Fc-Engineered Anti-CTLA-4 Monoclonal Antibody in Advanced 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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT03860272|
Recruitment Status : Recruiting
First Posted : March 1, 2019
Last Update Posted : April 28, 2023
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|Condition or disease||Intervention/treatment||Phase|
|Advanced Cancer Angiosarcoma Colorectal Cancer Without Liver Metastases Endometrial Cancer Fibrolamellar Carcinoma Melanoma Non-small-cell Lung Cancer Ovarian Cancer Prostate Cancer||Drug: Botensilimab Drug: Balstilimab||Phase 1|
This Phase 1 study will enroll up to approximately 450 evaluable adult participants with refractory cancer (solid tumors) regardless of diagnosis.
The study will consist of a 3+3 dose escalation. Different dose levels of botensilimab, both monotherapy and in combination with balstilimab, will be evaluated in individual cohorts based upon dose. Each participant will remain in the cohort of the dose level and schedule assigned at study entry. Participants can be replaced for any reason other than a dose-limiting toxicity (DLT). Participants will receive treatment for ≤ 2 years or until progressive disease, unacceptable toxicity, or any criterion for stopping the study drug or withdrawal of trial occurs.
Additionally, the study is intended to further explore the safety, PK, PD, and clinical activity in selected cancer types at dose levels (botensilimab monotherapy and combination therapy with balstilimab) determined as potentially effective. Indications of interest include, but are not limited to, non-small-cell lung cancer, melanoma, endometrial cancer, ovarian cancer, angiosarcoma, colorectal cancer without liver metastases, prostate cancer, and fibrolamellar carcinoma.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||450 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||Dose escalation|
|Masking:||None (Open Label)|
|Official Title:||A Phase 1 Study of AGEN1181, an Fc-Engineered Anti-CTLA-4 Monoclonal Antibody as Monotherapy and in Combination With AGEN2034 (Balstilimab), an Anti-PD-1 Monoclonal Antibody, in Subjects With Advanced Cancer|
|Actual Study Start Date :||April 1, 2019|
|Estimated Primary Completion Date :||December 2024|
|Estimated Study Completion Date :||December 2024|
Experimental: 3-Week Monotherapy
3+3 Dose escalation: botensilimab, every 3 weeks, starting at dose level 0.1 milligrams/kilogram (mg/kg) up to 4 mg/kg, administered intravenously (IV) for up to 2 years.
An Fc-engineered anti-CTLA-4 monoclonal antibody
Experimental: 6-Week Monotherapy
3+3 Dose escalation: botensilimab, every 6 weeks, starting at dose level 1 mg/kg up to 4 mg/kg, administered IV for up to 2 years.
An Fc-engineered anti-CTLA-4 monoclonal antibody
Experimental: 6-Week Combination Therapy
3+3 Dose escalation: balstilimab, every 2 weeks, at dose level 3 mg/kg in combination with botensilimab, every 6 weeks, starting at dose level 0.1 mg/kg up to 4 mg/kg, administered IV for up to 2 years. An additional cohort will investigate balstilimab, every 3 weeks, at 450 mg in combination with botensilimab every 6 weeks, at 150 mg, administered IV for up to 2 years.
An Fc-engineered anti-CTLA-4 monoclonal antibody
A fully human monoclonal anti-PD-1 antibody
- Incidence Of Treatment-emergent Adverse Events (TEAEs) [ Time Frame: First dose through 90 days following last study dose (up to 2 years) ]TEAEs will include adverse events of special interest, immune-related adverse events, and adverse drug reactions, according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 5.0.
- DLT Of Botensilimab [ Time Frame: First 28 days of treatment ]DLTs will include any Grade 2 or greater drug related toxicity for all dose groups, according to NCI CTCAE version 5.0 and protocol specifications.
- RP2D Of Botensilimab [ Time Frame: First dose through 90 days following last study dose ]MTD based on DLT occurrence at DLT period (28 days after first dose) and all TEAEs seen through 90 days following last study dose.
- Objective Response Rate (ORR) According To Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST 1.1) [ Time Frame: First dose through up to 2 years ]Confirmed ORR will be in the analysis population.
- ORR According to Prostate Cancer Working Group 3 (PCWG3) [ Time Frame: First dose through up to 2 years ]Confirmed ORR will be in the analysis population.
