Safety, Pharmacodynamics and Efficacy of MT-3724 for the Treatment of Patients With Relapsed or Refractory DLBCL
Trial Snapshot
- Phase
- Phase 1
- Status
- Terminated
- Sponsor
- Molecular Templates, Inc.
- Enrollment
- 38
- Locations
- 40
- Primary Endpoint
- Part 1 and 2: Time to Achieve Cmax (Tmax) of MT-3724
Study Overview
Brief Summary
The purpose of this study is to evaluate the safety and tolerability of MT-3724 in subjects with relapsed or refractory B-Cell NHL or relapsed and refractory CLL (Part 1 only) and relapsed and refractory DLBCL (Part 2 and Part 3). Part 3 evaluates the efficacy of MT-3724.
Detailed Description
This is a three-part Phase 2 study
Part 1: (MT-3724 Dose Escalation) Define the maximum tolerated dose (MTD) of MT-3724 [Completed]
Part 2: (MTD Expansion Cohort) Confirm the safety and tolerability of the MTD of MT-3724 in the MTD Expansion Cohort.
Part 3: (Phase 2 MTD Expansion Cohort) Determine the efficacy of MT-3724 as monotherapy in subjects with relapsed or refractory DLBCL based on the overall response rate (ORR) by the revised Lugano Classification for Lymphoma adjusted according to LYRIC.
It is anticipated that up to 100 patients will be enrolled in Part 3. Treatment will continue for up to six 21 days cycles. If the subject exhibits SD, CR or PR after the end of Cycle 6 and the investigator determines that the benefit-risk ratio is favorable, then the treatment with MT-3724 may be continued after discussion with the sponsor.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Participants must be informed about the study and fully consent to participation as demonstrated by signing the written ICF before any screening procedure.
- •Male and female participants >= 18 years of age at the time of informed consent.
- •Participants must have relapsed or refractory Diffuse large B cell lymphoma (DLBCL) according to the Revised European American Lymphoma/World Health Organization classification. Participants must have proof of cluster of differentiation 20 plus (CD20+) DLBCL, based on either:
- •a. historical biopsies (obtained with diagnosis of relapsed or refractory disease), or
- •b. fresh biopsies
- •c. bone marrow biopsy, excisional lymph node biopsy, and core biopsy of any involved organ are all acceptable methods; Fine Needle Aspirate is not acceptable.
- •Participants must have received at least 2 standard of care (SoC) regimens (including anti-CD20 antibody therapy) appropriate for DLBCL treatment.
- •a. Participants whose prior therapy includes chimeric antigen receptor T-cell (CAR-T-cell) therapy are eligible.
- •b. Participants who underwent stem cell transplant (SCT) > 100 days for autologous SCT or > 180 days for allogeneic SCT before study drug administration.
- •c. Participants who have been ineligible for SoC DLBCL treatments may be eligible at the investigator's discretion, upon sponsor approval.
- •Participants must have at least 1 bi-dimensional tumor lesion at screening that is measurable by computerized tomography (CT) and/or magnetic resonance imaging (MRI) according to the Lugano criteria. Bi-dimensionally measurable tumor lesion by CT and/or MRI is defined as longest diameter of > 1.5 centimeters (cm) for lymph nodes and > 1.0 cm for extranodal disease.
- •Participants must have life expectancy of > 3 months from the start of treatment.
- •Participants must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-
- •Participants must have met ALL the following laboratory criteria:
- •a. absolute neutrophil count (ANC) >= 1.0 × 10^9 cells per liter with no myeloid growth factors (granulocyte colony-stimulating factor [G-CSF] or granulocyte-macrophage colony-stimulating factor preparations) administered within 2 weeks of Cycle 1 Day
- •b. platelet count >= 50 × 10^9 cells per liter with no Thrombopoietin-receptor agonists agents or platelet transfusions given within 2 weeks of Cycle 1 Day
- •c. hemoglobin >= 8.0 grams per deciliter (g/dL) with no erythropoietin stimulating agents or peripheral red blood cell (PRBC) transfusions within 2 weeks of Cycle 1 Day 1
- •d. creatinine clearance (CLcr) to be >= 50 milliliter per minute (ml/min) either measured or estimated using the Cockcroft-Gault formula.
