The purpose of the phase 1b portion is to evaluate safety and tolerability and determine a recommended phase 2 dose for TRC105 when added to standard dose pazopanib in patients with advanced soft tissue sarcoma. Up to 30 patients will be treated. The purpose of the phase 2 portion is to estimate the PFS of patients with advanced soft tissue sarcoma by RECIST 1.1 and estimate ORR in a separate cohort of patients with angiosarcoma by RECIST 1.1. Up to 89 patients will be treated in phase 2, including two cohorts of up to 13 patients with angiosarcoma.
Pazopanib is an oral inhibitor of multiple receptor tyrosine kinases, including vascular endothelial growth factor receptor VEGFR-1, VEGFR-2, and VEGFR-3 at therapeutic plasma concentrations. These receptors are implicated in pathologic angiogenesis, tumor growth, and cancer progression. Pazopanib is approved for the treatment of advanced soft tissue sarcoma, following progression on one prior systemic therapy, based on improved progression free survival. TRC105 is an antibody to CD105, an important angiogenic target on vascular endothelial cells that is distinct from VEGFR. TRC105 inhibits angiogenesis, tumor growth and metastases in preclinical models and complements the activity of bevacizumab and multi-kinase inhibitors that target the VEGFR. In a phase 1 study of advanced solid tumors, TRC105 therapy caused a global reduction in angiogenic biomarkers and reduced tumor burden at doses that were well-tolerated. In a phase 1b study, the combination of TRC105 and bevacizumab produced radiographic reductions in tumor volume in bevacizumab-refractory patients, and was well tolerated. TRC105 potentiates bevacizumab and VEGFR tyrosine kinases (VEGFR TKI) in preclinical models. By targeting a non-VEGF pathway that is upregulated following VEGF inhibition, TRC105 has the potential to complement VEGFR TKIs and could represent a major advance in cancer therapy. Together, the use of TRC105 with pazopanib may result in more effective angiogenesis inhibition and improved clinical efficacy over that seen with pazopanib alone.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
111
Weekly TRC105 in combination with standard dose Pazopanib.
University of Alabama at Birmingham
Birmingham, Alabama, United States
Sarcoma Oncology Center
Santa Monica, California, United States
Mayo Clinic Jacksonville
Jacksonville, Florida, United States
Mayo Clinic Rochester
Rochester, Minnesota, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Mount Sinai School of Medicine-Tisch Cancer Institute
New York, New York, United States
Duke University
Durham, North Carolina, United States
Mary Crowley Cancer Research Center
Dallas, Texas, United States
University of Utah
Salt Lake City, Utah, United States
Number of Participants With Dose Limiting Toxicity (DLT)
For DLT evaluation, severity (grade) was classified according to common terminology criteria for adverse events version 4.0 (CTCAE v4.0). DLTs were defined as grade 4 neutropenia persisting for ≥ 5 days, febrile neutropenia (grade 4 neutropenia with fever \> 38.5 ºC both sustained over a 24 hour period), neutropenic infection (grade ≥ 3 neutropenia with grade ≥ 3 infection), anemia ≥ grade 4, grade \> 4 thrombocytopenia or grade ≥ 3 thrombocytopenia and grade ≥ 3 hemorrhage, or grade 3 or 4 nonhematologic toxicity with the following exceptions: nausea, vomiting, or diarrhea for \<48 hours, asymptomatic electrolyte abnormalities that are corrected to grade 1 or better in \< 72 hours, or headache lasting less than 48 hours.
Time frame: 56 days
Progression Free Survival of Patients With Advanced Soft Tissue Sarcoma (Phase 1 and 2)
Number of patients with progression free survival, as defined as time from screening to either first disease progression or death from any cause per RECIST version 1.1
Time frame: from screening to either disease progression or death
Objective Response Rate in a Cohort of Patients With Angiosarcoma
The best response according to RECIST 1.1 for each patient in the phase 2 angiosarcoma cohort with measurable disease and who received at least one dose of study drug will be listed by cohort and tumor type
Time frame: 1.5 years
Trough Concentrations of TRC105 (Phase 2)
Trough serum TRC105 concentrations will be measured using validated ELISA methods.
Time frame: 4, 6, 8, and 10 weeks
Number of Patients With and Without Development of Immunogenicity Antibodies (Phase 1 and 2)
Anti-product antibody concentrations will be measured using validated ELISA methods. Anti-product antibody concentrations will be evaluated in the context of pharmacokinetic parameters and AE profiles.
Time frame: 32 months
Number of Patients With and Without Expression of Endoglin on Sarcoma Tissue (Phase 1 and 2)
Expression will be determined by immunohistochemistry for each patient who received at least one dose of TRC105
Time frame: 12 months
Objective Response Rate in Patients With Advanced Soft Tissue Sarcoma by RECIST 1.1
The best response (CR, PR, SD or PD according to RECIST 1.1) for each patient (phase 1 and phase 2) with measurable disease who received at least one dose of TRC105 study drug
Time frame: 12 months
Progression Free Survival in a Cohort of Patients With Angiosarcoma (Phase 2)
Time from screening to either first disease progression or death from any cause per RECIST version 1.1
Time frame: 26 months
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