Safety, Tolerability, PK, PD, and Efficacy of AMG 427 in Subjects With Relapsed/Refractory Acute Myeloid Leukemia

Phase 1

Terminated

Conditions: Relapsed/Refractory Acute Myeloid Leukemia (AML)

Interventions: Drug: AMG 427

Registration Number: NCT03541369

Lead Sponsor: Amgen

Brief Summary: Evaluate the safety and tolerability of AMG 427 in adult subjects with relapsed/refractory (R/R) acute myeloid leukemia (AML). Estimate the maximum tolerated dose (MTD) and / or a biologically optimal dose (eg, recommended phase 2 dose \[RP2D\]).

Detailed Description: Evaluate the safety and tolerability of AMG 427 in adult subjects with relapsed/refractory AML. Estimate the maximum tolerated dose (MTD) and / or a biologically optimal dose (eg, recommended phase 2 dose \[RP2D\]). Approximately 80 subjects will be enrolled.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 64

Inclusion Criteria

Subject has provided informed consent prior to initiation of any study-specific activities/procedures.
Subjects greater than or equal to 18 years of age at the time of signing consent.
For relapsed/refractory AML subjects only, AML as defined by the WHO Classification as persisting or recurring following 1 or more treatment courses (exceptions noted in exclusion criteria).
Myeloblasts greater than or equal to 5% in bone marrow, as confirmed by immunophenotype by flow cytometry.
Eastern Cooperative Oncology Group (ECOG) Performance Status of less than or equal to 2.
Renal function as follows: serum creatinine less than 2.0 mg/dL (176.84 µmol/L); estimated glomerular filtration rate (eGFR) greater than 30 mL/min/1.73 m^2.
Hepatic function as follows: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal to 3.0 x upper limit of normal (ULN); bilirubin less than or equal to 1.5 x ULN (unless considered due to Gilbert's syndrome or hemolysis).
No active tuberculosis in the setting of anti-tumor necrosis factor (TNF) therapy - National guidelines should be followed for the appropriate tuberculosis screening in the setting of anti-TNF therapy, including a minimum of:
- Subject has a negative test for tuberculosis during screening defined as either:
  - Negative purified protein derivative (PPD) (< 5 mm induration at 48 to 72 hours after test is placed) OR
  - Negative Quantiferon test
- Subjects with positive PPD and a history of bacillus Calmette-Guérin vaccination are allowed with a negative Quantiferon test.
- Subjects with a positive PPD test (without a history of bacillus Calmette-Guérin vaccination) or subjects with a positive or indeterminate Quantiferon test are allowed if they have all of the following:
  - No symptoms, per tuberculosis worksheet provided by Amgen
  - Documented history of a completed course of adequate treatment or prophylaxis (per local standard of care) prior to the start of investigational product
  - No known exposure to a case of active tuberculosis after most recent prophylaxis
  - No evidence of active tuberculosis on chest radiograph within 3 months prior to the first dose of investigational product (substudy subjects only)

