1. Study population \[TB511 Monotherapy Cohort for Phase 1 and Phase 2a Clinical Trial\] Patients with advanced solid tumors who are either refractory or intolerant to standard of care (SoC). \[Immune checkpoint inhibitors (ICIs) Combination Therapy Cohort for Phase 2a Clinical Trial\] Patients with advanced solid tumors who are refractory to immune checkpoint inhibitors (ICIs) such as anti-PD-1, anti-PD-L1, or anti-CTLA-4 inhibitors or who have no available standard of care. 2. Objectives of the Clinical Trial 2.1 Primary Objectives \[Phase 1 Clinical Trial\] * To evaluate the safety and tolerability of TB511 monotherapy in patients with advanced solid tumors and to determine the Maximum Tolerated Dose (MTD) and the Recommended Phase II Dose (RP2D). \[Phase 2a Clinical Trial\] * To evaluate the Objective Response Rate (ORR) of TB511 monotherapy and TB511 in combination with Pembrolizumab in patients with advanced solid tumors (based on Response Evaluation Criteria In Solid Tumors Version 1.1, RECIST v1.1). 2.2 Secondary Objectives \[Phase 1 Clinical Trial\] * To evaluate the safety of TB511 monotherapy. * To assess the Objective Response Rate (ORR) and anti-tumor activity of TB511 monotherapy (based on RECIST v1.1). * To characterize the pharmacokinetic (PK) profile of TB511 monotherapy. \[Phase 2a Clinical Trial\] * To evaluate the Disease Control Rate (DCR), Duration of Response (DoR), and Progression-Free Survival (PFS) of TB511 monotherapy and TB511 in combination with Pembrolizumab. * To assess the safety and tolerability of TB511 monotherapy and TB511 in combination with Pembrolizumab. * To characterize the pharmacokinetic (PK) profile of TB511 monotherapy and TB511 in combination with Pembrolizumab. 2.3 Exploratory Objectives * To compare changes in biomarker levels of TB511 monotherapy. * To assess immunogenicity of TB511 by measuring anti-drug antibodies (ADA).
1. Number of participants \[Phase 1 Clinical Trial\] 3 to 6 patients per dose group \[Phase 2a Clinical Trial\] Approximately 20 patients per cohort (Cohort 1: Approximately 20 patients, Cohort 2: Approximately 20 patients) 2. Study Duration * Total clinical trial duration: Approximately 36 months from the date of IRB approval (however, this may be adjusted depending on the enrollment rate of participants.) * Participation duration for individual participants * Screening period: Up to 4 weeks (28 days) * Treatment period: Each cycle consists of 3 weeks (21 days), and administration will continue until a reason for discontinuation occurs. * Safety follow-up period: 6 weeks after the End of Treatment (EOT) 3. Investigational Product <!-- --> 1. Study drug * Product name or code: TB511 Injection (8 mg) * Formulation and appearance: White or off-white color of lyophilized powder ③ Main ingredient: TB511 ④ Storage method: Store in a hermetic container in a freezer (-20℃); protect from light 2. Concomitant drug * Product name or code: Keytruda * Formulation and appearance: An injection comprised of clear to slightly opalescent, colorless to slightly yellow solution contained in a colorless and transparent vial. * Main ingredient: Pembrolizumab ④ Storage method: Store in a hermetic container, refrigerated at 2 to 8℃; protect from light; do not freeze 4\. Dosage and method of administration \[Phase 1 Clinical Trial\] 1. TB511 * Starting Dose group: 4 mg * Dose Escalation groups: 4 mg, 8 mg, 16 mg, 24 mg ③ Dose De-escalation: 12 mg, 20 mg ④ Administration method: 1 cycle consists of 3 weeks (21 days). TB511 will be administered subcutaneously into the abdomen once every 7 days for 3 weeks (21 days). Repetitive injections at the same site should be avoided; instead, rotate injection sites within the abdominal area. Do not inject into sensitive or abnormal skin areas (e.g., wounds, rashes, redness, induration, etc.). ⑤ Administration Plan: Administration will continue until unacceptable toxicity, disease progression (PD) per RECIST v1.1, or other reasons requiring discontinuation occur. \[Phase 2a Clinical Trial\] 1. TB511 * Dose: Recommended dose for Phase 2a determined in Phase 1. ② Administration method: 1 cycle consists of 3 weeks (21 days). TB511 will be administered subcutaneously into the abdomen once every 7 days for 3 weeks (21 days). Repetitive injections at the same site should be avoided; instead, rotate injection sites within the abdominal area. Do not inject into sensitive or abnormal skin areas (e.g., wounds, rashes, redness, induration, etc.). ③ Administration Plan: Administration will continue until unacceptable toxicity, disease progression (PD) per RECIST v1.1, or other reasons requiring discontinuation occur. 2. Pembrolizumab * Dose: 200 mg or dose adjusted according to the approved labeling. ② Administration Method: Pembrolizumab is administered by continuous intravenous infusion for 30 minutes, once every 3 weeks (When used in combination with TB511, Pembrolizumab should be administered first, followed by TB511 at least 30 minutes later). * Administration Plan: Administration will continue until unacceptable toxicity, disease progression (PD) per RECIST v1.1, or other reasons requiring discontinuation occur. 