Trial of X4P-001 in Participants With Advanced Renal Cell Carcinoma

Phase 1

Completed

Conditions: Clear Cell Renal Cell Carcinoma

Interventions: Drug: X4P-001
Drug: axitinib

Registration Number: NCT02667886

Lead Sponsor: X4 Pharmaceuticals

Brief Summary: The purpose of the study is to test different doses of X4P-001 given alone and in combination with axitinib in participants diagnosed with advanced renal cell carcinoma. The goals of the study are to determine the safety and tolerability of X4P-001, as well as the potential effect it may have on the body and the cancer tumor.

Detailed Description: X4P-001 is an orally bioavailable C-X-C chemokine receptor type 4 (CXCR4) antagonist that has demonstrated activity in various tumor models. CXCR4 is the receptor for C-X-C chemokine ligand type 12 (CXCL12). CXCL12 has potent chemotactic activity for lymphocytes and myeloid-derived suppressor cells (MDSCs), and is important in homing of hematopoietic stem cells to the bone marrow. CXCR4 is also expressed and active on multiple types of human cancers, including clear cell Renal Cell Carcinoma (ccRCC), ovarian cancer, and melanoma, and increased expression of CXCR4 on tumor cells has been associated with significantly decreased overall participant survival.

Multiple observations implicate the CXCL12/CXCR4 axis in contributing to the lack (or loss) of tumor responsiveness to angiogenesis inhibitors (also referred to as "angiogenic escape"). In animal cancer models, interference with CXCR4 function has been demonstrated to disrupt the tumor microenvironment and unmask the tumor to immune attack by multiple mechanisms, including:

* Eliminating tumor re-vascularization

* Decreasing the infiltration of MDSCs

* Increasing the ratio of cluster of differentiation 8+ (CD8+) T cells to T regulatory (Treg) cells

The hypothesis and evidence of published data support is that effective CXCR4 antagonism by X4P-001 would be of potential benefit in participants with advanced ccRCC and other cancers by multiple mechanisms:

* Decreased recruitment of MDSCs, resulting in increased anti-tumor immune attack

* Sustained decrease in neoangiogenesis and tumor vascular supply

* Interference with the autocrine effect of increased expression by ccRCC of both CXCR4 and CXCL12, its only ligand, thereby, potentially reducing cancer cell metastasis

This initial clinical trial in participants with advanced ccRCC will evaluate X4P-001 both as a single agent (monotherapy) and also in combination with axitinib, a small molecule tyrosine kinase inhibitor (TKI) approved for second-line treatment of participants with ccRCC. This combination has the potential to further improve outcomes by reducing the angiogenic escape that typically occurs with TKI therapy.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 74

Inclusion Criteria

Have a histologically confirmed diagnosis of predominant ccRCC.
Have received at least one prior course of treatment for ccRCC. Part C only: Prior treatment must include at least 1 course of vascular endothelial growth factor (VEGF)-directed therapy.
Have on computed tomography (CT) imaging done within 28 days of Day 1 findings consistent with advanced ccRCC, including at least one extra-renal measurable target lesion meeting the criteria of Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1.
For women of childbearing potential and men, agree to use effective contraceptive methods from screening, through the study, and for at least 4 weeks after the last dose of study drug.
For women of childbearing potential, have a negative pregnancy test (serum or urine) on Day 1 prior to initiating study treatment.
Be willing and able to comply with the protocol

Exclusion Criteria

Has life expectancy of less than 3 months.
Has performance status Grade >2 (Eastern Cooperative Oncology Group [ECOG] criteria).
Has New York Heart Association (NYHA) Class III or IV heart failure or uncontrolled hypertension (systolic blood pressure [SBP] ≥160 millimeters of mercury [mm Hg]; diastolic blood pressure [DBP] ≥100 mm Hg).
Has previously received X4P-001.
Parts A and B only: Has received a prior course of axitinib.
Parts A and B only: Has received mechanistic target of rapamycin (mTOR) inhibitor(s) as their only prior treatment for ccRCC.
Has a prior history or current evidence of intracranial (CNS) metastatic RCC, except for

