ProAgio in Previously Treated Advanced Pancreatic Cancer and Other Solid Tumor Malignancies

A Phase I Trial of ProAgio, an Anti- αvβ3 Integrin Cytotoxin, for Previously Treated Advanced Pancreatic Cancer and Other Solid Tumor Malignancies

The study is a first-in-human, Phase I study to assess the safety of ProAgio in participants with advanced solid tumor malignancies including pancreatic cancer.

Study Overview

• Status: Completed
• Conditions: Advanced Pancreatic Cancer; Solid Tumor Malignancies
• Intervention / Treatment: Drug: ProAgio Dose Levels (DL) 1,2,3; Drug: ProAgio Dose Levels (DL) 4,5,6; Drug: ProAgio Dose Levels 4a,5a,6a

Detailed Description

Pancreatic cancer is the third leading cause of death from cancer in the United States. The median overall survival for patients with metastatic disease who are receiving the most effective combination of chemotherapy regimens remains less than 1 year.

ProAgio has been evaluated in nonclinical pharmacology, safety pharmacology, pharmacokinetic (PK), and toxicity studies. It has demonstrated efficacy at treating pancreatic cancer and prolonging survival in mice.

ProAgio is being developed for intravenous (IV) administration. All participants will receive ProAgio until disease progression, unacceptable toxicity, or withdrawal from study. Subjects in the dose escalation cohorts who will be administered ProAgio at doses ranging from 3.2 to 36.8 mg/kg.

Following the dose escalation phase, an expansion cohort of patients with advanced nonendocrine pancreatic adenocarcinoma will be administered ProAgio at the maximum tolerated dose (MTD) from the dose escalation phase. Patients will also be offered optional co-administration of gemcitabine (Gem). The expansion cohort will contain two arms: A) Biopsy Arm (8 participants), and B) Standard Arm (8 participants). Tumor biopsies performed pre- and post- (on Cycle 2 Day 2-3) ProAgio treatment are optional for participants enrolled in the Standard Arm, but mandatory for participants enrolled in the Biopsy Arm.

• Study Type: Interventional
• Enrollment (Actual): 46
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Bethesda, Maryland, United States, 20892
      • National Cancer Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

For the Escalation Cohort:

• Histologic or cytologic diagnosis of a solid tumor malignancy for which no curative therapy exists.
• Individuals must have evaluable disease, either by clinical exam, biochemical markers (including but not limited to CA 19-9 serum tumor marker for pancreatobiliary cancer, or other appropriate tumor marker in other tumor types), and/or radiographic studies.
• Individuals must have received at least one prior systemic treatment for advanced disease.
• For the Expansion Cohort:
• Histologic or cytologic diagnosis of non-neuroendocrine pancreatic cancer. Individuals with mixed acinar-neuroendocrine histology are eligible.
• All Participants must have measurable disease, per RECIST 1.1.

• All individuals must have advanced or recurrent disease and have received at least one prior systemic treatment. Specifically:

