Description:
This phase I/II trial studies the best dose and effect of pimasertib in combination with
bintrafusp alfa in treating patients with cancer that has spread to the brain (brain
metastases). Immunotherapy with bintrafusp alfa, a bifunctional fusion protein composed of
the monoclonal antibody anti-PD-L1 and TGF-beta, may help the body's immune system attack the
cancer, and may interfere with the ability of tumor cells to grow and spread. Pimasertib may
stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Giving pimasertib and bintrafusp alfa may help to prevent or delay the cancer from
progressing (getting worse) and/or coming back.
Title
- Brief Title: Bintrafusp Alfa and Pimasertib for the Treatment of Patients With Brain Metastases
- Official Title: Phase I/II Trial of BINTRAFUSP ALFA (M7824) and Pimasertib for Treatment of Intracranial Metastases
Clinical Trial IDs
- ORG STUDY ID:
2019-1091
- SECONDARY ID:
NCI-2021-00219
- SECONDARY ID:
2019-1091
- NCT ID:
NCT04789668
Conditions
- Anatomic Stage IV Breast Cancer AJCC v8
- Clinical Stage IV Cutaneous Melanoma AJCC v8
- Hematopoietic and Lymphoid Cell Neoplasm
- Hormone Receptor Positive Breast Adenocarcinoma
- Metastatic Lung Non-Small Cell Carcinoma
- Metastatic Malignant Neoplasm in the Brain
- Metastatic Malignant Solid Neoplasm
- Metastatic Melanoma
- Metastatic Triple-Negative Breast Carcinoma
- Pathologic Stage IV Cutaneous Melanoma AJCC v8
- Prognostic Stage IV Breast Cancer AJCC v8
- Stage IV Lung Cancer AJCC v8
- Stage IVA Lung Cancer AJCC v8
- Stage IVB Lung Cancer AJCC v8
Interventions
Drug | Synonyms | Arms |
---|
Bintrafusp Alfa | Anti-PDL1/TGFb Trap MSB0011359C, M7824, MSB0011359C | Treatment (bintrafusp alfa, pimasertib) |
Pimasertib | AS703026, EMD 1036239, MSC1936369 | Treatment (bintrafusp alfa, pimasertib) |
Purpose
This phase I/II trial studies the best dose and effect of pimasertib in combination with
bintrafusp alfa in treating patients with cancer that has spread to the brain (brain
metastases). Immunotherapy with bintrafusp alfa, a bifunctional fusion protein composed of
the monoclonal antibody anti-PD-L1 and TGF-beta, may help the body's immune system attack the
cancer, and may interfere with the ability of tumor cells to grow and spread. Pimasertib may
stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Giving pimasertib and bintrafusp alfa may help to prevent or delay the cancer from
progressing (getting worse) and/or coming back.
Detailed Description
PRIMARY OBJECTIVES:
I. Establish safety profile and recommended phase II dose for combining pimasertib with
bintrafusp alfa (M7824) in patients with brain metastases. (Phase I) II. Time to intracranial
progression (defined as progression of existing lesions and development of new lesions by
modified Response Evaluation Criteria in Solid Tumors [RECIST] 1.1). (Phase II) III. Overall
survival. (Phase II)
SECONDARY OBJECTIVES:
I. Intracranial progression 6, 12 and 18 months. II. Intracranial objective response rate as
measured by Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM), immunotherapy
(i)RANO, and RECIST 1.1.
III. Time to second intracranial progression after salvage stereotactic radiosurgery (SRS).
IV. Overall survival rate at 6, 12 and 18 months. V. Frequency of grade 3+ intracranial
toxicities at 4 weeks, and 3, 6, 9, 12 and 18 months.
VI. Frequency of extracranial progression and response rate at 8 weeks, and 3, 6, 9, 12 and
18 months.
VII. Frequency of neurocognitive decline at 6, 12 and 18 months (optional). VIII. Changes in
neurocognitive function and health-related quality of life. IX. Dose, duration and frequency
of steroid use for symptomatic management.
EXPLORATORY OBJECTIVES:
I. Identify molecular and/or immunological markers from biospecimens (tissue, blood, and
cerebrospinal fluid [CSF]) that are associated with treatment response and toxicity.
II. Identify imaging biomarkers of response and toxicity (acute radiation
effect/radionecrosis and neurocognitive changes) from multiparametric magnetic resonance
imaging (MRI) and/or delayed positron emission tomography (PET) that predict treatment
response and toxicity.
III. Identify correlative or surrogative relationship between systemic (blood) and imaging
markers and treatment outcomes.
OUTLINE: This is a phase I, dose-escalation study of followed by a phase II dose-expansion
study.
