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A Study Comparing the Efficacy of L19TNF+Doxorubicin vs Doxorubicin Alone as First-line Therapy in Patients With Advanced or Metastatic Soft Tissue Sarcoma (FIBROSARC)

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ClinicalTrials.gov Identifier: NCT04650984
Recruitment Status : Recruiting
First Posted : December 3, 2020
Last Update Posted : December 3, 2020
Sponsor:
Information provided by (Responsible Party):
Philogen S.p.A.

Brief Summary:

The present study is an open-label, randomized, controlled, two-arm multi-center study of the efficacy of L19TNF treatment in combination with doxorubicin versus doxorubicin alone in advanced or metastatic soft-tissue sarcoma patients.

In the study, 102 patients will be randomized in a 1:1 ratio to receive doxorubicin treatment (Arm 1) or L19TNF treatment in combination with doxorubicin (Arm 2).

The primary objective of the trial is to evaluate if L19TNF in combination with doxorubicin (Arm 2) given for unresectable or metastatic soft tissue sarcoma improves efficacy measured as progression free survival, as compared to doxorubicin alone (Arm 1).


Condition or disease Intervention/treatment Phase
Soft Tissue Sarcoma Drug: Onfekafusp alfa Drug: Doxorubicin Phase 3

Detailed Description:

Phase III, open label, randomized, controlled study in subjects with advanced or metastatic soft tissue sarcoma. In the study, 102 patients will be enrolled and parallel assigned in a 1:1 fashion to one of two different arms, as follows:

  • ARM 1: Patients will receive 75 mg/m2 doxorubicin once every 3 weeks (reference treatment).
  • ARM 2: Patients will receive 13 µg/kg L19TNF on days 1, 3 and 5 every 3 weeks in combination with 60 mg/m2 doxorubicin (once every 3 weeks).

Anti-cancer activity will be assessed every 6 weeks during therapy and every 12 weeks thereafter. Median PFS, PFS rates at 3, 6, 9, 12 and 18 months, mOS, OS rate at 12 and 18 months and ORR will be calculated.

Safety assessment will be performed on an ongoing basis during study participation, including standard laboratory assessments. The incidence of AEs will be summarized by severity in all patients with at least one study drug intake.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 102 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III Study Comparing the Efficacy of the Combination of Doxorubicin and the Tumor-targeting Human Antibody-cytokine Fusion Protein L19TNF to Doxorubicin Alone as First-line Therapy in Patients With Advanced or Metastatic Soft Tissue Sarcoma
Actual Study Start Date : November 29, 2017
Estimated Primary Completion Date : December 31, 2023
Estimated Study Completion Date : December 31, 2024


Arm Intervention/treatment
Active Comparator: Arm 1
Patients will receive 75 mg/m2 doxorubicin once every 3 weeks (reference treatment).
Drug: Doxorubicin
Patients will receive a fixed dose doxorubicin, administered as a 15 ± 5 minutes i.v. infusion.

Experimental: Arm 2
Patients will receive 13 µg/kg L19TNF on days 1, 3 and 5 every 3 weeks in combination with 60 mg/m2 doxorubicin (once every 3 weeks).
Drug: Onfekafusp alfa
Patients will receive a fixed dose of L19TNF in combination with a fixed dose of doxorubicin.
Other Name: L19TNF

Drug: Doxorubicin
Patients will receive a fixed dose doxorubicin, administered as a 15 ± 5 minutes i.v. infusion.




Primary Outcome Measures :
  1. Median Progression free survival (mPFS) [ Time Frame: From randomization up to week 72 ]
    Progression-free survival PFS in a time-to-event analysis in the L19TNF plus Doxorubicin control group (Arm 2) versus the Doxorubicin alone treatment group (Arm 1).


Secondary Outcome Measures :
  1. PFS rate [ Time Frame: At 3, 6, 9, 12, 18 months after randomization ]
    Progression Free Survival

  2. Overall Response Rate (ORR) [ Time Frame: At 3, 6, 9, 12, 18 months after randomization ]
    Rate of Complete Response and Partial Response of L19TNF plus Doxorubicin treatment group (Arm 2) versus Doxorubicin alone (Arm 1).

  3. Overall survival (OS) [ Time Frame: At 12 months and 18 months after randomization ]
    OS in the L19TNF plus Doxorubicin treatment group (Arm 2) versus Doxorubicin alone (Arm 1)

  4. Median Overall survival (mOS) [ Time Frame: At 12 months and 18 months after randomization ]
    mOS in the L19TNF plus Doxorubicin treatment group (Arm 2) versus Doxorubicin alone (Arm 1).

  5. Adverse Events [ Time Frame: From week 1 up to week 72 ]
    Number of patients with adverse events (AEs) assessed on CTCAE v.4.03

  6. HAFA assessment [ Time Frame: At day 1 of week 1 and week 2; at day 1 from week 4 up to week 18, every 3 weeks; at week 22-23 (EoT); at week 23-24 (first follow-up visit) ]
    Assessment of the formation of human anti-fusion protein antibodies (HAFA) against L19TNF (Arm 2).



