This is an open-label, multicenter, dose-escalation Phase Ib trial of APN401, a suspension of viable Peripheral Blood Mononuclear Cells (PBMCs) from an individual patient that have been transfected with a small interfering ribonucleic acid (siRNA) to reduce Cbl-b expression. Twelve evaluable participants with advanced solid tumors will be assessed. The primary objective is to evaluate the safety and tolerability of APN401 and to determine the Recommended Phase 2 Dose (RP2D) of APN401. The secondary objective is to collect preliminary data on the clinical efficacy of APN401. Participants will receive up to four APN401 treatments via intravenous infusion at 3-weekly intervals. Participants, who have completed four treatment cycles and a safety follow-up, will be contacted by telephone to evaluate survival status at 6 and 12 months after start of treatment.
APN401 is a suspension of autologous Peripheral Blood Mononuclear Cells (PBMCs), transiently transfected with an siRNA to reduce Cbl-b protein levels. The administration of autologous Cbl-b silenced PBMCs to the patient will promote activation of both adaptive and innate immune mechanisms targeting tumor cells; along these lines APN401 is assumed to demonstrate significant improvement in cancer immune therapy. In addition, silencing of Cbl-b in the context of cellular therapeutics has potential to reduce mortality rates for patients with advanced cancers. This is an open-label, single-arm trial to be conducted with up to twelve patients at four hospitals in Austria, Europe. Two dose levels of APN401 are evaluated using a Bayesian Optimal Interval (BOIN) study design with accelerated titration: * Dose Level/Cohort 1: 1.5x10\^7 PBMCs/kg * Dose Level/Cohort 2: 4.5x10\^7 PBMCs/kg Dose escalation requires at least one patient to be treated and observed for at least three weeks after the first dose. The BOIN method will be used to guide the dose level assignment and estimate the MTD/RP2D based on cumulative information on DLTs in Cycle 1 of treatment (i.e. 3 weeks after first dose). Patients with advanced solid tumors first undergo screening procedures during a 28-day time window between giving consent and starting APN401 treatment. Eligible patients are treated with up to four APN401 infusions. During each treatment cycle, patients undergo leukapheresis on the first day and APN401 infusion on the second day (i.e., D0/D1; D21/D22; D42/D43; D63/D64). During the subsequent follow-up phase, patients participate a safety-follow up 3 weeks post last APN401 dose and are contacted by telephone to evaluate survival status at 6 and 12 months after start of treatment. Tumor imagings to evaluate the efficacy of APN401 treatment are scheduled during the screening phase (baseline imaging), and prior to treatment Cycle 3 and the last Safety Follow-up.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
APN401 is a suspension of viable peripheral blood mononuclear cells (PBMCs) from an individual patient that have been transfected with a small interfering ribonucleic acid (siRNA) to reduce Cbl-b expression. It is administered intravenously in 3-weekly intervals (i.e. every 21 days) for a maximum of 4 treatment cycles.
Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT)
Salzburg, State of Salzburg, Austria
Medizinische Universität Wien, Universitätsklinik für Transfusionsmedizin und Zelltherapie
Vienna, State of Vienna, Austria
Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin V, Hämatologie und internistische Onkologie
Innsbruck, Tyrol, Austria
Ordensklinikum Linz, Barmherzige Schwestern, Abteilung für Hals-, Nasen-, Ohrenheilkunde
Linz, Upper Austria, Austria
Incidence of Treatment Emergent Adverse Events (TEAEs) and/or Serious Adverse Events (SAEs)
The safety and tolerability of APN401 will be assessed by recording the TEAEs and SAEs using National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 (NCI CTCAE 5.0)
Time frame: Up to 30 days post last dose
Occurence of Dose Limiting Toxicities (DLTs)
The safety and tolerability of APN401 will be assessed by recording DLTs
Time frame: Observed from Day 1 of APN401 infusion until the end of Cycle 1 (Day 21)
Determination of Recommended Phase 2 Dose (RP2D) of APN401
RP2D will be determined on the BOIN recommendations (based on DLT and MTD) and the overall safety information
Time frame: Through completion of DLT period of last evaluable patient, an average of 8 months
Overall Response Rate (ORR)
Preliminary data on clinical efficacy of APN401 will be assessed according to RECIST 1.1
Time frame: Up to 12 months
Disease Control Rate (DCR)
Preliminary data on clinical efficacy of APN401 will be assessed according to RECIST 1.1
Time frame: Up to 12 months
Overall Survival (OS)
Preliminary data on clinical efficacy of APN401 will be assessed
Time frame: Time from enrollment to death
Overall Survival (OS) at 3, 6 and 12 months
Preliminary data on clinical efficacy of APN401 will be assessed
Time frame: At 3, 6 and 12 months post start of treatment phase
Progression Free Survival (PFS)
Preliminary data on clinical efficacy of APN401 will be assessed according to RECIST 1.1
Time frame: From date of enrollment until the date of first evidence of disease progression or date of death from any cause, whichever came first, assessed up to 12 months
Progression Free Survival (PFS) Rate at 3 months
Preliminary data on clinical efficacy of APN401 will be assessed according to RECIST 1.1
Time frame: At 3 months post start of treatment phase
Immune responses in circulation to monitor APN401 immune activation
Preliminary data on clinical efficacy of APN401 will be assessed using ELISA-based techniques
Time frame: Prior to treatment cycles C1, C2, C3, C4 (each cycle is 21 +/- 3 days) and 21 days (+/-10 days) post last APN401 dose
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