- •e. total bilirubin (or direct bilirubin for patients with Gilbert's disease < 1.5 × upper limit of normal (ULN)
- •f. alanine transaminase (ALT) ≤ 3.0 × ULN (or <= 5.0 x ULN if liver involvement).
- •g. aspartate aminotransferase (AST) <= 3.0 × ULN (or <= 5.0 x ULN if liver involvement).
- •h. international normalized ratio (INR) or prothrombin time (PT) <= 1.5 x ULN (unless on therapeutic anticoagulants).
- •i. Activated partial thromboplastin time <= 1.5 x ULN (unless on therapeutic anticoagulants).
- •Have adequate serum albumin, as determined by: a. albumin >= 3.0 g/dL.
- •QT interval correction for heart rate using Fridericia's formula (QTcF) <= 480 milliseconds determined as the average of 3 QTcF values from the triplicate electrocardiogram (ECG) obtained at screening.
- •Women of reproductive potential must have a negative highly sensitive pregnancy test within 72 hours before the start of treatment. Women who are postmenopausal or permanently sterilized (eg, tubal occlusion, hysterectomy, bilateral salpingectomy) may be considered as not of reproductive potential.
- •Participants of reproductive potential must agree either to abstain continuously from heterosexual intercourse or to use a highly effective birth control method from signing the informed consent until the short term follow-up (STFU) visit for females and until 90 days after the last dose of MT-3724 for males.
- •Participants must be able to comply with all study-related procedures and medication use.
- •Exclusion Criteria
- •Prior or Current Therapies
- •Received any amount of anti-CD20 monoclonal antibodies (mAbs) within the following periods before the start of treatment:
- •a. Rituximab (Rituxan®/MabThera® or rituximab biosimilar): within 84 days (12 weeks); if a participant has received rituximab within 37 weeks before the start of treatment, then serum rituximab level must be negative (< 500 nanograms per milliliter [ng/mL]) at screening.
- •b. Obinutuzumab (Gazyva®/Gazyvaro®): 184 days c. Ofatumumab (Arzerra®): 88 days d. Any other anti-CD20 agents (eg, investigational agents), the washout period is 5 half-lives. The investigator must contact the medical monitor to discuss the most Compound: MT-3724 appropriate washout for non-approved CD20-targeting agents, where the half-life (t1/2) is not known.
- •Received approved or investigational treatment for DLBCL within 4 weeks before the start of treatment. For small molecules (MW < 0.9 kilodaltons [kDa]), the washout is 5 half-lives or at least 2 weeks. Radioimmunoconjugates are excluded within 12 weeks before the start of treatment.
- •Received radiation therapy to tumor lesions that would serve as target lesions (measurable disease) within 4 weeks before the start of treatment, unless the lesion exhibited objective progression between radiation therapy and screening according to the Lugano Classification
- •o a. Palliative radiation therapy to non-target lesions may be permitted at the investigator's discretion after consultation with the medical monitor and sponsor.
- •Require the use of systemic immune modulators during study treatment:
- •a. Systemic immune modulators include, but are not limited to, systemic corticosteroids at doses > 20 milligrams per day (mg/day) of prednisone equivalent, cyclosporine and tacrolimus.
- •b. The use of non-steroidal anti-inflammatory drugs (NSAIDS) is permitted.
- •Received any live vaccines within 4 weeks before the start of treatment.
- •Prior treatment with MT-
- •Medical History
- •Current evidence of Common Terminology Criteria for Adverse Events (CTCAE) Grade > 1 toxicity (due to prior anticancer therapy) before the start of treatment, except for hair loss and those Grade 2 toxicities listed as permitted in other eligibility criteria.
- •Current evidence of significant (CTCAE Grade ≥ 2) infection or wound within 4 weeks before the start of treatment. a. Participants with Grade 2 infection that has stabilized or improved with oral anti-infectives before the start of treatment may be eligible at the sponsor's discretion.
