The purpose of this study is to determine the safety and efficacy of quaratusugene ozeplasmid (Reqorsa), in combination with pembrolizumab in patients with previously treated NSCLC. Quaratusugene ozeplasmid consists of non-viral lipid nanoparticles that encapsulate a DNA plasmid with the TUSC2 tumor suppressor gene, and is a systemic gene therapy. The study will be conducted in 2 phases, a dose escalation phase (Phase 1) and a safety and efficacy evaluation phase (Phase 2). In Phase 1, patients will be enrolled in sequential cohorts treated with successively higher doses of quaratusugene ozeplasmid in combination with pembrolizumab to determine the recommended Phase 2 dose (RP2D). Phase 2 will be comprised of a dose expansion portion and a randomized portion. In the dose expansion portion, patients will be enrolled and treated with quaratusugene ozeplasmid at the RP2D in combination with pembrolizumab. In the randomized portion, patients will be randomized to receive either the investigational treatment of quaratusugene ozeplasmid at the RP2D in combination with pembrolizumab or a control treatment of either docetaxel +/- ramucirumab or the investigator's treatment of choice.
Acclaim-2 is a Phase 1/2 multicenter, open-label study of quaratusugene ozeplasmid in combination with pembrolizumab in patients with locally advanced or metastatic NSCLC with any PD-L1 TPS and NOT considered refractory to pembrolizumab, as defined by having achieved at least a 3-month clinical benefit to previous pembrolizumab-containing treatment. The total duration of study for each patient will be dependent upon the safety, tolerability, and efficacy of the study treatment. The Phase 1 portion of the study will involve a 3+3 dose escalation schema of quaratusugene ozeplasmid up to 0.12 mg/kg in combination with a fixed dose of pembrolizumab (200 mg) administered once via intravenous (IV) infusion during each 21-day treatment cycle. Three quaratusugene ozeplasmid doses will be tested (0.06, 0.09 and 0.12 mg/kg administered on Day 1 of a 21-day treatment cycle). Phase 2 will involve a dose expansion portion and a randomized portion. In the dose expansion portion 36 patients will be enrolled to better characterize the safety and preliminary efficacy of quaratusugene in combination with pembrolizumab. Patients in the dose expansion portion will receive quaratusugene ozeplasmid at the RP2D determined in Phase 1 in combination with pembrolizumab once in every 21-day treatment cycle. When the PFS rate at 18 weeks has been evaluated for all patients in the dose expansion portion and been shown to meet the criteria for advancement to the randomized portion of Phase 2, the randomized portion of Phase 2 will be initiated. In the randomized portion of Phase 2, 126 patients will be randomized 2:1 to the investigational (quaratusugene ozeplasmid in combination with pembrolizumab) versus control (docetaxel with or without ramucirumab, or investigator's choice of treatment) treatment arms, respectively. Patients will be stratified by NSCLC histology (squamous versus nonsquamous predominant histology) for efficacy analysis purposes. The 84 patients randomized to the investigational arm will receive quaratusugene ozeplasmid, at the RP2D determined in Phase 1, administered in combination with 200 mg pembrolizumab once in every 21-day treatment cycle. The 42 patients randomized to the control arm may either receive docetaxel with or without ramucirumab, or a non-investigational treatment chosen by the investigator.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
5
Quaratusugene ozeplasmid is an experimental non-viral therapy utilizing the TUSC2 gene, designed to target cancer cells by interrupting cell signaling pathways that allow cancer cells to grow, re-establishing pathways that promote cancer cell death and modulating the immune system response against cancer cells.
Pembrolizumab is a programmed death receptor-1 (PD-1) blocking antibody indicated for treatment of patients with metastatic NSCLC.
Docetaxel is a microtubule inhibitor indicated for locally advanced or metastatic NSCLC after platinum-based chemotherapy failure.
Ramucirumab is a human vascular endothelial growth factor receptor 2 (VEGFR2) antagonist indicated in combination with docetaxel for treatment of NSCLC with disease progression after platinum-based chemotherapy.
Treatment will be administered during 21-day treatment cycles. The investigator's treatment must not include investigational drugs or therapies.
Moffitt Cancer Center - Magnolia Campus
Tampa, Florida, United States
Ochsner Clinic Foundation
New Orleans, Louisiana, United States
Washington University School of Medicine - Siteman Cancer Center
St Louis, Missouri, United States
The Valley Hospital - Luckow Pavilion
Paramus, New Jersey, United States
Mary Crowley Cancer Research
Dallas, Texas, United States
Millennium Oncology
Houston, Texas, United States
Recommended Phase 2 Dose (RP2D) - Phase 1
RP2D which will be the MTD or if the MTD is not defined by the safety data, the RP2D will be determined based on an integrated assessment of all available clinical safety, PK, and preliminary efficacy data.
Time frame: First 21-days at each dose level
Progression-free Survival (PFS) - Phase 2 Dose Expansion
PFS rate at 18 weeks after first dose of study treatment. PFS according to RECIST.
Time frame: 18 weeks
Progression-free Survival (PFS) - Phase 2 Randomized
PFS from randomization to disease progression or death. PFS according to RECIST.
Time frame: Approximately 8 months
Progression-free Survival (PFS) - Phase 1
PFS from first study treatment to disease progression or death. PFS according to RECIST.
Time frame: Approximately 8 months
Overall Survival (OS) - Phase 1
OS from first study treatment to death or discontinuation due to withdrawal of consent.
Time frame: Approximately 11 months
Pharmacokinetics (PK) - Phase 1
Concentrations of quaratusugene ozeplasmid in whole blood samples.
Time frame: First 21-day treatment cycle
Adverse Events (AEs) - Phase 2 Dose Expansion
Number of treatment-related AEs graded according to the NCI-CTCAE.
Time frame: Approximately 9 months]
Progression-free Survival (PFS) - Phase 2 Dose Expansion
PFS from first study treatment to disease progression or death. PFS according to RECIST.
Time frame: Approximately 8 months
Overall Response Rate (ORR) - Phase 2 Dose Expansion
ORR (Complete Response \[CR\] + Partial Response \[PR\]) using best overall response from first study treatment to disease progression or death per RECIST compared to baseline tumor measurements.
Time frame: Approximately 8 months
Overall Survival (OS) - Phase 2 Dose Expansion
OS from first study treatment to death or discontinuation due to withdrawal of consent.
Time frame: Approximately 11 months
Pharmacokinetics (PK) - Phase 2 Dose Expansion
Concentrations of quaratusugene ozeplasmid in whole blood samples.
Time frame: First 21-day treatment cycle
Overall Response Rate (ORR) - Phase 2 Randomized
ORR (CR + PR) using best overall response from randomization to disease progression or death per RECIST compared to baseline tumor measurements.
Time frame: Approximately 8 months
Overall Survival (OS) - Phase 2 Randomized
OS from randomization to death or discontinuation due to withdrawal of consent.
Time frame: Approximately 11 months
Disease Control Rate (DCR) - Phase 2 Randomized
DCR (CR + PR + Stable Disease \[SD\]) using best overall response from randomization to death or discontinuation due to withdrawal of consent per RECIST compared to baseline tumor measurements.
Time frame: Approximately 8 months
Adverse Events (AEs) - Phase 2 Randomized
Number of treatment-related AEs graded according to the NCI-CTCAE.
Time frame: Approximately 9 months
Pharmacokinetics (PK) - Phase 2 Randomized
Concentrations of quaratusugene ozeplasmid in whole blood samples.
Time frame: First 21-day treatment cycle
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