This phase I/II trial studies the best dose and side effects of peposertib and to see how well it works with avelumab and hypofractionated radiation therapy in treating patients with solid tumors and hepatobiliary malignancies that have spread to other places in the body (advanced/metastatic). Peposertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as avelumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Hypofractionated radiation therapy delivers higher doses of radiation therapy over a shorter period of time and may kill more tumor cells and have fewer side effects. Giving peposertib in combination with avelumab and hypofractionated radiation therapy may work better than other standard chemotherapy, hormonal, targeted, or immunotherapy medicines available in treating patients with solid tumors and hepatobiliary malignancies.
PRIMARY OBJECTIVES: I. To determine the safety and tolerability and recommended phase 2 dose (RP2D) of peposertib (M3814) in combination with hypofractionated radiation and avelumab in patients with advanced/metastatic solid tumors. (Phase I) II. To determine the efficacy of the combination of hypofractionated radiation, peposertib (M3814), and avelumab as compared to the combination of hypofractionated radiation and avelumab in patients with advanced/metastatic hepatobiliary tumors by objective response rate (ORR) in non-irradiated lesions within 12 weeks following initiation of study treatment. (Phase II) SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity. (Phase I) II. To characterize the pharmacokinetic (PK) profile of peposertib (M3814) in combination with avelumab. (Phase I) III. To determine the efficacy and safety of the combination of hypofractionated radiation, peposertib (M3814), and avelumab as compared to hypofractionated radiation and avelumab by measurement of disease control rate (DCR), duration of response (DOR), progression free survival (PFS), PFS outside the irradiated field, and overall survival (OS) in patients with advanced/metastatic hepatobiliary tumors. (Phase II) IV. To determine if baseline deoxyribonucleic acid (DNA) repair defects inherent to some cholangiocarcinomas correlate with a more dramatic response to radiation compared to those without as measured by gamma H2AX, phosphorylated (p)NBS1 and pKAP1 immunofluorescence (IFA) with beta CATN segmentation assay. (Phase II) V. To characterize the pharmacokinetic (PK) profiles of peposertib (M3814) and avelumab. (Phase II) EXPLORATORY OBJECTIVES: I. To perform molecular profiling assays on malignant and normal tissues, including, but not limited to, whole exome sequencing (WES), ribonucleic acid (RNA) sequencing (RNAseq), mass cytometry (CyTOF), multiplexed ion beam imaging (MIBI), and T cell receptor sequencing in order to: Ia. To determine if baseline tumor mutation burden and pattern, and neoantigen burden correlate with response; Ib. To determine if combination therapy results in changes in the immune landscape in both the tumor and the host that correlate with response; Ic. To determine if baseline defects in deoxyribonucleic acid (DNA) damage repair in some cholangiocarcinomas correlate with an increased response. OUTLINE: This is a phase I, dose-escalation study of peposertib followed by a phase II study. PHASE I: Patients with advanced/metastatic malignant solid tumors undergo 8 fractions of hypofractionated radiation therapy (RT) every day (QD) on days -17 to -7. Patients also receive peposertib orally (PO) twice daily (BID) on days 1-28, and avelumab intravenously (IV) over 60 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT), biopsy, and collection of blood samples during screening and on study. PHASE II: Patients with advanced/metastatic cholangiocarcinoma/gallbladder cancer are randomized to 1 of 2 arms. ARM A: Patients undergo 8 fractions of hypofractionated RT QD on days -17 to -7. Patients also receive avelumab IV over 60 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo CT, biopsy, and collection of blood samples during screening and on study. ARM B: Patients undergo 8 fractions of hypofractionated RT QD on days -17 to -7. Patients also receive peposertib PO BID on days 1-28, and avelumab IV over 60 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo CT, biopsy, and collection of blood samples during screening and on study After completion of study treatment, patients are followed up at 30 days, every 3 months for 1 year, every 6 months for year 2, then annually thereafter.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
103
Given IV
Undergo biopsy of tumor
Undergo collection of blood samples
Undergo CT scan
Undergo hypofractionated RT
Given PO
City of Hope Comprehensive Cancer Center
Duarte, California, United States
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine, California, United States
UC San Diego Moores Cancer Center
La Jolla, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California, United States
University of California Davis Comprehensive Cancer Center
Sacramento, California, United States
Maximum tolerated doses and recommended phase 2 dose of peposertib (M3814) in combination with hypofractionated radiation and avelumab (Phase 1)
Will be determined by the occurrence of dose-limiting toxicities defined as the occurrence of one or more grade 3 adverse events that delays treatment for more than 7 days, or any grade 4-5 adverse events.
Time frame: Up to 28 days
Objective response rate (Phase 2)
Defined as best overall response (compete response \[CR\] and partial response \[PR\] in non-irradiated lesions as opposed to stable disease \[SD\] or progressive disease) within 12 weeks following initiation of study treatment by Response Evaluation Criteria in Solid Tumors (RECIST 1.1).
Time frame: Within 12 weeks following initiation of study treatment
Pharmacokinetics of avelumab (Phase 1)
Will determine concentrations of plasma avelumab using enzyme-linked immunosorbent assay.
Time frame: Day 7: predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 24 hours; Day 21: predose, 0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours
Pharmacokinetics of M3814 (Phase 1)
Will determine concentrations of plasma M3814 using liquid chromatography-mass spectrometry (MS)/MS.
Time frame: Day 21: predose
Disease control rate (Phase 2)
Defined as proportion of patients achieving a CR, PR, or SD in non-irradiated by RECIST 1.1 criteria. Will be analyzed by Kaplan-Meier estimates.
Time frame: Up to 12 months
Progression free survival (PFS) (Phase 2)
Will be analyzed by Kaplan-Meier estimates.
Time frame: From randomization until disease progression or death, assessed up to 12 months
PFS outside the irradiated field (Phase 2)
Will be analyzed by Kaplan-Meier estimates.
Time frame: From randomization until disease progression outside the irradiated field or death, assessed up to 12 months
Overall survival (Phase 2)
Will be analyzed by Kaplan-Meier estimates.
Time frame: From randomization until death from any cause, assessed up to 12 months
Incidence of adverse events (Phase 2)
Defined by Common Terminology Criteria for Adverse Events version 5.0.
Time frame: Up to 12 months
Pharmacokinetics of M3814 and avelumab (trough levels) (Phase 2)
Correlated with pharmacodynamics (e.g. toxicity). Will compare trough values between patients with and without toxicity, and/or response if warranted, with non-parametric testing.
Time frame: M3814 and avelumab: Day 21 (Predose)
Defects in deoxyribonucleic acid (DNA) damage repair
Assessed by the gamma H2AX phosphorylated (p)NBS1 multiplex immunofluorescence assay (IFA). The association of baseline DNA repair defects, scored as present or absent, with the response rate to treatment will be evaluated using Fisher's exact test.
Time frame: Up to 12 months
Differential response to therapy (Phase 2)
Assessed by the gamma H2AX pNBS1 multiplex IFA. The association of baseline DNA repair defects, scored as present or absent, with the response rate to treatment will be evaluated using Fisher's exact test.
Time frame: Up to 12 months
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