Exclusion Criteria

Patients with acute promyelocytic leukemia (APML).
Active extramedullary AML in the central nervous system (CNS)
Known hypersensitivity to immunoglobulins.
White blood cells (WBC) greater than 15,000 cells/mcL (15 cells x 10^9/L) at screening (hydroxyurea is permitted to enable eligibility).
Subjects with a prior or concurrent malignancy whose natural history or treatment is anticipated to interfere with the safety or efficacy assessment of the investigational regimen. Exception: Subjects with prior or concurrent malignancy not anticipated to interfere with the safety or efficacy of the investigational regimen may be included only after discussion with the Amgen Medical Monitor.
Autologous hematopoietic stem cell transplant (HSCT) within 6 weeks prior to start of AMG 427 treatment.
Allogeneic HSCT within 3 months prior to start of AMG 427 treatment.
Any graft-versus-host disease requiring systemic therapy with immunomodulators.
History or evidence of significant cardiovascular risk including any of the following: symptomatic congestive heart failure, unstable angina, clinically significant arrhythmias (eg, ventricular fibrillation, ventricular tachycardia etc.), recent coronary angioplasty, intra-cardiac defibrillators or any clinically relevant concurrent disorder that may pose a risk to subject safety or interfere with study evaluation, procedures, or completion.
History of arterial thrombosis (eg, stroke or transient ischemic attack) in the past 3 months.
Active infection requiring intravenous antibiotics within 1 week of study enrollment (day 1). Antibiotics may be administered for prophylaxis as per institutional standards up to and after enrollment.
Known positive test for human immunodeficiency virus (HIV).
Positive for hepatitis B surface antigen (HepBsAg).
Positive for hepatitis C or chronic hepatitis C. Possible exceptions: acute hepatitis C and completely cleared of the virus (demonstrated by negative viral load), chronic hepatitis C with undetectable viral load defined by sustained virologic response 24 weeks (SVR24) after completion of anti-hepatitis C treatment.
Live vaccination(s) within 4 weeks before the start of AMG 427 treatment on day 1, during treatment, and until the end of the last study dose.
Unresolved toxicities from prior antitumor therapy, defined as not having resolved to Common Terminology Criteria for Adverse Events (CTCAE), version 4.0 grade 1 (with the exception of myelosuppression, eg, neutropenia, anemia, thrombocytopenia), or to levels dictated in the eligibility criteria with the exception of alopecia or toxicities from prior antitumor therapy that are considered irreversible (defined as having been present and stable for greater than 2 months) which may be allowed if they are not otherwise described in the exclusion criteria AND there is agreement to allow by both the investigator and sponsor.
Antitumor therapy (chemotherapy, antibody therapy, molecular-targeted therapy, or investigational agent) within 14 days of day 1. Exception: hydroxyurea to control peripheral blood leukemic cell counts is allowed until start of investigational product treatment. Exception: antitumor therapies with short half-lives only require passing of 5 half-lives from last dose, and after discussion with sponsor.
Treatment with systemic immune modulators including, but not limited to, non-topical systemic corticosteroids, cyclosporine, and tacrolimus within 2 weeks before enrollment (day 1). Exceptions: physiologic replacement steroids or steroids for treatment of transfusion/hypersensitivity reactions.
Prior treatment with a fms-like tyrosine kinase 3 (FLT3) targeting chimeric antigen receptor T cell (CAR-T)
Major surgery within 28 days of study day 1 with the exception of biopsy and insertion of central venous catheter.
History or evidence of any other clinically significant disorder, condition or disease that, in the opinion of the investigator or Amgen medical monitor would pose a risk to subject safety or interfere with the study evaluation, procedures or completion.
Males and females of reproductive potential who are unwilling to practice a highly effective method(s) of birth control while on study through 4 weeks after receiving the last dose of study drug. Acceptable methods of highly effective birth control include sexual abstinence (males, females); vasectomy; bilateral tubal ligation/occlusion; or a condom with spermicide (men) in combination with hormonal birth control or intrauterine device (IUD) (women).
Females who are lactating/breastfeeding or who plan to breastfeed while on study through 4 weeks after receiving the last dose of study drug.
Females with a positive pregnancy test.
Females planning to become pregnant while on study through 4 weeks after receiving the last dose of study drug.
Subjects likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures to the best of the subject's and investigator's knowledge.
History of multiple sclerosis or any other demyelinating disease.
No active hepatitis secondary to alcoholic hepatitis or nonalcoholic steatohepatitis.
History or evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection unless agreed upon with Medical Monitor and meeting the following criteria:
- Negative test for SARS-CoV-2 RNA by reverse transcriptase-polymerase chain reaction (RT-PCR) within 72 hours of first dose of investigational product
- No acute symptoms of coronavirus disease 2019 (COVID-19) disease within 10 days prior to first dose of investigational product (counted from day of positive test for asymptomatic subjects)

Study & Design

Study Type: INTERVENTIONAL

Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Dose Escalation Phase	AMG 427	AMG 427 Dose-finding phase of the study
Dose Expansion Phase	AMG 427	AMG 427 MTD identified in dose escalation phase (or lower) will be administered to subjects.

Primary Outcome Measures

Name	Time	Method
Number of Participants Who Experienced a Dose Limiting Toxicity (DLT)	Days 1 to 28 for each cohort (28 days)	A DLT was any of the following during the DLT window, assessed by Common Terminology Criteria for Adverse Events (CTCAE) v 4.0 except for cytokine release syndrome (CRS) grading: * drug-induced liver injury * any treatment-related death * Grade 2 CRS not resolving to ≤ grade 1 within 7 days; grade 3 CRS not resolving to ≤ grade 1 within 7 days; grade 3 CRS reported at the initial run-in dose; 2 separate grade 3 CRS events * Grade 4 CRS/infusion reactions * Grade 3-5 non-hematologic toxicity not clearly resulting from underlying leukemia except: alopecia, grade 3 rash, fatigue, asthenia, fever, anorexia, or constipation, nausea, vomiting or diarrhea not requiring tube feeding, total parenteral nutrition, or requiring/prolonging hospitalization; infection, bleeding, or other expected complication of cytopenias due to underlying leukemia; grade 3 infusion reaction including CRS; grade 3 tumor lysis syndrome * Grade 4 neutropenia persisting beyond 42 days in absence of leukemia.
Number of Participants Who Experienced Treatment-emergent Adverse Events (TEAEs) and Treatment-related TEAEs	Day 1 Cycle 1 to 30 days after last dose of investigational product or end of study; median treatment duration was 0.62 months	An adverse event (AE) was defined as any untoward medical occurrence in a clinical trial participant. A TEAE was an AE that started on or after the first dose of investigational product (emirodatamab) up to 30 days after the end of investigational product or end of study date, whichever was earlier. A treatment-related AE was any TEAE that per investigator review had a reasonable possibility of being caused by the investigational product (emirodatamab).

