IL-15RF. Daratumumab is a targeted
      therapy (IgG1k human monoclonal antibody) that targets CD38.

      FT538 is administered once a week for 3 consecutive weeks (Day 1, Day 8, and Day 15). Up to 5
      dose levels will be tested. Fixed dose subcutaneous daratumumab is given on Day -12 and Day 5
      prior to the NK cells as lymphodepletion, and on Day +3, Day +10, and Day +17 to maximize
      targeting. A short course of outpatient lymphodepleting chemotherapy is given on Day -4 and
      Day -3 to promote adoptive transfer. Day 1, the day of the 1st FT538 infusion, must be a
      Monday.

      The primary analysis for Phase I is intent-to-treat in that all patients receiving the 1st
      infusion of FT538 are evaluable for toxicity and efficacy. Patients who discontinue therapy
      prior to the first FT538 will be replaced.

      There are five potential FT538 dose cohorts. The starting dose is FT538 1x10e8 cells per dose
      with a lower safety dose of 5x10e7 if needed (Dose Level -1). The subsequent planned FT538
      cohorts are 3x10e8, 1x10e9, and 1.5 x10e9 FT538 cells per dose. Dosing is based on hnCD16
      expression, where 90% ± 10% of administered FT538 cells express hnCD16. The trial is
      conducted with no intra-patient escalation.
    

Trial Arms

NameTypeDescriptionInterventions
Dose Level 1: FT538 at 1 x10^8 cells/doseExperimentalFT538 administered at assigned dose as an IV infusion via gravity on Day 1, Day 8, and Day 15
  • Daratumumab/rHuPH20
  • FT538
  • Fludarabine
  • Cyclophosphamide
Dose Level 2: FT538 at 3 x10^8 cells/doseExperimentalFT538 administered at assigned dose as an IV infusion via gravity on Day 1, Day 8, and Day 15
  • Daratumumab/rHuPH20
  • FT538
  • Fludarabine
  • Cyclophosphamide
Dose Level 3: FT538 at 1 x10^9 cells/doseExperimentalFT538 administered at assigned dose as an IV infusion via gravity on Day 1, Day 8, and Day 15
  • Daratumumab/rHuPH20
  • FT538
  • Fludarabine
  • Cyclophosphamide
Dose Level 4: FT538 at 1.5 x10^9 cells/doseExperimentalFT538 administered at assigned dose as an IV infusion via gravity on Day 1, Day 8, and Day 15
  • Daratumumab/rHuPH20
  • FT538
  • Fludarabine
  • Cyclophosphamide

Eligibility Criteria

        Disease specific Inclusion Criteria:

        Acute myeloid leukemia relapsed/refractory after 2 lines of therapy; with CD38 expression

          -  CD38 expression is defined by ≥20% of malignant cells with CD38 expression by flow
             cytometry on the most recent marrow biopsy (within 30 days of enrollment - archived or
             fresh).

          -  Relapsed/refractory is defined as failure to achieve at least a Morphological Leukemia
             Free State (MLFS) or reverting from MLFS.

          -  Lines of therapy are defined as (must have had 2 prior therapies):

               -  One cycle of Intensive induction chemotherapy such as 7+3, 5+2, MEC, FLAG,
                  FLAG-Ida, CLAG ± small molecule inhibitor

               -  Four weeks of HMA-based induction ± small molecule inhibitor

               -  Hematopoietic stem cell transplantation (HSCT) if relapse that occurs > 90 days
                  after HSCT

               -  Gemtuzumab Ozogamicin

               -  LDAC + glasdegib

               -  Biomarker-specific targeted agents (FLT3 inhibitors, IDH1/2 inhibitors, others if
                  available)

               -  Other treatments could be considered after discussion with the PI

        Inclusion Criteria:

          -  Age 12 years or older at the time of consent - Please note, enrollment of minors will
             be begin until permission to proceed is received from the FDA. At that time, the
             protocol will be updated to open enrollment to minors.

          -  Weight ≥ 50 kg due to FT538 fixed cell dosing and FT538 product pre-dose packaging

          -  Karnofsky performance status of 80-100% for 16 years and older or Lansky Play Score of
             80-100 for ≥12 and < 16 years of age

          -  Evidence of adequate organ function within 14 days of starting study treatment defined
             as:

               -  Estimated Glomerular Filtration Rate (estimated creatinine clearance) ≥50
                  mL/min/1.73m^2

               -  Total bilirubin ≤ 5 × upper limit normal (ULN), not applicable for patients with
                  Gilbert's syndrome

               -  AST ≤3 × ULN and ALT ≤ 3 × ULN, not applicable if determined to be directly due
                  to underlying malignancy

               -  LVEF ≥ 40% by echocardiogram or MUGA

          -  Contraceptive use by men or women

               -  Female subjects: Women of childbearing potential (WOCBP) must use a highly
                  effective form of contraception from the screening visit until at least 12 months
                  after the final dose of cyclophosphamide (CY), at least 4 months after the final
                  dose of FT538, and at least 3 months after the final dose of daratumumab,
                  whichever is latest.

               -  Male subjects: Males with a female partner of childbearing potential or a
                  pregnant female partner must be sterile (biologically or surgically) or use a
                  highly effective method of contraception from the screening visit until at least
                  4 months after the final dose of CY and at least 4 months after the final dose of
                  FT538, and at least 3 months after the final dose of daratumumab, whichever is
                  latest.

