Claudin 18.2 or CLDN18.2 is a protein found on cells in the digestive system. It is also found in some tumors. Researchers are looking at ways to attack CLDN18.2 to help control tumors. ASP2138 is thought to bind to CLDN18.2 and a type of immune cell called a T cell. This "tells" the immune system to attack the tumor. ASP2138 is a potential treatment for people with gastric cancer (also known as stomach cancer) or gastroesophageal junction cancer (GEJ cancer). GEJ is where the tube that carries food (esophagus) joins the stomach. This study is for people with gastric or GEJ cancer that has spread nearby (locally advanced) and is not removable by surgery (unresectable), or has spread to other parts of the body (metastatic). It is for those whose cancer is human epidermal growth factor receptor 2 (HER2)-negative and CLDN18.2-positive. HER2-negative means the cancer does not have extra HER2 protein, so medicines that target HER2 do not work and are therefore not used. CLDN18.2-positive means people have a certain amount of CLDN18.2 proteins on their cancer cells. In this study, researchers want to learn if ASP2138 given together with standard treatments (chemotherapy and pembrolizumab) help people with HER2-negative and CLDN18.2-positive gastric or GEJ cancer. The main aim is to learn how long people who are given ASP2138 with chemotherapy and pembrolizumab live without their cancer getting worse, compared with placebo given with chemotherapy with or without pembrolizumab, and if they live for longer. Placebo looks like the study treatment but does not have any medicine in it. The main aim of this study is to check how well ASP2138 works when given together with chemotherapy and pembrolizumab compared with placebo plus chemotherapy with or without pembrolizumab. People aged 18 years or older with locally advanced unresectable or metastatic gastric or GEJ cancer can take part. Their tumor should be HER2-negative and CLDN18.2-positive. The study doctors will check people for any health conditions that can exclude them from taking part, interfere with the study procedures, or pose an unacceptable risk. This is a double-blind study. That means the people and the study doctors will not know who will receive which treatment. People will be assigned to one of 2 treatment groups by chance: Group A: People will receive ASP2138 along with chemotherapy and pembrolizumab. Group B: People will receive placebo along with chemotherapy, with or without pembrolizumab. People will keep receiving treatment until their cancer gets worse, they have medical problems that require stopping treatment, or a study rule says they must stop. There will be regular safety checks. People will continue to have scans of their tumor until their cancer becomes worse.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
570
SC Injection
IV Infusion
IV Infusion
Oral administration
IV Infusion
IV Infusion or IV bolus
SC Injection
IV Infusion
Metro Minnesota Community Oncology Research Consortium
Saint Louis Park, Minnesota, United States
RECRUITINGNiigata Cancer Center Hospital
Niigata, Japan
RECRUITINGPan American Center for Oncology Trials
Dorado, Puerto Rico
RECRUITINGOverall Survival (OS)
OS is defined as the time from the date of randomization until the documented date of death from any cause.
Time frame: Up to 54 months
Progression Free Survival (PFS) per Response Evaluation Criteria in Solid Tumours Version 1.1 (RECIST V1.1) by Blinded Independent Central Review (BICR)
PFS is defined as the time from the date of randomization until the date of radiographic disease progression per RECIST V1.1 by BICR or death from any cause, whichever is earlier.
Time frame: Up to 54 months
Objective response rate (ORR) per RECIST V1.1 by BICR
ORR is defined as the proportion of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) based on RECIST V1.1 by BICR.
Time frame: Up to 54 months
Disease control rate (DCR) per RECIST V1.1 by BICR
DCR is defined as the proportion of subjects with a BOR of CR, PR, or stable disease (SD) based on RECIST V1.1 by BICR.
Time frame: Up to 54 months
Duration of response (DOR) per RECIST V1.1 by BICR
DOR is defined as the time from the date of the first response (CR/PR) until the date of disease progression as per RECIST V1.1 by BICR or date of death from any cause, whichever is earlier.
Time frame: Up to 54 months
PFS per RECIST V1.1 by investigator assessment
PFS per investigator assessment is defined as the time from the date of randomization until the date of documented radiologic disease progression based on RECIST V1.1 by investigator assessment or until death due to any cause, whichever is earlier.
Time frame: Up to 54 months
ORR per RECIST V1.1 by investigator assessment
ORR per investigator assessment is defined as the proportion of participants with a BOR of CR or PR based on RECIST V1.1.
