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Lag-3 and Gemcitabine for Treatment of Advanced Pancreas Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00732082
Recruitment Status : Terminated (Company manufacturing study drug was unable to continue production.)
First Posted : August 11, 2008
Last Update Posted : June 12, 2013
Sponsor:
Information provided by (Responsible Party):
Washington University School of Medicine

Study Description
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Brief Summary:
The overall purpose of this research is to evaluate the safety and toxicity of an investigational medication, IMP321, in patients being treated with gemcitabine. IMP321 is a synthetic protein (made in the laboratory to simulate a protein that your body makes on its own) and was designed to stimulate the immune system with the overall objective of improving the body's capacity to react to your pancreas cancer.

Condition or disease Intervention/treatment Phase
Pancreatic Neoplasms Drug: Gemcitabine Biological: LAG-3 Phase 1

Detailed Description:

This is a phase I, single center, open label, non-randomized, dose-escalation phase I study performed in the ambulatory setting in patients receiving first line chemotherapy for unresectable pancreas cancer with gemcitabine weekly and the investigational agent IMP321. IMP321 will be given at D2 and D16 of a 4-week cycle, for a period of 6 months. The hypothesis of this study is that IMP321 is safe for human administration. Additionally we hypothesize that IMP321 elicits an immunomodulatory effect that is therapeutic in the treatment of pancreas cancer.

Primary Objectives

  • To evaluate the safety and tolerability of repeated IMP321 subcutaneous injections in patients being treated with gemcitabine for advanced pancreas cancer.
  • To determine any dose limiting toxicities of IMP321 in patients being treated with gemcitabine for advanced pancreas cancer.

Secondary Objectives

  • To describe the pharmacokinetics of the last IMP321 subcutaneous injection compared to the first one, in a limited number of patients.
  • To determine the pharmacodynamics of IMP321 therapy by:
  • Quantify peripheral blood Treg (CD4+CD25+FoxP3+ T cells) in pancreatic cancer patients before and during treatment with IMP321 by flow cytometry.
  • Evaluate the B- and T-cell responses to the pancreatic cancer-expressed antigen, mesothelin, by testing for antibodies and T-cell response by ELISpot.
  • To evaluate the clinical response and time to disease progression with computed tomography examinations at two month intervals (current standard of care in gemcitabine-treated patients).
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 18 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I Study of Soluble LAG-3 (IMP321) and Gemcitabine in Patients With Advanced Pancreas Cancer
Study Start Date : February 2009
Actual Primary Completion Date : February 2010
Actual Study Completion Date : September 2012

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Dose Level 0
Gemcitabine (1 mg/m2 over 30 min) will be given on days 1, 8, and 15 of a 28 day cycle.
 Drug: Gemcitabine
Other Name: Gemzar
Experimental: Dose Level 1

Gemcitabine (1 mg/m2 over 30 min) will be given on days 1, 8, and 15 of a 28 day cycle.

IMP321 3 mg SQ anterior surface of either the right or left thigh on Day 2.

The subsequent doses will be given by subcutaneous injection on the contralateral thigh.

Each single injection will be separated by a 13-day administration free period.

 Drug: Gemcitabine
Other Name: Gemzar

Biological: LAG-3
Experimental: Dose Level 2

Gemcitabine (1 mg/m2 over 30 min) will be given on days 1, 8, and 15 of a 28 day cycle.

IMP321 6.5 mg SQ anterior surface of either the right or left thigh on Day 2.

The subsequent doses will be given by subcutaneous injection on the contralateral thigh.

Each single injection will be separated by a 13-day administration free perio

 Drug: Gemcitabine
Other Name: Gemzar

Biological: LAG-3
Experimental: Dose Level 3

Gemcitabine (1 mg/m2 over 30 min) will be given on days 1, 8, and 15 of a 28 day cycle.

IMP321 13 mg SQ anterior surface of either the right or left thigh on Day 2.

The subsequent doses will be given by subcutaneous injection on the contralateral thigh.

Each single injection will be separated by a 13-day administration free perio

 Drug: Gemcitabine
Other Name: Gemzar

Biological: LAG-3
Experimental: Dose Level 4

Gemcitabine (1 mg/m2 over 30 min) will be given on days 1, 8, and 15 of a 28 day cycle.

IMP321 26 mg SQ anterior surface of either the right or left thigh on Day 2.

The subsequent doses will be given by subcutaneous injection on the contralateral thigh.

