This is a Phase 1/2, open-label study of zalifrelimab (AGEN1884) in combination with balstilimab (AGEN2034) in participants with locally advanced, recurrent and/or metastatic solid tumors including cervical cancer. Balstilimab is a novel, fully human monoclonal immunoglobulin G4 antibody, designed to block program cell death-1 (PD-1). Zalifrelimab is a novel, fully human monoclonal immunoglobulin G1 antibody, designed to block cytotoxic T-lymphocyte antigen-4 (CTLA-4).
The trial consists of 2 phases: * Phase 1: Dose escalation * Phase 2: Expansion in advanced cervical cancer Phase 1: Dose Escalation: The enrollment to the Phase 1 portion of the study is completed. The trial will consist of a 3+3 dose escalation that will evaluate different combination dose levels (CDL) of zalifrelimab and balstilimab in participants with locally advanced, recurrent and/or metastatic solid tumors. Participants may be enrolled to the following CDL cohorts: * CDL1 - zalifrelimab 1 milligram/kilogram (mg/kg) every 6 weeks + balstilimab 1 mg/kg every 2 weeks (starting CDL) * CDL2 - zalifrelimab 1 mg/kg every 6 weeks + balstilimab 3 mg/kg every 2 weeks (maximum planned CDL) * CDL-1 - zalifrelimab 0.3 mg/kg every 6 weeks + balstilimab 1 mg/kg every 2 weeks (potential de-escalation CDL) CDL1 will be the first to be tested. Dose escalation will continue until the maximum planned CDL (CDL2) is shown to be safe or the maximum tolerated dose (MTD) is reached. The MTD is defined as the CDL below which ≥33% of participants develop dose-limiting toxicities (DLT). The decision to escalate to the next cohort will be made by a safety monitoring committee (SMC), based on safety assessments after all participants of a cohort reached the end of the DLT observation period of 21 days. Should ≥2 DLTs be observed in CDL1, the SMC may open enrollment to CDL-1. The SMC will also select the CDL for Phase 2. Each participant will receive the combination treatment for a maximum of 24 months or until confirmed disease progression, unacceptable toxicity, or any criterion for withdrawal from the trial or the investigational medicinal products occur. Participants who do not complete the DLT observation period of 21 days after the first dose, for reasons other than a DLT will be replaced. Additional participants will be backfilled, concurrently with the 3+3 dose escalation schema at the lower cleared CDL, to ensure that each cohort enrolls at least 10 participants. These additional participants at each dose level will have the purpose of generating additional safety, pharmacokinetics, and receptor occupancy data, and will not undergo formal DLT observation. The SMC selected CDL2 (zalifrelimab 1 mg/kg every 6 weeks + balstilimab 3 mg/kg every 2 weeks) as the recommended phase 2 dose (RP2D). Phase 2: Expansion in Select Tumors To further characterize safety and efficacy, the following expansion cohort will be enrolled: Advanced cervical cancer In Phase 2, the RP2D of balstilimab and zalifrelimab will be administered for a maximum of 2 years or until confirmed progression, unacceptable toxicity, or any criterion for stopping the study drugs or withdrawal from the trial occurs. For the Phase 2 portion of the trial, an independent data monitoring committee will be established to evaluate safety and efficacy and an independent endpoint review committee will be established to adjudicate tumor response.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
175
Zalifrelimab was administered over 30 minutes and following the infusion of balstilimab.
Balstilimab infusion was administered over 30 minutes.
Comprehensive Care and Research Center
Goodyear, Arizona, United States
City of Hope National Medical Center
Duarte, California, United States
University of Miami
Miami, Florida, United States
BRCR Medical Center, Inc
Plantation, Florida, United States
Augusta University
Augusta, Georgia, United States
Phase 2: Objective Response Rate (ORR) - Independent Endpoint Review Committee (IERC)
The ORR was defined as the percentage of participants with a confirmed best overall response (BOR) of partial response (PR) or complete response (CR), as determined by an IERC per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1).
Time frame: Up to 2 years
Phase 1: Number of Participants Experiencing Dose-limiting Toxicities (DLTs)
The number of participants with an occurrence of a DLT during dose escalation during the first 21 days of treatment in Phase 1 are reported. Any DLT immediately led to permanent withdrawal of zalifrelimab and balstilimab.
Time frame: First 21 days of treatment
Phase 1: Maximum Drug Concentration Observed Postdose at Steady-state (Cmax-ss) of Balstilimab and Zalifrelimab
Blood samples were collected for serum balstilimab and zalifrelimab concentration analyses. Each cycle was 6 weeks (42 days) long. Results are reported as micrograms/milliliter (ug/mL).
