Live Biotherapeutic Product MRx0518 and Pembrolizumab Combination Study in Solid Tumors

NCT03637803 | Terminated Phase 1 FDA Drug

• 2 other identifiers: MRx0518-I-002Keynote MK3475-823
• Study Type: interventional
• Target: 63
• Locations: 1 country
• Sites: 5

Brief Summary

This is an open label, safety and preliminary efficacy study of MRx0518 in combination with pembrolizumab in patients with solid tumours (non small cell lung cancer, renal cell carcinoma, bladder cancer or melanoma). Subjects will be treated with IV pembrolizumab every 3 weeks and 1 capsule twice daily of MRx0518. Treatment will continue as long as clinically relevant, until disease progression, unacceptable AEs or withdrawal of consent up to a maximum of 35 cycles (approx. 2 years).

Conditions

Oncology; Solid Tumor; Non Small Cell Lung Cancer; Renal Cell Carcinoma; Melanoma; Bladder Cancer

Keywords

MK-3475; pembrolizumab; MRx0518; PD-1 Inhibitor; Oncology; Live Biotherapeutic Product

Outcome Measures

Primary Outcomes (3)

• Part A: To assess the safety and tolerability of MRx0518 in combination with pembrolizumab through the collection of adverse events

  Adverse events will be assessed as per CTCAE v4

  Baseline to treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days)

• Part B: To assess safety and tolerability of MRx0518 in combination with pembrolizumab through the collection of adverse events

  Adverse events will be assessed as per CTCAE v4

  Baseline to treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days)

• Part B: To assess the clinical benefit of MRx0518 in combination with pembrolizumab

  To determine preliminary evidence of anti-tumor activity

  Baseline to treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days)

Secondary Outcomes (1)

• Antitumour effect

  Baseline and every 3 weeks until treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days)

Other Outcomes (4)

• Biomarkers of treatment effect - blood

  Day 1 of Cycle 1 and Cycle 2 and time of treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days)

• Biomarkers of treatment effect - tumour

  Baseline, Day 1 of Cycle 4 and time of treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days)

• Microbiota and metabolome

  Day 1 of Cycle 1 and Cycle 2, time of treatment discontinuation up to a maximum of 35 treatment cycles (one cycle = 21 days), and 30 Day follow up

Study Arms (1)

MRx0518 with pembrolizumab

EXPERIMENTAL

Subjects will receive IV infusion of pembrolizumab once every 3 weeks until disease progression, unacceptable AEs or withdrawal of consent up to a maximum of 35 cycles (approx. 2 years). Starting on the day of first pembrolizumab dose, subjects will take one capsule of MR0518 twice daily until the end of the treatment period.

Drug: MRx0518; Drug: Pembrolizumab 25 MG/1 ML Intravenous Solution [KEYTRUDA]

Interventions

MRx0518 DRUG

MRx0518 is a live biotherapeutic product consisting of a lyophilised formulation of a proprietary strain of bacterium. The study dosing regimen is one capsule two times per day for the duration of the treatment period.

MRx0518 with pembrolizumab

Pembrolizumab 25 MG/1 ML Intravenous Solution [KEYTRUDA] DRUG

Pembrolizumab is a potent humanised immunoglobulin G4 (IgG4) monoclonal antibody (mAb) with high specificity of binding to the programmed cell death 1 (PD1) receptor , thus inhibiting its interaction with programmed cell death ligand 1 (PD-L1) and programmed cell death ligand 2 (PD-L2). The study dosing regimen is 200mg (two 4ml vials of 25mg/ml solution) for IV infusion once every three weeks.