Each single injection will be separated by a 13-day administration free perio

 Drug: Gemcitabine
Other Name: Gemzar

Biological: LAG-3


Outcome Measures
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Primary Outcome Measures :
  1. To evaluate the safety and tolerability of repeated IMP321 subcutaneous injections in patients being treated with gemcitabine for advanced pancreas cancer. [ Time Frame: 6 months ]
  2. To determine the dose limiting toxicities of IMP321 in patients being treated with gemcitabine for advanced pancreas cancer. [ Time Frame: 6 months ]

Secondary Outcome Measures :
  1. To describe the pharmacokinetics of the last IMP321 subcutaneous injection compared to the first one, in a limited number of patients. [ Time Frame: Pre-dose, 2 hours, 4 hours, 8 hours, 24 hours, 72 hours, and 96 hours after IMP321 administration ]
    Performed only in patients enrolled in dose level 3 and 4.

  2. To determine the pharmacodynamics of IMP321 therapy [ Time Frame: 6 months ]
    1. Quantify peripheral blood Treg (CD4+ CD25+ Fox P3+ Tcells) in pancreatic cancer patients before and during treatment with IMP321 by flow cytometry.
    2. Evaluate the B- and T-cell responses to the pancreatic cancer-expressed antigen, mesothelin, by testing for antibodies and T-cell response by ELISpot

  3. To evaluate the clinical response and time to disease progression with computed tomography examinations at two month intervals (current standard of care in gemcitabine-treated patients). [ Time Frame: survival ]

Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient must have a newly diagnosed, histologically or cytologically confirmed diagnosis of pancreatic adenocarcinoma (primary tumor or metastasis). The histological slides or blocks must be available for review.
  • Patient must have advanced disease (characterized by metastasis or locally advanced disease), or unable to undergo surgical treatment due to extent of disease or pre-existing health conditions precluding surgical treatment.
  • Measurable or evaluable disease: RECIST Criteria will be used to assess and survey extent of disease
  • Patients must be ≥ 18 years old.
  • Performance Status: Karnofsky Performance Status (KPS) ≥ 70
  • Life Expectancy > 12 weeks.
  • No previous history of chemotherapy for pancreas cancer in the metastatic setting prior to the start of protocol treatment.
  • Patients must have recovered from uncontrolled, intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris or cardiac arrhythmia.
  • Patients must have adequate bone marrow function defined as an absolute neutrophil count >1,500/mm3, platelet count >100,000/mm3 and hemoglobin >10 g/dl.
  • Patients must have adequate renal function defined as serum creatinine ≤ 2.0 mg/dl or creatinine clearance ≥ 60 ml/min/1.73m2 for patients with creatinine levels above 2.0 mg/dl.
  • Patients must have adequate hepatic function with total bilirubin ≤ 1.5 times the institutional normal value and AST ≤ 2 times the institutional normal value.
  • Patient must have no prior or current active autoimmune disease requiring management with immunosuppression. This includes inflammatory bowel disease, systemic vasculitis, scleroderma, psoriasis, hemolytic anemia, immune-mediated thrombocytopenia, rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis or other rheumatologic disease. Asthma and chronic obstructive pulmonary disease that does not require daily systemic corticosteroids is acceptable.

  • The patient with previous history of malignancy is eligible for this study only if the patient meets the following criteria for cancer survivor:

    • (i) patient has undergone potentially curative therapy for all prior malignancies;
    • (ii) patient has been considered disease free for at least 5 years.
  • For all sexually active patients, the use of adequate barrier contraception (hormonal or barrier method of birth control) will be required during therapy, prior to study entry and for the duration of study participation. Patients must agree to refrain from becoming pregnant 2 years after beginning treatment with IMP321. Non-pregnant status will be determined in all women of childbearing potential.
  • After being informed of the treatment involved, patients must give written consent. The patient should not have any serious medical or psychiatric illness that would prevent either the giving of informed consent or the receipt of treatment.

Exclusion Criteria:

  • Patient is currently receiving other investigational agents.
  • Pregnant and nursing women patients are not eligible.
  • Patients known to be HIV (patient self-report) positive are ineligible because of the potential inability to modulate immune responses.
  • Patients with a QTc of >460 msec.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00732082


Locations
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United States, Missouri
Washington University
St. Louis, Missouri, United States, 63110
Sponsors and Collaborators
Washington University School of Medicine
Investigators
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Principal Investigator: William G. Hawkins, M.D. Washington Univerisity
More Information
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Additional Information:

Publications:
Immutep. 2006. ImmuFact IMP321 Product Information Brochure.
Co, E.L.a., Gemcitabine Product Info. 2003.
Series, M.H., 2003. MICROMEDEX, Greenwood Village, Colorado

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Responsible Party: Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT00732082    
Other Study ID Numbers: 07-0265
First Posted: August 11, 2008    Key Record Dates
Last Update Posted: June 12, 2013
Last Verified: June 2013
Keywords provided by Washington University School of Medicine:
LAG-3 and gemcitabine treatment for advanced pancreas cancer
Additional relevant MeSH terms:
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Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Gemcitabine
Antimetabolites, Antineoplastic
 Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs