Phase 1/2A Study of Rintatolimod and IFN Alpha Regimen in Cancer Patients With COVID-19
试验速览
- 阶段
- 1 期
- 状态
- 终止
- 入组人数
- 4
- 试验地点
- 1
- 主要终点
- Number of Participants With Adverse Events (AEs)
研究概览
简要总结
This phase I/IIa trial studies the best dose and side effects of rintatolimod and interferon (IFN) alpha-2b in treating cancer patients with COVID-19 infection. Interferon alpha is a protein important for defense against viruses. It activates immune responses that help to clear viral infection. Rintatolimod is double stranded ribonucleic acid (RNA) designed to mimic viral infection by stimulating immune pathways that are normally activated during viral infection. Giving rintatolimod and interferon alpha-2b may activate the immune system to limit the replication and spread of the virus.
详细描述
PRIMARY OBJECTIVES:
I. To determine the safety of the combination of intravenous (i.v.) rintatolimod administered with or without i.v. IFN alpha (recombinant interferon alfa-2b [Intron A]) in patients with cancer with coronavirus disease 2019 (COVID-19).
II. Determine the kinetics of viral load in nasopharyngeal swabs in the course of treatment and Days 7 and 14.
SECONDARY OBJECTIVES:
I. To assess the efficacy of the treatment combination in patients with cancer with COVID-19.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •INCLUSION CRITERIA (MAIN COHORT):
- •Patients with cancer, with the exception of patients with active acute leukemia and allogeneic hematopoietic stem cell transplant recipients. Patients may be on active therapy or received therapy (e.g., chemotherapy, radiation or surgery) within 7 years. Patients with active cancer who have not yet been treated (e.g. newly diagnosed cancer or early stage myelodysplastic syndrome [MDS] or chronic lymphocytic leukemia [CLL]) are eligible. Basal cell cancer and carcinoma in situ treated with local excision alone do not qualify for inclusion
- •Presence of symptomatic infection, defined by fever (temperature [T] >= 38 degrees Celsius [C]) OR respiratory symptoms (cough, nasal congestion, or shortness of breath) OR lung infilitrates on chest X-ray or CT imaging. Diagnosis of COVID-19 is based on polymerase chain reaction (PCR) testing of respiratory samples.
- •Age equal to >= 18 years or older (children are excluded because COVID-19 typically has a milder course in children, and lack of safety data of this regimen in children)
- •Platelet >= 75,000/uL
- •Hemoglobin >= 9 g/dL
- •Hematocrit >= 27%
- •Absolute neutrophil count (ANC) >= 1000/uL
- •Creatinine clearance >= 50 mL/min (Cockcroft-Gault Equation-note: plasma creatine instead of serum is used at Roswell Park)
- •Total bilirubin =< 2 X institutional upper limit of normal (ULN)
- •Aspartate transaminase (AST) (plasma) and alanine transferase (ALT) (plasma) =< 2 X institutional ULN
- •Plasma amylase and lipase =< 2 X institutional ULN
- •In the absence of COVID-19, a life expectancy of 6 months is expected
- •Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure
- •NOTE: For blood chemistry labs, Roswell Park clinical blood chemistries are performed on plasma unless otherwise indicated
- •EXPANSION COHORT: Patients with cancer or allogeneic stem cell transplant recipients with and without a cancer diagnosis
- •Patients with cancer may be on active therapy or received therapy (e.g., chemotherapy, radiation or surgery) within 7 years
- •Patients with active cancer who have not yet been treated (e.g. newly diagnosed cancer or early stage MDS or CLL) are eligible
- •Basal cell cancer and carcinoma in situ treated with local excision alone do not qualify for inclusion
- •Presence of symptomatic infection, defined by fever (T >= 38.0 degrees C ) OR respiratory symptoms (cough, nasal congestion, or shortness of breath) OR lung infiltrates by chest X-ray or CT imaging. Diagnosis of COVID-19 is based on PCR testing of respiratory samples. Severe infection is excluded
- •Age equal to >= 18 years or older (children are excluded because COVID-19 typically has a milder course in children, and lack of safety data of this regimen in children). In the absence of COVID-19, a life expectancy of 6 months is expected
- •Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure. There may be specific instances when the patient can't provide informed consent, e.g. they require mechanical ventilation and are sedated, in which case a health care proxy will be able to provide informed consent. Patients with temporary cognitive impairment will be consented once their capacity has returned. Patients with chronic cognitive impairment, e.g. dementia, that precludes informed consent will not be enrolled.
