Sym021 in Combination With Either Sym022 or Sym023 or Sym023 and Irinotecan in Patients With Recurrent Advanced Selected Solid Tumor Malignancies

Brief Summary
The study will evaluate the preliminary efficacy of 3 combinations (Sym021+Sym022, Sym021+Sym023 and Sym021+Sym023+irinotecan) in patients with biliary tract carcinomas (BTC) and with esophageal squamous cell carcinoma (ESCC) by assessing overall response rates (ORRs) per Investigator assessment using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 The study will also evaluate the safety and tolerability profile of the 3 combinations
Brief Title
Sym021 in Combination With Either Sym022 or Sym023 or Sym023 and Irinotecan in Patients With Recurrent Advanced Selected Solid Tumor Malignancies
Detailed Description
The study will evaluate safety and efficacy in patients with:

* Biliary tract carcinomas patients who have progressed on one prior line of gemcitabine and platinum-based chemotherapy in the metastatic setting.
* Esophageal squamous cell carcinoma patients who have progressed on one prior line of platinum-based chemotherapy in the metastatic setting.

The trial is set up as 3 sub-studies.

* Sub-study 1 includes biliary tract carcinoma patients and is composed of 2 investigational combination treatment arms (Sym021+Sym022 \[Arm A\] and Sym021+Sym023 \[Arm B\]).
* Sub-study 2, includes biliary tract carcinoma patients and is composed of one investigational combination treatment arm:Sym021+Sym023+irinotecan. A safety lead- in phase is included to assess tolerability of the combination. A Study Safety Team will review clinical and laboratory safety data and will make decisions regarding the continued enrollment after the safety lead-in phase.
* Sub-Study 3, includes esophageal squamous cell carcinoma patients and is composed of one investigational combination treatment arm: Sym021+Sym023+irinotecan. Dose of irinotecan in this arm will be selected based upon the safety lead in in sub-study 2 period.

August 2021 : Based upon results from a recent per protocol Interim Analysis (IA) it is has been decided as of 3rd of August 2021 to stop further enrollment into Sub-study 1 Arm A (Sym021+Sym022). Future patients will be allocated to either Sub-study 1 Arm B (Sym021+Sym023) or Sub-study 2 (Sym021+Sym023+irinotecan).
Completion Date
Completion Date Type
Actual
Conditions
Metastatic Cancer
Solid Tumor
Eligibility Criteria
Inclusion Criteria:

For Sub-study 1 and 2:

* Patients with locally advanced or metastatic biliary tract carcinoma including adenocarcinoma of the intra- and/or extra-hepatic bile ducts and gallbladder carcinoma. Patients with ampullary cancers are excluded.
* Patients must only have received and progressed on or be intolerant of first-line gemcitabine and platinum-based chemotherapy in metastatic/advanced setting and should not have received prior anti-PD-(L)1 therapy. Patients with known fibroblast growth factor receptor 2 (FGFR2) fusion or rearrangement, or isocitrate dehydrogenase 1 (IDH1) mutation will be excluded. Prior anti-PD-(L)1 therapy may be allowed during the trial if regulatory approval for such therapy is obtained while this trial is enrolling.

For Sub-study 3:

* Patients with with locally advanced or metastatic esophageal squamous cell carcinoma
* Patients must only have received and progressed on or be intolerant of first-line platinum-based chemotherapy in metastatic/advanced setting and should have received prior anti-PD-(L)1 therapy. Patients with mixed adenosquamous histology cancers are excluded.

For all Sub-studies :

* Patients with measurable disease according to RECIST v1.1
* Patients with an ECOG PS of 0 or 1, and anticipated life expectancy of ≥3 months
* Patients must have adequate organ function as indicated by laboratory values
* Adequate contraception required as appropriate

Exclusion Criteria:

* Patients with central nervous system (CNS) malignancy, untreated or unstable metastases
* Patients with significant cardiovascular disease
* Patients with

