This trial is a Phase I study to be conducted in patients with non-MSI-high advanced/metastatic pancreatic ductal adenocarcinoma (PDAC) or colorectal cancer (CRC) and is divided in two Parts. * Dose escalation Part :To determine the Maximum Tolerated Dose (MTD) and the Recommended Dose for Phase 2 (RP2D) of Debio1143 when combined with a fixed dose of Pembrolizumab. * Extension Part: To evaluate preliminary efficacy data of the proposed combination.
All patient wil receive a combinaison of Pembrolizumab and Debio 1143. Pembrolizumab is a potent and highly selective humanized monoclonal antibody (mAb) of the IgG4/kappa isotype designed to directly block the interaction between PD-1 and its ligands, PD-L1 and PD-L2. Debio 1143 is an investigational, oral monovalent second mitochondrial-derived activator of caspases (SMAC) mimetic designed to promote programmed cell death (apoptosis) in tumor cells and anti-tumour immunity. By antagonizing the activity of inhibitor of apoptosis proteins (IAPs (X-linked IAP \[XIAP\], cellular IAP 1 \[cIAP1\], cellular IAP 2 \[cIAP2\] and melanoma-linked IAP \[ML-IAP\])), Smac mimetics are an interesting treatment approach for cancer that may foster better tumor responses to chemo/radiotherapy- and/or immuno-therapy. A Dose escalation part (n= up to 18 patients ) aiming to define the Maximum Tolerated Dose and the the Recommended Dose for Phase 2 of the proposed combination. A classical 3+3 design will be used with a fixed dose of Pembrolizumab (200 mg, intravenous , to be administered on Day 1 of every 3-week cycle i.e. Q3W) and 3 escalating dose level of Debio 1143 administered daily for 14 days over a 21-day cycle period. There will be a 24-hour delay between the first and subsequent patients enrolled in each DL cohort to maximize the safety of enrolled patients. An extension part (n=28 patients: 14 patients per cohort) aiming to evaluate the clinical activity of the proposed combination.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
54
200 mg, intravenous (IV), to be administered on Day 1 of every 3-week cycle i.e. Q3W.
3 escalating dose level (100 mg, 150 mg, 200 mg) of Debio 1143 administered daily for 14 days over a 21-day cycle period.
Centre Léon Bérard
Lyon, France
Maximum Tolerated Dose
To determine the Maximum Tolerated Dose of Debio1143 when combined with a fixed dose of Pembrolizumab.
Time frame: 21 days
Recommended Dose for Phase 2
To determine the Recommended Dose for Phase 2 (RP2D) of Debio1143 when combined with a fixed dose of Pembrolizumab.
Time frame: 21 days
Extension Part Objective Response Rate
The Objective Response Rate will be defined as the proportion of patients with complete response or partial response, as per RECIST V1.1.
Time frame: 12 weeks
Duration of response
The duration of response will be measured from the time of first documented response (Complete Response or Partial Response as per RECIST V1.1) until the first documented disease progression or death due to underlying cancer, and censored at the date of the last available tumor assessment.
Time frame: Up to 2 years
Clinical Benefit Rate
The Clinical Benefit Rate will be defined as the proportion of patients with Complete Response, Partial Response or stable disease according to RECIST V1.1.
Time frame: 12 weeks
Tumor-response efficacy 1
The tumor-response efficacy endpoints described above will be evaluated by investigator-assessed RECIST v1.1 (Eisenhauer et al. E J Cancer 2009).
Time frame: Up to 2 years
Tumor-response efficacy 2
The tumor-response efficacy endpoints described above will be evaluated by modified criteria for immunotherapies iRECIST (Seymour et al. Lancet Oncol 2017).
Time frame: Up to 2 years
Progression-Free Survival
Progression-Free Survival (PFS) will be measured from the C1D1 until the date of event defined as the first documented progression or death from any cause. Patients with no event at the time of the analysis will be censored at the date of the last available tumor assessment.
Time frame: Up to 2 years
Overall survival
Overall survival (OS) will measured from C1D1 to the date of death from any cause. Patients who are alive at the time of analysis will be censored at the date of the last contact.
Time frame: Up to 2 years
Assessment of safety will be based mainly on the frequency of adverse events based on the common toxicity criteria (CTCAE v5.0) grade
The assessment of safety will be based mainly on the frequency of adverse events based on the common toxicity criteria (CTCAE v5.0) grade.
Time frame: Up to 2 years
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