  • Individuals with metastatic, locally advanced/unresectable, or borderline resectable pancreatic cancer at diagnosis, must have received at least one prior systemic treatment and still be considered ineligible for potentially curative resection.
  • Individuals who have undergone surgical resection and have tumor recurrence that is not amenable to local therapy, are eligible if:
• Tumor recurs within six months of the completion of adjuvant therapy, OR
• Further standard of care therapy is not a viable option due to prior resistance or intolerance, or a medical contraindication to both FOLFIRINOX (or NALIRIFOX) and gemcitabine-based chemotherapy
• Individuals in the Biopsy Arm of the expansion cohort must have disease amenable to safe biopsy and willingness to undergo the procedure.
• All individuals must be more than 14 days removed from most recent standard of care or experimental drug treatment for their tumor.
• Age ≥18 years. Because no dosing or adverse event data are currently available on the use of ProAgio in individuals <18 years of age, children are excluded from this study.
• ECOG performance status ≤ 2 (Karnofsky ≥>60%).
• Individuals must have adequate organ and marrow function as defined below:
• Aabsolute neutrophil count (ANC) ≥1,000/mcL
• hemoglobinHemoglobin (hgb) ≥9 g/ dL
• plateletsPlatelets ≥75,000/mcL
• Aspartate aminotransferase (AST)/ alanine transaminase (ALT) ( ≤ 2.5 x institutional upper limit of normal (ULN). AST and ALT (up to 5x ULN) is permitted for participants individuals with liver metastases)
• Total bilirubin ≤1.5 X institutional ULN
• Creatinine within normal institutional limits OR
• creatinine clearance ≥60 mL/min/1.73 m2 for participants with creatinine levels above institutional normal
• Serum albumin >2.5 mg/dL without intravenous supplementation
• Individuals must also have:
• Baseline QTcF interval of ≤ 470 ms
• Baseline resting heart rate > 45 beats per minute and <100 beats per minute
• Individuals of child-bearing potential (IOCBP) and individuals able to father a child men must agree to use an effective method of contraception as follows:
• IOCBP must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence) prior to study entry, for the duration of study participation, and for at least 6 months after the last dose of study drug(s).
• Individuals able to father a child must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence) for the duration of the study treatment and up to 6 months after the last dose of the study drug(s). We also will recommend individuals able to father a child with IOCBP partners to ask them to be on an effective birth control (hormonal, intrauterine device [(IUD)], surgical sterilization.
• Ability of individual to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

