A Phase I/II Study of M3814 and Avelumab in Combination with Hypofractionated Radiation in Patients with Advanced/Metastatic Solid Tumors and Hepatobiliary Malignancies.
Primary Objective:
Phase I:
(1) To determine the safety and tolerability and recommended phase 2 dose (RP2D) of M3814 in combination with hypofractionated radiation and avelumab in patients with advanced/metastatic solid tumors.
Phase II:
(1) To determine the efficacy of the combination of hypofractionated radiation, M3814, and avelumab as compared to the combination of hypofractionated radiation and avelumab in patients with advanced/metastatic hepatobiliary tumors by objective response rate (ORR) in non-irradiated lesions. All lesions (target and non-target) except the one or two lesions that were irradiated are to be included in the assessment of overall response using RECIST v1.1.
Secondary Objective(s):
Phase I:
(1) To observe and record anti-tumor activity. Although the clinical benefit of this combination has not yet been established, the intent of offering this treatment is to provide a possible therapeutic benefit, and thus the patient will be carefully monitored for tumor response and symptom relief in addition to safety and tolerability. Specifically, to determine efficacy of the combination by measurement of disease control rate (DCR), duration of response (DOR), progression free survival (PFS), PFS outside the irradiated field, and overall survival (OS) in patients with advanced/metastatic solid tumors.
(2) To characterize the pharmacokinetic (PK) profile of M3814 in combination with avelumab.
Phase II:
(1) To determine the efficacy and safety of the combination of hypofractionated radiation, M3814, and avelumab as compared to hypofractionated radiation and avelumab by measurement of DCR, DOR, PFS, PFS outside the irradiated field, and OS in patients with advanced/metastatic hepatobiliary tumors.
(2) To determine if baseline DNA repair defects inherent to some cholangiocarcinomas correlate with a more dramatic response to radiation compared to those without as measured by H2AX pNBS1 multiplex IFA assay.
(3) To characterize the pharmacokinetic (PK) profiles of M3814 and avelumab.
Any Site
Other Digestive Organ
Avelumab
Radiotherapy
Chemotherapy single agent systemic
- Rutgers Cancer Institute of New Jersey
Inclusion Criteria
- PHASE 1: Patients must have a histologically confirmed metastatic or locally
advanced unresectable solid tumor that has progressed on or after available standard
of care therapy or for which no acceptable standard of care therapy exists, or in
which the patient declines standard of care therapy (each patient that declines
standard of care therapy will be documented in the case report form)
- PHASE 2: Patients must have a histologically confirmed metastatic or locally
advanced unresectable cholangiocarcinoma/gallbladder carcinoma that has progressed
on at least 1 prior standard of care therapy or for which no acceptable standard of
care therapy exists, or in which the patient declines standard of care therapy (each
patient that declines standard of care therapy will be documented in the case report
form)
- Age >= 18 years
- Because no dosing or adverse event data are currently available on the use of
M3814 in combination with avelumab in patients < 18 years of age
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
- Patients with at least 1 index lesion to irradiate for whom palliative radiation
treatment is indicated (including but not limited to pain and/or symptom control,
prevention of disease -related complications, and preservation of organ function).
Lung and liver lesions are preferred, though alternate lesions may be considered
after discussion with trial principal investigator (PI). Up to 2 lesions may be
considered for irradiation provided at least 1 lesion will receive the study
treatment of total of 60 Gy and all prescribed irradiation will be completed within
the radiation window
- Patients with at least 1 Response Evaluation Criteria in Solid Tumors (RECIST)
measurable lesion (to be unirradiated) (defined as those accurately measured in at
least one dimension, with the longest diameter to be recorded for non-nodal lesions
and the shortest diameter for nodal lesions). Measurable is defined as at least 10
mm in longest diameter for solid tumors, at least 15 mm in shortest diameter for
lymph nodes
- Patients must be willing to undergo fresh biopsies at baseline (as opposed to using
archival tissue), in the event their baseline tissue was obtained > 12 months prior
to study consent and/or they are randomized to the gamma H2AX pNBS1 multiplex IFA
assay
- Absolute neutrophil count (ANC) >= 1,500/mcL
- Platelet count >= 100,000/mcL
- Hemoglobin >= 9.0 g/dL
- Serum creatinine =< 1.5 x upper limit of normal (ULN) OR calculated serum creatinine
clearance (glomerular filtration rate [GFR] can be used in place of creatinine or
creatinine clearance) >= 60 mL/min for participants with creatinine levels > 1.5 x
institutional ULN
- Calculate serum creatinine clearance using the standard Cockcroft-Gault formula
- Serum total bilirubin =< 1.5 x ULN or direct bilirubin =< ULN for participants with
total bilirubin > 1.5 x ULN
- Patients with known Gilbert disease with serum bilirubin level =< 3 x ULN are
eligible
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])
and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =<
2.5 x ULN or =< 5.0 x ULN for patients with hepatobiliary tumors/liver metastases
- Albumin >= 2.8 g/L
- International normalized ratio (INR) or prothrombin time (PT) or activated partial
thromboplastin time (aPTT) =< 1.5 x ULN
- This applies only to patients not receiving therapeutic anticoagulation;
patients receiving therapeutic anticoagulation should be on a stable dose
- Participants must have the ability to swallow and retain oral medication and not
have any clinically significant gastrointestinal abnormalities that might alter
absorption
- Female patients of childbearing potential must have a negative urine or serum
