Safety, Pharmacokinetics (PK), and Efficacy of ONC-392 as a Single Agent and in Combination With Pembrolizumab in Advanced Solid Tumors and NSCLC: An Open Label Phase IA/IB Study. Preserve CTLA4 Checkpoint Function (PRESERVE-001) (PRESERVE-001)

  • STATUS
    Recruiting
  • End date
    Dec 31, 2024
  • participants needed
    468
  • sponsor
    OncoC4, Inc.
Updated on 25 October 2022
ct scan
cancer
hysterectomy
monoclonal antibodies
serum pregnancy test
measurable disease
carcinoma
breast cancer
direct bilirubin
lung cancer
oophorectomy
x-rays
international normalized ratio
prothrombin
metastasis
neutrophil count
pembrolizumab
EGFR
pd-l1
aptt
gastric carcinoma
thromboplastin
conjugated bilirubin
solid tumour
ovarian cancer
antibody therapy
sarcoma
pancreatic cancers
stage iv non-small cell lung cancer
ovarian carcinoma
head and neck carcinoma
ovarian epithelial carcinoma
cancer of the ovary
osimertinib
lung carcinoma
adenoid cystic carcinoma

Summary

This is a First-in-Human Phase IA/IB/II open label dose escalation study of intravenous (IV) administration of ONC-392, a humanized anti-CTLA4 IgG1 monoclonal antibody, as single agent and in combination with pembrolizumab in participants with advanced or metastatic solid tumors and non-small cell lung cancers.

Description

Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), also known as CD152 (cluster of differentiation 152), is a cell surface protein receptor that interacts with B7-1 (CD80) and B7-2 (CD86) to ensure proper function of regulatory T cells and protect host against autoinflammatory diseases. Anti-CTLA-4 monoclonal antibodies (mAbs) have demonstrated strong and broad cancer immunotherapeutic effects (CITE) in a variety of preclinical models and are used clinically both as monotherapy and as part of combination therapy with Nivolumab (anti-PD-1). However, CTLA-4 monotherapy has more immunotherapy-related adverse effects (irAEs) than anti-PD-1/PD-L1 therapy. In addition, the rate of severe irAE (Grades 3 and 4) reached 55% in melanoma patients receiving combination of Ipilimumab and Nivolumab. The strong irAEs further limit the doses tolerated by cancer patients. Nevertheless, combination with anti-PD-1 resulted in significantly improved response rates and patient survival in multiple types of cancer. Furthermore, anti-CTLA-4 antibodies induce long-lasting immunity in cancer patients. Therefore, CTLA-4 remains an important immunotherapy target, but major challenges remain in improving both safety and efficacy of anti-CTLA-4 mAbs.

ONC-392 is a highly selective, humanized monoclonal IgG1-kappa isotype antibody against CTLA-4. The parental clone was identified through in vivo screening in humanized CTLA-4 mouse model for high anti-tumor efficacy and low autoimmune toxicity. We have recently demonstrated that ONC-392 is dissociation from CTLA-4 under low pH to allow its escape from lysosomal degradation and recycle to cell surface. We have provided several lines of evidence for the notion that a pH-sensitive antibody ONC-392 is not only safer but also more effective in Treg depletion and tumor rejection than the Ipilimumab, which is pH-insensitive. First, by preserving CTLA-4 on the cell surface, Onc-392 leaves higher ligand density for better ADCC.

Second, Onc-392 is more efficient in Treg depletion in tumor microenvironment. Third, Onc-392 is significantly more potent in inducing rejection of large tumors.

The study consists of four parts:

(1) The Part A study is a dose-finding rapid titration, Phase I trial of ONC-392 as a single agent in patients with advanced or metastatic solid tumors with various histology. The aim of this trial is to define the recommended Phase II dose for ONC-392 monotherapy (RP2D-M). (2) The Part B study is a dose-finding phase with ONC-392 in combination with a standard dose of 200 mg pembrolizumab in patients with advanced or metastatic solid tumors.

(3) The Part C consists of different expansion arms.

  1. Arm A: Pancreatic Cancer Cohort, ONC-392 monotherapy, will enroll advanced/metastatic pancreatic cancer patients who have progressive disease after first and second lines of systemic treatment.
  2. Arm B: TNBC Cohort, ONC-392 monotherapy, will enroll advanced/metastatic TNBC patients who have progressive disease after prior systemic treatments, including checkpoint inhibitor immunotherapy.
  3. Arm C: NSCLC Mono Cohort 1, ONC-392 monotherapy, will enroll advanced/metastatic NSCLC patients with EGFR or ALK mutations who have progressive disease after prior systemic treatments, including targeted therapy or checkpoint inhibitors.
  4. Arm D: NSCLC IO Naïve Cohort, ONC-392/Pembrolizumab combination therapy, will enroll advanced/metastatic NSCLC cancer patients who are treatment naïve, or anti PD (L)1 immunotherapy naïve and PD-L1-positive (PD L1 TPS ≥ 1%).
  5. Arm E: NSCLC IO R/R Cohort, ONC-392/Pembrolizumab combination therapy, will enroll advanced/metastatic NSCLC cancer patients who are R/R to prior anti-PD-(L)1 immunotherapy regardless of PD-L1 status and with disease progression with ONC-392 monotherapy from Arm C or Arm I.
  6. Arm F: Melanoma IO Naïve Cohort, ONC-392/Pembrolizumab combination therapy, will enroll advanced/metastatic Melanoma patients who are treatment naïve, or checkpoint inhibitor immunotherapy naive. Prior systemic chemotherapy or targeted therapy are allowed.
  7. Arm G: Melanoma IO R/R Cohort, ONC-392/Pembrolizumab combination therapy, will enroll advanced/metastatic melanoma patients who are R/R to anti-PD-(L)1 immunotherapy and progressed with ONC-392 monotherapy from Arm J.
  8. Arm I: NSCLC Mono Cohort 2, ONC-392 monotherapy, will enroll advanced/metastatic NSCLC patients without EGFR or ALK mutations who have progressive disease after prior systemic treatments, including chemotherapy or checkpoint inhibitors. Patient must have anti-PD-(L)1 treatment, either alone or in combination, as last treatment before enrollment. Prior anti-CTLA-4 treatment is allowed.
  9. Arm K: Head and Neck Squamous Cell Carcinoma (HNSCC), ONC-392 monotherapy, will enroll advanced/metastatic HNSCC patients with or without positive HPV who have progressive disease after prior systemic treatments, including chemotherapy or checkpoint inhibitors. Patient must have anti-PD-(L)1 treatment, either alone or in combination, as last treatment before enrollment.
  10. Arm L: Ovarian Cancer, ONC-392 monotherapy, will enroll patients with advanced/metastatic ovarian cancer who have progressive disease after prior systemic treatments, including chemotherapy, targeted therapy or checkpoint inhibitors.
  11. Arm M: Solid Tumors, ONC-392 monotherapy, will enroll patients with advanced/metastatic solid tumors who are not eligible for Arm A-C or H-L, who have progressive disease after prior systemic treatments, including chemotherapy, targeted therapy or checkpoint inhibitors.