- •Known or suspected hypersensitivity to the study drug or excipients contained in the study drug formulation.
- •Current evidence of hypersensitivity or other underlying illness requiring systemic corticosteroids at doses > 20 mg/day prednisone equivalent.
- •Current evidence of uncontrolled human immunodeficiency syndrome (HIV), hepatitis B virus (HBV) or /hepatitis C virus (HCV) at screening. Serology testing is not required if seronegativity is documented in the medical history, and if there are no clinical signs suggestive of HIV or hepatitis infections, or suspected exposure. The following exceptions apply for participants with positive viral serology:
- •a. Participants with HIV and an undetectable viral load and CD4+ T-cell (CD4+) counts >= 350 cells per milliliter may be enrolled, but must be taking appropriate opportunistic infection prophylaxis, if clinically relevant.
- •b. Participants with positive HBV serology are eligible if they have an undetectable viral load and the participant will receive antiviral prophylaxis for potential HBV reactivation per institutional guidelines.
- •c. Participants with positive HCV serology are eligible if quantitative polymerase chain reaction (PCR) for plasma HCV ribonucleic acid (RNA) is below the lower limit of detection. Concurrent antiviral HCV treatment per institutional guidelines is allowed.
- +19 more not shown
Exclusion Criteria
- Not provided
Arms & Interventions
Part 1: Cohort 1 - 5 Micrograms/Kilogram/Dose (mcg/kg/Dose)
Part 1: MT-3724 5 mcg/kg/dose IV for 6 doses over 12 days, followed by dose escalations (Part 1) until recommended phase 2 dose of MT-3724 is determined
Intervention: MT-3724 Phase 1 (Drug)
Part 1: Cohort 2- 10 mcg/kg/Dose
Part 1: MT-3724 10 mcg/kg/dose IV for 6 doses over 12 days, followed by dose escalations (Part) until recommended phase 2 dose of MT-3724 is determined
Intervention: MT-3724 Phase 1 (Drug)
Part 1: Cohort 3- 20 mcg/kg/Dose
Part 1: MT-3724 20 mcg/kg/dose IV for 6 doses over 12 days, followed by dose escalations (Part 1) until recommended phase 2 dose of MT-3724 is determined
Intervention: MT-3724 Phase 1 (Drug)
Part 1: Cohort 4- 50 mcg/kg/Dose
Part 1: MT-3724 50 mcg/kg/dose IV for 6 doses over 12 days, followed by dose escalations (Part 1) until recommended phase 2 dose of MT-3724 is determined
Intervention: MT-3724 Phase 1 (Drug)
Part 1: Cohort 5- 100 mcg/kg/Dose
Part 1: MT-3724 100 mcg/kg/dose IV for 6 doses over 12 days, followed by dose escalations (Phase 1) until recommended phase 2 dose of MT-3724 is determined
Intervention: MT-3724 Phase 1 (Drug)
Part 1: Cohort 6- 75 mcg/kg/Dose
Part 1b: MT-3724 75 mcg/kg/dose IV for 6 doses over 12 days of 21-Day cycle for up to 4 additional cycles to explore safety, tolerability and tumor response to repeat doses of MT-3724 (subject will continue with dose that was tolerated in the Part 1 portion of the study)
Intervention: MT-3724 Phase 1 (Drug)
Part 2: Cohort 7- MTD Expansion Cohort
Part 2: MT-3724 IV for 6 doses administered within 14 days of 21-Day cycle up to 6 Cycles. If the Subject exhibits stable disease or PR after end of Cycle 6 and investigator determines ratio is favorable, treatment with MT- 3724 may be continued for up to additional 6 cycles.
Intervention: MT-3724 Phase 1 (Drug)
Part 2: Cohort 7- MTD Expansion Cohort
Part 2: MT-3724 IV for 6 doses administered within 14 days of 21-Day cycle up to 6 Cycles. If the Subject exhibits stable disease or PR after end of Cycle 6 and investigator determines ratio is favorable, treatment with MT- 3724 may be continued for up to additional 6 cycles.