- Duration Of Response (DOR) According To RECIST 1.1 [ Time Frame: From first dose to first observation of documented disease progression (or death within 12 weeks of last tumor assessment) (up to 2 years) ]
- DOR According to PCWG3 [ Time Frame: From first dose to first observation of documented disease progression (or death within 12 weeks of last tumor assessment) (up to 2 years) ]
- Disease Control Rate (DCR) According To RECIST 1.1 [ Time Frame: First study dose through 24 weeks ]DCR will include complete response, partial response, and stable disease.
- DCR According to PCWG3 [ Time Frame: First study dose through 24 weeks ]DCR will include complete response, partial response, and stable disease.
- Progression-free Survival (PFS) According To RECIST 1.1 [ Time Frame: First study dose to first observation of documented disease progression (or death within 12 weeks of last tumor assessment) (up to 2 years) ]PFS time will be assessed.
- PFS According to PCWG3 [ Time Frame: First study dose to first observation of documented disease progression (or death within 12 weeks of last tumor assessment) (up to 2 years) ]PFS time will be assessed.
- Overall Survival Time [ Time Frame: First study dose through up to 3 years ]Duration of survival will be assessed.
- Maximum Drug Concentration At Steady-state (Cmax-ss) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Minimum Drug Concentration At Steady-state (Cmin-ss) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentration measured throughout the study
- Area Under The Drug Concentration-time Curve Within Time Span t1 To t2 At Steady-state (AUC(t1-t2)-ss) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Area Under The Drug Concentration-time Curve From Time Zero To Infinity [AUC(0-∞)] [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Terminal Elimination Rate Constant (λz) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Terminal Elimination Half-life (t1/2) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Systemic Clearance (CL) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Volume Of Distribution (Vd) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab concentrations measured throughout the study
- Anti-drug Antibodies (ADAs) [ Time Frame: First study dose (pre-dose) through 3 months following last study dose (up to 2 years) ]Serum botensilimab ADAs measured throughout the study
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|Ages Eligible for Study:||18 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
For inclusion in the trial, all of the following inclusion criteria must be fulfilled, as no waivers will be permitted:
- Provision of signed and dated written informed consent prior to any study specific procedures. Participation in pharmacogenomics testing is optional.
- Histologically or cytologically confirmed diagnosis of metastatic or locally advanced solid tumor for which no standard therapy is available or standard therapy has failed.
- Measurable disease on imaging based on RECIST 1.1, except for prostate cancer.
- Life expectancy of ≥ 3 months and Eastern Cooperative Oncology Group performance status of 0 or 1.
Adequate organ and bone marrow reserve function, as indicated by the following laboratory values:
- Adequate hematological function, defined as absolute neutrophil count ≥ 1.5 × 10^9/liter (L), platelet count ≥ 100 × 10^9/L, and hemoglobin ≥ 8 grams/deciliter without recent transfusion (defined as a transfusion that has occurred within 2 weeks of the hemoglobin measurement).
- Adequate liver function, defined as total bilirubin level ≤ 1.5 × institutional upper limit of normal (IULN) (except for participants with Gilbert syndrome who must have a total bilirubin level of ≤ 3.0 × IULN), aspartate aminotransferase ≤ 2.5 × IULN, and alanine aminotransferase ≤ 2.5 × IULN.
- Adequate renal function defined as creatinine ≤ 1.5 × IULN or measured or calculated creatinine clearance ≥ 40 milliliters (mL)/minute per institutional standard. Assessment methods should be recorded.
- Adequate coagulation, defined as international normalized ratio or prothrombin time ≤ 1.5 × IULN and activated partial thromboplastin time ≤ 1.5 × IULN (unless participant receiving anticoagulant therapy) or stable known coagulopathy with sponsor approval.
- No history of prior or concomitant malignancy that requires other active treatment.
- A sufficient and adequate formalin-fixed paraffin embedded tumor tissue sample (fresh or archival tumor tissue) collected since last treatment and before the first dose from a site not previously irradiated, if clinically feasible.
Female participants of childbearing potential must have a negative serum pregnancy test at screening (within 72 hours of first dose of study medication). Non-childbearing potential is defined as 1 of the following:
- ≥ 45 years of age and has not had menses for > 1 year.
- Amenorrheic for > 2 years without a hysterectomy and/or oophorectomy and follicle stimulating hormone value in the postmenopausal range upon pretrial (screening) evaluation.
- Status is post-hysterectomy, -oophorectomy, or -tubal ligation.
- Female participants of childbearing potential must be willing to use highly effective contraceptive measures starting with the Screening visit through 90 days after last dose of study treatment. Note: Abstinence is acceptable if this is the established and preferred contraception for the participant.