pregnancy test within 72 hours prior to receiving the first dose of study
medication. If the urine test is positive or cannot be confirmed as negative, a
serum pregnancy test will be required. The effects of M3814 and avelumab on the
developing human fetus are unknown and there is the potential for teratogenic or
abortifacient effects. For this reason, women and men of child-bearing potential
must agree to use adequate contraception (hormonal or barrier method of birth
control; abstinence) prior to study entry, for the duration of study treatment, and
for 6 months after completion of M3814 and avelumab administration. 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. Because there
is an unknown but potential risk for adverse events in nursing infants secondary to
treatment of the mother with M3814 and avelumab, breastfeeding should be
discontinued if the mother is treated with M3814 and avelumab
- Ability to understand and the willingness to sign a written informed consent
document. Participants with impaired decision-making capacity (IDMC) who have a
close caregiver or legally authorized representative (LAR) and/or family member
available will also be eligible
Exclusion Criteria
- PHASE I: Patients who have received prior anti-CTLA-4, anti-PD-1, anti-PD-L1 or
other immune checkpoint inhibitor therapeutic antibodies or pathway-targeting agents
- PHASE II: Patients who have received prior anti-CTLA-4, anti-PD-1, anti-PD-L1 or
other immune checkpoint inhibitor therapeutic antibodies or pathway-targeting agents
with the following exceptions:
- Patients who have only received previous durvalumab (anti-PD-L1) in combination
with gemcitabine +/- cisplatin as part of first line therapy (TOPAZ-1 regimen)
are eligible
- Patients who have only received previous pembrolizumab (anti-PD-1) in
combination with gemcitabine +/- cisplatin as part of first line therapy
(KEYNOTE-966 regimen) are eligible
- Patients who have had chemotherapy, definitive radiation, biological cancer therapy,
or investigational agent/device within 21 days of first planned dose of study
therapy (within 14 days for palliative radiation). Previously irradiated lesions may
be re-irradiated provided there is disease progression in the irradiated lesion and
the prescribed radiation dosage can safely be re- administered
- Patients who have not recovered from adverse events due to prior anti-cancer therapy
(i.e., have residual toxicities > Common Terminology Criteria for Adverse Events
[CTCAE] grade 1) with the exception of alopecia
- Patients with untreated/uncontrolled central nervous system (CNS)/leptomeningeal
disease. Patients with asymptomatic, treated CNS disease are eligible if the
treating physician determines that immediate CNS specific treatment is not required
and is unlikely to be required during the first cycle of therapy and the following
criteria are met:
- Radiographic demonstration of clinical stability upon the completion of
CNS-directed therapy and no evidence of interim progression between the
completion of CNS-directed therapy and the screening radiographic study done >=
4 weeks from completion of radiotherapy and >= 2 weeks from discontinuation of
corticosteroids
- No stereotactic radiation or whole-brain radiation within 28 days prior to
randomization
- Patients with active autoimmune disease requiring systemic corticosteroids greater
than the equivalent of prednisone 10 mg daily including but not limited to: systemic
lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, colitis,
vascular thrombosis associated with antiphospholipid syndrome, Wegener's
granulomatosis, Sjogren's syndrome, Bell's palsy, Guillain-Barre syndrome, multiple
sclerosis, autoimmune thyroid disease, vasculitis, or glomerulonephritis, with the
following exceptions:
- Patients with a history of autoimmune hypothyroidism on a stable dose of
thyroid replacement hormone are eligible
- Patients with controlled type 1 diabetes mellitus on a stable insulin regimen
are eligible
- Patients with eczema, psoriasis, lichen simplex chronicus of vitiligo with
dermatologic manifestations only who require only low potency topical steroids
(e.g., hydrocortisone 2.5%, hydrocortisone butyrate 0.1%, fluocinolone 0.01%,
desonide 0.05%, alclometasone dipropionate 0.05%) are eligible
- Patients receiving treatment with systemic immunosuppressive medications (including,
but not limited to, prednisone, cyclophosphamide, azathioprine, methotrexate,
thalidomide, and anti-tumor necrosis factor [TNF] agents) within 6 weeks must
discontinue these medications prior to starting M3814 and avelumab on day 7, with
the exception of:
- Patients with active autoimmune disease managed with systemic corticosteroids
less than the equivalent of prednisone 10 mg daily
- Patients who have received acute, low dose, systemic immunosuppressant
medications (e.g., a one-time dose of dexamethasone for nausea)
- The use of inhaled corticosteroids and mineralocorticoids (e.g.,
fludrocortisone) for patients with orthostatic hypotension and adrenocortical
insufficiency
- Patients who have undergone prior solid organ or bone marrow transplant with the
exception of patients with prior renal transplant for whom dialysis may be employed
in the event of graft rejection
- Patients with uncontrolled intercurrent illness (e.g., including but not limited to
uncontrolled hypertension [HTN] [systolic blood pressure (BP) > 150, diastolic BP >
100], symptomatic congestive heart failure [CHF], unstable angina pectoris, ischemic
myocardial infarction [MI] within 6 months, cardiac arrhythmia, recent transient
ischemic attack [TIA or cerebrovascular accident (CVA)]) within 6 months
- Patients with serious active infection (e.g. requiring hospitalization and/or
intravenous [IV] antibiotics) within 4 weeks prior to starting M3814 and avelumab,
or signs/symptoms of infection or receiving oral or IV antibiotics for the treatment
of active systemic infection within 2 weeks prior to starting M3814 and avelumab.