Secondary Outcome Measures

Name	Time	Method
Maximum Observed Concentration (Cmax) of Emirodatamab	Cohorts 1, 2, 3, 4, 5, 6, 7a, 7b, 8, 9, 10, 11, 12, 13, 16 and 17: Cycle 1 Day 5 (C1D5); Cohorts 14 and 15: Cycle 1 Day 8 (C1D8) (sampling pre-dose up to 72 hours post-dose)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of pharmacokinetic (PK) parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis.
Time to Reach Cmax (Tmax) of Emirodatamab	Cohorts 1, 2, 3, 4, 5, 6, 7a, 7b, 8, 9, 10, 11, 12, 13, 16 and 17: C1D5; Cohorts 14 and 15: C1D8 (sampling pre-dose up to 72 hours post-dose)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of PK parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis.
Minimum Concentration (Cmin) of Emirodatamab	Cohorts 1, 2, 3, 4, 5, 6, 7a, 7b, 8, 9, 10, 11, 12, 13, 16 and 17: C1D5; Cohorts 14 and 15: C1D8 (sampling pre-dose up to 72 hours post-dose)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of PK parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis.
Area Under the Concentration-time Curve (AUC) From Time 0 to Time of Last Quantifiable Concentration (AUC0-last) of Emirodatamab	Cohorts 1, 2, 3, 4, 5, 6, 7a, 7b, 8, 9, 10, 11, 12, 13, 16 and 17: C1D5; Cohorts 14 and 15: C1D8 (sampling pre-dose up to 72 hours post-dose)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of PK parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis. AUC(0-last) was calculated using the linear trapezoidal method.
AUC From Time 0 to Infinity (AUC0-inf) of Emirodatamab	Cohorts 1, 2, 3, 4, 5, 6, 7a, 7b, 8, 9, 10, 11, 12, 13, 16 and 17: C1D5; Cohorts 14 and 15: C1D8 (sampling pre-dose up to 72 hours post-dose)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of PK parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis. The AUC(0-inf) was calculated using the linear trapezoidal method.
AUC From Time Zero to 14 Days Post-dose (AUC14d) of Emirodatamab	For all cohorts: from time zero to 14-days following the C1D1 dose (1 cycle= 14 days)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of PK parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis. AUC(14d) was calculated as the sum of AUC values of all dosing days in cycle 1.
Terminal Half-life (t1/2,z) of Emirodatamab	Cohorts 1, 2, 3, 4, 5, 6, 7a, 7b, 8, 9, 10, 11, 12, 13, 16 and 17: C1D5; Cohorts 14 and 15: C1D8 (sampling pre-dose up to 72 hours post-dose)	Serum concentrations of emirodatamab were determined using a validated assay. Noncompartmental analysis was performed for estimation of PK parameters. Concentrations below the LLOQ (0.05 ng/mL) were set to zero before data analysis. t1/2,z was calculated as t1/2,z = ln(2)/λz, where λz is the first-order terminal rate constant estimated via linear regression of the terminal log-linear phase.
Best Overall Response According to Revised International Working Group (IWG) Response Criteria	Day 1 Cycle 1 to 30 days after last dose of investigational product or end of study; median treatment duration was 0.62 months	A response consisted of any of the following, assessed according to the IWG response criteria: * complete remission (CR): bone marrow (BM) blasts \<5%; no blasts with Auer rods; no extramedullary disease; absolute neutrophil count \>1.0 x 10\^9/L; platelet count \> 100 x 10\^9/L; independence of red cell transfusions * CR with incomplete recovery of peripheral blood counts (CRi): CR except for residual neutropenia (\< 1.0 x 10\^9/L) or thrombocytopenia (\< 100 x 10\^9/L) * complete response/remission with partial hematologic recovery (CRh): ≤5% BM blasts, no circulating blasts/extramedullary disease and partial recovery of peripheral blood counts (platelets \> 50,000/µL, hemoglobin ≥7g/dL and absolute neutrophil count \> 500/µL). * morphologic leukemia-free state: BM blasts \< 5%; no blasts with Auer rods; no extramedullary disease; no hematologic recovery required * partial remission: hematological criteria of CR; decrease BM blast to 5-25%; decrease of pretreatment BM blast percentage by ≤ 50%

Trial Locations

Locations (16): Klinikum der Universitaet Muenchen Campus Grosshadern
🇩🇪
Muenchen, Germany
Seoul National University Hospital
🇰🇷
Seoul, Korea, Republic of
City of Hope National Medical Center
🇺🇸
Duarte, California, United States
University of Fukui Hospital
🇯🇵
Yoshida-gun, Fukui, Japan
Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden
🇩🇪
Dresden, Germany
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
The Alfred Hospital
🇦🇺
Melbourne, Victoria, Australia
The Royal Melbourne Hospital
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Parkville, Victoria, Australia
National Cancer Center Hospital East
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Kashiwa-shi, Chiba, Japan
Severance Hospital Yonsei University Health System
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Seoul, Korea, Republic of
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Northwestern University
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Evanston, Illinois, United States
Johns Hopkins
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Baltimore, Maryland, United States
Duke University Medical Center
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Durham, North Carolina, United States
University Health Network-Princess Margaret Cancer Centre
🇨🇦
Toronto, Ontario, Canada
University of Texas MD Anderson Cancer Center
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Houston, Texas, United States