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Phase 1 Trial of D2C7-IT in Combination With 2141-V11 for Recurrent Malignant Glioma

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ClinicalTrials.gov Identifier: NCT04547777
Recruitment Status : Recruiting
First Posted : September 14, 2020
Last Update Posted : July 20, 2021
Sponsor:
Collaborator:
Rockefeller University
Information provided by (Responsible Party):
Darell Bigner, Duke University

Brief Summary:
This is a phase 1 study of an anti-CD40 monoclonal antibody (2141-V11) in combination with D2C7-IT for patients with recurrent World Health Organization (WHO) grade III or IV malignant glioma at the Preston Robert Tisch Brain Tumor Center (PRTBTC) at Duke.

Condition or disease Intervention/treatment Phase
Glioma, Malignant Drug: D2C7-IT Drug: 2141-V11 Phase 1

Detailed Description:
Within this study, a maximum of 30 patients with recurrent WHO grade III and IV malignant glioma will receive D2C7-IT and 2141-V11 to determine the impact of the combination of D2C7-IT and 2141-V11 on safety. D2C7-IT and 2141-V11 will be delivered sequentially directly into the tumor by Convection Enhanced Delivery (CED) using an intracerebral catheter placed within the enhancing portion of the tumor. Based on phase 1 studies of D2C7-IT alone and D2C7-IT in combination with atezolizumab in adult patients with recurrent glioblastoma (GBM), the amount of D2C7-IT to be delivered will be 4613.2 ng/mL (36 mL). 2141-V11 will be dose escalated during the study to determine the maximum tolerated dose (MTD) when used in combination with D2C7-IT.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Trial of D2C7-IT in Combination With an Fc-engineered Anti-CD40 Monoclonal Antibody (2141-V11) Administered Intratumorally Via Convection-Enhanced Delivery for Adult Patients With Recurrent Malignant Glioma
Actual Study Start Date : July 9, 2021
Estimated Primary Completion Date : December 2023
Estimated Study Completion Date : December 2025

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: D2C7-IT + 2141-V11
Single D2C7-IT intratumoral infusion (4613.2 ng/mL in 36 mL) over 72 hours followed by single 2141-V11 infusion (5 dose levels) over 7 hours
Drug: D2C7-IT
D2C7-IT intratumoral infusion

Drug: 2141-V11
2141-11 intratumoral infusion
Other Name: anti-CD40




Primary Outcome Measures :
  1. Proportion of patients with dose-limiting toxicity (DLT) within each dose level [ Time Frame: 28 days after catheter removal ]
    DLTs are defined as any of the following events that are at least possibly, probably, or definitely attributable to study treatment (D2C7-IT or 2141-V11) during dose escalation: Any Grade 3 or any Grade 4 toxicity that is not reversible (i.e., reversible means the toxicity is trending towards improvement and has downgraded to at least Grade 2 or back to baseline) within 2 weeks, including cerebral edema or worsening neurologic symptoms; any life-threatening event that is not reversible within 2 weeks; treatment-related death; any grade 2 or higher serious autoimmune toxicities particularly those affecting vital organs (e.g., cardiac, hepatic, renal, CNS) occurring with 2 weeks of the infusion



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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:

  • Histopathologically confirmed recurrent supratentorial WHO grade III or IV malignant glioma (high grade glioma with molecular features of glioblastoma will be eligible under WHO grade IV malignant glioma)
  • Patient or partner(s) meets one of the following criteria:

    1. Non-childbearing potential (i.e. not sexually active, physiologically incapable of becoming pregnant, including any female who is post-menopausal or surgically sterile, or any male who has had a vasectomy). Surgically sterile females are defined as those with a documented hysterectomy and/or bilateral oophorectomy or tubal ligation. Postmenopausal for purposes of this study is defined as 1 year without menses.; or
    2. Childbearing potential and agrees to use one of the following methods of birth control: approved hormonal contraceptives (e.g. birth control pills, patches, implants, or infusions), an intrauterine device, or a barrier method of contraception (e.g. a condom or diaphragm) used with spermicide.
  • Age ≥ 18 years of age at the time of entry into the study
  • Karnofsky Performance Score (KPS) ≥ 70%
  • Hemoglobin ≥ 9 g/dl prior to biopsy
  • Platelet count ≥ 100,000/µl unsupported is necessary for eligibility on the study; however, because of risks of intracranial hemorrhage with catheter placement, platelet count ≥ 125,000/µl is required for the patient to undergo biopsy and catheter insertion, which can be attained with the help of platelet transfusion
  • Neutrophil count ≥ 1000 prior to biopsy
  • Creatinine ≤ 1.5 x normal range prior to biopsy
  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN) prior to biopsy (Exception: Participant has known or suspected Gilbert's Syndrome for which additional lab testing of direct and/or indirect bilirubin supports this diagnosis. In these instances, a total bilirubin of ≤ 3.0 x ULN is acceptable)
  • Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ≤ 2.5 x ULN
  • Prothrombin and Partial Thromboplastin Times ≤ 1.2 x normal prior to biopsy. Patients with prior history of thrombosis/embolism are allowed to be on anticoagulation, understanding that anticoagulation will be held in the perioperative period per the neurosurgical team's recommendations. Low molecular weight heparin (LMWH) is preferred. If a patient is on warfarin, the international normalized ratio (INR) is to be obtained and value should be below 2.0 prior to biopsy.
  • At the time of biopsy, prior to administration of D2C7-IT, the presence of recurrent tumor must be confirmed by histopathological analysis
  • A signed informed consent form approved by the Institutional Review Board (IRB) will be required for patient enrollment into the study. Patients must be able to read and understand the informed consent document and must sign the informed consent indicating that they are aware of the investigational nature of this study
  • Able to undergo brain MRI with and without contrast