Male participants with a female partner(s) of childbearing potential must agree to use highly effective contraceptive measures throughout the trial starting with the Screening visit through 90 days after the last dose of study treatment is received. Males with pregnant partners must agree to use a condom; no additional method of contraception is required for the pregnant partner. Note: Abstinence is acceptable if this is the established and preferred contraception method for the participant.
The following inclusion criteria are in addition to the above criteria. If there are criteria below that differs from above, the below indication-specific criteria take precedence.
Additional Inclusion Criteria for Angiosarcoma Cohort
Histologically or cytologically confirmed diagnosis of metastatic or locally advanced angiosarcoma for which no standard therapy is available or standard therapy has failed.
Additional Inclusion Criteria for the Hepatocellular Cancer (HCC) Cohort
- Histologically or cytologically confirmed diagnosis or radiological diagnosis following the guidelines from the American Association for the Study of Liver Diseases of metastatic or locally advanced HCC.
- Must have progressed while receiving, or following, programmed death-ligand 1 (PD(L)-1)-based therapy.
- Child-Pugh score of A. Note: Participants on anticoagulant treatment would have an assigned value of 1 point when scoring prothrombin time/international normalized ratio so the overall Child-Pugh score is not adversely affected.
Adequate organ and bone marrow reserve function as indicated by the following laboratory values:
- Platelet count ≥ 60 × 10^6/cubic millimeter (mm^3) and absolute neutrophil count ≥ 1,000 × 10^6/L are acceptable provided that the investigator assesses these abnormalities as being due to liver disease.
- Adequate liver function, defined as aspartate aminotransferase and alanine aminotransferase ≤ 5 × IULN, bilirubin ≤ 2 × IULN.
Participants are eligible to enroll if they have non-viral-HCC or if they have hepatitis B (HBV), or hepatitis C virus (HCV) related HCC, defined as follows:
- Chronic HBV infection as evidenced by detectable HBV surface antigen or HBV DNA. Participants with chronic HBV infection must be on antiviral therapy and have HBV DNA < 500 international units/mL.
- Active or resolved HCV infection as evidenced by detectable HCV RNA or antibody.
Additional Inclusion Criteria for the Non-Small Cell Lung Cancer (NSCLC) Cohort
Histologically or cytologically confirmed diagnosis of metastatic or locally advanced NSCLC for which no standard therapy is available or standard therapy has failed:
- Adenocarcinoma or squamous cell carcinoma at the time of enrollment. If other histologies are also present, must be approved by the medical monitor prior to study entry.
- For participants without targetable alterations: Prior treatment with anti PD(L)-1-based therapy.
- Participants with targetable alterations (for example, estimated glomerular filtration rate, anaplastic lymphoma kinase, Kirsten rat sarcoma virus-single point mutation with a glycine-to-cysteine substitution at codon 12, reactive oxygen species, mesenchymal epithelial transition factor receptor, etc.): must have received or be intolerant of at least one approved targeted therapy.
Additional Inclusion Criteria for the Prostate Cancer Cohort
- Diagnosis of metastatic castrate resistant prostate cancer.
Must have demonstrated serologic or radiographic progression on or following the most recent therapy in the setting of castrate-level testosterone (< 50 nanograms per mL [ng/mL] and/or maintained on medical/surgical castration throughout) as defined by at least one of the following:
- Baseline PSA ≥ 2.0 ng/mL and 2 sequential rises in prostate-specific antigen (PSA) with each rising value being at least 1 week apart.
- Progression by RECIST 1.1.
- Progression by PCWG3 criteria for bone disease ("2+2" rule) with or without PSA progression.
Must maintain castration status defined as serum testosterone < 50 ng/mL. Must be either surgically castrate or on luteinizing hormone-releasing hormone analog for the duration of the study.
Additional Inclusion Criteria for Breast Cancer
- Must have received PD-(L)1 therapy if indicated. Note: Premenopausal participants may continue ongoing ovarian suppression on study. Permitted agents are goserelin, triptorelin or analogs.
For inclusion in the trial, participant must meet none of the following exclusion criteria, as no waivers will be permitted:
- Currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigation device within 3 weeks of first dose of current study drug.
- Received prior systemic cytotoxic chemotherapy, biological therapy, radiotherapy, or major surgery within 3 weeks prior to first dose of study drug; for tyrosine kinase inhibitor or similar within 4 × half-life prior to first dose of study drug. A 1-week washout is permitted for palliative radiation to non-central nervous system disease, with Sponsor approval.
- Participants who have received prior CTLA-4 therapy may be enrolled in selected indications upon agreement with the Sponsor.