Time frame: Pre-dose, up to 4 hours post-dose (Day 1 of Cycle 2 and Cycle 3)
Phase 2: Cmax-ss of Balstilimab and Zalifrelimab
Blood samples were collected for serum balstilimab and zalifrelimab concentration analyses. Each cycle was 6 weeks (42 days) long.
Time frame: Pre-dose, up to 4 hours post-dose (Day 1 of Cycle 4)
Phase 1: Area Under the Drug Concentration-time Curve From Day 0 to Day 14 at Steady-state (AUC0-14d-ss) of Balstilimab and Zalifrelimab
Blood samples were collected for serum balstilimab and zalifrelimab concentration analyses. Each cycle was 6 weeks (42 days) long. Results are reported as day times ug/mL (day\*ug/mL).
Time frame: Day 1 through Day 15 (Cycle 2 and Cycle 3)
Phase 2: AUC0-14d-ss of Balstilimab and Zalifrelimab
Blood samples were collected for serum balstilimab and zalifrelimab concentration analyses. Each cycle was 6 weeks (42 days) long.
Time frame: Day 1 through Day 15 (Cycle 4)
Phase 1/2: Number of Participants With Serum Anti-drug Antibodies (ADAs) for Balstilimab and Zalifrelimab
Blood samples were collected for serum balstilimab and zalifrelimab ADA determination.
Time frame: Pre-dose through Month 27
Phase 2: ORR - Investigator
The ORR was defined as the percentage of participants with a confirmed BOR of PR or CR, as determined by the investigator per RECIST 1.1.
Time frame: Up to 2 years
Phase 2: Duration of Response (DOR)
DOR was defined as time from first observation of response to first observation of documented disease progression (or death within 12 weeks after last tumor assessment), as determined by an IERC and investigator, per RECIST 1.1. Participants without an event at the analysis cutoff date were censored on date of last tumor assessment. DOR data are reported as 25th percentile estimated from Kaplan-Meier curve.
Time frame: Up to 3 years
Phase 2: Disease Control Rate (DCR)
DCR was defined as the percentage of participants with CR, PR, or stable disease (SD) without progressive disease (PD) within 81 days of study start, or durable SD following PD, as determined by an IERC and investigator, per RECIST 1.1.
Time frame: Up to 3 years
Phase 2: Time to Response (TTR)
TTR was defined as the time interval between the date of treatment initiation and the earliest date of first documented confirmed complete response or partial response based on independent radiologic review, as determined by an IERC per RECIST 1.1.
Time frame: Up to 2 years
Phase 2: Progression-free Survival (PFS)
PFS was defined as the interval from the date of first dose of investigational agent until the earliest date of PD, as determined by IERC and investigator assessment of objective radiographic disease assessments per RECIST 1.1, or death due to any cause if occurring sooner than progression.
Time frame: Up to 2 years
Phase 2: Overall Survival (OS)
OS was defined as the interval from the date of first dose of investigational agent until the date of death.
Time frame: Up to 2 years
Phase 1: Receptor Occupancy (RO) on Circulating T Cells
A validated flow cytometry-based assay was used to evaluate programmed cell death protein-1 (PD-1) RO on circulating T cells as an indication of target engagement of balstilimab. Blood samples were collected for the assay. Results are reported as a percentage of available drug receptors occupied (%RO) by balstilimab; the higher the percentage, the greater the engagement of balstilimab with the target receptor. Initial testing revealed technical limitations of the sample isolation procedure prior to the PD-1 RO assessment, causing the PD-1 RO assay to inaccurately reflect the actual PD-1 RO status in response to balstilimab/zalifrelimab combination treatment. As a result, further sample collection and subsequent testing was not conducted. Only initial test results are reported. Results reported as mean percentage of receptors occupied based upon data collected on Days 8, 15, 22, and 29 of Cycle 1 and Days 1 and 8 of Cycle 2 (each cycle was 6 weeks/42 days long).
Time frame: Days 8, 15, 22, and 29 (Cycle 1); Days 1 and 8 (Cycle 2)
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Cancer Treatment Centers of America
Zion, Illinois, United States
Ochsner Cancer Institute
New Orleans, Louisiana, United States
West Michigan Cancer Center
Kalamazoo, Michigan, United States
University of Oklahoma
Oklahoma City, Oklahoma, United States
Chattanooga's Program In Women's Oncology
Chattanooga, Tennessee, United States
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