TTAC-0001 and Pembrolizumab Phase Ib Combination Trial in Metastatic Triple-negative Breast Cancer

A Phase 1b, Open-Label, Safety and Tolerability Study of TTAC-0001 in Combination With Pembrolizumab in Patients With Metastatic Triple-Negative Breast Cancer

This is a phase 1b, open-Label clinical trial to determine the safety and tolerability and to establish a preliminary recommended Phase 2 dose (RP2D) of TTAC-0001 administered in combination with pembrolizumab in patients with metastatic triple-negative breast cancer.

Study Overview

• Status: Active, not recruiting
• Conditions: Triple Negative Breast Cancer
• Intervention / Treatment: Drug: TTAC-0001 and pembrolizumab combination

• Study Type: Interventional
• Enrollment (Actual): 11
• Phase: Phase 1

Contacts and Locations

Study Locations

• Australia
  • New South Wales
    • Liverpool, New South Wales, Australia, 2170
      • Liverpool Hospital
  • Western Australia
    • Nedlands, Western Australia, Australia, 6009
      • Hollywood Private Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Female and male patients ≥18 years old
2. Histologically proven metastatic breast carcinoma with triple negative receptor status (Estrogen receptor, Progesterone receptor and human epidermal growth factor receptor 2 [HER2] negative) by IHC and Fluorescence in situ hybridization (FISH) according to ASCO-CAP guideline3.
3. At least one confirmed measurable lesion by RECIST 1.1 criteria
4. Eastern Cooperative Oncology Group (ECOG) performance status 0-1
5. A person who satisfies the following criteria in hematologic, renal, and hepatic function tests performed within 7 days prior to screening:

(1) Hematologic tests

• Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
• Platelets ≥ 100 x 109/L
• Haemoglobin ≥ 9.0 g/dL (2) Blood coagulation tests
• Prothrombin time (PT) ≤ 1.5 x Upper limit of normal (UNL)
• Activated partial thromboplastin Time (aPTT) ≤ 1.5 x UNL (3) Hepatic function tests
• Total bilirubin ≤ 1.5 x UNL
• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤ 2.5 x ULN (≤ 5 x ULN in case of liver metastasis) (4) Renal function test
• ≤1.5 × ULN or creatinine clearance (CrCl) ≥30 mL/min for patient with creatinine levels >1.5 × institutional ULN 6) At least 12 weeks of expected life expectancy 7) The patient (or legally acceptable representative if applicable) is able and willing to provide written informed consent for the trial.

Exclusion Criteria:

1. Has a known additional malignancy that is progressing or has required active treatment within the past 2 years. (Note: Patients with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (e.g., breast carcinoma, cervical cancer in situ) controlled by curative therapy are not excluded)
2. Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases may participate provided they are radiologically stable, i.e., without evidence of progression for at least 4 weeks by repeat imaging (note that the repeat imaging should be performed during study screening), clinically stable and without requirement of steroid treatment for at least 14 days prior to first dose of study treatment
3. Has a history of (non-infectious) pneumonitis/interstitial lung diseases that required steroids or current pneumonitis/interstitial lung disease.
4. Has an active infection requiring systemic therapy
5. Uncontrolled hypertension (systolic blood pressure [SBP]> 150 or diastolic blood pressure [DBP]> 90 mmHg)
6. Uncontrolled seizures
7. Class III or IV heart failure by New York Heart Association (NYHA) classification
8. Has oxygen-dependent chronic disease
9. Active psychiatric disorder (schizophrenia, major depressive disorder, bipolar disorder etc.). Treated depression with ongoing antidepressant medication is not an exclusion
10. History of abdominal fistula or gastrointestinal perforation within 6 months prior to start of study drug
11. History of serious gastrointestinal haemorrhage within 6 months prior to start of study drug
12. History of severe arterial thromboembolic event within 12 months of start of study drug
13. Serious grade 4 venous thromboembolic event including pulmonary embolism
14. History of hypertensive crisis or hypertensive encephalopathy
15. History of posterior reversible encephalopathy syndrome
16. Planned surgery within 4 weeks post last dose
17. Moderate to severe proteinuria
18. Requiring therapeutic anticoagulation with warfarin at baseline
19. Not recovered below National Cancer Institute -Common Terminology Criteria for Adverse Events (NCI-CTCAE) grade 1 or baseline from AEs due to previous therapy
20. Treatment with systemic chemotherapy, hormonal therapy, immunotherapy or biologic therapy within 2 weeks prior to the baseline visit
21. Has received prior radiotherapy within 2 weeks of start of study treatment.
22. Undergone major surgery requiring general anaesthesia or a respiratory assistance device within 4 weeks prior to the baseline visit
23. Treated with other investigational drugs within 4 weeks prior to the baseline visit for this study
24. Female who is pregnant* or lactating and of childbearing potential who does not agree to a reliable and adequate method of contraception
25. A known history of severe drug hypersensitivity or hypersensitivity to a therapy similar to the study drugs
26. Unable to participate in the trial according to the investigator's decision.
27. Previous therapy with vascular endothelial growth factor (VEGF)-targeted agents including (but not limited to) bevacizumab
28. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (e.g., CTLA-4, OX 40, CD137) and was discontinued from that treatment due to a Grade 3 or higher irAE

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: TTAC-0001 and pembrolizumab; TTAC-0001 and pembrolizumab combination therapy will be administered.

Drug: TTAC-0001 and pembrolizumab combination; Investigational product (IP): TTAC-0001 and Pembrolizumab (Merck, Keytruda®); Treatment groups: 3 dose levelsDose level 1 (optimal starting dose): TTAC-0001 12 mg/kg on D1, D8 and D15 + Pembrolizumab 200 mg on D1Dose level 2 (first escalation dose): TTAC-0001 16 mg/kg on D1, D8 and D15 + Pembrolizumab 200 mg on D1Dose level 0 (de-escalation dose): TTAC-0001 8 mg/kg on D1, D8 and D15 + Pembrolizumab 200 mg on D1; Cycle: 3 weeks (21 days per cycle)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dose limiting toxicities	The frequency and percentage of DLT will be presented by dose level	During the first cycle (every cycle is 21 days) of treatment
Adverse events	The frequency and percentage of AEs will be presented by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Immunogenicity	Presence anti-drug antibody (ADA) will be listed	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall response rate	complete response (CR) or partial response (PR) by RECIST criteria	At every 2nd cycles until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years (every cycle is 21 days)]
Disease control rate	complete response (CR), partial response (PR) or stable disease (SD) by RECIST criteria	At every 2nd cycles until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years (every cycle is 21 days)
Progression free survival	Period from the date of the drug administration to the disease progression time point	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Overall survival	Period from the date of the drug administration to the patient's death	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pharmacokinetic parameters - Cmax	Maximum concentration of drug by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - Cmin	Minimum concentration of drug by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - AUC0-t	Area under the curve from baseline to each timepoint by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - Tmax	Time of Cmax by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - CL	Clearance by dose level	FFrom date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - Vd	Volume of distribution by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - Ke	Elimination rate constant by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Pharmacokinetic parameters - T½	Half-life by dose level	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
Change in concentration of serum angiogenic factor or receptor	VEGF, placental growth factor [PLGF], soluble vascular endothelial growth factor receptor [sVEGFR]-2, sVEGFR-1, etc.	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years
PD-L1, VEGFR-2 expression level	PD-L1, VEGFR-2 expression level in tumour environment such as tumour, tumour vessel and parenchymal tissue	From date of screening visit until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years

Collaborators and Investigators

• Sponsor: PharmAbcine

Study record dates

Study Major Dates

• Study Start (Actual): January 3, 2019
• Primary Completion (Actual): March 18, 2020
• Study Completion (Anticipated): October 26, 2022

Study Registration Dates

• First Submitted: October 22, 2018
• First Submitted That Met QC Criteria: October 24, 2018
• First Posted (Actual): October 25, 2018

Study Record Updates

• Last Update Posted (Actual): August 17, 2022
• Last Update Submitted That Met QC Criteria: August 15, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Triple Negative Breast Neoplasms; Antineoplastic Agents; Antineoplastic Agents, Immunological; Pembrolizumab
• Other Study ID Numbers: PMC_TTAC-0001_05

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No