A Study to Assess RXC004 Efficacy in Advanced Solid Tumours After Progression on Standard of Care (SoC) Therapy (PORCUPINE2)
- Conditions
- Advanced Solid Tumours
- Interventions
- Registration Number
- NCT04907851
- Lead Sponsor
- Redx Pharma Ltd
- Brief Summary
This study is to evaluate the preliminary efficacy and safety of RXC004 monotherapy and in combination with pembrolizumab in advanced solid tumours that have progressed following SoC treatment.
- Detailed Description
This Phase II, modular, open label, multicentre study initially opened with ring finger protein 43 (RNF43) loss of function (LoF) mutation-positive pancreatic ductal adenocarcinoma (PDAC) (Module 1) and molecularly unselected biliary tract cancer (BTC) (Module 2) modules. Module 3 will investigate RXC004 in combination with pembrolizumab in BTC. Modules 1 and 2 are monotherapies and Module 3 is the combination therapy.
The primary objective of the study is to assess the preliminary efficacy of RXC004 in each module. This will be evaluated in terms of progression free survival (PFS) at 6 months in Modules 1 and 2, and in terms of Objective response rate (ORR) in Module 3. Following radiological progression, patients will be followed-up for survival.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 45
- At least one lesion that is measurable by RECIST 1.1 at baseline (within 6 weeks prior to start of study treatment).
- Mandatory paired biopsies; Patients must have at least one lesion suitable for biopsy at screening
- Adequate organ and marrow function
- Female patients of childbearing potential must have a negative pregnancy test prior to start of dosing
- Female patients of childbearing potential and male patients with female partners of childbearing potential must agree to use a highly effective method of contraception during the study from the time of treatment initiation, and for at least 5 months after the last dose of study drug.
Module 1 (PDAC) Specific Inclusion Criteria
- Histological documentation of advanced (unresectable)/metastatic (Stage III/IV) PDAC, with documented loss of function tumour mutation in RNF43
- Patients must have received one prior systemic treatment for advanced (unresectable)/metastatic PDAC (Stage III/IV), with clear evidence of radiological disease progression
- Patients must be enrolled and receive first dose of study treatment within 6 weeks of radiologically confirmed progression
- Karnofsky performance status ≥70.
Module 2 and Module 3 (BTC) Specific Inclusion Criteria
- Histological documentation of advanced (unresectable)/metastatic (Stage III/IV) BTC (intrahepatic or extrahepatic cholangiocarcinoma, ampulla of Vater, or gallbladder cancer)
- Patients must have received one prior systemic treatment for advanced (unresectable)/metastatic BTC, with clear evidence of radiological disease progression
- Patients must be enrolled and receive first dose of study treatment within 6 weeks of radiologically confirmed progression
- ECOG status 0 or 1.
Core
- Prior therapy with a compound of the same mechanism of action as RXC004
- Patients at higher risk of bone fractures
- Any known uncontrolled inter-current illness or persistent clinically significant toxicity related to prior anti-cancer treatment
- Patients who have any history of an active (requiring treatment) other malignancy within 2 years of study entry
- Patients with known or suspected brain metastases
- Use of anti-neoplastic agents
- Patients with a known hypersensitivity to any RXC004 excipients
- Patients with a contra-indication for denosumab treatment
- Patients who are pregnant or breast-feeding
- Known active human immunodeficiency viruses (HIV), hepatitis B (HBV), or hepatitis C (HCV) infections
- Use of any live or live-attenuated vaccines against infectious diseases (e.g., influenza nasal spray, varicella) within 4 weeks (28 days) of initiation of study treatment
- Mean resting corrected QTcF >470 ms, obtained from triplicate ECGs performed at screening.
There are no exclusion criteria specific to Modules 1 and 2.
Module 3 Specific Exclusion Criteria:
- Patients with any contraindication to the use of pembrolizumab as per approved label
- Has received prior therapy with an anti-programmed cell death-1 (anti-PD-1), anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor, and was discontinued from that treatment due to a Grade 3 or higher AE
- Has received prior radiotherapy within 2 weeks of start of study treatment or have had a history of radiation pneumonitis
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of pembrolizumab in this study
- Has severe hypersensitivity (≥ Grade 3) to pembrolizumab and/or any of its excipients
- Has an active autoimmune disease that has required systemic treatment in past 2 years
- Has a history of (non-infectious) pneumonitis / interstitial lung disease that required steroids or has current pneumonitis / interstitial lung disease
- Has an active infection requiring systemic therapy
- Patients with a history of allogeneic tissue/solid organ transplant
- Patients with active infections, including tuberculosis, HIV, HBV, or HCV
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Module 1 - RNF43 Mutated Advanced (unresectable)/Metastatic Pancreatic Cancer (Stage III/IV) Denosumab Patients (Karnofsky performance status ≥70) will be recruited and dosed with RXC004 (2 mg once daily \[QD\], orally) within 6 weeks of progression following 1st line SoC treatment. Module 2 -Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage III/IV) Denosumab Patients (Eastern Cooperative Oncology Group \[ECOG\] performance status 0-1) will be recruited and dosed with RXC004 within 6 weeks of progression, following 1st line SoC treatment. Module 3-Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage Ill/IV) Combination Therapy RXC004 Patients (ECOG performance status 0-1) will be recruited and dosed with RXC004 (1.5 mg QD, orally) in combination with pembrolizumab 400 mg IV infusion every 6 weeks (q6w) within 6 weeks of progression, following 1st line Soc treatment. Module 3-Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage Ill/IV) Combination Therapy Denosumab Patients (ECOG performance status 0-1) will be recruited and dosed with RXC004 (1.5 mg QD, orally) in combination with pembrolizumab 400 mg IV infusion every 6 weeks (q6w) within 6 weeks of progression, following 1st line Soc treatment. Module 1 - RNF43 Mutated Advanced (unresectable)/Metastatic Pancreatic Cancer (Stage III/IV) RXC004 Patients (Karnofsky performance status ≥70) will be recruited and dosed with RXC004 (2 mg once daily \[QD\], orally) within 6 weeks of progression following 1st line SoC treatment. Module 2 -Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage III/IV) RXC004 Patients (Eastern Cooperative Oncology Group \[ECOG\] performance status 0-1) will be recruited and dosed with RXC004 within 6 weeks of progression, following 1st line SoC treatment. Module 3-Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage Ill/IV) Combination Therapy pembrolizumab Patients (ECOG performance status 0-1) will be recruited and dosed with RXC004 (1.5 mg QD, orally) in combination with pembrolizumab 400 mg IV infusion every 6 weeks (q6w) within 6 weeks of progression, following 1st line Soc treatment.
- Primary Outcome Measures
Name Time Method Monotherapy (Modules 1 and 2): Progression Free Survival Rate at 6 Months At 6 months The anti-tumour activity of RXC004 was assessed. Progression free survival rate at 6 months was defined as the percentage of patients who remained alive and free of progression at 6 months according to Kaplan-Meier estimates.
Combination Therapy (Module 3): Objective Response Rate (ORR) Up to 23 months The anti-tumour activity of RXC004 as a combination therapy was assessed. ORR was defined as the percentage of patients with a best overall response of complete response or partial response based on local investigator assessment as defined in RECIST 1.1.
- Secondary Outcome Measures
Name Time Method Monotherapy (Modules 1 and 2): ORR Up to 23 months The preliminary efficacy of RXC004 was assessed. ORR was defined as the percentage of patients with a best overall response of complete response (CR) or partial response (PR) based on local Investigator assessment as defined in RECIST 1.1.
Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): Disease Control Rate (DCR) Up to 23 months The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. DCR was defined as the percentage of patients with a best overall response of either CR, PR or stable disease (SD) for at least 6 weeks.
Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): PFS Up to 23 months The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. PFS was defined as the time from first dose of study treatment until the date of disease progression or death (by any cause in the absence of progression) regardless whether the patient withdrew from the assigned study treatment or received another anticancer prior to progression.
Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): Best Percentage Change in Tumor Size Up to 23 months The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. The best percentage change in tumour size was determined at a patient level. For each patient, it represents the largest decrease (or smallest increase) in tumour size. Percentage change in tumour size was derived at each visit by the percentage change from baseline in the sum of diameters of all target lesions.
Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): Overall Survival (OS) Up to 23 months The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. OS was defined as the time from first day of study treatment until death due to any cause.
Maximum Observed Plasma Concentration (Cmax) At Cycle 0 Day 1 and Cycle 1 Day 15 (Each cycle was 21 days in length) The pharmacokinetics (PK) of RXC004 as a monotherapy and as a combination therapy was assessed.
Time to Cmax (Tmax) At Cycle 0 Day 1 and Cycle 1 Day 15 (Each cycle was 21 days in length) The PK (tmax) of RXC004 as a monotherapy and as a combination therapy was assessed.
Minimum Observed Concentration Across the Dosing Interval (Cmin) At Cycle 1 Day 15 (The cycle was 21 days in length) (Up to 23 months) The PK (Cmin) of RXC004 as a monotherapy and as a combination therapy was assessed.
Terminal Rate Constant (λz) At Cycle 0 Day 1 (The cycle was 21 days in length) The PK (λz) of RXC004 as a monotherapy and as a combination therapy was assessed.
Terminal Half-life (t½) At Cycle 0 Day 1(The cycle was 21 days in length) The PK (t½) of RXC004 as a monotherapy and as a combination therapy was assessed.
Area Under the Plasma Concentration-time Curve From Zero to Infinity (AUC0-∞) At Cycle 0 Day 1 (The cycle was 21 days in length) The PK (AUC0-∞) of RXC004 as a monotherapy and as a combination therapy was assessed.
Total Plasma Clearance After Oral Administration (CL/F) At Cycle 0 Day 1 (The cycle was 21 days in length) The PK(CL/F) of RXC004 as a monotherapy and as a combination therapy was assessed.
Apparent Volume of Distribution After Oral Administration (Vz/F) At Cycle 0 Day 1 (The cycle was 21 days in length) The PK (Vz/F) of RXC004 as a monotherapy and as a combination therapy was assessed.
Number of Patients With Adverse Events (AEs) From time of signature of main study informed consent form throughout the treatment period and until the 30 days after last dose of RXC004 (Up to 23 months) The safety, and tolerability profile of RXC004 as a monotherapy and as a combination therapy was assessed. The grading scales found in the revised National Cancer Institute CTCAE latest version was utilized for all events with an assigned CTCAE grading. Grade refers to the severity of the AE. The CTCAE displays Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental ADL. Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL; Grade 4: Life-threatening, urgent intervention required; Grade 5: Death related to AE.
Trial Locations
- Locations (13)
The Alfred Hospital - Alfred Health
🇦🇺Melbourne, Victoria, Australia
Wollongong Hospital
🇦🇺Wollongong, New South Wales, Australia
Barts Cancer Institute - Haemato-Oncology
🇬🇧London, United Kingdom
Weston Park Hospital
🇬🇧Sheffield, United Kingdom
Cambridge University Hospital NHS Foundation Trust
🇬🇧Cambridge, United Kingdom
St James University Hospital
🇬🇧Leeds, United Kingdom
Oxford Cancer and Haematology Centre Churchill Hospital
🇬🇧Oxford, United Kingdom
Beatson West of Scotland Cancer Care
🇬🇧Glasgow, United Kingdom
Royal Free London Foundation NHS Trust
🇬🇧London, United Kingdom
The Christie NHS Foundation Trust - Medical Oncology
🇬🇧Manchester, United Kingdom
Imperial College Healthcare NHS Trust - Hammersmith Hospital
🇬🇧London, United Kingdom
The Royal Marsden Hospital (Surrey)
🇬🇧Sutton, United Kingdom
University College Hospitals NHS Foundation Trust
🇬🇧London, United Kingdom