          -  Must agree to and sign the consent for the companion Long-Term Follow-Up study (UMN
             CPRC #2020LS166) to fulfill the FDA required 15 years of follow-up for a genetically
             modified cell product.

          -  Must agree to and sign the consent for the companion Long-Term Follow-Up study (UMN
             CPRC #2020LS166) to fulfill the FDA required 15 years of follow-up for a genetically
             modified cell product.

        Exclusion Criteria:

          -  Diagnosis of acute promyelocytic leukemia (APL)

          -  Pregnant or breastfeeding, Menstruating females of child-bearing potential must have a
             negative pregnancy test within 14 days of study treatment start

          -  Known allergy to any of study drugs or their components

          -  Clinically significant cardiovascular disease including any of the following:
             myocardial infarction within 6 months prior to first study treatment; unstable angina
             or congestive heart failure of New York Heart Association Grade 2 or higher or cardiac
             ejection fraction <40%

          -  Any known condition that requires systemic immunosuppressive therapy (> 5mg prednisone
             daily or equivalent) during the FT538 dosing period (3 days before the 1st dose
             through 14 days after the last dose) excluding pre-medications - inhaled and topical
             steroids are permitted

          -  Receipt of any biological therapy, chemotherapy, or radiation therapy, except for
             palliative purposes, within 2 weeks prior to Day 1 or five half-lives, whichever is
             shorter; or any investigational therapy within 28 days prior to the to the first dose
             of daratumumab. Maintenance hydroxyurea for blast control up to the initiation of
             lympho-conditioning is permitted

          -  Known active central nervous system (CNS) involvement or treated CNS disease that has
             not cleared. If prior disease related CNS involvement must have completed effective
             treatment of their CNS disease at least 2 months prior to Day 1 with no evidence of
             disease clinically and at least stable findings on relevant CNS imaging

          -  Non-malignant CNS disease such as epilepsy, CNS vasculitis, or neurodegenerative
             disease or receipt of medications for these conditions in the 2-year period leading up
             to study enrollment

          -  Clinically significant untreated/uncontrolled infection

          -  Live vaccine <6 weeks prior to start of lympho-conditioning

          -  Known seropositive for HIV or known active Hepatitis B or C infection with detectable
             viral load by PCR

          -  Prior solid organ transplant

          -  Allogeneic HSCT relapse occurring <90 days after HSCT

          -  Active graft-versus-host-disease (GvHD) requiring systemic immunosuppression within 14
             days prior to enrollment

          -  Presence of any medical or social issues that are likely to interfere with study
             conduct or may cause increased risk to the participant.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:12 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Number of participants experiencing Dose Limiting Toxicity (DLT) events
Time Frame:42 days from the 1st FT538 infusion
Safety Issue:
Description:Dose limiting toxicity (DLT) is defined as any AE (based on CTCAE v5) that is at least possibly related to FT538 that occurs after the first FT538 infusion through the end of the DLT assessment period on Day 29 as defined below: Any Grade 4 non-hematologic AE, Grade 3 pulmonary or cardiac AE of any duration, Grade 3 immune cell associated neurotoxicity syndrome (ICANS) of any duration, Any other Grade 3 non-hematologic AE of >72 hours duration or Grade ≥2 acute GvHD requiring systemic steroid administration

Secondary Outcome Measures

Measure:Number of participants achieving complete remission (CR + CRi)
Time Frame:28 days from the 1st FT538 infusion
Safety Issue:
Description:Efficacy of treatment is measured by the objective response rate (Complete Remission [CR] + Complete Remission with Incomplete Hematologic Recovery [CRi]) assessed by Day 28 based on the 2017 European LeukemiaNet (ELN) response criteria CR - defined as bone marrow blast <5%, absence of circulating blasts and blasts with auer rods, absence of extramedullary disease, Absolute neutrophil count >= 1.0 × 10e9/L (1000/μL) and platelet count >=100 × 10e9/L 100,000/μL) CRi - defined as all CR criterial except for residual neutropenia (<1.0 × 10e9/L [1000/μL]) or thrombocytopenia (<100 × 10e9/L [100,000/μL])
Measure:Overall Response Rate
Time Frame:12 months from the 1st FT538 infusion
Safety Issue:
Description:Overall response rate is defined as number of patients who have a partial or complete response to therapy divided by the total number of patients who received treatment. Response criteria will be based on 2017 European LeukemiaNet (ELN) response criteria assessing the bone marrow blast percentage, presence/absence of circulating blasts, presence/absence of blasts with auer rods, presence/absence of extramedullary disease, Absolute neutrophil counts per liter pf blood and platelet counts per liter blood
Measure:Number of participants with Progression Free Survival (PFS)
Time Frame:12 months from the 1st FT538 infusion
Safety Issue:
Description:Number of participants experiencing progression free survival at one year follow up
Measure:Number of participants with Overall Survival (OS)
Time Frame:12 months from the 1st FT538 infusion
Safety Issue:
Description:Number of participants experiencing progression free survival at one year follow up
Measure:Number of participants experiencing adverse events
Time Frame:12 months from the 1st FT538 infusion
Safety Issue:
Description:Number of participants experiencing adverse events with the combination of Daratumumab and FT538

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Masonic Cancer Center, University of Minnesota

Trial Keywords

  • FT538, AML, Daratumumab, CD38

Last Updated

January 19, 2021