Patients receive bintrafusp alfa intravenously (IV) over 1 hour every 2 weeks and pimasertib
orally (PO) twice daily (BID) on days 1-28. Treatment repeats every 28 days for up to 1 year
in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 and 90 days, every 6
weeks during year 1, and then every 12 weeks for up to 2 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (bintrafusp alfa, pimasertib) | Experimental | Patients receive bintrafusp alfa IV over 1 hour every 2 weeks and pimasertib PO BID on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. | - Bintrafusp Alfa
- Pimasertib
|
Eligibility Criteria
Inclusion Criteria:
- Age >= 18 years old
- Life expectancy > 12 weeks
- Subjects must be willing and able to comply with scheduled visits, treatment schedule,
laboratory testing, and other requirements of the study
- At least one measurable untreated brain lesion >= 0.5 cm and < 3.0 cm in the longest
axis according to modified RECIST 1.1
- Prior stereotactic radiosurgery (SRS) with up to 3 lesions treated with at least a 14
day interval is allowed as long as the previous treatment volume does not overlap with
the current targets
- Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG)
performance scale
- Subjects must be free of neurologic signs and symptoms related to metastatic brain
lesions and must not have required or received systemic corticosteroid therapy in the
10 days prior to beginning protocol therapy
- Prior treatment with immunotherapy and targeted therapy allowed as long as it did not
include a combination of MEK inhibitor (i) + anti-PD(L)-1 antibody and is > 14 days
prior to start of protocol therapy. All tumor types will be eligible and included in
the dose escalation phase. Dose expansions will include 10 patients each from lung,
breast, and melanoma
- Patients with melanoma must have received prior PD-1 based therapy and have evidence
of progression
- Patients with non-small cell lung cancer (NSCLC) must have received prior PD-1 based
therapy and have evidence of progression
- Patients with triple-negative breast cancer (TNBC) and hormone receptor positive (HR+)
are included (any number of prior lines of therapy-including immuno-oncology [IO]
naive patients)
- For HR+ patients, patients are allowed to receive endocrine therapy with or without
CDK4/6 inhibitors per treating physician discretion (Arimidex, letrozole, exemestane,
or fulvestrant)
- Systematic radiation therapy is allowed (> 14 day washout)
- Prior platinum-based chemotherapy for NSCLC patients is allowed
- Absolute neutrophil count (ANC) >= 1500/uL
- Platelets >= 100 000/uL
- Hemoglobin >= 9.0 g/dL or >= 5.6 mmol/L
- Criteria must be met without erythropoietin dependency and without packed red
blood cell (pRBC) transfusion within last 2 weeks
- Creatinine =< 1.5 x upper limit of normal (ULN) OR measured or calculated creatinine
clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or
creatinine clearance [CrCl]) >= 60 mL/min for participant with creatinine levels > 1.5
x institutional ULN
- Creatinine clearance (CrCl) should be calculated per institutional standard
- Total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for participants with total
bilirubin levels > 1.5 x ULN
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and
alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x
ULN (=< 5 x ULN for participants with liver metastases)
- International normalized ratio (INR) OR prothrombin time (PT) =< 1.5 x ULN unless
participant is receiving anticoagulant therapy as long as PT or activated partial
thromboplastin time (aPTT) is within therapeutic range of intended use of
anticoagulants
- Activated partial thromboplastin time (aPTT) =< 1.5 x ULN unless participant is
receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of
intended use of anticoagulants
- Women of child-bearing potential (WOCBP) must not be breastfeeding and must have a
negative pregnancy test within 3 days prior to initiation of dosing. She must agree to
use an acceptable method of birth control from the time of the negative pregnancy test
up to 120 days after the last dose of study drug. WOCBP must agree to adhere to the
contraceptive guidance
- Note: A female participant is eligible to participate if she is not a woman of
childbearing potential
- Fertile men must agree to use an acceptable method of birth control while on study
drug and up to 120 days after the last dose of study drug and also refrain from
donating sperm during this period
- All associated toxicity from previous or concurrent cancer therapy must be resolved
(to =< grade 1 or baseline) prior to study treatment administration. Steroids for
physiological replacement are allowed
Exclusion Criteria:
- Patients with clinical or radiographic evidence of leptomeningeal disease
- Those who experienced grade 3 or 4 neurotoxicity from prior SRS
- Prior external beam radiation to the brain or whole brain radiation
- Contraindications to MRI (implanted metal device or foreign bodies) or MRI contrast
(insufficient renal function or allergy)
- Subjects with major medical, neurologic or psychiatric condition who are judged as
unable to fully comply with study therapy or assessments should not be enrolled
- Active secondary malignancy unless the malignancy is not expected to interfere with
the evaluation of safety and is approved by the principle investigator (PI). Examples
of the latter include basal or squamous cell carcinoma of the skin, in-situ carcinoma
of the cervix, and isolated elevation of prostate-specific antigen. Subjects with a
completely treated prior malignancy and no evidence of disease for >= 2 years are
eligible
- Has a known history of or is positive for hepatitis B (hepatitis B surface antigen
[HBsAg] reactive) or known active hepatitis C virus infection (note treated and cured
history of hepatitis C is allowed) (hepatitis C virus [HCV] ribonucleic acid [RNA]
[qualitative] is detected)
- Note: Without known history, testing needs to be performed to determine
eligibility. Hepatitis C antibody (Ab) testing is allowed for screening purposes
in countries where HCV RNA is not part of standard of care
- Has a known history of human immunodeficiency virus (HIV) infection. No HIV testing is
