This study is a prospective, open-label, multi-cohort, exploratory phase II clinical trial in patients with either CEACAM5-positive NSQ NSCLC, ER+ breast cancer or gastric cancer. Eligible subjects will receive Tusamitamab ravtansine (100mg/m2 IV Q2W). The investigators hypothesize that intratumoral exposure of Tusamitamab ravtansine would be an important factor in determining treatment efficacy. Combining exposure with measurements of tumor PD reactions in a proper PK/PD study is the goal of this study.
The investigators hypothesize that intratumoral exposure of Tusamitamab ravtansine would be an important factor in determining treatment efficacy. The rationale to develop an antibody-drug conjugate, like tusamitamab ravtansine, is that it concentrates the active compound (DM4) in cancer tissues, thus confirming this hypothesis in human subjects would be an important step forward. Combining exposure with measurements of tumor PD reactions in a proper PK/PD study is the goal of the study. Tusamitamab ravtansine is being developed in NSQ NSCLC. The results of the first-in-human study in NSQ NSCLC patients were promising and participants could thus benefit from this treatment. However, other tumor types also express CEACAM5 in tumor cells. The investigators will also recruit metastatic ER+ breast cancer patients and metastatic gastric cancer patients. Hence, there has been more limited data on the safety and efficacy in this patient populations. Addition of these cohorts will help to understand the influence of primary tumor type in determining intratumoral concentrations of Tusamitamab ravtansine. CEACAM5-positive is defined as IHC ≥2+ in intensity in ≥50% of the tumor cells expressing CEACAM5. Yet, the cut-off value for CEACAM5 expression is arbitrarily selected. A PK/PD relation between CEACAM5 expression and exposure would support the current applied cut-off value for CEACAM5 expression.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Eligible subjects will receive Tusamitamab ravtansine (100mg/m2 IV Q2W). Subjects without evidence of disease progression or drug related toxicity can continue treatment with Tusamitamab ravtansine (100 mg/m2 IV Q2W) until disease progression, unacceptable toxicity occurs, or the participant's or Investigator's decision to stop the treatment.
Erasmus MC
Rotterdam, Netherlands
intratumoral DM4 concentration
Intratumoral DM4 exposure, as measured in a biopsied lesion using a PK assay.
Time frame: approximately 5 weeks, more specific day 3 of cycle 2 (each cycle is 14 days)
Intratumoral tusamitamab ravtansine concentration
Intratumoral concentrations of Tusamitamab ravtansine and metabolites of DM4: Lys-SPDB-DM4, Me-DM4 using a PK assay
Time frame: approximately 5 weeks, more specific day 3 of cycle 2 (each cycle is 14 days)
Incidence of grade 3 or 4 adverse events
Incidence of grade 3 or 4 adverse events as assessed by CTCAE version 5.0
Time frame: during treatment (up to 2 years and 12 weeks)
Response to treatment
Number of participants with either progressive disease, stable disease, partial response or complete response according to RECIST v 1.1
Time frame: every 8 weeks during treatment (up to 2 years and 12 weeks)
CEACAM5 expression
Change in CEACAM5 expression from baseline as assessed by immunohistochemistry
Time frame: approximately 5 weeks, more specific day 3 of cycle 2 (each cycle is 14 days)
RNA expression levels
Change from baseline in RNA expression levels as assessed with differential gene-level analysis in DESeq2
Time frame: approximately 5 weeks, more specific day 3 of cycle 2 (each cycle is 14 days)
circulating CEA levels
Number of patients with elevated levels of circulation CEA
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Time frame: every 8 weeks during treatment (up to 2 years and 12 weeks)
tumor genomic features
Somatic copy number, strucural and nucleotide alterations as assessed by whole genome sequencing
Time frame: baseline
Maximal plasma concentration
Cmax and its corresponding time (Tmax)
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
AUCinf
AUCinf - Area under the curve form time of dosing extrapolated to infinity of AUC0-t + Clast/lambda z
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
AUClast
AUClast - Area under the curve form the time of dosing to the time of the last quantifiable concentration calculated using the linear trapezoidal rule
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
AUCt
AUCt - Area under the concentration versus time curve
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
Thalf
Thalf will be calculated as ln(2)/Lambda z
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
systemic tusamitamab ravtansine concentration
Clearance (Cl)
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
Volume of distribution
Volume of distribution
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
concentration DM4 metabolites: Lys-SPDB-DM4, Me-Dm4
concentration of metabolites of DM4 will be described
Time frame: baseline and at 7 different time points during treatment (3x cycle 1 day 1, 1x pre-dose cycle 2 day 1, 2x cycle 2 day 2, and 1x pre-dose cycle 4 day 1) (each cycle is 14 days)
features in tumor micro-environment
RNA-sequencing to deduce the immune contexture using quanTIseq, tumor infiltrating lymphocyte signatures and related workflows
Time frame: approximately 5 weeks, more specific day 3 of cycle 2 (each cycle is 14 days)