排除标准
- •EXCLUSION CRITERIA (MAIN COHORT):
- •Patients with severe COVID-19 infection defined by pulmonary infiltrates on chest x-ray or computed tomography (CT) imaging plus one of the following: room air oxygen saturation (SaO2) =< 92%, room air partial pressure of oxygen (PaO2) < 70 mm Hg, or partial pressure of oxygen in arterial blood (PaO2)-PaO2 (alveolar gas) >= 35 mm Hg
- •Contraindication to recombinant (r)-INFalpha based on prior hypersensitivity, autoimmune hepatitis, decompensated liver disease
- •Patients who have active acute myeloid leukemia or acute lymphoid leukemia or are allogeneic hematopoietic stem transplant recipients. Acute leukemia in remission and chronic leukemias are not exclusion criteria
- •Cardiac events:
- •Acute coronary syndrome, myocardial infarction, or ischemia within past 3 months
- •New York Heart Association classification of III or IV congestive heart failure
- •Unwilling or unable to follow protocol requirements
- •Patients with known serious mood disorders
- •Any additional condition, such as pre-existing inflammatory lung disease, which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs
- •Concurrent infections, e.g. bacterial pneumonia or sepsis, that would make it difficult to evaluate clinical response to therapy or study drug toxicities
- •Therapies known to cause cytokine release syndrome (CRS), e.g. engineered T cells, within 30 days
- •Patients at high risk for tumor lysis syndrome
- •Concurrent active pneumonitis predating COVID-19, such as from checkpoint inhibitor therapy, chemotherapy-associated toxicity, or radiation pneumonitis
- •Autoimmune disease that requires systemic immunosuppression
- •Protocol-defined baseline abnormalities in cell counts, renal, or hepatic function
- •Any additional condition which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs
- •EXCLUSION CRITERIA: EXPANSION COHORT:
- •Patients with respiratory failure requiring mechanical ventilation with FIO2 of > 60%.
- •Allogeneic hematopoietic stem cell transplant recipients with active pulmonary graft versus host disease (GvHD) (any grade)
- •Cardiac events:
- •Acute coronary syndrome, myocardial infarction, or ischemia within past 3 months,
- •New York Heart Association classification of III or IV congestive heart failure
- •Unwilling or unable to follow protocol requirements
- •Any additional condition which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs
- •Cognitively impaired adults/adults with impaired decision-making capacity
- •Individuals who are not yet adults (infants, children, teenagers)
- •Pregnant women
- •Prisoners
研究组 & 干预措施
Rintatolimod, recombinant interferon alfa-2b 0 MU/M^2
Dose level 1:Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 0 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Recombinant Interferon Alfa-2b (Biological)
Rintatolimod, recombinant interferon alfa-2b 0 MU/M^2
Dose level 1:Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 0 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Rintatolimod (Drug)
Rintatolimod, recombinant interferon alfa-2b 5 MU/M^2
Dose level 2 :Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 5 MU/M^2 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Recombinant Interferon Alfa-2b (Biological)
Rintatolimod, recombinant interferon alfa-2b 5 MU/M^2
Dose level 2 :Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 5 MU/M^2 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Rintatolimod (Drug)
Rrintatolimod plus Standard of Care)
Patients receive rintatolimod IV over 2.5-3 hours once plus standard of care.
干预措施: Rintatolimod (Drug)
Rintatolimod, recombinant interferon alfa-2b 10 MU/M^2
Dose level 3: Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 10 MU/M^2 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Recombinant Interferon Alfa-2b (Biological)
Rintatolimod, recombinant interferon alfa-2b 10 MU/M^2
Dose level 3: Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 10 MU/M^2 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Rintatolimod (Drug)
Rintatolimod, recombinant interferon alfa-2b 20 MU/M^2
Dose level 4: Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 20 MU/M^2 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Recombinant Interferon Alfa-2b (Biological)
Rintatolimod, recombinant interferon alfa-2b 20 MU/M^2
Dose level 4: Patients receive rintatolimod IV over 2.5-3 hours plus recombinant interferon alfa-2b IV 20 MU/M^2 over 20 minutes on day 1 and on day 3 (or 4) in the absence of disease progression or unacceptable toxicity.
干预措施: Rintatolimod (Drug)
结局指标
主要结局
Number of Participants With Adverse Events (AEs)
时间窗: Up to 30 days post treatment initiation, On average, the timeframe is 25 days
This refers to the frequency of grade 3 or 4 AEs considered to be probably or definitely related to the treatment regimen. Toxicity will be assessed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE version \[v\] 5.0).
Kinetics of Viral Load
时间窗: Treatment and days 1, 3/4, 7 and 11
Will be assessed as cycle threshold values in nasopharyngeal swabs based on quantitative polymerase chain reaction (PCR) in the course of treatment and days 1, 3/4, 7, and 11.
次要结局
- Number of Participants With Selected Clinical Efficacy Complications(Up to 30 days post treatment initiation)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (CCL22)(Days 1, 4, 7, 14 and 30 post treatment)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (IDO1)(Days 1, 4, 7, 14 and 30 post treatment)
- Kinetics of Viral Load(Days 1, 3, 7, 14 post treatment initiation)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (COX2)(Days 1, 4 , 7, 14 and 30 post treatment initiation)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (IL-10)(Days 1, 4, 7, 14 and 30 post treatment)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (CCL5)(Days 1, 4, 7, 14 and 30 post treatment)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (CXCL10)(Days 1, 4, 7, 14, and 30 post treatment)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (CXCL12)(Days 1, 4, 7, and 30 post treatment)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (IFNB1)(Days 1, 4, 7, 14 and 30 post treatment)
- Kinetics of Changes of the Immune Subsets and Circulating Inflammatory Mediators in Peripheral Blood (IFNa)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (RIG-1)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (TLR-3)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (ISG-15)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (RNAseL)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (OAS2)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (ACE2)(Days 1, and 14 post treatment)
- Known Mediators of Antiviral Immunity (Mx1)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (IFIT1)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (IFITM3)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (IRF3)(Days 1, 4, 7, 14 and 30 post treatment)
- Known Mediators of Antiviral Immunity (IRF7)(Days 1, 4, 7, 14 and 30 post treatment)