Patients receiving prophylactic antibiotics are eligible
- Patients with known chronic hepatitis B virus (HBV) infection must have an
undetectable viral load on suppressive therapy if indicated. Patients with known
chronic hepatitis C (HCV) infection must have been treated and cured. Patients who
are currently on curative treatment are eligible if they have an undetectable HCV
viral load
- Patients with known human immunodeficiency virus (HIV) are allowed on study provided
they have:
- A stable regimen of highly active anti-retroviral therapy (HAART)
- No requirement for concurrent antibiotics or antifungal agents for the
prevention of opportunistic infection
- A CD4 count above 250 cells/mcL
- An undetectable HIV viral load on standard polymerase chain reaction
(PCR)-based testing
- Patients with history of idiopathic pulmonary fibrosis, pneumonitis (including drug
induced), organizing pneumonia (e.g., bronchiolitis obliterans, cryptogenic
organizing pneumonia), or evidence of active pneumonitis on screening chest computed
tomography (CT) scan
- Patients with known concurrent malignancy that is expected to require active
treatment within two years, or may interfere with the interpretation of the efficacy
and safety outcomes of this study in the opinion of the treating investigator.
Superficial bladder cancer, nonmelanoma skin cancers, and low-grade prostate cancer
not requiring cytotoxic therapy should not exclude participation in this trial.
Patients with chronic lymphocytic leukemia (CLL) may be enrolled if they do not
require active chemotherapy and their hematologic, renal and hepatic function meets
criteria previously mentioned
- Patients with psychiatric illness/social situations that would limit compliance with
study requirements
- History of allergic reactions attributed to compounds of similar chemical or
biologic composition to M3814 or avelumab
- Patients unable to discontinue medications or substances that are potent inhibitors,
inducers or sensitive substrates of CYP3A4/5 or CYP2C19 prior to starting M3814 and
avelumab are ineligible. Medications or substances that are strong inhibitors of
CYP3A4/5 or CYP2C19 must be discontinued at least 1 week prior to first M3814 dose.
Strong inducers of CYP3A4/5 or CYP2C19 must be stopped at least 3 weeks prior to the
first dose. Drugs mainly metabolized by CYP3A with a narrow therapeutic index as
judged by the investigator must stop at least 1 day prior to first M3814 dose.
Because the lists of these agents are constantly changing, it is important to
regularly consult a frequently-updated medical reference. As part of the
enrollment/informed consent procedures, the patient will be counseled on the risk of
interactions with other agents, and what to do if new medications need to be
prescribed or if the patient is considering a new over-the-counter medicine or
herbal product. The primary elimination mechanism of avelumab is proteolytic
degradation, thus there are no contraindicated medications with respect to avelumab
- Patients who cannot discontinue concomitant proton-pump inhibitors (PPIs) prior to
starting M3814 and avelumab. These must be discontinued >= 5 days prior to starting
M3814 and avelumab. Patients do not need to discontinue calcium carbonate. H2
blockers are allowed provided they are taken at least 2 hours after M3814 dose
- Patients receiving sorivudine or any chemically related analogues (such as
brivudine) and not able to discontinue prior to starting M3814 and avelumab are
excluded
- Pregnant and lactating women are excluded from this study because M3814 and avelumab
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 M3814 and avelumab, breastfeeding should
be discontinued if the mother is treated with M3814 and avelumab
- Patients who have received live vaccination within 30 days before starting M3814 and
avelumab
Please note that we have obtained the inclusion and exclusion criteria information from the National Institutes of Health’s clinical trials web site ClinicalTrials.gov. The listed criteria may not necessarily reflect recent amendments to the protocol and the current criteria.
For further information about clinical trials, please contact us at 732-235-7356.