Time frame: Up to 54 months
DCR per RECIST V1.1 by investigator assessment
DCR per investigator assessment is defined as the proportion of subjects with a BOR of CR, PR, or SD based on RECIST V1.1.
Time frame: Up to 54 months
DOR per RECIST V1.1 by investigator assessment
DOR per investigator assessment is defined as the time from the date of the first response (CR/PR) until the date of disease progression as per RECIST V1.1 or date of death from any cause, whichever is earlier.
Time frame: Up to 54 months
Number of participants with adverse events (AEs)
An AE is any untoward medical occurrence in a patient or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavourable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study intervention.
Time frame: Up to 46 months
Number of participants with serious adverse events (SAEs)
An SAE is defined as any untoward medical occurrence that, at any dose results in death, is life threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect, and other medically important events.
Time frame: Up to 46 months
Number of participants with potentially clinically significant vital sign changes
Number of participants with potentially clinically significant vital sign values.
Time frame: Up to 44 months
Number of participants with laboratory value abnormalities and/or AEs
Number of participants with potentially clinically significant laboratory values.
Time frame: Up to 44 months
Number of participants with electrocardiogram (ECG) normals, abnormalities and/or AEs
Number of participants with potentially clinically significant ECG values.
Time frame: Up to 44 months
Number of participants at each grade of Eastern Cooperative Oncology Group (ECOG) performance status
The ECOG scale will be used to assess performance status. Grades range from 0 (fully active) to 5 (dead). Negative change scores indicate an improvement. Positive scores indicate a decline in performance.
Time frame: Up to 44 months
Pharmacokinetics (PK): concentration immediately prior to dosing at multiple dosing (Ctrough) of ASP2138
Ctrough will be reported from the PK serum samples collected.
Time frame: Up to 45 months
Functional Assessment of Chronic Illness Therapy-General item GP5 (FACIT-GP5) Responses Over Time
FACIT-GP5 is a single item to measure the overall impact of treatment toxicity, based upon its association with the number and degree of AEs. The item "I am bothered by side effects of treatment," is rated on a 5-point scale ranging from "not at all" (0) to "very much" (4).
Time frame: Up to 46 months
Patient reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) Responses Over Time
PRO-CTCAE questionnaire allow participants to report on the frequency severity, and interference of the side effects they experience. Selected items from the PRO CTCAE questionnaire will be used to enhance the assessment of symptomatic AEs in the study.
Time frame: Up to 46 Months
Change from Baseline in Health-related Quality of Life (HRQoL) Measured by European Organisation for Research and Treatment of Cancer Quality of Life of Cancer Patients Core Questionnaire (EORTC QLQ-C30)
EORTC QLQ-C30 is a cancer-specific instrument consisting of global health status/quality of life scale; 5 functional scales (physical, role, emotional, social and cognitive); 3 symptom scales (fatigue, nausea, and vomiting and pain); and 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties). Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." For functional scales, higher scores indicate better functioning, while for symptom scales/items, higher scores indicate worse symptoms.
Time frame: Baseline and up to 46 months
Change from Baseline in HRQoL measured by European Organisation for Research and Treatment of Cancer Quality of Life of Cancer Patients Oesophago-Gastric Module (EORTC QLQ OG25)
EORTC QLQ-OG25 questionnaire is a 25-item instrument that evaluates gastric and GEJ cancer-specific symptoms. This module consists of 6 scales: dysphagia (3 items), eating restrictions (4 items), reflux (2 items), odynophagia (2 items), pain and discomfort (2 items) and anxiety (2 items), as well as 10 single items: eating in front of others, dry mouth, trouble with taste, body image, trouble swallowing saliva, choked when swallowing, trouble with coughing, trouble talking, weight loss and hair loss. Each item is scored on a scale of 1 (Not at all) to 4 (Very much). Individual item scores are transformed to a 0 (no symptoms) to 100 (maximum symptom burden) scale
Time frame: Baseline and up to 46 months
Change from Baseline in HRQoL measured by EQ-5D, 5-Level Questionnaire (EQ-5D-5L)
EQ-5D-5L is a standardized instrument for use as a measure of health outcome consisting of 6 items that cover 5 main scales (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) and a general visual analog scale for health status. Each item is scored on a scale of 1 (no problem or none) to 5 (unable to perform activity). The VAS ranges from 0 (worst health status) and 100 (best health status).
Time frame: Baseline and up to 46 months
Number of participants with anti-drug antibodies-positive against ASP2138
Number of participants with anti-drug antibodies-positive will be reported.
Time frame: Up to 45 months
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