• Diagnosis of primary malignant CNS tumor.
• Individuals who are receiving any other investigational agents.
• Evidence of significant, uncontrolled concomitant diseases which could affect compliance with the protocol or interpretation of results, including but not limited to significant pulmonary disease other than that related to the primary cancer, uncontrolled diabetes mellitus, unstable angina, significant cardiovascular disease (such as New York Heart Association Class III or IV cardiac disease) and/or psychiatric illness/social situations within 12 weeks that would limit compliance with study requirements.
• Individuals with known diagnosis of a chronic neurologic disorders (such as multiple sclerosis, Huntington's disease, Parkinson's disease, or uncontrolled epilepsy) which causes motor disturbance, visual disturbance or seizure and could confound assessment of neurologic toxicity caused by the study drug.
• Pregnant or nursing individuals are excluded from this study because ProAgio is an agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with ProAgio, breastfeeding should be discontinued if the mother is treated with ProAgio.
• Individuals with leptomeningeal disease or with CNS metastases that are untreated, have required steroid treatment within the last 4 weeks, or anti-convulsant therapy in the last 14 days. For dose escalation cohort only: Individuals with any known CNS metastases are excluded. Those with symptoms suggestive of possible CNS metastases (such as new headaches) must undergo brain MRI as part of screening.
• Individuals who have undergone a recent minor surgical procedure (within <14 days) such as biliary stenting or major surgical procedure (within ≥ 28 days).
• Individuals who have undergone recent (within ≤ 14 days) external beam radiation therapy are excluded. Individuals who have undergone recent (within ≤ 28 days) treatment with radioactive therapeutics (such as Y90 or radio-immune conjugates) are ineligible.
• Individuals with uncontrolled bleeding episodes <28 days prior to enrollment are excluded.
• Individuals with active or uncontrolled infections are excluded.
• Individuals with HIV and detectable viral load are excluded. Patents on appropriate highly active anti-retroviral therapy with undetectable viral load are eligible.
• Individuals with a history of Hepatitis B or C are excluded unless there is documented evidence of effective treatment and/or cure with undetectable viral load.
• Individuals with recent (within < 28 days) thromboembolic disease including but not limited to acute coronary syndrome, stroke, or transient ischemic attack, recent deep vein thrombosis or pulmonary embolism.
• Individuals with thromboembolic disease including but not limited to acute coronary syndrome, stroke, or transient ischemic attack, recent deep vein thrombosis or pulmonary embolism who have continued symptoms, or who are not on stable doses of appropriate antiplatelet / anticoagulant regimens are excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dose Escalation; Participants will receive ProAgio in escalating doses.	Drug: ProAgio Dose Levels (DL) 1,2,3; ProAgio is administered to study participants by intravenous injections once every 14 days.; Other Names: ACT50; Drug: ProAgio Dose Levels (DL) 4,5,6; ProAgio is administered to study participants by intravenous injections once every 7 days.; Other Names: ACT50; Drug: ProAgio Dose Levels 4a,5a,6a; ProAgio is administered to study participants by intravenous injections once every 7 days with a drug holiday after every 5 administrations. Optional co-administration of gemcitabine (Gem) during dose expansion beginning with Cycle 2.; Other Names: ACT50; Gemcitibine
Experimental: Expansion Biopsy Arm; Pre- and post-treatment tumor biopsy is optional for participants enrolled in the standard arm, but mandatory for participants enrolled in the biopsy arm.	Drug: ProAgio Dose Levels 4a,5a,6a; ProAgio is administered to study participants by intravenous injections once every 7 days with a drug holiday after every 5 administrations. Optional co-administration of gemcitabine (Gem) during dose expansion beginning with Cycle 2.; Other Names: ACT50; Gemcitibine
Experimental: Standard Arm; Participants will receive ProAgio at the RP2D and may elect to receive concurrent gemcitabine beginning with the start of Cycle 2.	Drug: ProAgio Dose Levels (DL) 4,5,6; ProAgio is administered to study participants by intravenous injections once every 7 days.; Other Names: ACT50; Drug: ProAgio Dose Levels 4a,5a,6a; ProAgio is administered to study participants by intravenous injections once every 7 days with a drug holiday after every 5 administrations. Optional co-administration of gemcitabine (Gem) during dose expansion beginning with Cycle 2.; Other Names: ACT50; Gemcitibine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine Recommended Phase 2 Dose (RP2D)	Following completion of the dose escalation cohort, all available data relating to the pharmacokinetics, pharmacodynamics, efficacy and safety of ProAgio will be reviewed by the study team including the Principle Investigator, clinical pharmacology collaborators and the sponsor. A single ideal dose will then be selected for further investigation in the dose escalation cohort. This ideal dose may or may not be the same as the MTD.	3 Years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety and Tolerability of ProAgio	Toxicities will be tabulated and reported per dose level according to grade and type of toxicity experienced. This will take place during the dose escalation phase as well as during the expansion phase.	3 Years
