ALT-100 Monoclonal Antibody (mAb) in Bone-Predominant Metastatic Androgen Pathway Modulation Resistant (APMR) Prostate Cancer -- The ALTAR-100 Trial
Aqualung Therapeutics Corporation has developed ALT-100, a humanized murine monoclonal antibody (mAb) that specifically targets and neutralizes extracellular nicotinamide phosphoribosyltransferase (eNAMPT) and prevents activation of a dysregulated proinflammatory signaling cascade.
Pre-clinical and clinical information from acute respiratory distress syndrome and prostate cancer studies show a novel treatment option for the patients with androgen pathway modulator-resistant (APMR) prostate cancer and bone metastases. Secreted eNAMPT drives prostate cancer progression, and a humanized eNAMPT-neutralizing antibody prevented aggressive disease in preclinical models by Sun et al. The anti-fibrotic activity of the eNAMPT-neutralizing antibody acts on type I collagen turnover-the same biology as osteoblastic bone metastasis.
Bone-predominant androgen pathway modulator-resistant (APMR) prostate cancer is a common clinical problem. Treatment options are often limited after progression on ADT and androgen receptor pathway inhibitors. The bone microenvironment itself is still largely untargeted. No eNAMPT-directed therapy has been tested in any oncology population, and no trial has asked whether eNAMPT/toll-like receptor 4 (TLR4) blockade can modify the osseous tumor microenvironment in humans. This trial would test a first-in-class agent aimed at the bone microenvironment rather than at the tumor alone, in a setting where most available therapies offer short-lived benefit.
This study will evaluate the safety, tolerability and efficacy of the use of ALT-100 for treatment of bone-predominant metastatic androgen pathway modulation resistant prostate cancer. The recommended phase 2 dose of ALT-100 for treatment of bone-predominant metastatic androgen pathway modulation resistant prostate cancer will also be determined in the phase 1 portion of this study.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
- Fase 1
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Alexandra Leggett
- Telefonnummer: 352-273-9785
- E-mail: agmueller@ufl.edu
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
-
Male, age ≥ 18 years
-
Prostate cancer, histologically confirmed or presumed on the basis of clinical, biochemical, and/or radiographic findings.
-
Metastatic disease confined to bone and lymph nodes, with bone metastases predominant, documented on conventional imaging (CT/MRI and bone scan). Measurable soft tissue disease is not required.
-
Androgen pathway modulation-resistant (APMR) disease per Prostate Cancer Working Group 4 (PCWG4) with progression on at least one prior androgen receptor pathway inhibitor documented as any of the following:
- Serum PSA progression defined as 2 consecutive increases in PSA over a previous reference value measured at least 1 week prior. The minimal start value is 2.0 ng/mL,
- Soft tissue progression defined as an increase ≥20% in the sum of the diameter (SOD) (short axis for nodal lesions and long axis for non-nodal lesions) of all target lesions based on the smallest SOD since treatment started or the appearance of one or more new lesions or unequivocal progression of existing non-target lesions,
- For PSMA-PET: Two new PSMA-avid lesions, or
- Progression of bone disease defined by the appearance of ≥2 new bone lesions on bone scan per PCWG4 criteria
-
Ongoing androgen deprivation therapy (ADT) with a Gonadotropin-releasing hormone analogue, or prior bilateral orchiectomy, with serum testosterone <50 ng/dL
-
ECOG performance status 0-2
-
Life expectancy ≥6 months
-
Adequate organ and marrow function defined as:
- ANC ≥1,500/µL
- Platelets ≥100,00/µL
- Hemoglobin ≥9.0 g/dL without transfusion within 14 days
- Total bilirubin ≤1.5 x ULN (≤ 3 x ULN for Gilbert's)
- AST and ALT ≤3 x ULN
- Creatinine clearance ≥30 mL/min
-
Concurrent bone-modifying agent (including, but not limited to denosumab or bisphosphonates such as zoledronic acid or pamidronate), permitted but not required. If receiving one, it must have been at a stable dose and scheduled for ≥8 weeks before C1D1.