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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients aged 18-75 years.
  2. Patients must have histological evidence of advanced unresectable and/or metastatic high-grade soft tissue sarcoma (grade 2 - 3 according to the FNLCC grading system) not amenable to curative treatment with surgery or radiotherapy. The following tumor types are included:

    • Malignant fibrous histiocytoma
    • Myxoid and round cell liposarcoma, pleomorphic liposarcoma or dedifferentiated
    • Liposarcoma
    • Pleomorphic rhabdomyosarcoma
    • Myxofibrosarcoma intermediate and high-grade
    • Fibrosarcoma
    • Leiomyosarcoma
    • Angiosarcoma
    • Alveolar rhabdomyosarcoma
    • Unclassified sarcoma NOS

    The following tumor types will not be included:

    • GIST
    • Mixed mesodermal tumor
    • Chondrosarcoma
    • Synovial sarcoma
    • Malignant peripheral nerve sheath tumor
    • Epithelioid sarcoma
    • Embryonal rhabdomyosarcoma
    • Malignant mesothelioma
    • Neuroblastoma
    • Osteosarcoma
    • Ewing's sarcoma / primitive neuroectodermal tumor
    • Desmoplastic small round cell tumor
    • Alveolar soft part sarcoma
  3. Patients must have at least one unidimensionally measurable lesion by computed tomography as defined by RECIST criteria 1.1. This lesion should not have been irradiated during previous treatments.
  4. Life expectancy of at least 3 months.
  5. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2.
  6. Documented negative test for HIV-HBV-HCV. For HBV serology: the determination of HBsAg, anti-HBsAg-Ab and anti-HBCAg-Ab is required. In patients with serology documenting previous exposure to HBV (i.e., anti-HBs Ab with no history of vaccination and/or anti-HBc Ab), negative serum HBV-DNA is required. For HCV: HCV-RNA or HCV antibody test. Subjects with a positive test for HCV antibody but no detection of HCV-RNA indicating no current infection are eligible.
  7. Negative serum pregnancy test for females of childbearing potential* within 14 days of starting treatment.
  8. Informed consent signed and dated to participate in the study.
  9. Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures.

Exclusion Criteria:

  1. Prior therapy (except surgery and radiation) for unresectable or metastatic malignant soft tissue sarcoma.
  2. Previous treatment with anthracycline-containing chemotherapy.
  3. Radiotherapy within 4 weeks prior to therapy.
  4. Known history of allergy to TNFα, anthracyclines or other intravenously administered human proteins/peptides/antibodies.
  5. Absolute neutrophil count (ANC) < 1.5 x 109/L, platelets < 100 x 109/L and haemoglobin (Hb) < 9.0 g/dl.
  6. Chronically impaired renal function or creatinine ≥ 2.0 x ULN.
  7. Inadequate liver function (ALT, AST, ALP or total bilirubin ≥ 2.5 x ULN.
  8. Any severe concomitant condition which makes it undesirable for the patient to participate in the study or which could jeopardize compliance with the protocol.
  9. History within the last year of acute or subacute coronary syndromes including myocardial infarction, unstable or severe stable angina pectoris.
  10. Heart insufficiency (> Grade II, New York Heart Association (NYHA) criteria).
  11. Clinically significant cardiac arrhythmias or requiring permanent medication.
  12. Uncontrolled hypertension, despite optimal therapy.
  13. Ischemic peripheral vascular disease (Grade IIb-IV according to Leriche-Fontaine classification).
  14. Severe diabetic retinopathy such as severe non-proliferative retinopathy and proliferative retinopathy.
  15. Major trauma including major surgery (such as abdominal/cardiac/thoracic surgery) within 4 weeks of administration of study treatment.
  16. Pregnancy or breast-feeding.
  17. Requirement of chronic administration of corticosteroids or other immunosuppressant drugs. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criterion.
  18. Presence of active and uncontrolled infections or other severe concurrent disease, which, in the opinion of the investigator, would place the patient at undue risk or interfere with the study.
  19. Known active or latent tuberculosis (TB).
  20. Concurrent malignancies other than Soft Tissue Sarcoma, unless the patient has been disease-free for at least 2 years.
  21. Growth factors or immunomodulatory agents within 7 days prior to the administration of study treatment.
  22. Serious, non-healing wound, ulcer or bone fracture.
  23. Allergy to study medication or excipients in study medication.
  24. Concurrent therapy with anticoagulants.
  25. Concurrent use of other anti-cancer treatments or agents other than study medication.

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): NCT04650984


Contacts
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Contact: Teresa Hemmerle, PhD +39 0577 17816 regulatory@philogen.com
Contact: Serena Bettarini, Pharmacist regulatory@philogen.com

Locations
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Germany
Helios Klinikum Bad Saarow Recruiting
Bad Saarow, Germany, 15526
Contact: Daniel Pink, Dr         
Universitaetsklinikum Muenster Recruiting
Münster, Germany, 48149
Contact: Christoph Schliemann, Prof. MD         
Sponsors and Collaborators
Philogen S.p.A.
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Responsible Party: Philogen S.p.A.
ClinicalTrials.gov Identifier: NCT04650984    
Other Study ID Numbers: PH-L19TNFDOX2-03/16
First Posted: December 3, 2020    Key Record Dates
Last Update Posted: December 3, 2020
Last Verified: November 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Sarcoma
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Doxorubicin
Antibiotics, Antineoplastic
Antineoplastic Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action