Clinical Trials /

Intratumor Injection of Anti-Mesothelin Immunotoxin LMB-100 With Ipilimumab in Malignant Mesothelioma

NCT04840615

Description:

Background: Mesothelioma is a type of cancer. It originates in cells that line human body cavities. Most people have advanced disease when they are diagnosed. Researchers want to see if a combination of drugs can help. Objective: To find a safe dose of LMB-100 in combination with ipilimumab when LMB-100 is injected into tumors. Eligibility: Adults ages 18 and older with malignant pleural or peritoneal mesothelioma that cannot be cured with surgery and has not responded to standard first-line treatments for mesothelioma. Design: Participants will be screened with: - Tumor biopsy or effusion, if needed - Medical history - Physical exam - Blood and urine tests - Imaging scans - Heart and lung function tests - Pregnancy test, if needed Some screening tests will be repeated during the study. Participants will get LMB-100 on Days 1 and 4 for up to 2 cycles. Each cycle lasts 21 days. They will stay in the hospital for about 8 days each time they get LMB-100. It will be injected into their tumor with needles. Participants will get ipilimumab through a tube that is put in a vein. It will be given on Day 2 of the first 2 cycles and Day 1 of the next 2 cycles. Participants will be assessed for how well they do daily activities. They will give blood and tissue samples for research. Participants will have a safety visit 4 to 6 weeks after the last dose of the study drugs. Then they will have scans every 6 weeks until their disease gets worse. If their tumor gets bigger, they will have phone, video, or email follow-ups every 12 weeks. Participants will be on this study for life....

Related Conditions:
  • Peritoneal Mesothelioma
  • Pleural Mesothelioma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Intratumor Injection of Anti-Mesothelin Immunotoxin LMB-100 With Ipilimumab in Malignant Mesothelioma
  • Official Title: Phase I Study of Intratumor Injection of Anti-Mesothelin Immunotoxin LMB-100 With Ipilimumab in Malignant Mesothelioma

Clinical Trial IDs

  • ORG STUDY ID: 10000059
  • SECONDARY ID: 000059-C
  • NCT ID: NCT04840615

Conditions

  • Mesothelioma

Interventions

DrugSynonymsArms
LMB-1001/Intratumoral LMB-100 Administration
ipilimumab1/Intratumoral LMB-100 Administration

Purpose

Background: Mesothelioma is a type of cancer. It originates in cells that line human body cavities. Most people have advanced disease when they are diagnosed. Researchers want to see if a combination of drugs can help. Objective: To find a safe dose of LMB-100 in combination with ipilimumab when LMB-100 is injected into tumors. Eligibility: Adults ages 18 and older with malignant pleural or peritoneal mesothelioma that cannot be cured with surgery and has not responded to standard first-line treatments for mesothelioma. Design: Participants will be screened with: - Tumor biopsy or effusion, if needed - Medical history - Physical exam - Blood and urine tests - Imaging scans - Heart and lung function tests - Pregnancy test, if needed Some screening tests will be repeated during the study. Participants will get LMB-100 on Days 1 and 4 for up to 2 cycles. Each cycle lasts 21 days. They will stay in the hospital for about 8 days each time they get LMB-100. It will be injected into their tumor with needles. Participants will get ipilimumab through a tube that is put in a vein. It will be given on Day 2 of the first 2 cycles and Day 1 of the next 2 cycles. Participants will be assessed for how well they do daily activities. They will give blood and tissue samples for research. Participants will have a safety visit 4 to 6 weeks after the last dose of the study drugs. Then they will have scans every 6 weeks until their disease gets worse. If their tumor gets bigger, they will have phone, video, or email follow-ups every 12 weeks. Participants will be on this study for life....

Detailed Description

      Background:

      LMB-100, and a closely related immunotoxin, SS1P, also targeting mesothelin, given
      intravenously, have been studied in Phase 1 clinical studies for mesothelioma and pancreatic
      cancer.

      LMB-100 given intravenously, results in systemic inflammation in patients, but as a single
      agent has limited anti-tumor efficacy.

      Almost all patients develop neutralizing anti-LMB-100 antibodies after 2 cycles of therapy.

