Clinical Trials /

A Phase I Trial of ProAgio, an Anti- Alpha-v-beta3 Integrin Cytotoxin, for Previously Treated Advanced Pancreatic Cancer and Other Solid Tumor Malignancies

NCT04937686

Description:

Background: - Pancreatic cancer is the third leading cause of death from cancer in the United States. - The median overall survival for patients with metastatic disease and excellent performance status receiving the most effective combination chemotherapy regimens remains less than 1 year - Pancreatic ductal adenocarcinoma (PDAC), the most common pancreatic cancer histology, is surrounded by a dense desmoplastic stromal reaction generated by cross-talk between tumor cells and the cancer associated stellate cells (CASC) and fibroblasts (CAF) in the microenvironment. - This stroma physically inhibits delivery of therapeutic drugs to tumor cells, secretes growth factors and nutrients that promote therapy resistance and cancer cell survival and is also highly immunosuppressive - Activated CASCs, CAFs and angiogenic endothelial cells which form the abnormal vasculature around tumors, all express high levels of integrin vbeta3. - ProAgio is a rationally designed pegylated peptide drug that binds to integrin vbeta3 at a novel binding site that directly triggers cell apoptosis - ProAgio induces apoptosis of CASCs and angiogenic endothelial cells in pre-clinical models, inhibiting tumor growth and prolonging animal survival - Safety of ProAgio in rodent and non-human primate models has been established - ProAgio has never been tested in humans Primary Objectives: To determine the recommended phase 2 dose (RP2D) of ProAgio in participants with previously treated advanced solid tumors for which no curative therapy exists Eligibility: - Adults >= 18 years of age - Histologically confirmed solid tumor malignancy for which no curative therapy exists as confirmed by the NCI Laboratory of Pathology - For the expansion cohort only: Histologically confirmed diagnosis of pancreatic cancer that is not neuroendocrine - Participants must have received at least one prior systemic treatment - Adequate end organ function is required - Participants in the Biopsy Arm of the expansion cohort must have disease amenable to safe biopsy and willingness to undergo the procedure Design: - This is a Phase I study to assess the safety of ProAgio in Participants with advanced solid tumor malignancies including pancreatic cancer - All participants will receive ProAgio until disease progression, unacceptable toxicity, or withdrawal from study - For the dose escalation cohort, a modified 3+3 design with accelerated dose escalation in initial cohorts will be used - For the expansion cohort, all participants will receive ProAgio at the ideal dose identified during the dose escalation - The expansion cohort has two arms: standard arm and biopsy arm. Pre- and post-treatment tumor biopsy is optional for participants enrolled in the standard arm, but mandatory for participants enrolled in the biopsy arm....

Related Conditions:
  • Malignant Solid Tumor
  • Pancreatic Carcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: A Phase I Trial of ProAgio, an Anti- Alpha-v-beta3 Integrin Cytotoxin, for Previously Treated Advanced Pancreatic Cancer and Other Solid Tumor Malignancies
  • Official Title: A Phase I Trial of ProAgio, an Anti- Alpha-v-beta3 Integrin Cytotoxin, for Previously Treated Advanced Pancreatic Cancer and Other Solid Tumor Malignancies

