A Randomized Non-comparative Open-label Phase 1b/2 Study of Nadunolimab in Combination with Gemcitabine Plus Carboplatin in Patients with Advanced Triple Negative Breast Cancer. TRIFOUR Study

Who is this study for? Patients with advanced triple negative breast cancer
What treatments are being studied? Carboplatin+Gemcitabine+Nadunolimab
Status: Recruiting
Location: See all (24) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 1/Phase 2
SUMMARY

Triple negative breast cancer (TNBC) represents approximately 15% of all breast cancers (BC) worldwide. The term triple negative means that tumor growth is not stimulated by the hormones estrogen and progesterone, nor by the HER2 protein, so unlike other types of BC, TNBC, which is an aggressive form of BC, does not have specific effective therapies available being the least common form of BC and the most difficult to treat. Advanced or metastatic TNBC is treated with combinations of platinum-based chemotherapy with taxanes or gemcitabine with a 5-year survival rate of 12%. Recent studies have shown that TNBC expresses Interleukin 1 Receptor Accessory Protein (IL1RAP) at higher levels than other forms of BC. Nadunolimab is a fully humanized monoclonal antibody that blocks the signals that occur within the cell produced by IL1RAP protein, thereby impairing the cancer cells' ability to secrete tumor stimulating substances, in turn reducing the tumor, inflammation and tumor progression. On the other hand, it is an antibody designed to activate the immune system to fight cancer cells. This clinical trial is divided into two phases, phase Ib in which it is expected to include up to 15 patients and phase II in which it is expected to include 102 patients. The main purpose of phase Ib is to ensure that the combination of nadunolimab plus chemotherapy (gemcitabine plus carboplatin) is safe and determine the highest dose of nadunolimab that can be given safely without causing serious side effects. If the pre-specified objectives in this part are achieved, the trial will be expanded to a randomized phase II, to evaluate the efficacy of the combination of nadunolimab plus gemcitabine plus carboplatin, compared to a control group that will receive gemcitabine plus carboplatin only.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• The patient has signed and dated the informed consent form (ICF) and it has been obtained before conducting any specific procedure for the study.

• Female or male BC patients of ≥ 18 years of age.

• Permission to access archived tumor tissue sample (either from primary breast tumor or a metastatic lesion, preferably the most recent one) for biomarker analysis. Not having archived tissue is not a reason to exclude the patient from enrollment.

• Paired tumor biopsies, pre-treatment and on-treatment, for pharmacodynamic analysis are not compulsory and will be obtained as per investigator judgement and patient decision. However, patients and investigators are encouraged to obtain them if the patient has easily accessible disease like skin or superficial lymph nodes. Ideally, the same lesion (always in the same organ) should be biopsied before treatment and on treatment whenever possible. It is allowed to use archived biopsies as pre-treatment samples, obtained after ending the previous systemic treatment).

• The lesion accessible for biopsy may not be the only target lesion and should not be located in a previously irradiated field (unless this index lesion has PD ≥ 20% post-radiation).

• Histologically confirmed TNBC that is either locally recurrent, inoperable and cannot be treated with curative intent or is metastatic:

∙ Documented Hormone Receptor (HR) negative BC based on local laboratory determination on the most recent tumor biopsy. HR negative defined as \< 1% positive cells by immunohistochemistry (IHC) for estrogen receptor (ER) and progesterone receptor (PgR).

‣ Documented Human Epidermal Growth Factor Receptor 2 (HER2) negative BC based on local laboratory determination on the most recent tumor biopsy. HER2 negative tumor is determined according to recommendations of the applicable American Society of Clinical Oncology (ASCO)/ College of American Pathologists (CAP) guidelines available.

‣ Patients are eligible for the study irrespectively of BRCA1/2 mutational status. It is not required to have the analysis performed before the study inclusion.

• Patients should be eligible to receive gemcitabine and carboplatin as the following line of therapy. No more than 1 previous line of systemic therapy for the advanced disease is allowed:

∙ Those patients with PD during or within 6 months after completing the (neo)adjuvant treatment are allowed to be included in the study and are considered for second-line group of patients.