Intervention: MT-3724 Phase 2 (Drug)
Part 3: All MT-3724 Treated Participants
Part 3: MT-3724 IV 50 µg/kg/dose administered on Days 1, 3, 5, 8, 10, and 12 of each 21-day cycle. Treatment will continue until death, disease progression, unacceptable toxicity, withdrawal of consent, or another reason for withdrawal, or until study discontinuation
Intervention: MT-3724 Phase 2 (Drug)
Part 4: All MT-3724 Treated Participants
Part 4: In this arm, subjects were planned to receive all doses of MT-3724 as IV infusion as confirmed in Part 3.
Intervention: MT-3724 Phase 2 (Drug)
Outcomes
Primary Outcomes
Part 1 and 2: Time to Achieve Cmax (Tmax) of MT-3724
Time Frame: Part 1 and 2: Days 1, 3 and 12
Blood samples were collected at indicated timepoints for the determination of tmax.
Part 1: Number of Participants With Dose Limiting Toxicities of a Single Cycle of MT-3724
Time Frame: Days 1, 3, 5, 8, 10 and 12
The MTD is defined to be the dose cohort below which participants experience dose-limiting toxicities during cycle 1. Dose-limiting toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
Part 1 and 2: Area Under the Plasma Concentration Time Curve From 0 to 4 Hours (AUC [0-4]), AUC (0-infinity) and AUC From Dosing to Last Measurable Concentration (AUClast) of MT-3724
Time Frame: Part 1 and 2: Days 1, 3 and 12
Blood samples were collected at indicated timepoints for the determination of AUC (0-4), AUC (0-infinity) and AUClast.
Part 1 and 2: Maximum Observed Concentrations (Cmax) of MT-3274
Time Frame: Part 1 and 2 : Days 1, 3 and 12
Blood samples were collected at indicated timepoints for the determination of Cmax of MT-3274.
Part 1 and 2: Clearance (CL) of MT-3724
Time Frame: Part 1 and 2: Days 1, 3 and 12
Blood samples were collected at indicated timepoints for the analysis of CL of MT-3724.
Part 1 and 2: Half Life (t1/2) of MT-3724
Time Frame: Part 1 and 2: Days 1, 3 and 12
Blood samples were collected at indicated timepoints for the analysis of t1/2 of MT-3724.
Part 3: Number Participants With Clinically Significant Vital Signs
Time Frame: Up to Day 45
Vital signs including systolic and diastolic blood pressure, respiratory rate, heart rate and body temperature were assessed at indicated time points.
Part 1 and 2: Volume of Distribution (Vz) of MT-3724
Time Frame: Part 1 and 2: Days 1, 3 and 12
Blood samples were collected at indicated timepoints for the analysis of Vz of MT-3724.
Part 1 and 2: Absolute Values of Cluster of Differentiation 19 Plus (CD19+) for B-cell Lymphocytes
Time Frame: Part 1 and 2: Cycle 1: Days 8 and 23; Cycle 3: Day1; Cycle 5: Day 1 and Day 120 (end of study)
CD19+ cells in the peripheral blood were counted as measures of malignant B-cells and were measured by flow cytometry. Flow cytometry is a technique for counting and examining microscopic particles with an electronic detection apparatus
Part 1 and 2: Number of Participants With Positive Anti-drug Antibody (ADA) Confirmed
Time Frame: Part 1 and 2: Cycle 1, Day 23; Cycle 2, Day 1; Cycle 3, Day 1; Cycle 4, Day 1; Cycle 5, Day 1 and Day 120 (end of study)
Blood samples were collected to analyze the presence of ADA that bind MT-3724. Number of participants with positive ADA confirmed has been presented.
Part 3: Number of Participants With Clinically Significant Laboratory Parameters
Time Frame: Up to Day 45
Blood samples were collected at indicated timepoints for the analysis of laboratory parameters.