-
Written informed consent obtained from the subject and the subject agrees to comply with all the study-related procedures.
-
Subjects with partners of child-bearing potential must agree to use physician-approved contraceptive methods (e.g., abstinence, condoms, vasectomy) throughout the study and should avoid conceiving children for 6 months following the last dose of study drug.
Exclusion Criteria:
- Visceral metastases, including liver, lung, adrenal, brain or peritoneal disease. Lymph node involvement is permitted
- Known pure small cell or neuroendocrine prostate carcinoma
- Radium-223 within 6 months of C1D1
- External beam radiotherapy to a bone lesion within 4 weeks of C1D1 or radiotherapy planned during the DLT window of 30 days after first dose of ALT-100.
- Impending skeletal-related event requiring immediate radiotherapy or surgical intervention or untreated spinal cord compression
- Chemotherapy, investigational therapy, or any systemic anticancer therapy other than ADT within 4 weeks or 5 half-lives of C1D1, whichever is shorter
- Prior exposure to any extracellular nicotinamide phosphoribosyltransferase (eNAMPT)-directed or toll-like receptor 4 (TLR4)-directed therapeutic agent.
- Known hypersensitivity to a monoclonal antibody, or prior grade ≥3 infusion-related reaction to a biologic
- Active infection requiring systemic therapy at C1D1
- Known HIV infection, or known active hepatitis B or hepatitis C, that is uncontrolled or requires a change in therapy. Testing is not required at screening
- Cardiovascular or thromboembolic disease that, in the investigator's judgment, is uncontrolled or would place the patient at undue risk on study
- Chronic systemic immunosuppressive therapy at doses that in the investigator's judgement would place the patient at undue infection risk
- Active osteonecrosis of the jaw, or invasive dental procedure planned during the DLT window of 30 days after first dose of ALT-100
- Another malignancy requiring active treatment, except non-melanoma skin cancer or adequately treated in situ disease
- Any condition that in the investigator's judgement would compromise safety or protocol compliance
- Administration of a vaccine containing live virus within 30 days prior to the first dose of trial treatment. Note: Most flu vaccines are killed viruses, with the exception of the intra-nasal vainer (Flu-Mist) which is an attenuated live virus and therefore prohibited for 30 days prior to first dose.
- Prisoners or subjects who are involuntarily incarcerated, or subjects who are compulsorily detained for treatment of either a psychiatric or physical illness.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Sekventiel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Phase 1 - Dose level 1 - 1.0 mg/kg ALT-100
This is the starting dose for the phase 1 portion of the study. |
Participants will receive either 1.0 mg/kg or 4.0 mg/kg of ALT-100 intravenously once every 28 days for up to 6 treatment cycles while receiving standard of care androgen deprivation therapy. The assigned dose will determined by either a 3 + 3 design (for phase 1) or 1:1 randomization (for phase 2). |
|
Eksperimentel: Phase 1 - Dose Level 2 - 4.0 mg/kg of ALT-100
This is the second dose level that will be tested in the phase 1 portion of the study. |
Participants will receive either 1.0 mg/kg or 4.0 mg/kg of ALT-100 intravenously once every 28 days for up to 6 treatment cycles while receiving standard of care androgen deprivation therapy. The assigned dose will determined by either a 3 + 3 design (for phase 1) or 1:1 randomization (for phase 2). |
|
Eksperimentel: Phase 2 - Recommended phase 2 dose of ALT-100
Participants randomized to this arm will receive the recommended phase 2 dose determined in the phase 1 portion of the study. |
Participants will receive either 1.0 mg/kg or 4.0 mg/kg of ALT-100 intravenously once every 28 days for up to 6 treatment cycles while receiving standard of care androgen deprivation therapy. The assigned dose will determined by either a 3 + 3 design (for phase 1) or 1:1 randomization (for phase 2). |
|
Aktiv komparator: Phase 2 - Comparator dose of ALT-100
Participants randomized to this arm will receive a comparator dose of ALT-100 that is not the recommended phase 2 dose determined in phase 1. |
Participants will receive either 1.0 mg/kg or 4.0 mg/kg of ALT-100 intravenously once every 28 days for up to 6 treatment cycles while receiving standard of care androgen deprivation therapy. The assigned dose will determined by either a 3 + 3 design (for phase 1) or 1:1 randomization (for phase 2). |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Incidence of dose limiting toxicities
Tidsramme: first 30 days of treatment with ALT-100
|
Determine the incidence of dose-limiting toxicities during the dose-limiting toxicity evaluation period for participants on the phase 1 portion. |