(4) Part D is a Phase II study in recurrent and/or metastatic adenoid cystic carcinoma with ONC-392 monotherapy.

Details
Condition Non Small Cell Lung Cancer, Advanced Solid Tumor, Metastatic Melanoma, Metastatic Head and Neck Carcinoma, Metastatic Renal Cell Carcinoma, Metastatic Colorectal Cancer, Sarcomas, Metastatic Prostate Cancer, Ovarian Cancer, Small Cell Lung Cancer, Metastatic Breast Cancer, Pancreas Cancer, Gastric Cancer, Esophageal Cancer, Gastroesophageal Junction Adenocarcinoma, Cervical Cancer, Adenoid Cystic Carcinoma, Salivary Gland Cancer, Urothelial Carcinoma
Treatment Pembrolizumab, Osimertinib, ONC-392
Clinical Study IdentifierNCT04140526
SponsorOncoC4, Inc.
Last Modified on25 October 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Patients must have a histological or cytological diagnosis of NSCLC or any other type of carcinoma or sarcomas, progressive metastatic disease, or progressive locally advanced disease not amenable to local therapy
In the Part A Phase I dose escalation study of ONC-392 monotherapy, patients with advanced/metastatic solid tumors of any histology are eligible for participation
Please note: tumor types of primary interest in this study are malignant
melanoma, renal cell carcinoma, hepatocellular carcinoma, non-small cell lung
cancer, head and neck carcinoma, gastric carcinoma, ovarian carcinoma
colorectal cancer, any type of sarcoma
In Part B dose finding of the ONC-392 plus pembrolizumab combination, patients with advanced/metastatic solid tumors of any histology that Pembrolizumab has been approval as standard of care are eligible for participation
In Part C, patients with pancreatic cancer, triple negative breast cancer, non small cell lung cancer, melanoma, Head and Neck cancer, ovarian cancer, and other solid tumors are eligible
In Part D, patients with recurrent and/or metastatic adenoid cystic carcinoma with disease progression within 12 months are eligible
Patients must have RECIST V1.1 Measurable disease
Patient must have a performance status of 0 or 1 on the ECOG Performance Scale
Patient is male or female and >18 years of age on day of signing informed consent
Hematological: Absolute neutrophil count (ANC) ≥1,500 /mcL; Plateletsa ≥100,000 / mcL
Hemoglobin ≥9 g/dL or ≥5.6 mmol/L- without qualifications; Renal: Serum creatinine
Patient must have adequate organ function as indicated by the following laboratory
≤1.5 X upper limit of normal (ULN); Hepatic: Serum total bilirubin ≤1.5 X ULN; OR
values
Direct bilirubin ≤ ULN for patients with total bilirubin levels >1.5 ULN; AST (SGOT)
and ALT (SGPT) ≤2.5 X ULN, OR ≤5 X ULN for patients with active liver metastases
Coagulation: International Normalized Ratio (INR) or Prothrombin Time (PT) ≤1.5 X ULN
Activated Partial Thromboplastin Time (aPTT) ≤1.5 X ULN
Patient has voluntarily agreed to participate by giving written informed consent
Female patient of childbearing potential has a negative urine or serum pregnancy test
Female and Male patients must agree to use adequate methods of contraception starting
with the first dose of study drug through 90 days after the last dose of study
therapy

Exclusion Criteria

A patient meeting any of the following criteria is not eligible to participate in this
Patients who have not recovered to CTCAE ≤ 1 from the AE due to cancer therapeutics
The washout period for cancer therapeutic drugs (such as chemotherapy, radioactive, or
targeted therapy) is 21 days, and for antibody drug 28 days
Patients who are currently enrolled in a clinical trial of an investigational agent or
device
Patients who have active symptomatic brain metastasis or leptomeningeal metastasis
Patients who have an active infection requiring systemic IV therapy within 14 days of
prior to administration of ONC-392 or combined ONC-392 and Pembrolizumab
Patients who have a history or current evidence of any condition, therapy, or
For the Part B and Part C Arm D to G, the patients that are deemed to be not suitable
laboratory abnormality that might confound the results of the study, interfere with
the patient's participation for the full duration of the study, or is not in the best
interest of the patient to participate, in the opinion of the treating Investigator
Patients with known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial
for Pembrolizumab
study
Patients who are on chronic systemic steroid therapy at doses >10 mg/day
Patients who are pregnant or breastfeeding
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