5\. Study Method This clinical trial consists of a Phase 1 dose-escalation study to determine the maximum tolerated dose (MTD) of TB511 and establish the recommended Phase 2a dose (RP2D) in patients with advanced solid tumors who are refractory or intolerant to standard of care, and a Phase 2a study to evaluate the anti-tumor effect of TB511 monotherapy in dose determined in Phase 1 (Cohort 1) and TB511 in combination with Pembrolizumab (Cohort 2) in patients with advanced solid tumors for whom no standard of care is available, including those who are refractory to immune checkpoint inhibitors (ICIs) such as anti-PD-1, anti-PD-L1, or anti-CTLA-4 agents or who have experienced disease progression. Participants who voluntarily sign the written informed consent form will undergo screening tests to assess eligibility during the screening period. Subjects who meet all inclusion and none of the exclusion criteria will be enrolled in this clinical trial and receive the investigational product at the assigned dose level. 1 cycle of administration of the investigational product is 3 weeks (21 days), and enrolled participants continue to receive the investigational product until intolerable toxicity, verification of progressive disease (PD) as defined by RECIST v1.1, or any other reason for discontinuing administration occur. Tumor response assessments (CT/MRI) will be conducted on Day 1 of Cycle 1 and every 2 cycles thereafter. Pharmacokinetic (PK) evaluation will be performed on Day 1 and Day 15 of Cycle 1, and exploratory evaluation will be performed during screening, and on Day 8 and Day 15 of Cycle 1. \[Phase 1 Clinical Trial - TB511 Monotherapy\] The Phase I clinical trial will follow a 3+3 design, starting from the lowest dose cohort and continuing until the maximum tolerated dose (MTD) is determined. Depending on the MTD determination method, 3 to 6 participants will be sequentially enrolled in each dose-escalation level (TB511: 4 mg, 8 mg, 16 mg, 24 mg) with at least a 3-day interval and TB511 is administered for 1 cycle to determine dose limiting toxicity(DLT). DLT assessment will be conducted in Cycle 1. Dose escalation or de-escalation will be decided by the Safety Review Committee (SRC) after the completion of DLT evaluation of the last participant in each dose level. If no DLT is observed, the study will proceed to the next higher dose level. If DLT occurs, the trial may proceed with an intermediate dose level, as defined below. After completion of dose escalation or de-escalation, the Recommended Phase 2a Dose (RP2D) will be determined based on the MTD and overall toxicity evaluation. The SRC will also decide whether to continue or discontinue the trial. \<Dose De-escalation Scheme\> If DLT is observed at a given dose level, the dose will be de-escalated to an intermediate dose\* as follows: \- If toxicity occurs at 24 mg, the intermediate dose will be 20 mg. * If toxicity occurs at 16 mg, the intermediate dose will be 12 mg. * Intermediate dose: An intermediate dose between the given dose level and one-step lower dose level.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
12
TB511 is a peptide drug conjugate (PDC) which composed of TAMpep826 peptide. TB511 is a white amorphous powder used for subcutaneous injections. TB511 is a peptide drug conjugate that combines a transporter peptide with a specific targeting of M2 macrophages and an apoptosis-inducing peptide (dKLA). As a transporter, the M2 binding peptide acts as a drug conjugate, explicitly binding to M2 macrophages and inducing cell penetration. In the cells, the dKLA component of TB511 binds to the mitochondrial membrane, destroys the mitochondrial membrane, and induces apoptosis by causing cytochrome release, leading to the destruction of the mitochondria and subsequent death of M2 macrophages.
KEYTRUDA binds to the PD - 1 receptor, blocking both immune-suppressing ligands, PD L1 and PD L2, from interacting with PD - 1 to help restore T-cell response and immune response.
Phase I Clinical trial-Maximum tolerated dose (MTD).
1. Definition and Assessment of Dose Limiting Toxicity (DLT) DLT is an adverse event or abnormal laboratory level unrelated to the progress of the disease or intercurrent disease that limits dose escalation and is consistent with one or more of the following criteria: DLT assessment is conducted only at Cycle 1 after completion of Cycle 1. However, even during Cycle 1, DLT can be immediately evaluated if toxicity is determined to be DLT. DLT assessment is conducted in accordance with NCI-CTCAE v5.0 based on individual assessment items on hematological/non-hematological toxicity and other toxicities. 2. Definition and Determination of Maximum Tolerated Dose (MTD) When 2 out of 3 subjects or 2 out of 6 subjects experience DLTs, the dose is considered intolerable, the subsequent dose escalation is stopped, and a level lower than the dose is declared the maximum tolerable dose (MTD).
