Objectives: To characterize safety, tolerability, MTD and OBD of intratumoral injection of SGN1 in patients with advanced solid tumors, and to preliminarily investigate the efficacy and safety of SGN1 in specific tumor subtypes. Study Rationale: The mechanism of action for SGN1 is based on the fact that most tumors are methionine dependent. SGN1 is designed to be used as a tumor therapeutic bacterium that can preferentially replicate and accumulate in tumors and starve them of essential amino acids by delivering the oncolytic enzyme L-Methioninase. Patient Population: Patients presenting with histologically confirmed advanced and/or metastatic solid tumors that are refractory to standard therapy and for which no other conventional therapy exists.
Methionine starvation can powerfully modulate DNA methylation, cell cycle transition, polyamines and antioxidant synthesis of tumor cells, in contrast to normal ones. L-Methioninase is a pyridoxal phosphate dependent enzyme that catalyzes the γ-elimination reaction of L-methionine to methanethiol, α-ketobutyrate and ammonia . Absolute-dependency on exogenous supply of L-methionine, not homocysteine, for growth and proliferation of tumors is the pivotal biochemical criterion for various human cancers. SGN1 is a genetically modified strain of Salmonella enterica, serotype typhimurium that expresses L-Methioninase. The attenuated live bacterium has been investigated in China for utility in treating advanced solid tumors. The mechanism of action for SGN1 is based on the fact that most tumors are methionine dependent. SGN1 is designed to be used as a tumor therapeutic bacterium that can preferentially replicate and accumulate in tumors and starve them of essential amino acids by delivering the oncolytic enzyme L-Methioninase. This study is a multi-center phase I/IIa clinical trial with 2 parts: Part 1 is a phase I open-label, dose escalation study phase. The purpose of Part 1 is to characterize safety, tolerability, MTD and OBD of intratumoral injection of SGN1 in patients with advanced solid tumors. Part 2 is as a part of a phase Ib/IIa study, which is a specific Tumor-type expansion study, the purpose of Part 2 is to preliminarily investigate the efficacy and safety of SGN1 in specific tumor subtypes at Safety Monitoring Committee (SMC) determined doses. SGN1 will be administrated in 28-days cycles (once weekly for 3 weeks followed by 1-week rest). Intratumoral injection of SGN1 can be performed directly using methods including but not limited to color doppler ultrasound guidance, which is the preferred method. If the Investigator(s) judge(s) it necessary, the intratumoral injection can also be performed under CT guidance by an interventional radiologist or specialist with adequate qualifications and trainings.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
70
SGN1,will be administered intratumorally,which dosage is 0.9-2.0×109 cfu /vial.
Guangdong Clifford Hospital
Guangzhou, Guangdong, China
RECRUITINGWest China Hospital of Sichuan University
Chengdu, Sichuan, China
RECRUITINGTaipei Medical University-Shuang Ho Hospital,Ministry of Health and Welfare
New Taipei City, Taiwan
RECRUITINGChina Medical University Hospital
Taichung, Taiwan
RECRUITINGIncidence of adverse events (AEs)
An AE is any untoward medical occurrence in a patient or clinical investigation patient, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Events meeting the definition of an AE include: * Any abnormal laboratory test results (hematology, serum chemistry, or urinalysis) or other safety assessments (e.g., ECGs, vital signs measurements), including those that worsen from baseline, and was felt to be clinically significant in the medical and scientific judgment of the Investigator. * Exacerbation of a chronic or intermittent pre-existing condition including either an increase in frequency and/or intensity of the condition. * New conditions detected or diagnosed after study treatment administration even though it may have been present prior to the start of the study. * Signs, symptoms, or the clinical sequelae of a suspected interaction.
