This study is a First In Human, phase 1, open-label, non-randomized, multi-center, multiple ascending dose escalation study evaluating AFM28 as a monotherapy in subjects with Relapsed/Refractory CD123-positive Acute Myeloid Leukemia (AML). AFM28 is a tetravalent monoclonal antibody targeting the interleukin-3 receptor subunit alpha (IL3RA, CD123) and the low affinity immunoglobulin gamma Fc region receptor III-A (FCGR3A, CD16A). It is developed as an antineoplastic agent for hematologic malignancies known to express CD123. The primary pharmacological Mode of Action of AFM28 is induction of cell death of CD123-expressing cells by stimulating Antibody-Dependent Cell-mediated Cytotoxicity mediated by CD16A-expressing immune cells, primarily Natural Killer cells. The aim of the dose escalation is to determine the Maximum Tolerated Dose (MTD) and/or establish one or more Recommended Phase 2 Doses, based on safety, preliminary anti-leukemic activity and Pharmacokinetics / Pharmacodynamics data.
The study drug will be given by intravenous infusion once weekly as long as the subject is deriving clinical benefit until disease progression or other treatment discontinuation criteria met, unacceptable toxicity, or subject's refusal, whichever occurs first. The dose-limiting toxicity observation period will be 28 days, reflecting adequate exposure for safety assessment. The dose-escalation scheme will follow a Bayesian logistic regression model. A safety review committee will monitor safety and recommend all cohort dosing decisions. The starting First In Human dose for AFM28 will be 25 mg i.v. and treatment in each cohort will utilize a staggered approach, with at least 7 days between the first dose of the first subject and the first dose of subsequent subjects. In order to gather additional Pharmacokinetics/ Pharmacodynamics and safety data to inform potential final dose escalation decisions and selection of one or more recommended phase 2 doses at selected dose levels, additional subjects may be enrolled in at least two cohorts consistent with backfilling a cohort (up to 12 subjects).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
AFM28 dose escalation
Institut Universitaire du Cancer Toulouse - Oncopole
Toulouse, France
Gustave Roussy
Villejuif, France
Institut Català d'Oncologia-Hospital Duran i Reynals
Barcelona, Spain
Hospital Universitario 12 de Octubre
Madrid, Spain
Hospital Universitari i Politècnic La Fe
Valencia, Spain
The Incidence of dose limiting toxicities
The incidence of dose limiting toxicities during dose limiting toxicities observation period considering the totality of treatment-emergent adverse events is evaluated using * National Cancer Institute Common Terminology Criteria for Adverse Events, v5.0 * the American Society of Transplantation and Cellular Therapy Cytokine Release Syndrome grading system for Cytokine Release Syndrome * the Cairo-Bishop Tumor Lysing Syndrom (TLS) grading system for TLS
Time frame: 28 days following the first dose of study treatment
Incidence and severity of Treatment Emergent Adverse Events
Incidence and severity of Treatment Emergent Adverse Events
Time frame: through study completion (up to 36 weeks)
Incidence and severity of Serious Adverse Events
Incidence and severity of Serious Adverse Events
Time frame: through study completion (up to 36 weeks)
Incidence of subjects developing anti-drug antibodies
Incidence of anti-drug antibodies during treatment with AFM28 (by measurement of anti-drug antibodies before and throughout treatment with AFM28)
Time frame: through study completion (up to 36 weeks)
Area under the concentration-time curve
Area under the concentration-time curve over the dose interval
Time frame: cycle 1 (day 1 and day 28)
Cmax
Maximum observed plasma concentration
Time frame: cycle 1 (day 1 and day 28)
Tmax
Time to reach maximum observed plasma concentration
Time frame: cycle 1 (day 1 and day 28)
Ctrough
Concentration measured immediately prior to the fourth dose
Time frame: immediately prior to the fourth dose
Complete Response
Complete response (Disease assessment in accordance with the International Working Group (IWG) criteria for AML and the European Leukemia Network (ELN) 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
Complete Response hematological
Complete Response with partial hematologic recovery (Disease assessment in accordance with the IWG criteria for AML and the ELN 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
Complete Response composite rate
Composite complete response rate (Disease assessment in accordance with the IWG criteria for AML and the ELN 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
Complete Response + Complete Response hematological rate
Complete Response plus Complete Response with partial hematologic recovery rate (Disease assessment in accordance with the IWG criteria for AML and the ELN 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
Overall Response Rate
Overall response rate (Disease assessment in accordance with the IWG criteria for AML and the ELN 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
Disease Control Rate
Disease control rate (Disease assessment in accordance with the IWG criteria for AML and the ELN 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
Duration of Response
Duration of Response (Disease assessment in accordance with the IWG criteria for AML and the ELN 2017 classification criteria)
Time frame: Through treatment period until 14 days after last dose
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