‣ Prior therapy with immuno-checkpoint inhibitors (ICIs) either in the metastatic setting (as first-line therapy) or in the (neo)adjuvant setting is allowed.

‣ Previous treatment with platinum-derived agents in early-stage setting is allowed if the platinum-free interval is at least of 12 months.

‣ Prior therapy with PARP inhibitors is allowed.

• Documented progressive disease (i.e. biopsy sample, pathology or imaging report) from the last treatment.

• Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1.

⁃ Patients must have at least one measurable lesion that can be accurately assessed at baseline and is suitable for repeated assessment by CT scan, MRI, plan X-ray or physical examination. Clinical lesions will only be considered measurable when they are superficial and ≥ 10mm in diameter as assessed using callipers (e.g. skin nodules). Patients with bone-only disease must have a lytic or mixed (lytic + blastic) lesion, which has not been previously irradiated and can be accurately assessed by CT scan/MRI according to RECIST version 1.1 (with a component of soft tissue mass).

⁃ Adequate organ and bone marrow function defined as follows:

• Absolute Neutrophil Count (ANC) ≥ 1.500/mm3 (1.5x109/L), without previous Granulocyte Colony-Stimulating Factor (G-CSF) within 2 weeks prior to the study treatment.

∙ Platelets ≥ 100.000/mm3 (100x109/L), without previous transfusion within 2 weeks prior to the study treatment.

∙ Hemoglobin ≥ 9 g/dL (90 g/L), without previous transfusion within 28 days before starting with the study treatment.

∙ Serum creatinine ≤ 1.5 x Upper Limit of Normal (ULN) or estimated creatinine clearance ≥ 60 mL/min as calculated using the Cockcroft-Gault formula.

∙ Total serum bilirubin ≤ 1.5 x ULN (≤ 3.0 x ULN if Gilbert´s disease).

∙ Aspartate aminotransferase (AST) and/or Alanine aminotransferase (ALT) ≤ 3.0 x ULN (≤ 5.0 x ULN if liver metastases present).

∙ Alkaline phosphatase ≤ 2.5 x ULN (≤ 5.0 x ULN if bone or liver metastases present).

⁃ Resolution of all acute toxic effects of prior anti-cancer therapy or surgical procedures to NCI CTCAE v5.0 Grade ≤ 1 (except alopecia or other toxicities not considered a safety risk for the patient at investigator's discretion). In case of immune-related toxicities, adequately resolved to Grade 1 or non-persistent Grade 2 AEs with the recommended measures by the current guidelines.

⁃ Patients testing positive for human immunodeficiency virus (HIV) are NOT excluded from this study, but HIV-positive patients must meet ALL the following criteria:

• Have CD4+ T-cell (CD4+) counts ≥ 350 cells/µL.

∙ Have not had an opportunistic infection within the past 12 months. Patients on prophylactic antimicrobials can be included in the study.

∙ Should be on stable antiretroviral therapy for at least 4 weeks.

∙ Have an HIV viral load less than 400 copies/mL prior to enrolment.

⁃ Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests and other study procedures.

⁃ Negative serum pregnancy test within 7 days prior to enrolment for premenopausal women, and for women who have experienced menopause onset \< 12 month prior to first dose of therapy..

∙ For premenopausal women: agreement to remain abstinent or use single or combined non-hormonal contraceptive methods that result in a failure rate of \< 1% per year during the treatment period and for at least 7 months after the last dose of study treatment.

‣ For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and to refrain from donating sperm during the same period, as defined below with female partners of childbearing potential or pregnant female partners, men must remain abstinent or use a condom during the treatment period and for at least 6 months after the last dose of carboplatin/gemcitabine to avoid exposing the embryo. Due to the possibility of irreversible infertility with carboplatin/gemcitabine, men receiving these chemotherapies should consult with their doctor regarding conservation of sperm prior to treatment initiation.