Evaluate the Maximum Plasma Concentration of ProAgio	ProAgio concentrations will be measured by a validated ELISA assay modified from the assay used in non-clinical studies. This PK data will be used to mathematically describe the kinetic disposition of ProAgio in humans following the current dosing schedule.	3 Years
Evaluate the area under the curve of ProAgio	Statistical analysis of study data will calculate the area under the plasma concentration curve for each study subject that received ProAgio.	3 Years
Evaluate the Serum half-life of ProAgio	ProAgio Serum half-life will be determined using standard statistical calculations. .	3 Years
Evaluate the volume of distribution of ProAgio	If there are sufficient participant data available, a population PK analyses will be conducted to identify covariates that may be significantly associated with the inter-individual variability for a particular PK parameter (e.g. clearance of volume of distribution).The NCI CPP may also conduct dose-response and/or exposure-response analyses that will assess PK/PD relationships with relevant biomarkers, clinical response, and adverse event data.	3 Years
Rate of study drug elimination in research participants	58 study participants will have study drug concentration levels analyzed with regard to drug elimination. Results will be expressed in units of inverse time, i.e. 1/hr or 1/day.	3 Years
Objective Response Rate (ORR)	Make a preliminary assessment of anti-tumor activity by measuring objective response rate (ORR),	3 Years
Disease control rate (DCR).	Make a preliminary assessment of anti-tumor activity by measuring disease control rate at 18 weeks (DCR).	At 18 Weeks
Assess serum tumor marker CA19-9 or appropriate tumor specific marker.	Make a preliminary assessment of anti-tumor activity by measuring change in relevant serum tumor marker CA19-9 appropriate tumor specific marker.	Day 1 of each treatment cycle and 30 days after the last dose of study therapy.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assess whether a host antibody response against ProAgio develops with repeated administration	Change in ADA titer, as measured between baseline and EOT	2 Years
Assess biologic effect of ProAgio on apoptosis of tumor cells in tumor tissue	Pre- to on-therapy tumor biopsy specimen assessment of changes in apoptosis of tumor cells	2 Years
Assess biologic effect of ProAgio on integrin αvβ3 expression in tumor tissue	Pre- to on-therapy tumor biopsy specimen assessment of changes in integrin αvβ3 expression (% of cells expressing both integrins)	2 Years
Assess biologic effect of ProAgio on tumor collagen density and architecture	Pre- to on-therapy tumor biopsy specimen assessment of changes in tumor collagen density and architecture (Sirius Red stain)	2 Years
Assess biologic effect of ProAgio on tumor vasculature	Pre- to on-therapy tumor biopsy specimen assessment of changes in tumor vasculature (% of CD31 positive cells)	2 Years
Assess biologic effect of ProAgio on CAF and CASCs populations	Pre- to on-therapy tumor biopsy specimen assessment of changes on CAF and CASCs populations (% of α-SMA positive cells)	2 Years
Assess biologic effect of ProAgio on changes on Localization / populations of tumor cells	Pre- to on-therapy tumor biopsy specimen assessment of changes on Localization / populations of tumor cells as measured by Digital spatial profiling (DSP)	2 Years
Identify surrogate circulating biomarkers of ProAgio bioactivity in serum PKM2 concentrations	Pre- to on-therapy change in serum PKM2 concentration	2 Years
Identify surrogate circulating biomarkers of ProAgio bioactivity in CECs quantities	Pre- to on-therapy change in CECs quantities	2 Years
Identify surrogate circulating biomarkers of ProAgio bioactivity on circulating fibroblasts quantities	Pre- to on-therapy change on circulating fibroblasts quantities	2 Years
Identify surrogate circulating biomarkers of ProAgio bioactivity in Circulating αvβ3 expressing cells	Pre- to on-therapy change in Circulating αvβ3 expressing cells (all cells and CTCs)	2 Years
Assess the safety of co-administering ProAgio with gemcitabine (Gem)	For cycles where participants receive both ProAgio and Gem, tabulated list of: Grade ≥ 3 and higher adverse events (AEs); All AEs attributable to research; Whether or not stopping rules for optional addition of Gem are met	2 Years
Evaluate maximum plasma concentration (Cmax) of ProAgio when given in combination with Gem	For cycles where participants receive both ProAgio and Gem determine maximum plasma concentration (Cmax)	2 Years
Evaluate serum half-life of ProAgio when given in combination with Gem	For cycles where participants receive both ProAgio and Gem estimate serum half-life	2 Years

Collaborators and Investigators

• Sponsor: ProDa BioTech, LLC
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Anish Thomas, MBBS, MD, National Cancer Institute (NCI)

Study record dates

Study Major Dates

• Study Start (Actual): October 29, 2021
• Primary Completion (Actual): April 24, 2025
• Study Completion (Actual): April 10, 2026

Study Registration Dates

• First Submitted: September 10, 2021
• First Submitted That Met QC Criteria: October 18, 2021
• First Posted (Actual): October 20, 2021

Study Record Updates

• Last Update Posted (Actual): April 27, 2026
• Last Update Submitted That Met QC Criteria: April 23, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Endocrine System Diseases; Neoplasms by Site; Digestive System Neoplasms; Digestive System Diseases; Endocrine Gland Neoplasms; Pancreatic Diseases; Neoplasms; Pancreatic Neoplasms
• Other Study ID Numbers: 000194; 2R42CA217482-02 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No