Clinical Trial IDs

  • ORG STUDY ID: 10000194
  • SECONDARY ID: 000194-C
  • NCT ID: NCT04937686

Conditions

  • Pancreatic Cancer
  • Solid Tumors

Interventions

DrugSynonymsArms
ProAgio1/Dose Escalation

Purpose

Background: - Pancreatic cancer is the third leading cause of death from cancer in the United States. - The median overall survival for patients with metastatic disease and excellent performance status receiving the most effective combination chemotherapy regimens remains less than 1 year - Pancreatic ductal adenocarcinoma (PDAC), the most common pancreatic cancer histology, is surrounded by a dense desmoplastic stromal reaction generated by cross-talk between tumor cells and the cancer associated stellate cells (CASC) and fibroblasts (CAF) in the microenvironment. - This stroma physically inhibits delivery of therapeutic drugs to tumor cells, secretes growth factors and nutrients that promote therapy resistance and cancer cell survival and is also highly immunosuppressive - Activated CASCs, CAFs and angiogenic endothelial cells which form the abnormal vasculature around tumors, all express high levels of integrin vbeta3. - ProAgio is a rationally designed pegylated peptide drug that binds to integrin vbeta3 at a novel binding site that directly triggers cell apoptosis - ProAgio induces apoptosis of CASCs and angiogenic endothelial cells in pre-clinical models, inhibiting tumor growth and prolonging animal survival - Safety of ProAgio in rodent and non-human primate models has been established - ProAgio has never been tested in humans Primary Objectives: To determine the recommended phase 2 dose (RP2D) of ProAgio in participants with previously treated advanced solid tumors for which no curative therapy exists Eligibility: - Adults >= 18 years of age - Histologically confirmed solid tumor malignancy for which no curative therapy exists as confirmed by the NCI Laboratory of Pathology - For the expansion cohort only: Histologically confirmed diagnosis of pancreatic cancer that is not neuroendocrine - Participants must have received at least one prior systemic treatment - Adequate end organ function is required - Participants in the Biopsy Arm of the expansion cohort must have disease amenable to safe biopsy and willingness to undergo the procedure Design: - This is a Phase I study to assess the safety of ProAgio in Participants with advanced solid tumor malignancies including pancreatic cancer - All participants will receive ProAgio until disease progression, unacceptable toxicity, or withdrawal from study - For the dose escalation cohort, a modified 3+3 design with accelerated dose escalation in initial cohorts will be used - For the expansion cohort, all participants will receive ProAgio at the ideal dose identified during the dose escalation - The expansion cohort has two arms: standard arm and biopsy arm. Pre- and post-treatment tumor biopsy is optional for participants enrolled in the standard arm, but mandatory for participants enrolled in the biopsy arm....

Detailed Description

      Background:

        -  Pancreatic cancer is the third leading cause of death from cancer in the United States.

        -  The median overall survival for patients with metastatic disease and excellent
           performance status receiving the most effective combination chemotherapy regimens
           remains less than 1 year

        -  Pancreatic ductal adenocarcinoma (PDAC), the most common pancreatic cancer histology, is
           surrounded by a dense desmoplastic stromal reaction generated by cross-talk between
           tumor cells and the cancer associated stellate cells (CASC) and fibroblasts (CAF) in the
           microenvironment.

        -  This stroma physically inhibits delivery of therapeutic drugs to tumor cells, secretes
           growth factors and nutrients that promote therapy resistance and cancer cell survival
           and is also highly immunosuppressive

        -  Activated CASCs, CAFs and angiogenic endothelial cells which form the abnormal
           vasculature around tumors, all express high levels of integrin alpha-v-beta3.

        -  ProAgio is a rationally designed pegylated peptide drug that binds to integrin
           alpha-v-beta3 at a novel binding site that directly triggers cell apoptosis

        -  ProAgio induces apoptosis of CASCs and angiogenic endothelial cells in pre-clinical
           models, inhibiting tumor growth and prolonging animal survival

        -  Safety of ProAgio in rodent and non-human primate models has been established

        -  ProAgio has never been tested in humans

      Primary Objectives:

      To determine the recommended phase 2 dose (RP2D) of ProAgio in participants with previously
      treated advanced solid tumors for which no curative therapy exists

      Eligibility:

        -  Adults >= 18 years of age

        -  Histologically confirmed solid tumor malignancy for which no curative therapy exists as
           confirmed by the NCI Laboratory of Pathology

        -  For the expansion cohort only: Histologically confirmed diagnosis of pancreatic cancer
           that is not neuroendocrine