first 30 days of treatment with ALT-100
|
|
Percentage of participants who achieve a PSA decrease of at least 30%
Tidsramme: After up to 6 months of treatment with ALT-100
|
Compare the percentage of participants on each arm on the phase 2 portion who achieve a PSA decrease of at least 30% |
After up to 6 months of treatment with ALT-100
|
|
Percentage of participants who achieve a PSA decrease of at least 50%
Tidsramme: After up to 6 months of treatment with ALT-100
|
Compare the percentage of participants on each arm on the phase 2 portion who achieve a PSA decrease of at least 50% |
After up to 6 months of treatment with ALT-100
|
|
Radiographic progression-free survival
Tidsramme: After up to 6 months of treatment with ALT-100
|
Compare the radiographic progression-free survival (per Prostate Cancer Working Group 4) of participants on each arm on the phase 2 portion. |
After up to 6 months of treatment with ALT-100
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Maximum plasma concentration of ALT-100
Tidsramme: At 4 hours after each dose of ALT-100
|
Determine the maximum plasma concentration of ALT-100 for participants on the Phase 2 portion. |
At 4 hours after each dose of ALT-100
|
|
Time to reach maximum plasma concentration of ALT-100
Tidsramme: At 4 hours after each dose of ALT-100
|
Determine the time to reach maximum plasma concentration of ALT-100 for participants on the Phase 2 portion. |
At 4 hours after each dose of ALT-100
|
|
Area under the curve (AUC) up to the last measurable plasma concentration for ALT-100
Tidsramme: At 4 hours after each dose of ALT-100
|
Determine the area under the curve (AUC) up to the last measurable plasma concentration for ALT-100 for participants on the Phase 2 portion. |
At 4 hours after each dose of ALT-100
|
|
Area under the curve (AUC) over the dosing interval for ALT-100
Tidsramme: Over the 4 weeks between doses of ALT-100
|
Determine the area under the curve (AUC) over the dosing interval for ALT-100 for participants on the Phase 2 portion. |
Over the 4 weeks between doses of ALT-100
|
|
Half-life for ALT-100
Tidsramme: At 4 hours after each dose of ALT-100
|
Determine the half-life for ALT-100 for participants on the Phase 2 portion. |
At 4 hours after each dose of ALT-100
|
|
Trough plasma concentration for ALT-100
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Determine the trough plasma concentration for ALT-100 for participants on the Phase 2 portion. |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Average plasma concentration during a dosing interval for ALT-100
Tidsramme: Over the 4 weeks between doses of ALT-100
|
Determine the average plasma concentration during a dosing interval for ALT-100 for participants on the Phase 2 portion. |
Over the 4 weeks between doses of ALT-100
|
|
Plasma concentration of eNAMPT
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of eNAMPT |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of IL-6
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of IL-6 |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of IL-8
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of IL-8 |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of TNF-a
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of TNF-a |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of IL-1b
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of IL-1b |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of IL-1RA
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of IL-1RA |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of Ang2
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of Ang2 |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of VEGF
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of VEGF |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of BMP-2
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of BMP-2 |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of PDGF-BB
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of PDGF-BB |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of osteopontin
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of osteopontin |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of osteocalcin
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of osteocalcin |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
|
Plasma concentration of bALP
Tidsramme: Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Measure the plasma concentration of bALP |
Prior to dosing of ALT-100 on day 1 of each cycle (each cycle is 28 days)
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Daniel Araujo, MD, University of Florida
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- UF-GU-015
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