Time frame: 1 year
Phase I Clinical trial-Recommended Phase IIa dose (RP2D).
RP2D of Phase IIa clinical trial is determined through MTD and overall toxicity assessment.
Time frame: 1 year
Phase IIa Clinical trial-anti-tumor effect-to evaluate the Objective response rate (ORR) of TB511 monotherapy and combination therapy with Pembrolizumab in patients with advanced solid tumors (based on RECIST v1.1).
Solid tumor response is evaluated in accordance with RECIST v1.1 and immune RECIST (iRECIST). Objective response rate (ORR): Fraction of subjects whose best overall response is Complete Response (CR) or Partial Response (PR)
Time frame: 2 years
Phase I clinical trial-anti-tumor effects of TB511 Monotherapy-the Objective response rate (ORR)
Solid tumor response is evaluated in accordance with RECIST v1.1. Objective response rate (ORR): Fraction of subjects whose best overall response is Complete Response (CR) or Partial Response (PR)
Time frame: 1 year
Phase I clinical trial-anti-tumor effects of TB511 Monotherapy-Disease control rate (DCR)
Disease control rate (DCR): Fraction of subjects whose best overall response is CR, PR or Stable Disease (SD)
Time frame: 1 year
Phase I clinical trial-anti-tumor effects of TB511 Monotherapy-Duration of response (DoR)
Duration of response (DoR): From the point of time when response occurs to (CR or PR) PD or death due to any reason.
Time frame: 1 year
Phase I clinical trial-safety-adverse events of TB511 Monotherapy
Safety Assessment and Method of Assessment 1\) Adverse Events Adverse events are a general term for symptoms, signs, and abnormal values of laboratory tests that occur or worsen after the administration of an investigational product. The AE name, onset/end dates, severity, treatment and outcomes, and relationship to the investigational product should be documented in the AE pages of the eCRFs.
Time frame: 1 year
Phase I clinical trial-safety-vital signs of TB511 Monotherapy
2\) Vital signs Findings of vital signs that meet the definitions of AEs after the administration of the investigational product should be reported as AEs.
Time frame: 1 year
Phase I clinical trial-safety-physical examination and ECG of TB511 Monotherapy
3\) Physical examination and ECG After the administration of the investigational product, findings in physical examinations that meet the definitions of AEs or ECGs showing clinically significant changes should be reported as AEs.
Time frame: 1 year
Phase I clinical trial-safety-laboatory test of TB511 Monotherapy
4\) Laboratory test Laboratory test results will be categorized into normal or abnormal (NCS or CS). Any result after the administration of the investigational product showing clinically significant changes from baseline should be reported as AEs.
Time frame: 1 year
PK parameters for TB511 (Area Under the Curve from 0 to 24 h (AUC)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 AUC
Time frame: 1 year
PK parameters for TB511 (AUC to the Last Measurable Concentration from 0 to 24 h (AUClast)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 AUClast
Time frame: 1 year
PK parameters for TB511 (Area under the plasma concentration-time curve extrapolated to infinity from 0 to 24 h (AUCinf)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 AUCinf
Time frame: 1 year
PK parameters for TB511 (Peak Plasma Concentration from 0 to 24 h (Cmax)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 Cmax
Time frame: 1 year
PK parameters for TB511 (Time to Obtain Maximum Plasma Concentration from 0 to 24 h (Tmax)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 Tmax
Time frame: 1 year
PK parameters for TB511 from 0 to 24 h (half-life (t1/2)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 half-life (t1/2)
Time frame: 1 year
PK parameters for TB511 (Clearance from 0 to 24 h (CL/F)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 CL/F
Time frame: 1 year
PK parameters for TB511 (Volume of distribution from 0 to 24 h (Vd/F)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 Vd/F
Time frame: 1 year
PK parameters for TB511 (Area Under the Curve from 0 to 24 h at steady-state (AUCss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 AUCss
Time frame: 1 year
PK parameters for TB511 (AUC to the Last Measurable Concentration from 0 to 24 h at steady-state (AUClast ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 AUClast, ss
Time frame: 1 year
PK parameters for TB511 (Area under the plasma concentration-time curve extrapolated to infinity from 0 to 24 h at steady-state (AUCinf, ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 AUCinf, ss
Time frame: 1 year
PK parameters for TB511 (Peak Plasma Concentration from 0 to 24 h at steady-state (Cmax ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 Cmax, ss
Time frame: 1 year
PK parameters for TB511 (Time to Obtain Maximum Plasma Concentration from 0 to 24 h at steady-state (Tmax, ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 Tmax, ss
Time frame: 1 year
PK parameters for TB511 (half-life from 0 to 24 h at steady-state (t1/2, ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 half-life (t1/2, ss)
Time frame: 1 year
PK parameters for TB511 (Clearance from 0 to 24 h at steady-state (CL, ss/F)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 CL, ss/F
Time frame: 1 year
PK parameters for TB511 (Volume of distribution from 0 to 24 h at steady-state (Vd, ss/F)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 Vd, ss/F
Time frame: 1 year
Phase IIa-anti-tumor effects of TB511 Monotherapy and TB511 & pembronizumab compination therapy-Disease control rate (DCR)
Disease control rate (DCR): Fraction of subjects whose best overall response is CR, PR or SD
Time frame: 2 years
Phase IIa-anti-tumor effects of TB511 Monotherapy and TB511 & pembronizumab compination therapy-Duration of response (DoR)
Duration of response (DoR): From the point of time when response occurs to (CR or PR) PD or death due to any reason.