      Intra-tumoral delivery of LMB-100 has been shown to induce immune cell infiltration in
      immune-competent mice, bearing murine malignant mesothelioma tumors. Combination with CTLA-4
      blockage eradicates murine tumors by promoting anti-cancer immunity.

      Ipilimumab is a fully human anti CTLA-4 monoclonal antibody, that is approved for treatment
      of melanoma and in combination with nivolumab for many solid tumors.

      It is hypothesized that intra-tumoral delivery of anti-mesothelin immunotoxin LMB-100 in
      combination with ipilimumab will result in greater anti-tumor efficacy in patients with
      mesothelioma.

      Objective:

      To determine the safety and feasibility of intra-tumoral LMB-100 injection plus ipilimumab
      infusion in patients with mesothelioma

      To identify the recommended phase 2 dose (RP2D) of intratumorally administered LMB-100 +
      ipilimumab in patients with malignant mesothelioma

      Eligibility:

      Histologically confirmed pleural or peritoneal mesothelioma not amenable to potentially
      curative surgical resection.

      Have locally accessible disease suitable for intra-tumor injection of LMB-100. This includes
      superficial or visceral lesions.

      Subjects must have received prior immune checkpoint therapy with anti-PD-1/PD-L1 inhibitors
      alone or in combination with anti-CTLA4 blocking antibodies, as well as platinum-based
      chemotherapy.

      Age >= 18 years.

      ECOG performance status of 0 or 1.

      Adequate organ and bone marrow function

      Subjects with clinically significant pericardial effusion are excluded

      Chemotherapy within 3 weeks or radiotherapy within 2 weeks prior to start of study therapy is
      prohibited.

      Subjects with active CNS metastasis are excluded

      Subjects with active autoimmune disease for which they have received systemic
      immunosuppressive medications during the previous 2 years (excluding daily
      glucocorticoid-replacement therapy for conditions such as adrenal or pituitary insufficiency)
      are excluded

      Subjects with active interstitial lung disease, or a history of pneumonitis or interstitial
      lung disease for which they had received glucocorticoids are excluded

      Design:

      This is an open-label, single center phase I dose escalation study of intratumorally
      administered LMB-concurrently with ipilimumab in subjects with malignant mesothelioma.

      Subjects will receive intratumorally administered LMB-100, beginning at dose level 1, in
      21-day cycles. LMB-100 will be given on days 1 and 4 and ipilimumab 3 mg/kg given on day 2.
      Patients will receive 2 cycles of LMB-100 plus ipilimumab, followed by 2 cycles of ipilimumab
      alone

      Tumor biopsies will be performed prior to each administration of LMB-100, to evaluate changes
      in the tumor immune microenvironment

      Up to 12 evaluable subjects will be enrolled.
    

Trial Arms

NameTypeDescriptionInterventions
1/Intratumoral LMB-100 AdministrationExperimentalThose with pleural or peritoneal mesothelioma receiving intratumoral administration of LMB-100 + ipilimumab in for up to 4 cycles (cycles 1 and 2 include LMB-100 plus ipilimumab; cycles 3 and 4 consist of ipilimumab only)
  • LMB-100
  • ipilimumab

Eligibility Criteria

        -  INCLUSION CRITERIA:

               1. Histologically confirmed malignant pleural or peritoneal mesothelioma not
                  amenable to potentially curative surgical resection. The diagnosis will be
                  confirmed by the Laboratory of Pathology, CCR, NCI.

               2. Tumor must have epithelioid histology determined by the Laboratory of Pathology
                  at the NCI. If the patient has biphasic histology, the epithelioid component must
                  be >50%

               3. Have provided archival tumor tissue sample or able to provide newly obtained core
                  or excisional biopsy of a tumor lesion not previously irradiated. Formalin-fixed,
                  paraffin embedded (FFPE) tissue blocks are preferred to slides. Newly obtained
                  biopsies are preferred to archived tissue.

                  Note: If submitting unstained cut slides, newly cut slides should be submitted to
                  the testing laboratory within 14 days from the date slides are cut.

               4. Have disease locally accessible disease to suitable for intratumoral injection of
                  LMB- 100.

               5. Have measurable disease based on RECIST 1.1. Lesions in a previously irradiated
                  area are considered measurable if progression has been demonstrated in such
                  lesions.

