This is a Phase I, open-label, dose-escalation study for a novel cancer treatment, AM-928, intravenous infusion antibody for advanced solid tumor. The study is aimed to learn the safety, tolerability, pharmacokinetics, and preliminary efficacy profile of AM-928. The dose escalation strategy will adopt accelerated titration combined with a Bayesian optimal interval (BOIN) design. Seven dose levels are designed and each participant will be assigned to a specific dose regimen depending on the time of enrollment. In the study, each participant will receive AM-928 treatment cycles till meeting any treatment discontinuation criterion and be followed for safety and long-term survival. The whole study is expected to take approximately three years to complete.
This is a first-in-human Phase I, open-label, dose-escalation study to investigate the safety, tolerability, pharmacokinetics (PK), and preliminary efficacy of AM-928 infusion in subjects with advanced solid tumors in multiple sites in Taiwan. Eligible subjects will be dosed with different dosages of AM-928 in 1 of the 7 dose levels (0.1, 0.3, 1, 3, 6, 10, 15 mg/kg). Dose levels will be escalated from dose Level 1 at 0.3 mg/kg to Level 6 at 15 mg/kg of AM-928 (or may be de-escalated to Level -1 at 0.1 mg/kg), which will be administered (intravenous infusion) once weekly (QW) for 4 weeks (D1, D8, D15, D22) as a treatment cycle until any treatment discontinuation criterion is met. Basically, there will be no breaks between dosing cycles. From Cycle 4, intra-subject dose escalation may be applied if supported by preliminary safety and PK data. The dose escalation strategy will adopt accelerated titration combined with a Bayesian optimal interval (BOIN) design. The accelerated titration will be adopted for 0.3 mg/kg, while the BOIN design will be adopted for other dose levels, including 1 mg/kg, 3 mg/kg, 6 mg/kg, 10 mg/kg, and 15 mg/kg. In the "accelerated titration" stage, if any ≥ Grade 2 adverse event occurs, the current and subsequent dose groups will be changed to the BOIN dose escalation method. The target toxicity rate for the maximum tolerated dose (MTD) is ϕ= 0.3, and the maximum sample size is determined to be 30, maximum of 9 subjects per dose level. A cohort size of 3 and a maximum cohort number of 3 for each dose level will be adopted for subject recruitment. The dose escalation may end when one of the following criteria is met: (1) The planned sample size of 30 has been reached; (2) 9 subjects have been treated and evaluable for DLT at the next intended dose level (should not exceed 9 subjects at one dose level); (3) all doses explored appear to be overly toxic, and the MTD cannot be determined. The Scientific Review Committee (SRC) will review the safety and/or efficacy data at the end of each dose level cohort for escalation or de-escalation decision (when the DLT rate indicates staying at the current dose, the review process may be waived). Besides, an emergency meeting will be held if the SRC has any safety concerns. A final review process is scheduled at the end of dose escalation for MTD determination. The dose with the toxicity rate closest to the target toxicity rate (ϕ= 0.3) will be selected as MTD. If the SRC determines that the safety profile of a specific dose level is unfavorable for subjects, the SRC may eliminate that dose level even if the toxicity rate is below 0.3. In this case, the subsequent subjects will be enrolled into the lower dose level(s) following the BOIN design and the lower dose level with the toxicity rate closest to the target toxicity rate (ϕ= 0.3) will be selected as MTD.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
38
AM-928, which is a humanized anti-EpCAM monoclonal antibody developed by AcadeMab Biomedical Inc.
National Taiwan University Hospital
Taipei, Taiwan
RECRUITINGThe maximum tolerated dose (MTD)
The MTD is defined the highest dose level that is closely to the toxicity rated defined in the study.
Time frame: Up to 29 days
The incidence of dose-limiting toxicity (DLT)
The DLT is specified treatment-emergent events that occur in cycle 1 treatment period, graded by NCI-CTCAE v5.0, and causality to study drug cannot be clearly ruled out.
Time frame: Up to 29 days
Number of participants with abnormalities in Laboratory Values
Number of participants with abnormal hematology (RBC, WBC with differentials (neutrophils, lymphocytes, monocytes, eosinophils, and basophils), platelet count, hemoglobin, and hematocrit), biochemistry (Albumin, total cholesterol, total bilirubin, direct bilirubin, alkaline phosphatase (ALP), AST, ALT, gamma-glutamyl transferase (γ-GT), total protein, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), creatine kinase (CK), creatinine, estimated glomerular filtration rate (eGFR; 2021 CKD-EPI), triglyceride, amylase, lipase, glucose, uric acid, bicarbonate, calcium, chloride, inorganic phosphorus, iron, magnesium, potassium, and sodium), coagulation (prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR)), urinalysis (specific gravity, pH, occult blood, leukocytes, glucose, protein, ketones, bilirubin, and urine sediment (RBC, WBC, casts, epithelial cells, crystal, and microorganism)), and Troponin-T results
Time frame: Up to 28 days after the last dose
Number of treatment-emergent adverse events (TEAEs)
The TEAE is defined as adverse event (AE) occurred after the study drug administration. All TEAE will be assessed for severity by the investigator based on National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0
Time frame: Up to 28 days after the last dose
Incidence of subjects experiencing treatment-related AE with ≥ Grade 3
The TEAE is defined as adverse event (AE) occurred after the study drug administration. All TEAE will be assessed for severity by the investigator based on National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0
Time frame: Up to 28 days after the last dose
Incidence of subjects experiencing infusion-related reaction
The infusion-related reaction is adverse reaction due to study drug and occurred during an infusion and for 2 hours after the infusion completes. The symptom includes but not limited to fever, hypotension, hypertension, rash, nausea, dizziness.
Time frame: Day 1, Day 8, Day 15, Day 22 of Cycle 1 treatment
Incidence of all-grade and Grade 3-4 laboratory abnormalities
The grading of the laboratory abnormalities is assessed based on National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0
Time frame: Up to 28 days after the last dose
Percentage of subjects tolerated at least 75% of the intended dose per cycle
A subject will be treated weakly, 4 doses in a cycle
Time frame: Up to 3 months
Number of participants with physical abnormalities
Physical examination includes the following items: general appearance, skin, eyes, ears, nose, throat, head and neck (including thyroid), heart, chest and lungs, abdomen, extremities, lymph nodes, musculoskeletal, neurological system, and other body systems if applicable for describing the status of the subject's health.
Time frame: Up to 3 months
Number of participants with chest x-ray abnormalities
The chest x-ray will be evaluated by the investigators and noted as "normal", "NCS" or "CS".
Time frame: Up to 3 months
Number of participants with abnormalities in vital signs
Vital signs measurement will consist of systolic/diastolic blood pressure, respiratory rate, pulse rate, body temperature, and oxygen saturation (SpO2).
Time frame: Up to 28 days after the last dose
Number of participants with abnormalities in 12-lead electrocardiogram (ECG) for each post-treatment evaluation until the end of Cycle 3
The results of ventricular rate, PR interval, QRS interval, QT interval, and QTc interval will be recorded.
Time frame: Up to 3 months
AM-928 serum concentration
The serum concentration of AM-928
Time frame: Day 1, 2, 3, 4, 8 and 15 of Cycle 1 treatment, Day 1 and 15 of Cycle 2, Day 1 of the following Cycle 3 and Cycle 5, and in 7 days after the last dose
AM-928 Pharmacokinetic Parameter - Cmax
The peak post-dose concentration
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - Tmax
Time at which Cmax is observed
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - T 1/2
Terminal phase elimination half-life
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - AUC last
Area under the serum concentration-time profile (AUC) from time zero (T0) to the time of the last quantifiable concentration
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - AUC 0-infinity
AUC from T0 extrapolated to infinite time
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - CL
The volume of serum cleared of the drug per unit time.
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - Vz
Volume of distribution
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - Vss
Steady-state volume of distribution
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - MRT
Mean Residence Time
Time frame: Week 1
AM-928 Pharmacokinetic Parameter - C trough
The last pre-dose concentration at steady state before the next dose is administered
Time frame: Day 8, Day 15, Day 22 of Cycle 1 treatment; Day 1, Day 15 of Cycle 2; Day 1 of Cycle 3 and Cycle 5
Objective response rate (ORR)
The proportion of treated subjects achieving the best overall response of Complete Response (CR) or Partial Response (PR) per RECIST 1.1
Time frame: 6 months
Disease control rate (DCR)
The proportion of treated subjects having achieved Complete Response (CR) + Partial Response (PR) + Stable Disease (SD) per RECIST 1.1
Time frame: 6 months
Tumor growth rate (TGR)
The percent increase in the tumor volume per month
Time frame: Up to 28 days after the last dose
Tumor growth kinetics (TGK)
Change in the sum of the diameters of the target lesions per month
Time frame: Up to 28 days after the last dose
Change in Eastern Cooperative Oncology Group (ECOG) score
ECOG- Eastern Cooperative Oncology Group performance status is a scale used to assess how the disease affects the daily living abilities, and determine appropriate treatment and prognosis. It is a simple measure of functional status that determines ability of patient to tolerate therapies in cancer
Time frame: Up to 28 days after the last dose
Change in European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 score
The EORTC QLQ-C30 is a patient-reported outcome (PRO) questionnaire to assess the quality of life of cancer patients. Version 3.0 will be applied.
Time frame: Up to 28 days after the last dose
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