The purpose of the study is to test different doses of X4P-001 given alone and in combination with axitinib in participants diagnosed with advanced renal cell carcinoma. The goals of the study are to determine the safety and tolerability of X4P-001, as well as the potential effect it may have on the body and the cancer tumor.
X4P-001 is an orally bioavailable C-X-C chemokine receptor type 4 (CXCR4) antagonist that has demonstrated activity in various tumor models. CXCR4 is the receptor for C-X-C chemokine ligand type 12 (CXCL12). CXCL12 has potent chemotactic activity for lymphocytes and myeloid-derived suppressor cells (MDSCs), and is important in homing of hematopoietic stem cells to the bone marrow. CXCR4 is also expressed and active on multiple types of human cancers, including clear cell Renal Cell Carcinoma (ccRCC), ovarian cancer, and melanoma, and increased expression of CXCR4 on tumor cells has been associated with significantly decreased overall participant survival. Multiple observations implicate the CXCL12/CXCR4 axis in contributing to the lack (or loss) of tumor responsiveness to angiogenesis inhibitors (also referred to as "angiogenic escape"). In animal cancer models, interference with CXCR4 function has been demonstrated to disrupt the tumor microenvironment and unmask the tumor to immune attack by multiple mechanisms, including: * Eliminating tumor re-vascularization * Decreasing the infiltration of MDSCs * Increasing the ratio of cluster of differentiation 8+ (CD8+) T cells to T regulatory (Treg) cells The hypothesis and evidence of published data support is that effective CXCR4 antagonism by X4P-001 would be of potential benefit in participants with advanced ccRCC and other cancers by multiple mechanisms: * Decreased recruitment of MDSCs, resulting in increased anti-tumor immune attack * Sustained decrease in neoangiogenesis and tumor vascular supply * Interference with the autocrine effect of increased expression by ccRCC of both CXCR4 and CXCL12, its only ligand, thereby, potentially reducing cancer cell metastasis This initial clinical trial in participants with advanced ccRCC will evaluate X4P-001 both as a single agent (monotherapy) and also in combination with axitinib, a small molecule tyrosine kinase inhibitor (TKI) approved for second-line treatment of participants with ccRCC. This combination has the potential to further improve outcomes by reducing the angiogenic escape that typically occurs with TKI therapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
74
Unnamed facility
Scottsdale, Arizona, United States
Unnamed facility
Washington D.C., District of Columbia, United States
Parts A, B, and C: Number of Participants With Treatment-emergent Adverse Events (TEAEs)
An AE was as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. An SAE was an AE that met at least 1 of the following criteria: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization for the AE, persistent or significant disability/incapacity or substantial disruption of the ability to conduct normal life functions, congenital anomaly/birth defect (in the child of a participant who was exposed to the study drug), important medical event or reaction. Adverse events with onset after administration of the first dose of study drug up to 10 days after last dosing date were considered TEAEs. A summary of all Serious Adverse Events and Other Adverse Events (nonserious) regardless of causality is located in the 'Reported Adverse Events' Section.
Time frame: From first dose of study drug up to 10 days after last dosing (maximum exposure: 52.1 months)
Parts A and B: Objective Response Rate (ORR), as Assessed Using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1
The ORR was defined as percentage of participants with best overall response of complete response (CR) or partial response (PR). CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 millimeters (mm). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: From administration of first dose of study medication until disease progression, study completion or early termination (up to 80 weeks)
Parts A and B: Time to Objective Response, as Assessed Using RECIST v1.1
Time to objective response was defined as time from first administration of combination regimen to first CR or PR whichever came first. CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
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Unnamed facility
Jacksonville, Florida, United States
Unnamed facility
Chicago, Illinois, United States
Unnamed facility
Indianapolis, Indiana, United States
Unnamed facility
Iowa City, Iowa, United States
Unnamed facility
New Orleans, Louisiana, United States
Unnamed facility
Boston, Massachusetts, United States
Unnamed facility
Detroit, Michigan, United States
Unnamed facility
Saint Paul, Minnesota, United States
...and 10 more locations
Time frame: From administration of first dose of study medication until first appearance of CR or PR (up to 80 weeks)
Parts A and B: Duration of Objective Response (DOR), as Assessed Using RECIST v1.1
The DOR was defined as the time from first CR or PR whichever came first until the time of disease progression or death by any cause. CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Disease progression: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. Unequivocal progression of existing non-target lesions. The appearance of 1 or more new lesions was also considered progression.
Time frame: Time from first CR or PR until the time of disease progression or death due to any cause (up to 80 weeks)
Parts A and B: Disease Control Rate (DCR), as Assessed Using RECIST v1.1
The DCR was defined as the percentage of participants with best overall response of CR, PR or stable disease (SD). CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), taking as reference the smallest sum diameters while on study. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. Unequivocal progression of existing non-target lesions. The appearance of 1 or more new lesions was also considered progression.
Time frame: From administration of first dose of study medication until disease progression, study completion or early termination (up to 80 weeks)
Parts A and B: Time to Progression (TTP), as Assessed Using RECIST v1.1
The TTP was defined as the time from first administration of combination regimen until PD. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. Unequivocal progression of existing non-target lesions or the appearance of 1 or more new lesions was also considered progression.
Time frame: From administration of first dose of study medication until disease progression (up to 80 weeks)
Parts A and B: Progression Free Survival (PFS), as Assessed Using RECIST v1.1
The PFS was defined as the time from first administration of combination regimen until disease progression or death from any cause. Disease progression: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. An unequivocal progression of existing non-target lesions or the appearance of 1 or more new lesions was also considered progression.
Time frame: From administration of first dose of study medication until disease progression or death from any cause (up to 80 weeks)
Parts A and B: Maximum Plasma Concentration (Cmax) of X4P-001
Time frame: Day 1 and Day 15 of Cycle 1
Area Under the Curve From Time 0 to the Last Quantifiable Timepoint (AUC0-tlast)
Time frame: Day 1 and Day 15 of Cycle 1