Part 3: Number of Participants With Clinically Significant Electrocardiogram (ECG) Values
Time Frame: Up to Day 26
Standard resting 12-lead ECG assessments was performed after the participant has rested quietly for at least 5 minutes in supine or semi-recumbent position.
Part 3: Number of Participants With Clinically Significant Physical Findings
Time Frame: Up to Day 26
Physical examination was performed by a physician or a qualified delegate at the investigating site.
Part 3: Number of Participants Reporting Serious Treatment-emergent Adverse Events (TEAEs) and Non-serious TEAEs
Time Frame: Up to Day 45
An adverse event is any untoward medical occurrence or clinical investigation in a participant administered a pharmaceutical product(s) and which does not necessarily have to have a causal relationship with this experimental treatment(s). SAE is any untoward medical occurrence, at any dose; is fatal or life-threatening, is life-threatening, results in permanently disabling; results in unplanned in-patient hospitalization or prolongation of existing hospitalization; results in a congenital abnormality or birth defect; important medical events that may not result in death, be life-threatening, or require hospitalization may be considered serious when based upon appropriate medical judgment, they may jeopardize the participant or may require medical or surgical intervention.
Part 4: Overall Response Rate (ORR) in MT-3724 Treated Participants With Relapsed or Refractory DLBCL
Time Frame: Up to Day 45
Overall response rate is defined as the percentage of participants with either a CR or a PR as determined by independent, blinded central review.
Secondary Outcomes
- Part 3: Tmax of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: Vz of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: CL of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: DCR in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: Duration of Tumor Response (DOR) in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 1 and 2: Number of Participants Reporting Worst Case Serious Treatment Emergent Adverse Events (TEAEs) and Non-serious TEAEs(Up to Day 45)
- Part 3: ORR in MT-3724 Treated Participants With Relapsed or Refractory DLBCL by the Lugano Classification for Lymphoma(Up to Day 45)
- Part 3: PD of MT-3724 Measured by Circulating Immunoglobulins in Participants With Relapsed or Refractory DCBCL(Up to Day 45)
- Part 4: Number of Participants With SAEs(Up to Day 45)
- Part 3: ORR in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: t1/2 of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: PD of MT-3724 Measured by Immunophenotyping in Participants With Relapsed or Refractory DCBCL(Up to Day 45)
- Part 4: DOR in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: Number of Participants Reporting Serious Treatment-emergent Adverse Events (TEAEs) and Non-serious TEAEs(Up to Day 45)
- Part 4: Number of Participants With Clinically Significant Laboratory Parameters(Up to Day 45)
- Part 4: Number Participants With Clinically Significant Vital Signs(Up to Day 45)
- Part 4: Number of Participants With Adverse Events Suggestive of Cardiotoxicity(Up to Day 26)
- Part 4: ORR in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: Tmax of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: PD of MT-3724 Measured by Immunophenotyping in Participants With Relapsed or Refractory DCBCL(Up to Day 45)
- Part 4: PD of MT-3724 Measured by Circulating Immunoglobulins in Participants With Relapsed or Refractory DCBCL(Up to Day 45)
- Part 3: Disease Control Rate (DCR) in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: Cmax of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: AUC (0-4), AUC (0-infinity) and AUClast of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 3: PD of MT-3724 Measured by B-cell Count in Participants With Relapsed or Refractory DCBCL(Up to Day 45)
- Part 3: Number of Participants With ADA When Treated With MT-3724(Up to Day 45)
- Part 4: Number of Participants With Clinically Significant ECG Values(Up to Day 26)
- Part 4: t1/2 of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: Number of Participants With ADA When Treated With MT-3724(Up to Day 45)
- Part 4: Progression-free Survival (PFS) in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: Overall Survival (OS) in MT-3724 Treated Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: Cmax of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: AUC (0-4), AUC (0-infinity) and AUClast of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: Vz of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: CL of MT-3724 Monotherapy in Participants With Relapsed or Refractory DLBCL(Up to Day 45)
- Part 4: PD of MT-3724 Measured by B-cell Count in Participants With Relapsed or Refractory DCBCL(Up to Day 45)