               6. Subjects must have received prior immune checkpoint therapy with anti-PD-1/PD-L1
                  inhibitors alone or in combination with anti-CTLA4 blocking antibodies, as well
                  as platinum based chemotherapy.

               7. Age >= 18 years.

               8. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
                  Evaluation of ECOG is to be performed within 28 days prior to initiation of study
                  therapy.

               9. Have adequate organ and marrow function as defined below:

                  System and Laboratory Value

                  Hematological<TAB>

                  hemoglobin >= 9 g/dL(a)

                  absolute neutrophil count >= 1,500/mcL

                  platelets >= 100,000/mcL

                  Hepatic

                  total bilirubin <= 2.5 X institutional ULN OR direct bilirubin <=ULN for
                  participants with total bilirubin levels >1.5 X ULN

                  AST and ALT <= 2.5 X institutional ULN (<= 5 X ULN for participants with liver
                  metastases)

                  Renal

                  Creatinine <=1.5 x ULN OR Measured or calculated(b) creatinine clearance (GFR can
                  also be used in place of creatinine or CrCl) >= 50 mL/min for participant with
                  creatinine levels; > 1.5 X institutional ULN

                  Coagulation

                  International normalized ratio (INR) OR prothrombin time (PT); 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

                  ALT (SGPT)=alanine aminotransferase (serum glutamic pyruvic transaminase); AST
                  (SGOT)=aspartate aminotransferase (serum glutamic oxaloacetic transaminase);
                  GFR=glomerular filtration rate; ULN=upper limit of normal.

                    1. Criteria must be met without erythropoietin dependency and without packed
                       red blood cell (pRBC) transfusion within last 2 weeks.

                    2. Creatinine clearance (CrCl) should be calculated per institutional standard.

              10. Must have left ventricular ejection fraction >50%.

              11. The effects of LMB-100 on the developing human fetus are unknown. For this reason
                  and because ipilimumab is a Category C agent, women of child-bearing potential
                  and men must agree to use adequate contraception (hormonal or barrier method of
                  birth control; abstinence) while on study therapy and for four months after the
                  last dose of study therapy. Should a woman become pregnant or suspect she is
                  pregnant while she or her partner is participating in this study, she should
                  inform her treating physician immediately.

              12. Ability of subject to understand and the willingness to sign a written informed
                  consent document.

        EXCLUSION CRITERIA:

          1. Is currently participating in or has participated in a study of an investigational
             agent or has used an investigational device within 3 weeks prior to initiation of
             study therapy.

             Note: Participants who have entered the follow-up phase of an investigational study
             may participate as long as it has been 3 weeks after the last dose of the previous
             investigational agent. Patients with active devices will be excluded from the study

          2. Has known active CNS metastases and/or carcinomatous meningitis. Participants with
             previously treated brain metastases may participate provided they are radiologically
             stable, i.e. without evidence of progression for at least 4 weeks by repeat imaging
             (note that the repeat imaging should be performed during study screening), clinically
             stable and without requirement of steroid treatment for at least 14 days prior to
             initiation of study therapy.

          3. Has active systemic issues as bleeding diathesis or active infections

          4. Presence of a clinically significant pericardial effusion

          5. Has severe hypersensitivity (>=Grade 3) anti-CTLA4 therapies and/or any of their
             excipients.

          6. Has received prior radiotherapy to the site of local administration

          7. Subjects who have received LMB-100 previously

          8. Has received prior systemic anti-cancer therapy including investigational agents
             within 3 weeks prior to initiation of study therapy. Patients who have received prior
             anti-PD-1/PD- L1 or CTLA4 antibodies are eligible. Any toxicity related to these
             agents must have resolved to grade 1 and they must not be on systemic
             immunosuppressive therapies (physiologic dose of steroids are permitted).

          9. Has received prior radiotherapy to site other than target lesion within 2 weeks prior
             to initiation of study therapy. Participants must have recovered from all
             radiation-related toxicities, not require corticosteroids, and not have had radiation
             pneumonitis. A 1-week washout is permitted for palliative radiation (<=2 weeks of
             radiotherapy) to non-CNS disease.

         10. Has not recovered from all AEs due to previous therapies to <=Grade 1 or baseline.
             Participants with <=Grade 2 neuropathy may be eligible. If participant received major
             surgery, they must have recovered adequately from the toxicity and/or complications
             from the intervention prior to initiation of study therapy.

         11. Has received a live vaccine within 30 days prior to initiation of study therapy.
             Examples of live vaccines include, but are not limited to, the following: measles,
             mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus
             Calmette-Guerin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection
             are generally killed virus vaccines and are allowed; however, intranasal influenza
             vaccines (e.g., FluMist(R)) are live attenuated vaccines and are not allowed.

         12. Is receiving therapeutic anti-coagulation. Patients receiving prophylactic
             anticoagulation may be eligible if in the opinion of the study team, anti-coagulation
             may be stopped during the time of LMB-100 administration and tumor biopsies

         13. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
             (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of
             immunosuppressive therapy within 7 days prior to initiation of study therapy.

         14. Has active autoimmune disease that has required systemic treatment in the past 2 years
             (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
             drugs). Replacement therapy (e.g.. thyroxine, insulin, or physiologic corticosteroid
             replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
             form of systemic treatment.

         15. Has a QTcF interval >480 milliseconds

         16. Has a history of (non-infectious) pneumonitis/interstitial lung disease(ILD) that
             required steroids or has current pneumonitis/ILD

         17. Has a history or current evidence of any condition, therapy, or laboratory abnormality
             that might confound the results of the study, interfere with the subject s
             participation for the full duration of the study, or is not in the best interest of
             the subject to participate, in the opinion of the treating investigator.

         18. Has known psychiatric or substance abuse disorders that would interfere with
             cooperation with the requirements of the trial.

         19. A woman of childbearing potential who has a positive pregnancy test within 72 hours
             prior to initiation of study therapy. If the using a urine test and test positive or
             cannot be confirmed as negative, a serum pregnancy test will be required. Note: in the
             event that 72 hours have elapsed between the screening pregnancy test and the first
             dose of study treatment, another pregnancy test (urine or serum) must be performed and
             must be negative in order for subject to start receiving study medication.

         20. Is pregnant or breastfeeding, or expecting to conceive or father children within the
             projected duration of the study, starting with the screening visit through 4 months
             after the last dose of trial treatment. Pregnant women are excluded from this study
             because LMB-100 + ipilimumab are agents with the potential for 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 LMB-100 +
             ipilimumab, breastfeeding should be discontinued if the mother is treated with LMB-100
             + ipilimumab. These potential risks may also apply to other agents used in this study.

         21. HIV positive patients will be excluded due to a theoretical concern that the degree of
             immune suppression associated with the treatment may result in progression of HIV
             infection.

         22. Positive for Hepatitis B or C (defined as Hepatitis B surface antigen reactive) or
             known active Hepatitis C virus (defined as HCV RNA detected) infection. or active HBV
             or HCV infection.

         23. Has a known additional malignancy that is progressing or has required active treatment
             within the past 2 years. Note: Participants with basal cell carcinoma of the skin,
             squamous cell carcinoma of the skin, or carcinoma in situ (e.g. breast carcinoma,
             cervical cancer in situ) that have undergone potentially curative therapy are not
             excluded.

         24. Has an active infection requiring systemic therapy.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:recommended phase 2 dose
Time Frame:21 days after first LMB-100 administration
Safety Issue:
Description:The highest dose at which fewer than 2 of 6 subjects experience a dose limiting toxicity

Secondary Outcome Measures

Measure:objective response rate
Time Frame:every 6 weeks until disease progression
Safety Issue:
Description:fraction of subjects who experience either a partial or complete response
Measure:duration of response
Time Frame:disease recurrence or progression
Safety Issue:
Description:median time criteria are met for partial or complete response to the first date that recurrence or progression is documented
Measure:progression free survival
Time Frame:disease progression
Safety Issue:
Description:median time from start of treatment to time of progression or death, whichever occurs first
Measure:Overall survival
Time Frame:death
Safety Issue:
Description:median time from start of treatment to death from any cause

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Immunotherapy
  • Checkpoint Inhibitor
  • anti CTLA-4

Last Updated

June 16, 2021