        -  Participants must have received at least one prior systemic treatment

        -  Adequate end organ function is required

        -  Participants in the Biopsy Arm of the expansion cohort must have disease amenable to
           safe biopsy and willingness to undergo the procedure

      Design:

        -  This is a Phase I study to assess the safety of ProAgio in Participants with advanced
           solid tumor malignancies including pancreatic cancer

        -  All participants will receive ProAgio until disease progression, unacceptable toxicity,
           or withdrawal from study

        -  For the dose escalation cohort, a modified 3+3 design with accelerated dose escalation
           in initial cohorts will be used

        -  For the expansion cohort, all participants will receive ProAgio at the ideal dose
           identified during the dose escalation

        -  The expansion cohort has two arms: standard arm and biopsy arm. Pre- and post-treatment
           tumor biopsy is optional for participants enrolled in the standard arm, but mandatory
           for participants enrolled in the biopsy arm.
    

Trial Arms

NameTypeDescriptionInterventions
1/Dose EscalationExperimentalTreatment with ProAgio at escalating doses if necessary
  • ProAgio
2A/Biopsy ArmExperimentalTreatment with ProAgio at MTD fixed dose
  • ProAgio
2B/Standard ArmExperimentalTreatment with ProAgio at MTD fixed dose
  • ProAgio

Eligibility Criteria

        -  INCLUSION CRITERIA:

          -  Histologically or cytologically confirmed diagnosis of a solid tumor malignancy for

        which no curative therapy exists as confirmed by the NCI Laboratory of Pathology.

          -  For expansion cohort: histologically or cytologically confirmed diagnosis of non-
             neuroendocrine pancreatic cancer. Participants with mixed acinar-neuroendocrine
             histology are permitted.

          -  Participants in the Biopsy Arm of the expansion cohort must have disease amenable to
             safe biopsy and willingness to undergo the procedure.

          -  Participants must have received at least one prior systemic treatment for advanced
             disease. Participants must be more than 14 days removed from most recent standard of
             care or experimental drug treatment for their tumor

          -  Participants in the dose escalation cohort must have evaluable disease, either by
             clinical exam, biochemical markers (including but not limited to CA 19-9 serum tumor
             marker for pancreatobiliary cancer participants, or other appropriate tumor marker in
             other tumor types), and/or radiographic studies.

          -  Participants in the expansion cohort must have measurable disease, per RECIST 1.1.

          -  Age >=18 years. Because no dosing or adverse event data are currently available on the
             use of ProAgio in participants <18 years of age, children are excluded from this
             study.

          -  ECOG performance status <=2 (Karnofsky >= 60%).

          -  Participants must have adequate organ and marrow function as defined below:

               -  absolute neutrophil count >=1,000/mcL

               -  hemoglobin >=9 g/ dL

               -  platelets >=75,000/mcL

               -  AST(SGOT)/ALT(SGPT) <= 2.5 x ULN. AST and ALT (up to 5x ULN is permitted for
                  participants with liver metastases)

               -  Total bilirubin <=1.5 X institutional ULN

               -  creatinine within normal institutional limits

        OR

          -  creatinine clearance >=60 mL/min/1.73 m^2 for participants with creatinine levels
             above institutional normal

          -  Serum albumin > 2.5 mg/dL without intravenous supplementation

             -Participants must have:

          -  Resting systolic blood pressure < 145 and diastolic blood pressure < 90.

          -  Baseline QTcF interval of <= 470 ms

          -  Baseline resting heart rate > 45 beats per minute and <100 beats per minute

               -  The effects of ProAgio on the developing human fetus are unknown. For this
                  reason, women of child-bearing potential and men must agree to use adequate
                  contraception (hormonal or barrier method of birth control; abstinence) prior to
                  study entry, for the duration of study participation and for the 3 months
                  following the last dosing of study drug. 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.

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

        EXCLUSION CRITERIA:

          -  Diagnosis of primary malignant CNS tumor

          -  Participants who are receiving any other investigational agents.

