A modular, first time in human, open label, multiple dose, accelerated escalation with cohort expansion study of the safety and pharmacokinetics of intravenous infusion of CP-506, a tumor agnostic Hypoxia Activated Prodrug in patients with HRD/FAD solid tumours or tumor types with high incidence of HRD/FAD in monotherapy or in combination with carboplatin or patients with solid tumour and oligoprogressive disease receiving immune checkpoint inhibitors (ICI): a phase I-IIa clinical trial
This study is a First in Human, early phase (I/IIa), 3 modules, 2 parts (A- dose escalation and B- cohort expansion), open-label, uncontrolled, multi-center, multiple dose, accelerated 3+3 dose escalation study. The study consist of 3 study modules. Module 1 is monotherapy with accelerated dose escalation. Modules 2 and 3 are also accelerated dose escalation modules, but with a combination of CP-506 with either Carboplatin or ICI. Initiation of modules 2 and 3 are dependent on the decision by the Independent Data Monitoring Committee (IDMC) based on the safety, tolerability and feasibility information from the study as a whole. Each study modules will consist of a Part A (dose finding) and an optional Part B (cohort expansion). The option to start Part B will be decided by the IDMC based on safety, tolerability and feasibility information from the study as a whole. The expansion cohorts will explore preliminary efficacy. Modules 2 and 3 will start after completion of module 1 and definition of the "minimal biological effective dose" (MBED) as the dose that results in 1) a decrease of 20% of hypoxia radiomics score on sequential CT of at least one lesion OR 2) a decrease of 20% of the initial tumour volume of at least one lesion. MBED is assessed by CT scan at visit 7, 12 and 13. After observation of an MBED in three patients, the data supporting the MBED assessment will be reviewed by the IDMC for confirmation. A maximum of 126 patients with advanced or metastatic cancer will be recruited in this study. * Module 1 - Monotherapy: up to 24 patients for Part A and 10 patients for Part B for whom no standard of care or known effective treatment options are available and with cancers that show a considerable incidence of Homologous Recombination or Fanconi Anaemia DNA repair defects (HRD/FAD) * Module 2 - Combination with Carboplatin: up to 24 patients for Part A and 22 patients for Part B for patients that receive carboplatin as standard of care: triple negative breast cancer and ovarian cancer. * Module 3 - Combination with ICI: up to 24 patients for Part A and 22 patients for Part B with advanced or metastatic cancer for whom standard of care immune checkpoint inhibitor (ICI) are currently administered for at least 6 months, would still be administered according to the treating clinician, outside any clinical trial but resulted in oligoprogression. The complete CP-506 therapy consists of three cycles of CP-506 treatment. Each treatment cycle consists of three consecutive days of IV infusion for two hours and one day for observation and blood sampling, and a recovery time of 3 weeks. Patients are expected to come to the hospital for 18 visits. They consist of 1 screening visit, 3 cycles of CP-506 treatment. Each cycle will be followed by a post cycle visit after 14 and 21 days. The follow up visit will take place at day 105.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
126
CP-506 is a hypoxia-activated DNA alkylating agent specifically designed to have a bystander effect, aqueous solubility, oral bioavailability, and no off-mechanism activation by the human aerobic reductase AKR1C3
Antineoplastic agent, ATC Code: LO1X A02
Drug that blocks immune checkpoint proteins: PD-1, PD-L1, CTLA-4
Institut Jules Bordet
Brussels, Belgium
NOT_YET_RECRUITINGUZ Gent
Ghent, Belgium
NOT_YET_RECRUITINGAcademisch Ziekenhuis Maastricht (Leading Centre)
Maastricht, Limburg, Netherlands
RECRUITINGErasmus MC
Rotterdam, Netherlands
RECRUITINGInstitut Vall d'Hebron
Barcelona, Spain
NOT_YET_RECRUITINGIncidence of treatment-emergent adverse events including dose-limiting toxicities
The proportion of patients with treatment-emergent (serious) adverse events including dose-limiting toxicity (DLT)
Time frame: Baseline until 60 days after last administration of CP-506
Incidence of clinically significant abnormal measurements in physical examination, vital signs, electrocardiogram (ECG), lab tests and ECOG performance status
Physical examination; vital signs; electrocardiogram (ECG); haematology; clinical chemistry; urinalysis; plasma/renal makers; tumour markers; ECOG performance status
Time frame: Baseline until 60 days after last administration of CP-506
Area under curve of CP-506 plasma concentration
Measurement of CP-506 levels in plasma over time to calculate AUC Area under the curve (AUC) of CP-506 plasma concentration
Time frame: At the end of cycle 1 day 4
Determine the minimal biological effective dose
Number of patients that show 1) a decrease of 20% of hypoxia radiomics score on sequential CT of at least one lesion OR 2) a decrease of 20% of the initial tumour volume of at least one lesion
Time frame: Baseline until 60 days after last administration of CP-506
Objective Response Rate
Objective response rate (ORR) by RECIST 1.1 - the proportion of patients with a confirmed reduction in tumour burden of a predefined amount (this will include short lived responses).
Time frame: Baseline until 60 days after last administration of CP-506
Percentage change in tumour size
Percentage change in tumour size will be determined for patients with measurable disease at baseline and is derived at each visit by the percentage change from baseline in the sum of the diameters of target lesions. The best percentage change in tumour size will be the patient's value representing the largest decrease (or smallest increase) from baseline in tumour size
Time frame: Baseline until 60 days after last administration of CP-506
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