Exclusion Criteria:

  • Females who are pregnant or breast-feeding
  • Patients with an impending, life-threatening cerebral herniation syndrome, based on the assessment of the study neurosurgeons or their designate
  • Patients with severe, active co-morbidity, defined as follows:

    1. Patients with an active infection requiring intravenous treatment or having an unexplained febrile illness (Tmax > 99.5°F/37.5°C)
    2. Patients with known immunosuppressive disease or known human immunodeficiency virus infection
    3. Patients with unstable or severe intercurrent medical conditions such as severe heart disease (New York Heart Association Class 3 or 4)
    4. Patients with known lung (forced expiratory volume in the first second of expiration (FEV1) < 50%) disease or uncontrolled diabetes mellitus
    5. Patients with albumin allergy
  • Patients may not have received chemotherapy or bevacizumab ≤ 4 weeks [except for nitrosourea (6 weeks), or metronomic dosed chemotherapy such as daily etoposide or cyclophosphamide (1 week)] prior to starting the study drug unless patients have recovered from side effects of such therapy
  • Patients may not have received immunotherapy ≤ 4 weeks prior to starting the study drug unless patients have recovered from side effects of such therapy
  • Patients may not have received treatment with tumor treating fields (e.g., Optune) ≤ 1 week prior to starting the study drug
  • Patients may not be less than 12 weeks from radiation therapy, unless progressive disease outside of the radiation field or 2 progressive scans at least 4 weeks apart or histopathologic confirmation
  • Patients who have not completed all standard of care treatments, including surgical procedure and radiation therapy (at least 59 Gy)

    1. If the O^6-methylguanine-DNA methyltransferase (MGMT) promoter in their tumor is known to be unmethylated, patients are not mandated to have received chemotherapy prior to participating in this trial
    2. If the MGMT promoter in their tumor is known to be methylated or the MGMT promoter methylation status is unknown at time of screening, patients must have received at least one chemotherapy regimen prior to participating in this trial
  • Patients with neoplastic lesions in the brainstem, cerebellum, or spinal cord; radiological evidence of active (growing) disease (active multifocal disease); extensive subependymal disease (tumor touching subependymal space is allowed); tumor crossing the midline or leptomeningeal disease
  • Patients on greater than 4 mg per day of dexamethasone within the 2 weeks prior to the D2C7-IT infusion
  • Patients with worsening steroid myopathy (history of gradual progression of bilateral proximal muscle weakness, and atrophy of proximal muscle groups)
  • Patients with prior, unrelated malignancy requiring current active treatment with the exception of cervical carcinoma in situ and adequately treated basal cell or squamous cell carcinoma of the skin
  • Patients with active autoimmune disease requiring systemic immunomodulatory treatment within the past 3 months

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): NCT04547777


Contacts
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Contact: Daniel Landi, MD 919-684-5301 dukebrain1@dm.duke.edu
Contact: Stevie Threatt 919-684-5301 dukebrain1@dm.duke.edu

Locations
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United States, North Carolina
Duke University Medical Center Recruiting
Durham, North Carolina, United States, 27710
Contact: Daniel Landi, MD    919-684-5301    dukebrain1@dm.duke.edu   
Contact: Stevie Threatt    919-684-5301    dukebrain1@dm.duke.edu   
Sponsors and Collaborators
Darell Bigner
Rockefeller University
Investigators
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Principal Investigator: Daniel Landi, MD Duke University
Additional Information:
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Responsible Party: Darell Bigner, Sponsor-Investigator, Duke University
ClinicalTrials.gov Identifier: NCT04547777    
Other Study ID Numbers: Pro00104852
First Posted: September 14, 2020    Key Record Dates
Last Update Posted: July 20, 2021
Last Verified: July 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Darell Bigner, Duke University:
D2C7
D2C7-IT
Glioblastoma
Glioma
2141-V11
Pro00104852
Duke
Rockefeller
CD40
epidermal growth factor receptor (EGFR)
EGFR
Landi
Additional relevant MeSH terms:
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Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue