A Phase 1 Study of RGX-104, a Small Molecule LXR Agonist, as a Single Agent and as Combination Therapy in Patients with Advanced Solid Malignancies and Lymphoma with an Expansion in Select Malignancies.
Primary Objectives
The primary objective during the dose escalation stage is to identify the maximum tolerated dose (MTD), or the maximum tested dose at which multiple dose-limiting toxicities (DLTs) are not observed, of RGX-104 as a single agent, and separately, in combination with nivolumab, ipilimumab, docetaxel, or pembrolizumab plus carboplatin/pemetrexed.
The primary objectives during the expansion stage are the following:
1. The primary efficacy objective is to estimate the antitumor activity of RGX-104 as a single agent in patients with previously treated advanced or metastatic epithelial ovarian carcinoma (EOC); in combination with docetaxel in patients with small cell lung cancer (SCLC)/high-grade neuroendocrine tumors (HG-NET) or non-small cell lung cancer (NSCLC); and in combination with pembrolizumab plus carboplatin/pemetrexed in patients with NSCLC.
2. The primary safety objective is to characterize the safety profile of RGX-104 at the MTD or maximum tested dose as a single agent, and separately, in combination with nivolumab, ipilimumab, docetaxel, or pembrolizumab plus carboplatin/pemetrexed.
Secondary Objectives:
The secondary objectives are to evaluate the pharmacokinetic (PK) profile of RGX-104 and its metabolites in plasma and urine.
PEMETREXED
Pembrolizumab (MK-3475)
CARBOPLATIN
Pembrolizumab(MK-3475)
RGX-104
IPILIMUMAB (MDX-010)
Chemotherapy multiple agents systemic
- Rutgers Cancer Institute of New Jersey
Inclusion Criteria
1. The patient must have histologic or cytologic evidence of a malignant solid tumor or
lymphoma (any histology) and must have advanced disease, defined as cancer that is
either metastatic or locally advanced and unresectable (and for which additional
radiation therapy or other locoregional therapies are not considered feasible).
2. With the exception of dose escalation with pembrolizumab plus carboplatin/pemetrexed,
patients enrolled in the dose escalation stages must have disease that is resistant to
or relapsed following available standard systemic therapy, or for which there is no
standard systemic therapy or reasonable therapy in the physician's judgment likely to
result in clinical benefit or if such therapy has been refused by the patient.
Documentation of the reason must be provided for patients who have not received a
standard therapy likely to result in clinical benefit.
3. Patients enrolled in the expansion stages: Optional tumor biopsy may be obtained
during the screening period and toward the beginning of Cycle 2 or at the time of PD,
if earlier. If a biopsy is deemed by the investigator to not be in the patient's best
interest, prior approval must be obtained from the Medical Monitor to waive this
requirement.
4. The patient must have disease that is measurable by standard imaging techniques per
RECIST or immune-related response criteria (irRC; all tumor types except lymphoma) or
International Working Group (IWG) revised response criteria for malignant lymphoma
(lymphoma only). For patients with prior radiation therapy, measurable lesions must be
outside of any prior radiation field(s), unless disease progression has been
documented at that disease site subsequent to radiation.
5. The patient is ≥18 years old.
6. The patient has an ECOG PS of ≤1.
7. The patient has adequate baseline organ function, as demonstrated by the following:
- Serum creatinine ≤1.5 × institutional upper limit of normal (ULN) or calculated
creatinine clearance >30 mL/min (>45 ml/min for patients receiving
carboplatin/pemetrexed).
- Serum albumin ≥2.5 g/dl;
- Bilirubin ≤1.5 × institutional ULN.
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 ×
institutional ULN. Patients enrolled in an expansion stage may have ALT and AST <
5 × institutional ULN if the patient has hepatic metastases;
- For patients not taking warfarin or other oral anticoagulants: international
normalized ratio (INR) ≤1.5 or prothrombin time (PT) ≤1.5 × ULN; and either
partial thromboplastin time or activated partial thromboplastin time (PTT or
aPTT) ≤1.5 × ULN. Patients taking warfarin should be on a stable dose that
results in a stable INR <3.5. Among patients receiving other oral anticoagulant
therapy, PT or aPTT must be within the intended therapeutic range of the
anticoagulant.
8. The patient has adequate baseline hematologic function, as demonstrated by the
following:
- Absolute neutrophil count (ANC) ≥1.5×109/L;
- Hemoglobin ≥8 g/dL and no red blood cell (RBC) transfusions during the prior 14
days;
- Platelet count ≥100×109/L and no platelet transfusions during the prior 14 days.
9. The patient has a normal left ventricular ejection fraction (LVEF) per institutional
criteria as determined by either echocardiography (ECHO) or multigated acquisition
(MUGA) scanning.
10. If the patient is a woman of child-bearing potential (WOCBP), she has had a negative
serum or urine pregnancy test within 2 weeks prior to treatment.
11. The patient (men and WOCBP) agrees to use acceptable contraceptive methods for the
duration of time on the study, and continue to use acceptable contraceptive methods
for 1 month after the last dose of study therapy. Patients receiving combination
therapy must agree to use acceptable contraceptive methods for the duration of time on
the study and continue to use acceptable contraceptive methods for 6 months after the
last dose of study therapy.
12. The patient has signed informed consent prior to initiation of any study-specific
procedures or treatment.
13. The patient is able to adhere to the study visit schedule and other protocol
requirements, including follow-up for survival assessment.
14. Tumor tissue (a minimum of 10 and up to 15 unstained slides, or paraffin block,
ideally from the patient's most recent biopsy, must be made available prior to the
first dose of study therapy.
15. For patients with endometrial cancer enrolled in the ipilimumab combination expansion
stage:
- The patient has Stage III, Stage IV, or recurrent, histologically-confirmed
endometrial carcinoma with disease that is measurable per RECIST 1.1.
- The patient may have received up to THREE lines of prior therapy:
Prior systemic platinum-based adjuvant and/or neoadjuvant chemotherapy counts as one
prior line of therapy.
A prior systemic therapy for advanced or recurrent disease counts as one prior line of
therapy (if not given in the adjuvant or neoadjuvant setting).
A prior checkpoint inhibitor therapy (anti PD-1/PD-L1) with or without an angiogenesis
inhibitor counts as one prior line of therapy.
Prior hormone and radiation therapy is not counted as prior therapies. The patient has
either archival tumor tissue sample available (preferable) or in the absence has
documented determination of mismatch repair (MMR) status.
- The patient may not have received treatment with immune checkpoint inhibitors
(e.g., products that target PD-L1, PD-1, or CTLA-4).
- The patient must not have required a paracentesis within the preceding 4 weeks
nor be projected to require a paracentesis within the next 8 weeks.
16. For patients with NSCLC enrolled in the pembrolizumab plus carboplatin/pemetrexed
combination dose escalation or expansion stages:
- The patient must have histologic or cytologic evidence of newly-diagnosed
non-squamous, NSCLC that is advanced disease, defined as cancer that is either
metastatic (Stage 4) or locally advanced (Stage 3B) and unresectable.
- The patient has confirmation that epidermal growth factor receptor (EGFR) or
anaplastic lymphoma kinase (ALK)-directed therapy is not indicated.
- The patient has not received prior systemic treatment for their
advanced/metastatic disease.
- For patients in the expansion stage only: the patient's tumor block must
demonstrate PD-L1 expression TPS <1% as determined with a validated assay.
- The patient must have adequate organ function and performance status eligible for
treatment with a platinum-based regimen and checkpoint inhibitor.
Exclusion Criteria
1. The patient has persistent clinically significant toxicities (Grade ≥2) from previous
anticancer therapy (excluding Grade 2 chemotherapy-related neuropathy and alopecia
which are permitted). Prior toxicities that resulted in laboratory abnormalities
should have resolved to Grade ≤1, unless a higher-grade abnormality is allowed by the
inclusion criteria. If medical therapy is required for the treatment of a laboratory
abnormality, the dose and laboratory value(s) should be stable.
2. If considered for combination therapy with nivolumab or ipilimumab, the patient has:
- Uncontrolled clinically significant pulmonary disease.
- A history of any grade immune-related ocular event.
- A history of Grade ≥3 immune-related adverse event regardless of offending agent.
- Active autoimmune disease that required systemic treatment in the past. Patients
who have not required systemic treatment for at least two years may be enrolled
if permission is provided after discussion with the Medical Monitor (replacement
therapy, e.g., thyroxine, insulin, or physiologic corticosteroid replacement
therapy for adrenal or pituitary insufficiency, is not considered a form of
systemic treatment, and is allowed).
- Evidence of active noninfectious pneumonitis or history of interstitial lung
disease.
- A risk of reactivation of hepatitis B or C.
- Previously received an immune therapy that was discontinued due to immune-related
AEs, regardless of grade.
- Uncontrolled endocrine disorder. Patients who are on endocrine replacement
therapy must be on a stable dose.
3. The patient has received treatment with chemotherapy, external-beam radiation, or
other systemic anticancer therapy within 14 days prior to study therapy administration
(42 days for prior nitrosourea or mitomycin-C; patients with advanced prostate cancer
who are receiving luteinizing hormone releasing hormone (LHRH) agonists are permitted
onto the study and should continue use of these agents during study treatment).
4. The patient has received treatment with an investigational systemic anticancer agent
within 14 days prior to study therapy administration.
5. The patient has previously received treatment with RGX-104 or another investigational
agent that is a known LXR agonist.
6. The patient has an additional active malignancy that may confound the assessment of
the study endpoints. Patients with a past cancer history with substantial potential
for recurrence must be discussed with the Medical Monitor before study entry. Patients
with the following concomitant neoplastic diagnoses are eligible: non-melanoma skin
cancer, carcinoma in situ (including transitional cell carcinoma, cervical
intraepithelial neoplasia, and melanoma in situ), organ-confined prostate cancer with
no evidence of progressive disease.
7. The patient has clinically significant cardiovascular disease (e.g., uncontrolled or
any New York Heart Association Class 3 or 4 heart failure (see Appendix 1),
uncontrolled angina, history of myocardial infarction, unstable angina or stroke
within 6 months prior to study entry, uncontrolled hypertension or clinically
significant arrhythmias not controlled by medication).
8. The patient has uncontrolled, clinically significant pulmonary disease (e.g., chronic
obstructive pulmonary disease, pulmonary hypertension) that in the opinion of the
Investigator would put the patient at significant risk for pulmonary complications
during the study.
9. The patient has known active or suspected brain or leptomeningeal metastases. Central
Nervous System (CNS) imaging is not required prior to study entry unless there is a
clinical suspicion of CNS involvement. Patients with stable, treated brain metastases
are eligible provided there is no evidence of CNS disease growth on imaging for at
least 8 weeks following radiation therapy or other locoregional ablative therapy to
the CNS.
10. The patient has a condition requiring systemic treatment with either corticosteroids
(> 10 mg daily prednisone equivalents) or other immunosuppressive medications within
14 days prior to study therapy administration. Inhaled or topical steroids are
permitted in the absence of active autoimmune disease.
11. The patient has uncontrolled intercurrent illness including, but not limited to,
uncontrolled infection requiring therapy, disseminated intravascular coagulation, or
psychiatric illness/social situations that would limit compliance with study
requirements.
12. The patient is pregnant or breast feeding.
13. The patient has known positive status for human immunodeficiency virus or active or
chronic Hepatitis B or Hepatitis C.
14. The patient is oxygen-dependent.
15. The patient has a history of pancreatitis.
16. The patient has Grade ≥2 hypercholesterolemia (total cholesterol >300 mg/dL or >7.75
mmol/L) and/or hypertriglyceridemia (triglyceride >300 mg/dL or >3.42 mmol/L) in the
fasting state.
17. QTcF >450 msec (males) or >470 msec (females).
18. The patient has a physical abnormality or medical condition that limits swallowing
multiple pills, or has a history of non-adherence to oral therapies.
19. The patient requires statin (e.g., rosuvastatin, atorvastatin, etc.) therapy. If the
patient is taking a statin but discontinuation is considered appropriate, the statin
must be discontinued at least 5 days prior to starting study therapy.
20. The patient requires treatment with a medication that is a strong inhibitor of CYP3A4
(boceprevir, clarithromycin, conivaptan, grapefruit juice, indinavir, itraconazole,
ketoconazole, lopinavir/ritonavir, mibefradil, nefazodone, nelfinavir, posaconazole,
ritonavir, saquinavir, telaprevir, telithromycin, or voriconazole).
21. For the docetaxel escalation stage, patients with NSCLC with alkaline phosphatase >
2.5 × institutional ULN and AST or ALT > 1.5 × institutional ULN.
22. For patients with NSCLC enrolled in the pembrolizumab plus carboplatin/pemetrexed
combination dose escalation or expansion stages:
- The patient received radiation therapy to the lung that is >30 Gray (Gy) within 6
months of the first dose of study medication
- The patient completed palliative radiotherapy ≤7 days of the first dose of study
medication
- The patient has received live-virus vaccination ≤30 days of planned start of
study medication
- The patient has clinically active diverticulitis, intra-abdominal abscess,
gastrointestinal obstruction, peritoneal carcinomatosis
- The patient is expected to require any other form of antineoplastic therapy while
on study.
- The patient has known hypersensitivity to another monoclonal antibody (mAb)
- The patient has known sensitivity to any component of carboplatin or pemetrexed
- The patient is unable to interrupt aspirin or other nonsteroidal
anti-inflammatory drugs (NSAIDs), other than an aspirin dose ≤1.3 g per day, for
a 5-day period (8-day period for long-acting agents, such as piroxicam)
- The patient is unable or unwilling to take folic acid or vitamin B12
supplementation
23. The patient has clinical or laboratory evidence of a paraneoplastic syndrome.
24. The patient has experienced weight loss of >10% of their body weight over the
preceding 3 months.
25. The patient has any medical condition which, in the opinion of the Investigator,
places the patient at an unacceptably high risk for toxicities.
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.