⁃ Abstinence is only acceptable if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or post-ovulation methods) and withdrawal are not acceptable methods of contraception.

⁃ Examples of non-hormonal contraceptive methods with a failure rate of \< 1% per year include tubal ligation, male sterilization, and certain intrauterine devices. Alternatively, two methods (e.g., two barrier methods such as a condom and a cervical cap) may be combined to achieve a failure rate of \< 1% per year. Barrier methods must always be supplemented with the use of a spermicide.

Locations
Other Locations
Spain
Complejo Hospitalario Universitario A Coruña
RECRUITING
A Coruña
Complejo Hospitalario Universitario de Albacete
RECRUITING
Albacete
Hospital Universitario San Juan de Alicante
RECRUITING
Alicante
Hospital Clinic de Barcelona
RECRUITING
Barcelona
Hospital del Mar
RECRUITING
Barcelona
Onkologikoa
RECRUITING
Donostia
Hospital Universitario Clinico San Cecilio
RECRUITING
Granada
Hospital Universitario Virgen de las Nieves
RECRUITING
Granada
ICO Institut Catalá d'Oncologia de L´Hospitalet
RECRUITING
Hospitalet De Llobregat, Barcelona
Complejo Hospitalario de Jaén
RECRUITING
Jaén
Hospital Materno Infantil de Gran Canaria
RECRUITING
Las Palmas De Gran Canaria
Hospital Universitario Arnau de Vilanova Lleida
RECRUITING
Lleida
Hospital Universitario Lucus Augusti
RECRUITING
Lugo
Hospital Clínico San Carlos
RECRUITING
Madrid
Hospital Universitario 12 de Octubre
RECRUITING
Madrid
Hospital Universitario Gregorio Marañón
RECRUITING
Madrid
Hospital Universitario Virgen De La Victoria
RECRUITING
Málaga
Hospital Universitario Central de Asturias
WITHDRAWN
Oviedo
Clínica Universidad de Navarra
RECRUITING
Pamplona
Hospital Universitario Virgen Del Rocío
RECRUITING
Sevilla
Hospital Universitario Virgen Macarena
RECRUITING
Sevilla
Hospital Universitario de Toledo
RECRUITING
Toledo
Fundación Instituto Valenciano de Oncología
RECRUITING
Valencia
Hospital Clínico Universitario Lozano Blesa
RECRUITING
Zaragoza
Contact Information
Primary
CANTARGIA AB
clinicaltrials@cantargia.com
+46 46 2756260
Time Frame
Start Date: 2022-01-11
Estimated Completion Date: 2026-08
Participants
Target number of participants: 116
Treatments
Experimental: Phase Ib: Single-arm (dose-escalation 3+3 design).
* Carboplatin Area Under the Curve (AUC) 2 mg/mL/min intravenous (IV) on days 1 and 8, every 3-week cycles.~* Gemcitabine 1000 mg/m2 IV on days 1 and 8, every 3-week cycles.~* Nadunolimab escalation (DL -1: 0.5 mg/Kg, DL 1: 1 mg/kg, DL 2: 2.5 mg/kg), DL 3: 5 mg/kg IV on days 1 and 8, every 3-week cycles.
Experimental: Phase II: Randomized 1:1, non-comparative, open-label.Patients randomized to arm A
* Carboplatin AUC 2 mg/mL/min IV on days 1 and 8, every 3-week cycles.~* Gemcitabine 1000 mg/m2 IV on days 1 and 8, every 3-week cycles.~* Nadunolimab Recommended Phase II Dose (RP2D) mg/kg IV on days 1 and 8, every 3-week cycles
Active_comparator: Phase II: Randomized 1:1, non-comparative, open-label.Patients randomized to arm B
* Carboplatin AUC 2 mg/mL/min IV on days 1 and 8, every 3-week cycles.~* Gemcitabine 1000 mg/m2 IV on days 1 and 8, every 3-week cycles.
Sponsors
Collaborators: Spanish Breast Cancer Research Group
Leads: Cantargia AB

This content was sourced from clinicaltrials.gov