≤3 lesions treated by CyberKnife or excisional surgery, clinically stable for at least 4 weeks, and without evidence of recurrence on MRI imaging at screening.
Has ongoing acute clinical adverse events National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Grade >1 resulting from prior cancer therapies (except alopecia, tyrosine kinase inhibitor [TKI]-related hand-foot syndrome, or thyroid dysfunction).
Has had within the past 6 months the occurrence or persistence of one or more of the following medical conditions that could not be controlled with usual medical care (for example, required emergency care or hospitalization): hypertension, angina, congestive heart failure, diabetes, seizure disorder.
Has had within the past 6 months the occurrence of one or more of the following events: myocardial infarction, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, hemorrhage (CTC Grade 3 or 4), chronic liver disease (meeting criteria for Child-Pugh Class B or C), a second active malignancy (excluding basal cell carcinoma and cervical carcinoma in situ), organ transplantation.
Has had within the 4 weeks prior to initiation of study drug, or is expected to have during the study period, surgery requiring general anesthesia.
Has, at screening, serologic laboratory tests meeting one or more of the following criteria:
An indeterminate or positive test for antibody to human immunodeficiency virus (HIV)-1 or -2.
An indeterminate or positive test for antibody to hepatitis C virus (HCV), unless documented to have no detectable viral load on two independent samples.
A positive test for hepatitis B surface antigen (HBsAg).
Has, at screening, safety laboratory tests meeting one or more of the following criteria:
Hemoglobin <8.0 grams (g)/deciliter (dL)
Absolute neutrophil count (ANC) <1,500/microliter (μL)
Platelets <75,000/μL
Creatinine >2.0x upper limit of normal (ULN)
Serum aspartate transaminase (AST) >2.5x ULN
Serum alanine transaminase (ALT) >2.5x ULN
Total bilirubin >1.5x ULN (unless due to Gilbert's Syndrome)
International normalized ratio (INR) >1.5x ULN
Has received other anti-cancer therapy within the following specified intervals prior to Day 1:
TKI within 2 weeks.
Radiation therapy within 2 weeks.
Bevacizumab within 4 weeks.
Other chemotherapy (for example, mitomycin-C, nitrosourea) or immunotherapy (for example, antibody, cytokine) within 4 weeks
For investigational anti-cancer therapies, the interval will be determined in consultation with the Medical Monitor.
Has, within 2 weeks prior to Day 1, received a medication prohibited based on cytochrome P3A4 (CYP3A4) interaction
Has, within 2 weeks prior to Day 1, received systemic corticosteroids exceeding prednisone 10 mg per day or equivalent; for other immunosuppressive agents, the exclusionary dose and duration will be determined in consultation with the Medical Monitor.
Is, within 2 weeks prior to Day 1, nursing.
Has, at the planned initiation of study drug, an uncontrolled infection.
Has any other medical or personal condition that, in the opinion of the Investigator, may potentially compromise the safety or compliance of the participant, or may preclude the participant's successful completion of the clinical trial.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Dose Escalation (Part A): X4P-001 200 mg BID with Axitinib	X4P-001	Participants will receive X4P-001 200 milligrams (mg) orally twice daily (BID) with axitinib at 5 mg orally BID.
Dose Expansion (Part B): X4P-001 400 mg QD With Axitinib	X4P-001	Participants received X4P-001 400 mg orally QD with axitinib at 5 mg orally BID.
Dose Escalation (Part A): X4P-001 400 mg QD with Axitinib	X4P-001	Participants will receive X4P-001 400 mg orally once daily (QD) with axitinib at 5 mg orally BID.
Dose Escalation (Part A): X4P-001 600 mg QD with Axitinib	X4P-001	Participants will receive X4P-001 600 mg orally QD with axitinib at 5 mg orally BID.
Dose Escalation and Expansion (Part C): X4P-001 600 mg QD Monotherapy	X4P-001	Participants will receive X4P-001 600 mg orally QD.
Dose Escalation (Part A): X4P-001 600 mg QD with Axitinib	axitinib	Participants will receive X4P-001 600 mg orally QD with axitinib at 5 mg orally BID.
Dose Escalation (Part A): X4P-001 400 mg QD with Axitinib	axitinib	Participants will receive X4P-001 400 mg orally once daily (QD) with axitinib at 5 mg orally BID.
Dose Escalation (Part A): X4P-001 200 mg BID with Axitinib	axitinib	Participants will receive X4P-001 200 milligrams (mg) orally twice daily (BID) with axitinib at 5 mg orally BID.
Dose Expansion (Part B): X4P-001 400 mg QD With Axitinib	axitinib	Participants received X4P-001 400 mg orally QD with axitinib at 5 mg orally BID.