          -  Evidence of significant, uncontrolled concomitant diseases which could affect

        compliance with the protocol or interpretation of results, including but not limited to
        significant pulmonary disease other than that related to the primary cancer, uncontrolled
        diabetes mellitus, unstable angina, significant cardiovascular disease (such as New York
        Heart Association Class III or IV cardiac disease) and/or psychiatric illness/social
        situations within 12 weeks that would limit compliance with study requirements.

          -  Participants with known diagnosis of a chronic neurologic disorders (such as multiple
             sclerosis, Huntington s disease, Parkinson s disease, or uncontrolled epilepsy) which
             causes motor disturbance, visual disturbance or seizure and could confound assessment
             of neurologic toxicity caused by the study drug.

          -  Pregnant or nursing women are excluded from this study because ProAgio is an agent
             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 ProAgio, breastfeeding should be discontinued if the
             mother is treated with ProAgio.

          -  Participants with leptominengeal disease or with CNS metastases that are untreated,
             have required steroid treatment within the last 4 weeks, or anti-convulsant therapy in
             the last 14 days. For dose escalation cohort only: Participants with any known CNS
             metastases are excluded. Those with symptoms suggestive of possible CNS metastases
             (such as new headaches) must undergo brain MRI as part of screening.

          -  Participants who have undergone a recent minor surgical procedure (within <=14 days)
             such as biliary stenting or major surgical procedure (within <= 28 days) are excluded.

          -  Participants who have undergone recent (within <=14 days) radiation therapy are
             excluded.

          -  Participants with uncontrolled bleeding episodes <=28 days prior to enrollment are
             excluded.

          -  Participants with active or uncontrolled infections are excluded.

          -  Participants with HIV and detectable viral load are excluded. Patents on appropriate
             highly active anti-retroviral therapy with undetectable viral load are eligible.

          -  Participants with a history of Hepatitis B or C are excluded unless there is
             documented evidence of effective treatment and/or cure with undetectable viral load.

          -  Participants with recent (within <= 28 days) thromboembolic disease including but not
             limited to acute coronary syndrome, stroke, or transient ischemic attack, recent deep
             vein thrombosis or pulmonary embolism are excluded.

          -  Participants with thromboembolic disease including but not limited to acute coronary
             syndrome, stroke, or transient ischemic attack, recent deep vein thrombosis or
             pulmonary embolism who have continued symptoms, or who are not on stable doses of
             appropriate

        antiplatelet/anticoagulant regimens are excluded.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Determine the recommended phase 2 dose (RP2D) of ProAgio
Time Frame:until confirmed progression, unacceptable toxicity or trial withdrawal
Safety Issue:
Description:Identification of maximum tolerated dose

Secondary Outcome Measures

Measure:safety and tolerability of ProAgio
Time Frame:duration of treatment
Safety Issue:
Description:The fraction of patients with toxicity noted at each dose level will be reported by grade and type of toxicity identified.
Measure:pharmacokinetics of ProAgio
Time Frame:Cycle 1 and Cycle 3
Safety Issue:
Description:Calculate the concentration of circulating ProAgio
Measure:objective response rate (ORR)
Time Frame:every 45 days until completion of therapy, then until 1 year post-last dose of ProAgio
Safety Issue:
Description:Percentage of patients with the best overall response of CR or PR to therapy
Measure:disease control rate (DCR)
Time Frame:18 weeks
Safety Issue:
Description:Percentage of patients with CR, PR and SD to therapy
Measure:change in relevant serum tumor marker
Time Frame:every 15 days from start until completion of therapy, then 30 days post-last dose of ProAgio
Safety Issue:
Description:Calculate the concentration of serum tumor markers before, during and after therapy

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Pancreatic Ductal Adenocarcinoma
  • pegylated peptide drug
  • Apoptosis
  • Endothelial Cells
  • Angiogenesis

Last Updated

June 29, 2021