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.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 2
- Phase 1
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Alexandra Leggett
- Telefonnummer: 352-273-9785
- E-Mail: agmueller@ufl.edu
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
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
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Ongoing androgen deprivation therapy (ADT) with a Gonadotropin-releasing hormone analogue, or prior bilateral orchiectomy, with serum testosterone <50 ng/dL
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ECOG performance status 0-2
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Life expectancy ≥6 months
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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
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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.
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Written informed consent obtained from the subject and the subject agrees to comply with all the study-related procedures.
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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.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Sequenzielle Zuweisung
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: 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). |
|
Experimental: 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). |
|
Experimental: 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). |
|
Aktiver 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). |
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Incidence of dose limiting toxicities
Zeitfenster: 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%
Zeitfenster: 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%
Zeitfenster: 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
Zeitfenster: 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
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Maximum plasma concentration of ALT-100
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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)
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Daniel Araujo, MD, University of Florida
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- UF-GU-015
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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