Primary Outcome Measures

Name	Time	Method
Parts A, B, and C: Number of Participants With Treatment-emergent Adverse Events (TEAEs)	From first dose of study drug up to 10 days after last dosing (maximum exposure: 52.1 months)	An AE was as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. An SAE was an AE that met at least 1 of the following criteria: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization for the AE, persistent or significant disability/incapacity or substantial disruption of the ability to conduct normal life functions, congenital anomaly/birth defect (in the child of a participant who was exposed to the study drug), important medical event or reaction. Adverse events with onset after administration of the first dose of study drug up to 10 days after last dosing date were considered TEAEs. A summary of all Serious Adverse Events and Other Adverse Events (nonserious) regardless of causality is located in the 'Reported Adverse Events' Section.

Secondary Outcome Measures

Name	Time	Method
Parts A and B: Objective Response Rate (ORR), as Assessed Using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1	From administration of first dose of study medication until disease progression, study completion or early termination (up to 80 weeks)	The ORR was defined as percentage of participants with best overall response of complete response (CR) or partial response (PR). CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 millimeters (mm). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Parts A and B: Time to Objective Response, as Assessed Using RECIST v1.1	From administration of first dose of study medication until first appearance of CR or PR (up to 80 weeks)	Time to objective response was defined as time from first administration of combination regimen to first CR or PR whichever came first. CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Parts A and B: Maximum Plasma Concentration (Cmax) of X4P-001	Day 1 and Day 15 of Cycle 1
Parts A and B: Disease Control Rate (DCR), as Assessed Using RECIST v1.1	From administration of first dose of study medication until disease progression, study completion or early termination (up to 80 weeks)	The DCR was defined as the percentage of participants with best overall response of CR, PR or stable disease (SD). CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), taking as reference the smallest sum diameters while on study. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. Unequivocal progression of existing non-target lesions. The appearance of 1 or more new lesions was also considered progression.
Parts A and B: Duration of Objective Response (DOR), as Assessed Using RECIST v1.1	Time from first CR or PR until the time of disease progression or death due to any cause (up to 80 weeks)	The DOR was defined as the time from first CR or PR whichever came first until the time of disease progression or death by any cause. CR: Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) with a reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Disease progression: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. Unequivocal progression of existing non-target lesions. The appearance of 1 or more new lesions was also considered progression.
Parts A and B: Progression Free Survival (PFS), as Assessed Using RECIST v1.1	From administration of first dose of study medication until disease progression or death from any cause (up to 80 weeks)	The PFS was defined as the time from first administration of combination regimen until disease progression or death from any cause. Disease progression: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. An unequivocal progression of existing non-target lesions or the appearance of 1 or more new lesions was also considered progression.
Area Under the Curve From Time 0 to the Last Quantifiable Timepoint (AUC0-tlast)	Day 1 and Day 15 of Cycle 1
Parts A and B: Time to Progression (TTP), as Assessed Using RECIST v1.1	From administration of first dose of study medication until disease progression (up to 80 weeks)	The TTP was defined as the time from first administration of combination regimen until PD. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study In addition to the relative increase of 20%, the sum also demonstrated an absolute increase of at least 5 mm. Unequivocal progression of existing non-target lesions or the appearance of 1 or more new lesions was also considered progression.