- Persistent toxicity of NCI CTCAE version 5.0 Grade > 1 severity that is related to prior therapy. Note: Sensory neuropathy, hypothyroidism or alopecia of Grade ≤ 2 are acceptable. Other Grade 2 toxicities of prior treatments that are controlled with medication (for example, diabetes or hypertension) may be permitted with sponsor approval.
- Expected to require any other form of systemic or localized antineoplastic therapy while on trial (including maintenance therapy with another agent, radiation therapy, and/or surgical resection).
- Severe (Grade ≥ 3) hypersensitivity reaction to a fully human monoclonal antibodies
- Immune-related adverse event requiring treatment with systemic steroids for > 7 days excluding Grade 1 or 2 rash.
- Interstitial lung disease or lung disease which may interfere with the assessment of pneumonitis.
- Uncontrolled asthma (that is, ≥ 3 features of partly controlled asthma)
- Pneumonitis that has required oral or IV corticosteroids.
- Receiving systemic corticosteroid therapy 1 week prior to the first dose of study drug or receiving any other form of systemic immunosuppressive medication. Note: Corticosteroid use as a premedication for IV contrast allergies/reactions is allowed. Participants who are receiving daily corticosteroid replacement therapy are also an exception to this rule. Daily prednisone at doses of ≤ 7.5 mg or equivalent hydrocortisone dose are examples of permitted replacement therapy. Use of inhaled or topical corticosteroids is permitted.
- Brain metastases or leptomeningeal metastases with the following exceptions: Note: Brain metastases which have been treated with either surgical resection or stereotactic radio surgery. These participants must be off steroids ≥ 10 days prior to randomization for the purpose of managing their brain metastases. Repeat brain imaging following surgical resection or stereotactic radiosurgery is not required if their last brain magnetic resonance imaging is within screening window. Prior whole-brain radiation may be permitted only with sponsor approval. Note: Untreated isolated brain metastases that are too small for treatment by surgical resection or stereotactic radiosurgery (for example, 1-2 mm) and/or of uncertain etiology are potentially eligible but must be approved by the sponsor.
- Active or history of autoimmune disease that requires systemic treatment within 2 years of the start of study drug (that is, with use of disease-modifying agents, corticosteroids, or immunosuppressive drugs). Note: Participants with autoimmune conditions requiring hormone replacement therapy or topical treatments are eligible.
- Has had an allogeneic tissue/solid organ transplant, except for corneal transplants.
- Active infection requiring systemic treatment.
- Known history of human immunodeficiency virus type 1 or 2 antibodies.
- Known active infection with hepatitis B and/or hepatitis C virus.
- Clinically significant (that is, active) cardiovascular disease: cerebral vascular accident/stroke or myocardial infarction within 6 months of enrollment, unstable angina, congestive heart failure (New York Heart Association class ≥ II), or serious uncontrolled cardiac arrhythmia requiring medication.
- History or current evidence of any condition, therapy, any active infections, or laboratory abnormality that might confound the results of the trial, interfere with the participant's participation for the full duration of the trial, or is not in the best interest of the participant to participate, in the opinion of the treating Investigator.
- Known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the study.
- Legally incapacitated or has limited legal capacity.
- Pregnant or breastfeeding.
Concurrent malignancy requiring treatment or history of prior malignancy active within 2 years prior to the first dose of study treatment. Exceptions: participants with completely resected prior early-stage basal/squamous cell skin cancer or treated cervical carcinoma in situ.
The following exclusion criteria are in addition to the above criteria. If there are criteria below that differs from above, the below indication-specific criteria take precedence.
Additional Exclusion Criteria for the HCC Cohort
- Received locoregional therapy (for example, transcatheter chemoembolization, radiation, surgery) within 6 weeks or yttrium-90 within 12 weeks.
- Hepatic encephalopathy within the last 6 months requiring admission or initiation of or intensification of therapy. Participants taking rifaximin/lactulose as encephalopathy prophylaxis are allowed as long as they have not had clinically evident encephalopathy in the past 6 months.
- Gastro-esophageal varices bleeding in the last 6 months.
- Ascites requiring paracentesis within the last 3 months. Participants with previous ascites that is managed with stable doses of diuretics and have a Child Pugh score of A are allowed.