Time frame: 2 years
Phase IIa-anti-tumor effects of TB511 Monotherapy and TB511 & pembronizumab compination therapy-Progression-free survival (PFS) period
Progression-free survival (PFS) period: Period from the initial date of administration of the investigational product to the date when objective progressive disease (PD) is verified by the investigator, or the date of death, whichever occurs first.
Time frame: 2 years
Phase IIa-the safety-adverse events of TB511 Monotherapy and TB511 & pembronizumab compination therapy
1\) Adverse Events Adverse events are a general term for symptoms, signs, and abnormal values of laboratory tests that occur or worsen after the administration of an investigational product. The AE name, onset/end dates, severity, treatment and outcomes, and relationship to the investigational product should be documented in the AE pages of the eCRFs.
Time frame: 2 years
Phase IIa-the safety-vital signs of TB511 Monotherapy and TB511 & pembronizumab compination therapy
2\) Vital signs Findings of vital signs that meet the definitions of AEs after the administration of the investigational product should be reported as AEs.
Time frame: 2 years
Phase IIa-the safety-Physical examination and ECG of TB511 Monotherapy and TB511 & pembronizumab compination therapy
3\) Physical examination and ECG After the administration of the investigational product, findings in physical examinations that meet the definitions of AEs or ECGs showing clinically significant changes should be reported as AEs. Findings of vital signs that meet the definitions of AEs after the administration of the investigational product should be reported as AEs.
Time frame: 2 years
Phase IIa-the safety-Laboratory test of TB511 Monotherapy and TB511 & pembronizumab compination therapy
4\) Laboratory test Laboratory test results will be categorized into normal or abnormal (NCS or CS). Any result after the administration of the investigational product showing clinically significant changes from baseline should be reported as AEs.
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Area Under the Curve from 0 to 24 h (AUC)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination AUC
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (AUC to the Last Measurable Concentration from 0 to 24 h (AUClast)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination AUClast
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Area under the plasma concentration-time curve extrapolated to infinity from 0 to 24 h (AUCinf)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination AUCinf
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Peak Plasma Concentration from 0 to 24 h (Cmax)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination Cmax
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Time to Obtain Maximum Plasma Concentration from 0 to 24 h (Tmax)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination Tmax
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (half-life from 0 to 24 h (t1/2)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination half-life (t1/2)
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Clearance from 0 to 24 h (CL/F)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination CL/F
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Volume of distribution from 0 to 24 h (Vd/F)) [Time Frame: Day 1 of first 1 cycle]
Determine TB511 and Pembrolizumab combination Vd/F
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Area Under the Curve from 0 to 24 h at steady-state (AUCss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination AUCss
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (AUC to the Last Measurable Concentration from 0 to 24 h at steady-state (AUClast ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination AUClast, ss
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Area under the plasma concentration-time curve extrapolated to infinity from 0 to 24 h at steady-state (AUCinf, ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination AUCinf, ss
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Peak Plasma Concentration from 0 to 24 h at steady-state (Cmax ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination Cmax, ss
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Time to Obtain Maximum Plasma Concentration from 0 to 24 h at steady-state (Tmax, ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination Tmax, ss
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (half-life from 0 to 24 h at steady-state (t1/2, ss)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination half-life (t1/2, ss)
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Clearance from 0 to 24 h at steady-state (CL, ss/F)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination CL, ss/F
Time frame: 2 years
PK parameters for TB511 and Pembrolizumab combination (Volume of distribution from 0 to 24 h at steady-state (Vd, ss/F)) [Time Frame: Day 21 of first 1 cycle]
Determine TB511 and Pembrolizumab combination Vd, ss/F
Time frame: 2 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.