1. Active thrombosis, or a history of deep vein thrombosis or pulmonary embolism, within 4 weeks prior to the first study drug dose
2. Active uncontrolled bleeding or a known bleeding diathesis
* Patients with a significant pulmonary disease or condition
* Patients with a current or recent (within 6 months) significant gastrointestinal disease or condition
* Patients with Gilbert's syndrome or patients with UGT1A1\*28 homozygosity (also known as UGT1A1 7/7 genotype)
* Patients with a significant ocular disease or condition
* Patients with an active, known or suspected autoimmune disease
* Patients with any other serious/active/uncontrolled infection
* Patients with a history of organ transplantation
* Patients with human immunodeficiency virus (HIV) (HIV 1/2 antibodies) or active infection with hepatitis B virus or hepatitis C virus
* Prior therapy with irinotecan
* For Sub-study 1 and Sub-study 2: Anti-PD-(L)1, anti -LAG-3\* or anti-TIM-3 containing regimen, or combination with any other systemic or localized therapy or any other immuno-oncology (IO) therapies.
* For Sub-study 3: Anti-TIM-3 containing regimen, or combination with any other systemic or localized therapy or any other IO therapies (other than anti-PD-(L)1 agents).
* Patients must not be on warfarin, if they have a history of acute immune-related thrombocytopenia; patients must not be on strong cytochrome P450 (CYP) 3A4 inducers, strong CYP3A4 inhibitors, or strong UGT1A1 inhibitors.
* Patients with a known or suspected hypersensitivity to any of the excipients of formulated study drug
* Patients with unresolved \>Grade 1 toxicity associated with any prior antineoplastic therapy
* Sub-study 1 and Sub-study 2: Patients with known FGFR2 fusion or rearrangement, or IDH1 mutation.
* For Sub-study 3: Patients with a history of significant toxicities associated with previous administration of immune checkpoint inhibitors that necessitated permanent discontinuation of that therapy.
Inclusion Criteria
Inclusion Criteria:

For Sub-study 1 and 2:

* Patients with locally advanced or metastatic biliary tract carcinoma including adenocarcinoma of the intra- and/or extra-hepatic bile ducts and gallbladder carcinoma. Patients with ampullary cancers are excluded.
* Patients must only have received and progressed on or be intolerant of first-line gemcitabine and platinum-based chemotherapy in metastatic/advanced setting and should not have received prior anti-PD-(L)1 therapy. Patients with known fibroblast growth factor receptor 2 (FGFR2) fusion or rearrangement, or isocitrate dehydrogenase 1 (IDH1) mutation will be excluded. Prior anti-PD-(L)1 therapy may be allowed during the trial if regulatory approval for such therapy is obtained while this trial is enrolling.

For Sub-study 3:

* Patients with with locally advanced or metastatic esophageal squamous cell carcinoma
* Patients must only have received and progressed on or be intolerant of first-line platinum-based chemotherapy in metastatic/advanced setting and should have received prior anti-PD-(L)1 therapy. Patients with mixed adenosquamous histology cancers are excluded.

For all Sub-studies :

* Patients with measurable disease according to RECIST v1.1
* Patients with an ECOG PS of 0 or 1, and anticipated life expectancy of ≥3 months
* Patients must have adequate organ function as indicated by laboratory values
* Adequate contraception required as appropriate

Gender
All
Gender Based
false
Keywords
Locally advanced/unresectable
Metastatic solid tumor
Anti-PD-1
PD-1
PD1
Anti-TIM-3
TIM-3
TIM3
Cholangiocarcinoma
CCA
Biliary Tract Carcinomas
Gallbladder
Esophageal Squamous Cell Carcinoma
ESCC
Irinotecan
Healthy Volunteers
No
Last Update Submit Date
Minimum Age
18 Years
NCT Id
NCT04641871
Org Class
Industry
Org Full Name
Symphogen A/S
Org Study Id
Sym021-02
Overall Status
Completed
Phases
Phase 1
Primary Completion Date
Primary Completion Date Type
Actual
Official Title
An Exploratory, Open-label, Multicenter Phase 1b Trial to Evaluate Safety and Efficacy of Sym021 (Anti-PD 1) in Combination With Either Sym022 (Anti-LAG-3) or Sym023 (Anti-TIM-3) or Sym023 and Irinotecan in Patients With Recurrent Advanced Selected Solid Tumor Malignancies
Primary Outcomes
Outcome Description
Objective Response Rate (ORR) per Investigator assessment of antitumor activity (based on radiological evidence per RECIST v1.1)
Outcome Measure
To evaluate the preliminary efficacy of the combinations Sym021+Sym022, Sym021+Sym023 and Sym021+Sym023+irinotecan in patients with BTC or ESCC by assessing overall response rates (ORRs) per Investigator assessment using RECISTv.1.1
Outcome Time Frame
Until disease progression or end of study, whichever comes first, assessed up to 24 months
Outcome Description
Calculation of AE incidence will be based on the number of patients per AE category; AEs in total and sorted by frequency, AEs by relationship, SAEs in total and by relationship, Immune mediated AEs, Fatal AEs
Outcome Measure
To evaluate the incidence, severity, and relationship of (S)AEs collected from administration of the first dose of study drug until 30 days after the last dose of the 3 combinations (Sym021+Sym022, Sym021+Sym023 and Sym021+Sym023+irrinotecan)
Outcome Time Frame
Through study completion up to 30 days after last dose of the three combinations
Outcome Description
Calculation of AE incidence will be based on the number of patients per AE category ; AEs leading to dose interruption, dose delays, and permanent treatment stop
Outcome Measure
To evaluate the AEs leading to dose interruption, dose delays, and permanent treatment stop of the 3 combinations (Sym021+Sym022 and Sym021+Sym023 and Sym021+Sym023 +irinotecan)
Outcome Time Frame
Through study completion up to a maximum of 24 months
Secondary Outcomes
Outcome Description
Peak serum concentration (Cmax) for each mAbs in each combination.
Outcome Time Frame
First study dose and throughout the trial, up to 2 years
Outcome Measure
Peak plasma (irinotecan) and serum( mAbs) Concentration (Cmax) of the 3 combinations (Sym021+Sym022 and Sym021+Sym023 and Sym021+Sym023+irinotecan)
Outcome Description
Area under the serum concentration versus time curve (AUC) for each mAbs in each combination.
Outcome Time Frame
First dose of study drug and throughout the trial, up to 2 years
Outcome Measure
Area under the serum concentration versus time curve (AUC) of the 3 combinations (Sym021+Sym022 and Sym021+Sym023 and Sym021+Sym023+ irinotecan)
Outcome Description
Time to reach maximum concentration (Tmax) for each mAbs in each combination.
Outcome Time Frame
First dose of study drug and throughout the trial, up to 2 years
Outcome Measure
Time to reach maximum concentration (Tmax) of the 3 combinations (Sym021+Sym022 and Sym021+Sym023 and Sym021+Sym023+irinotecan)
Outcome Description
Trough concentration (Ctrough) for each mAbs in each combination.
Outcome Time Frame
First dose of study drug and throughout the trial, up to 2 years
Outcome Measure
Trough concentration (Ctrough) of the 3 combinations (Sym021+Sym022 and Sym021+Sym023 and Sym021+Sym023 + irinotecan)
Outcome Description
Plasma concentration at the end of infusion for irinotecan and its metabolite in the combination Sym021+Sym023+ Irinotecan
Outcome Time Frame
First dose of study drug and throughout the trial, up to 2 years
Outcome Measure
Plasma concentration for irinotecan and its metabolite in the combination Sym021+Sym023+ Irinotecan
Outcome Description