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): NCT03860272
|Contact: Agenus Inc. Clinical Trial Information||781-674-4265||clinicaltrialinfo@Agenusbio.com|
|United States, Arizona|
|HonorHealth Research Institute||Recruiting|
|Scottsdale, Arizona, United States, 85258|
|Contact: Clinical Trials Nurse Navigation 480-323-1364 firstname.lastname@example.org|
|Principal Investigator: Michael Gordon, MD|
|United States, California|
|City of Hope Comprehensive Cancer Center||Recruiting|
|Duarte, California, United States, 91010|
|Contact: Erin Morones email@example.com|
|Principal Investigator: Marwan G Fakih, MD|
|The Angeles Clinic & Research Institute, a Cedars-Sinai Affiliate||Recruiting|
|Los Angeles, California, United States, 90025|
|Contact: Teri Mata 310-231-2115 firstname.lastname@example.org|
|Principal Investigator: Ani Balmanoukian, MD|
|University of Southern California Norris Comprehensive Cancer Center||Recruiting|
|Los Angeles, California, United States, 90033|
|Contact: Igor Gorodniuk 323-409-4365 Igor.Gorodniuk@med.usc.edu|
|Principal Investigator: Anthony El-Khoueiry, MD|
|Saint John's Cancer Institute||Recruiting|
|Santa Monica, California, United States, 90404|
|Contact: Irving Ledesma 310-582-7047 email@example.com|
|Principal Investigator: Kim Margolin, MD|
|United States, Colorado|
|University of Colorado||Recruiting|
|Aurora, Colorado, United States, 80045|
|Contact: Meghan Ayers 720-848-5278 firstname.lastname@example.org|
|Principal Investigator: Breelyn Wilky, MD|
|United States, Florida|
|University of Miami Sylvester Comprehensive Cancer Center||Recruiting|
|Miami, Florida, United States, 33136|
|Contact: Marialby Donis Ramos 305-243-8237 email@example.com|
|Principal Investigator: Jonathan Trent, MD|
|United States, Massachusetts|
|Beth Israel Deaconess Medical Center||Recruiting|
|Boston, Massachusetts, United States, 02215|
|Contact: Alisa Posner 617-975-7433 firstname.lastname@example.org|
|Principal Investigator: Bruno Buckorny, MD|
|Dana-Farber Cancer Institute||Recruiting|
|Boston, Massachusetts, United States, 02215|
|Contact: Benjamin Schlechter, MD 617-632-3000 email@example.com|
|Principal Investigator: Benjamin Schlechter, MD|
|United States, New York|
|Columbia University Medical Center||Recruiting|
|New York, New York, United States, 10032|
|Contact: Ellen Alt 212-304-5545 firstname.lastname@example.org|
|Principal Investigator: Gary K Schwartz, MD|
|Memorial Sloan Kettering Cancer Center||Recruiting|
|New York, New York, United States, 10065|
|Contact: Amin Yaqubie 212-639-2000 email@example.com|
|Contact: Olivia Heffernan 212-639-2000 firstname.lastname@example.org|
|Principal Investigator: Ghassan Khaled Abou-Alfa, MD|
|United States, Ohio|
|Ohio State University||Withdrawn|
|Columbus, Ohio, United States, 43210|
|United States, Oregon|
|Providence Portland Cancer Center||Recruiting|
|Portland, Oregon, United States, 97213|
|Contact: Melissa Ngirailemesang, RN 503-215-2714 CanClinRsrchStudies@providence.org|
|Principal Investigator: Rachel E Sanborn, MD|
|United States, Texas|
|MD Anderson Cancer Center||Recruiting|
|Houston, Texas, United States, 77030|
|Contact: Becky Norris email@example.com|
|Principal Investigator: Apostolia Tsimberidou, MD, PhD|
|The University of Texas Health Science Center at San Antonio||Recruiting|
|San Antonio, Texas, United States, 78229|
|Contact: Hope Moreno, RN MorenoH@uthscsa.edu|
|Principal Investigator: Mahadevan Daruka, MD|
|Study Director:||Medical Director||Agenus Inc.|
|Responsible Party:||Agenus Inc.|
|Other Study ID Numbers:||
|First Posted:||March 1, 2019 Key Record Dates|
|Last Update Posted:||April 28, 2023|
|Last Verified:||April 2023|
|Individual Participant Data (IPD) Sharing Statement:|
|Plan to Share IPD:||No|
|Studies a U.S. FDA-regulated Drug Product:||Yes|
|Studies a U.S. FDA-regulated Device Product:||No|
Neoplasms by Site
Neoplasms by Histologic Type
Genital Diseases, Female
Female Urogenital Diseases
Female Urogenital Diseases and Pregnancy Complications
Genital Neoplasms, Female
Neoplasms, Connective and Soft Tissue
Neoplasms, Vascular Tissue