This phase Ib trial will investigate the effect of N-803 in combination with pembrolizumab and enfortumab vedotin in treating participants with urothelial cancer that has spread to nearby tissue or lymph nodes (locally advanced) or that has spread from where it first started (primary site) to other places in the body (metastatic).
PRIMARY OBJECTIVE: I. To assess the safety and tolerability of the treatment regimen (N-803, enfortumab vedotin, and pembrolizumab). II. To assess 12-month progression-free survival (PFS) of participants with locally advanced or metastatic urothelial carcinoma (mUC) receiving enfortumab vedotin (EV) plus pembrolizumab and N-803. SECONDARY OBJECTIVE: I. To evaluate the preliminary efficacy of the treatment regimen (EV, pembrolizumab, and N-803) as measured by complete response rate (CRR), objective response rate (ORR), clinical benefit rate (CBR), 12-month overall survival (12-OS), median duration of response (mDOR), median progression-free survival (mPFS) and median overall survival (mOS). EXPLORATORY OBJECTIVES: I. To determine the immune status of the tumor microenvironment using multiplex immunohistochemistry (IHC) and identify potential correlations with participant outcomes. II. To determine T-cell receptor (TCR) clonality. III. To analyze tumor/immune gene expression profiles, DNA methylation, DNA damage response and repair (DDR) genes \[e.g., BRCA1/2, ERCC1/2\]). IV. Observe changes in circulating tumor DNA (ctDNA). V. To monitor the maintenance of absolute lymphocyte counts (ALC) relative to baseline, throughout the course of treatment. OUTLINE: This is an open-label, single center, phase Ib single-arm trial with a safety lead-in cohort. Participants will receive treatment for up to 12 cycles administered. Depending on response, participants may continue treatment with pembrolizumab and N-803 for maximum of 2 years. Participants will undergo safety follow-up approximately 30 days following the end of study treatment and be followed for survival until death (any cause) or end of study for a up to 5 years from start of treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
University of California, San Francisco
San Francisco, California, United States
Proportion of participants with reported Treatment-Emergent Adverse Events
Treatment emergent adverse events will be graded using National Cancer Institute Common Terminology Criteria for Adverse Events version (v) 5.0.
Time frame: Up to 2 years
Number of participants with reported Dose-limiting toxicities (DLTs)
Safety will be evaluated by assessing for DLTs in the first 6 participants treated with the study drug combination. If \>33% or \>2 of the first six participants experiences a DLT, the dose will be reviewed, and study will be considered for modification.
Time frame: Up to 28 days
Percentage of participants alive and progression free at 12 months (PFS12)
The percentage of participants alive and progression free at 12 months is defined from the date of first dose of study drugs (C1D1) to the date of disease progression or death (any cause), whichever occurs first, by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. If disease progression or death from any cause is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the PFS will be censored as the last available disease assessment. Kaplan Meier analyses will be used to estimate 12 month PFS with 90% confidence interval.
Time frame: 12 months
Complete Response (CR) Rate
Defined as the portion of participants who experience a confirmed complete response (CR) per RECIST 1.1. Data will be collected from enrollment until the participant experiences disease progression, initiates subsequent anti-cancer therapy, or completes study participation (whichever occurs first).
Time frame: Up to 2 years
Clinical Benefit Rate (CBR)
Clinical benefit rate is defined as the proportion of participants who experience clinical benefit (CR, partial response (PR) or stable disease (SD)) for at least 24 weeks (two consecutive scans) per RECIST 1.1. criteria.
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NONE
Enrollment
18
Undergo blood collection for research purposes
Undergo radiographic imaging for disease assessment
Undergo tumor biopsy
Time frame: Up to 24 weeks
Objective Response Rate (ORR)
Defined as the portion of participants who experience an objective response (confirmed complete response (CR) or confirmed partial response (PR)) per RECIST 1.1. ORR data will be collected from enrollment until the response has been confirmed, the participant experiences disease progression, initiates subsequent anti-cancer therapy, or completes study participation (whichever occurs first).
Time frame: Up to 2 years
Median Overall Survival (OS)
Defined as the amount of time that elapses between /the initiation of trial therapy (C1D1) and the time of death from any cause. OS data will be collected from enrollment until the participant completes study follow-up participation, experiences death from any cause or is documented as lost to follow up per institutional standard (whichever is sooner). If death from any cause is not observed prior to completing study participation, the OS will be censored as the time of the last available documentation of survival status. (Last available documentation of survival status is defined as the date of death or the latest of the following times: treatment discontinuation date, last dosing administration date, last disease assessment date, or the last follow up date when the participant was known to be alive.)
Time frame: Up to 5 years
Median Duration of Response (DOR)
Defined as the time that elapses between the first day of documented response to trial therapy and subsequent disease progression. For DOR analysis, response is defined as confirmed complete response (CR), or confirmed partial response (PR), per RECIST 1.1 and disease progression is defined as progressive disease (PD) per RECIST 1.1. If disease progression is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the DOR will be censored as the last available disease assessment.
Time frame: Up to 5 years
Median Progression-Free Survival (PFS)
Defined as the amount of time that elapses between the initiation of trial therapy (C1D1) and the day of first documented disease progression or death. If disease progression or death from any cause is not observed prior to initiating subsequent anti-cancer therapy or completing study participation, the PFS will be censored as the last available disease assessment.
Time frame: Up to 5 years