required unless mandated by local health authority
- The use of corticosteroids is not allowed for 10 days prior to initiation of therapy
(based upon 5 times the expected half-life of dexamethasone) except patients who are
taking steroids for physiological replacement. If alternative corticosteroid therapy
has been used, consultation with the PI is required to determine the washout period
prior to initiating study treatment
- Subjects with a condition requiring systemic treatment with either corticosteroids (>
10 mg daily prednisone equivalent) or other immunosuppressive medications within 14
days of study initiation. Inhaled or topical steroids, and adrenal replacement steroid
doses > 10 mg daily prednisone equivalent, are permitted in the absence of active
autoimmune disease
- Major surgical procedure, open biopsy (excluding skin cancer resection), or
significant traumatic injury within 14 days of initiating study drug (unless the wound
has healed) or anticipation of the need for major surgery during the study
- Non-healing wound, ulcer, or bone fracture
- Women who are breast-feeding or pregnant
- Subjects with a history of serious intercurrent chronic or acute illness, such as
cardiac or pulmonary disease, hepatic disease, bleeding diathesis or recent major
bleeding events or other illness considered by the Investigator as high risk for
investigational drug treatment
- Arterial or venous thrombotic or embolic events such as cerebrovascular accident
(including transient ischemic attacks), deep vein thrombosis or pulmonary embolism
within the 6 months before start of study medication (except for adequately treated
catheter-related venous thrombosis occurring more than 1 month before the start of
study medication)
- History of clinically significant cardiac disease or congestive heart failure > New
York Heart Association (NYHA) class 2. Subjects must not have unstable angina (anginal
symptoms at rest) or new-onset angina within the last 3 months or myocardial
infarction within the past 6 months
- Investigational drug use within 14 days (or 5 half-lives, whichever is longer) of the
first dose of bintrafusp alfa and/or pimasertib
- Has a history of (grade 3 or 4) non-infectious pneumonitis that required steroids or
current pneumonitis
- Retinal degenerative disease (hereditary retinal degeneration or age-related macular
degeneration), history of retinal vein occlusion (RVO) or any eye condition that would
be considered as risk factor for RVO (e.g. uncontrolled glaucoma or ocular
hypertension)
- Creatine phosphokinase level at baseline National Cancer Institute (NCI) Common
Terminology Criteria for Adverse Events (CTCAE) grade >= 2 (> 2.5 x ULN - 5 x ULN)
and/or previous history of myositis or rhabdomyolysis
- For NSCLC cohort patients whose tumor exhibit activating EGFR mutation, ALK or ROS
translocation and have a standard of care molecular targeted therapy available for
these mutations, will be excluded from this study. Patients who progressed or could
not tolerate these standard of care molecular targeted agents are eligible for this
study. Lung adenocarcinoma patients may be consented prior to the EGFR and ALK status
being known, but EGFR and ALK status must be determined prior to initiating therapy
- Administration of live, attenuated vaccine therapies for the prevention of infectious
diseases within 4 weeks prior to day 1 of treatment and during therapy
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Clinical benefit rate |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Will be summarized by grade, relationship, time during the treatment, etc., for each dose in each group. |
Secondary Outcome Measures
Measure: | Intracranial progression |
Time Frame: | From the time of study enrollment to intracranial progression (event) or the last follow-up date if the patient has not developed the intracranial progression yet, assessed up to 18 months |
Safety Issue: | |
Description: | Will be determined by modified RECIST 1.1 and estimated and reported with 95% confidence interval utilizing the method of Kaplan and Meier. Will be performed overall and within each treatment group. Completing risk analysis may be considered by treating events outside of intracranial disease progression (e.g. events such as extracranial disease progression, early dropout due to toxicity, or death) as competing risks. |
Measure: | Time to extracranial progression |
Time Frame: | From the time of study enrollment to extracranial progression (event) or thelast follow-up date if the patient has not developed the extracranial progression yet, assessed up to 18 months |
Safety Issue: | |
Description: | Will be determined by modified RECIST 1.1. The cumulative incidence rate may be estimated by competing risk analysis treating events outside of extracranial disease progression (e.g. events such as intracranial disease progression, early dropout due to toxicity, or death) as competing risks. |
Measure: | Best achieved extracranial objective response rate |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Will be reported for each patient. The frequency of extracranial objective response will be reported overall and within each treatment group. |
Measure: | Duration of response |
Time Frame: | From date of first imaging identifying partial response (PR) or complete response (CR) until the date of first imaging identifying progressive disease is noted, assessed up to 2 years |
Safety Issue: | |
Description: | Will be assessed in patients who achieve extracranial, PR or CR via RECIST 1.1 criteria and calculated utilizing the Kaplan-Meier method with reporting of the median and range overall and within each treatment group. |
Measure: | Dose, duration and frequency of steroid use for symptomatic management |
Time Frame: | Up to 2 years |
Safety Issue: | |
Description: | Will record and report steroid requirements for symptom management overall and within each treatment group. Patients who require at least 4 mg of dexamethasone/day for symptom management will be considered as requiring high dose steroids. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
March 12, 2021