Confirmation of the RP2D, based on the dose-response relationship (in case more than one dose level is implemented), overall tolerability and safety profile, and the PK and pharmacodynamic data
Outcome Time Frame
36 month
Outcome Measure
To confirm the RP2D of each combination
Outcome Description
Duration of the OR will be determined from the day initial response is observed to day of progression is observed. Number and percentages of patients with documented OR will be presented.
Outcome Time Frame
Until disease progression or end of study, whichever comes first, assessed up to 24 months
Outcome Measure
Evaluation of Duration of Response (DOR)
Outcome Description
Will be calculated as from the first study drug dose to the day progression of disease is confirmed radiological or date of death.
Outcome Time Frame
From first study drug dose until disease progression or end of study, whichever comes first, assessed up to 24 months
Outcome Measure
Evaluation of Progression-Free Survival (PFS)
Outcome Description
Will be calculated according to standard response criteria
Outcome Time Frame
Until disease progression or end of study, whichever comes first, assessed up to 6 months
Outcome Measure
Evaluation of Disease Control Rate (DCR), defined as CR, PR, or stable disease (SD) ≥6 months
Outcome Description
Will be calculated from the day the initial response is observed to the day progression of disease is observed
Outcome Time Frame
Until disease progression or end of study, whichever comes first, assessed up to 24 months
Outcome Measure
Evaluation of duration of response.
Outcome Description
Will be based on Investigators assessment on Immunotherapeutic Response Evaluation Criteria in Solid Tumors (iRECIST)
Outcome Time Frame
Until disease progression or end of study, whichever comes first, assessed up to 24 months
Outcome Measure
Evaluation of Objective Response Rate (ORR) per Investigator assessment (based on Immunotherapeutics Response Evaluation Criteria in Solid Tumors [iRECIST])
Outcome Description
Overall survival will be derived from start of treatment until death or latest survival follow-up.
Outcome Time Frame
From first dose of study drug until death or latest survival follow-up assessed up to 30 month
Outcome Measure
Evaluation Overall Survival (OS)
Outcome Description
Occurrence of antidrug antibody (ADA) measured in serum at selected time points during the study
Outcome Time Frame
From screening up to 30 months
Outcome Measure
Evaluation of immunogenicity of each antibody drug in the combinations
Start Date
Start Date Type
Actual
Status Verified Date
First Submit Date
First Submit QC Date
Std Ages
Adult
Older Adult
Maximum Age Number (converted to Years and rounded down)
999
Minimum Age Number (converted to Years and rounded down)
18
Investigators
Investigator Type
Principal Investigator
Investigator Name
Eric Feldman
Investigator Email
efeldman@montefiore.org
Categories Mesh Debug
Cancer --- NEOPLASMS
Endocrine System Cancers --- ADENOCARCINOMA
Cancer --- CARCINOMA
Lung & Chest Cancers --- NEOPLASMS, GLANDULAR AND EPITHELIAL
Gastrointestinal (GI) Cancers --- GASTROINTESTINAL NEOPLASMS
Gastrointestinal (GI) Cancers --- DIGESTIVE SYSTEM NEOPLASMS
Cancer --- NEOPLASMS BY SITE
Endocrine System Cancers --- HEAD AND NECK NEOPLASMS
Gastrointestinal (GI) Cancers --- DIGESTIVE SYSTEM DISEASES
Digestive System --- DIGESTIVE SYSTEM DISEASES
Liver --- DIGESTIVE SYSTEM DISEASES
Gastrointestinal (GI) Cancers --- GASTROINTESTINAL DISEASES
Digestive System --- GASTROINTESTINAL DISEASES
MeSH Terms
NEOPLASM METASTASIS
CHOLANGIOCARCINOMA
ESOPHAGEAL SQUAMOUS CELL CARCINOMA
NEOPLASTIC PROCESSES
NEOPLASMS
PATHOLOGIC PROCESSES
PATHOLOGICAL CONDITIONS, SIGNS AND SYMPTOMS
ADENOCARCINOMA
CARCINOMA
NEOPLASMS, GLANDULAR AND EPITHELIAL
NEOPLASMS BY HISTOLOGIC TYPE
CARCINOMA, SQUAMOUS CELL
NEOPLASMS, SQUAMOUS CELL
ESOPHAGEAL NEOPLASMS
GASTROINTESTINAL NEOPLASMS
DIGESTIVE SYSTEM NEOPLASMS
NEOPLASMS BY SITE
HEAD AND NECK NEOPLASMS
DIGESTIVE SYSTEM DISEASES
ESOPHAGEAL DISEASES
GASTROINTESTINAL DISEASES
SPARTALIZUMAB
IRINOTECAN
CAMPTOTHECIN
ALKALOIDS
HETEROCYCLIC COMPOUNDS