Time frame: From receiving study drug and throughout the study, until 28 days after the last dosing
Incidence of SAEs
An AE or suspected adverse reaction is considered "serious" if it results in any of the following outcomes: * Death * Life-threatening * In patient hospitalization or prolongation of existing hospitalization * A persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions * A congenital anomaly/birth defect * Important medical events that may not result in death, be life-threatening, or require hospitalization may be considered serious when, based upon appropriate medical judgment, they may jeopardize the patient and may require medical or surgical intervention to prevent one of the outcomes listed in this definition. Examples of such medical events include allergic bronchospasm requiring intensive treatment in an emergency room or at home, blood dyscrasias or convulsions that do not result in inpatient hospitalization, or the development of drug dependency or drug abuse.
Time frame: From receiving study drug and throughout the study, until 28 days after the last dosing
Objective response rate (ORR)
The efficacy endpoints include ORR, DCR and PFS. • The ORR is defined as the proportion of patients who achieve PR or better according to the RECIST v1.1. mRECIST is used to assess Hepatocellular carcinoma only, Choi criteria is used for all solid tumors, during the whole study, as the only exploratory tumor assessment method in the study, and LYRIC is used to assess Lymphoma as assessed by the investigator.
Time frame: From signing the informed consent form until 28 days after the last dose.
Disease control rate (DCR)
The efficacy endpoints include ORR, DCR and PFS. • The DCR is defined as the proportion of patients who achieve SD or better according to the RECIST v1.1, mRECIST is used to assess Hepatocellular carcinoma only, Choi criteria is used for all solid tumors, during the whole study, as the only exploratory tumor assessment method in the study, and LYRIC is used to assess Lymphoma as assessed by the investigator.
Time frame: From signing the informed consent form until 28 days after the last dose.
Progression Free Survival (PFS)
The efficacy endpoints include ORR, DCR and PFS. • PFS is defined as the time interval from date of first dose of SGN1 to the date of documented disease progression (iRECIST is used when the patient is suspected to be pseudo disease progression) or death due to any cause, whichever occurs first.
Time frame: From signing the informed consent form until 28 days after the last dose.
Incidence of dose limiting toxicity (DLTs)
Any of the following judged to be associated with SGN1 may be considered a DLT: 1. Any Grade 5 adverse event that is at least possibly related to investigational drug 2. Non-hematological toxicities: 1. Grade 4 non-hematological toxicities (excluding alopecia) lasting \> 3 days despite optimal supportive care (OSC). 2. Grade 3 non-hematologic toxicities lasting \> 7 days despite OSC. 3. Hematological toxicities: 1. Grade 4 hematologic toxicities lasting \> 7 days (except following b and c). 2. Grade 3 or 4 febrile neutropenia (body temperature ≥38.5°C) lasting \> 7 days. 3. Grade 3 thrombocytopenia with bleeding or Grade 4 thrombocytopenia.
Time frame: Up to 28 days post first dose
SGN1 level in blood for PK analysis
In Part 1 and Part 2, blood sampling will be collected for pharmacokinetics (PK). The blood collection times for PK are within 30 minutes predose and 30 minutes postdose of intratumoral injection on C1D1(cycle1 day1), C1D8(cycle1 day8), C1D15(cycle1 day15), C2D1(cycle2 day1), C2D8(cycle2 day8), and C2D15(cycle2 day15), and at the following timepoints after the end of dose on C1D1 and C2D1: 5 minutes (± 1 minute), 10 minutes (± 1 minute), 1 hour (± 2 minutes), 1.5 hours (± 2 minutes), 2 hours (± 2 minutes), 4 hours (± 5 minutes), 6 hours (± 10 minutes), 8 hours (± 15 minutes), 24 hours ± 1 hour, 48 hours ± 1 hour, 72 hours ± 1 hour. If there are still symptoms of fever or infection after 72 hours, extend the PK collection time and expect to increase it every 24 hours(± 1 hour) until the infection symptoms disappear.
Time frame: Before and after SGN1 injection in the first two cycles in Part 1 and Part 2.
Immunogenicity (anti-drug antibodies)
Anti-drug antibody blood sample collection time points: each predose (within 2 days) in the first 2 cycles, before the first dose in Cycles 3 and 4 (within 2 days), and at the EOT/withdrawal visit.
Time frame: Before and after SGN1 injection in the first 4 cycles in Part 1 and Part 2.
SGN1 level in blood for bacterial shedding.
In Part 1 and Part 2,blood samples will be collected for Bacterial Shedding. Blood samples will be collected within 2 hours prior to the start of SGN1 intratumoral injection on C1D8 and C1D15, and within 24±3 hours after the end of each SGN1 intratumoral injection on C1D8 and C1D15. Blood bacterial samples within 30 minutes predose and 30 minutes postdose of intratumoral injection on C1D1, C1D8, C1D15, C2D1, C2D8, and C2D15 are measured in the PK analysis described above. The results from PK blood samples will contribute to the analysis as the bacterial shedding. In EOT/ET visit, blood samples for bacterial shedding will be collected.
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Time frame: Before the first administration up to 28 days after the last dosing.
SGN1 level in urine for bacterial shedding.
In Part 1 and Part 2, urine samples will be collected for Bacterial Shedding. For the first SGN1 administration (C1D1), urine sampling will be conducted within 2 hours before intratumoral injection, 3 hours ±1 hour, 6 hours ±1 hour, 24 hours ±3 hours, 48 hours ±3 hours and 72 hours ±3 hours after end of intratumoral injection. For the second and third administration(C1D8 and C1D15),urine samples for bacterial shedding will be collected within 2 hours prior to the start of SGN1 intratumoral injection, and within 24 ± 3 hours after the end of each SGN1 intratumoral injection. In EOT/ET visit, urine samples for bacterial shedding will be collected.
Time frame: Before the first administration up to 28 days after the last dosing.
SGN1 level in saliva for bacterial shedding.
In Part 1 and Part 2, saliva samples will be collected for Bacterial Shedding. For the first SGN1 administration (C1D1), saliva sampling will be conducted within 2 hours before intratumoral injection, 3 hours ±1 hour, 6 hours ±1 hour, 24 hours ±3 hours, 48 hours ±3 hours and 72 hours ±3 hours after end of intratumoral injection. For the second and third administration(C1D8 and C1D15),saliva samples for bacterial shedding will be collected within 2 hours prior to the start of SGN1 intratumoral injection, and within 24 ± 3 hours after the end of each SGN1 intratumoral injection. In EOT/ET visit, saliva samples for bacterial shedding will be collected.
Time frame: Before the first administration up to 28 days after the last dosing.
SGN1 level in feces for bacterial shedding.
In Part 1 and Part 2, feces samples will be collected for Bacterial Shedding. For the first SGN1 administration (C1D1), feces sampling for bacterial shedding will be collected by the patient before the intratumoral injection of SGN1,this sample may be collected at any time during the screening period. Additional feces samples will be collected after the end of the intratumoral injection on C1D1 within the time frames below: 0-24 hours 24-48 hours 48-72 hours For the second and third administration(C1D8 and C1D15),feces samples for bacterial shedding will be collected by the patient within 24 hours prior to the start of each SGN1 intratumoral injection, and within 24 hours after the end of each SGN1 intratumoral injection. In EOT/ET visit, feces samples will be collected by the subject within 24 hours prior to the EOT/ET visit.
Time frame: Before the first administration up to 28 days after the last dosing.
Proinflammatory cytokines
Blood samples will be collected to assess proinflammatory cytokines including IL-1β, IFN-γ, TNF-α, IL-6 and IL-8.
Time frame: Within 7 days prior to first dosing, and at 2, 4, 6, and 24 hours post end of first infusion.
Assessment of tumor colonization
For superficial tumors, biopsy puncture tissue samples or tissue samples within the last half year will be collected from patients (if lesions are appropriate and patients agree) during the screening period, and tissue samples will be collected, and after the intratumoral injection, tissue biopsy puncture will be performed in pre-dose of the C2D15 (within 2 days).
Time frame: From signing the informed consent form until 28 days after the last dose.