Also known as: MK3475, Pembrolizumab, Keytruda

MRx0518 with pembrolizumab

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Willing and able to provide written informed consent/assent for the trial.
• ≥18 years of age on day of signing informed consent.
• Histological or cytological evidence of advanced and/or metastatic or recurrent NSCLC, renal cell carcinoma, bladder cancer or melanoma.
• At least one measurable lesion per RECIST v 1.1 criteria.
• Failure to respond or intolerance to standard therapy or for whom no appropriate therapies are known to provide clinical benefit (per the judgement of the Investigator).
• Subjects must have progressed on treatment with a PD-1/PD-L1 inhibitor administered either as monotherapy, or in combination with other checkpoint inhibitors or other therapies. PD-1/PD-L1 inhibitor treatment progression is defined by meeting all of the following criteria:
• Has received at least 2 doses of a PD-1/PD-L1 inhibitor.
• Has demonstrated disease progression after PD-1/PD-L1 therapy as defined by RECIST v1.1, iRECIST or irRECIST. The initial evidence of disease progression (PD) is to be confirmed by a second assessment no less than four weeks from the date of the first documented PD, in the absence of rapid clinical progression.
• Progressive disease has been documented within 12 weeks from the last dose of a PD-1/PD-L1 inhibitor.
• Have adequate organ function
• Be willing to provide archival tissue
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
• Female subjects of childbearing potential should have a negative serum pregnancy test within 72 hours prior to receiving the first dose of study medication. Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for ≥2 years.
• Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication
• Male subjects with female partners of childbearing potential should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy.

You may not qualify if:

• Subjects who failed to show any response to initial treatment with PD-1/PD-L1 inhibitor (i.e. no Response or no Stable Disease).
• Has active brain metastases or leptomeningeal disease. Subjects with asymptomatic CNS metastases which have been stable (defined as without evidence of progression by MRI for at least 28 days prior to initiation of therapy and any neurologic symptoms have returned to baseline) following treatment with surgery or radiation therapy are allowed.
• Prior solid organ or hematologic transplant.
• Treatment-related immune-mediated (or immune related) AEs from immune-modulatory agents (including but not limited to anti-PD1/PD-L1 agents, anti-CTLA4 monoclonal antibodies) that caused permanent discontinuation of the agent, or that were grade 3 or 4 in severity.
• Subjects treated with tyrosine kinase inhibitor therapy or completed palliative radiotherapy \<14 days from initiation of therapy.
• Comorbidity requiring corticosteroid therapy (\>10mg prednisone/day or equivalent) within 7 days of starting experimental therapy. Physiologic replacement doses are allowed if they are ≤10mg of prednisone/day or equivalent, as long as they are not being administered for immunosuppressive intent. Inhaled or topical steroids are permitted, provided that they are not for treatment of an autoimmune disorder.
• Significant cardiac dysfunction, New York Heart Association classification for chronic heart failure III-IV, symptomatic coronary artery disease, significant ventricular arrhythmias; myocardial infarction within 6 months; unstable, poorly controlled angina pectoris
• Active, known or suspected autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs), except for replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.). Note: corticosteroids given within 24 hours of an imaging study for purposes of pre-medication in subjects with hypersensitivity to radiologic contrast agents are allowed
• Has a serious active infection requiring systemic therapy
• Subjects who have completed a course of antibiotics within the two weeks prior to dosing
• Has a known psychiatric or substance abuse disorder that would interfere with the subject's ability to cooperate with the requirements of the trial
• Receipt of a live-virus vaccination within 28 days of planned treatment start
• Known HIV infection, or active infection with hepatitis A, B or C
• Has a history of (non-infectious) pneumonitis that required steroids or has current active pneumonitis
• Known additional malignancy either progressing r requiring active treatment (except for non-melanoma skin cancer, in situ cervical cancer or prostate intraepithelial neoplasia) within the last 2 years

Sponsors & Collaborators

• 4D pharma plc: lead
• Merck Sharp & Dohme LLC: collaborator

Study Sites (5)

University of Kansas Medical Center

Kansas City, Kansas, 66160, United States

Location

UPMC Hillman Cancer Center

Pittsburgh, Pennsylvania, 15232, United States

Location

Houston Methodist Cancer Center

Houston, Texas, 77030, United States

Location

MD Anderson Cancer Center

Houston, Texas, 77030, United States

Location

Summit Cancer Center

Spokane, Washington, 99208, United States

Location

MeSH Terms

Conditions

Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Renal Cell; Melanoma; Urinary Bladder Neoplasms

Interventions

pembrolizumab

Condition Hierarchy (Ancestors)

Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Lung Diseases; Respiratory Tract Diseases; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Kidney Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Kidney Diseases; Urologic Diseases; Male Urogenital Diseases; Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Nevi and Melanomas; Skin Neoplasms; Skin Diseases; Skin and Connective Tissue Diseases; Urinary Bladder Diseases

Study Officials

• Shubham Pant, MD

  M.D. Anderson Cancer Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 3, 2018
• First Posted: August 20, 2018
• Study Start: January 10, 2019
• Primary Completion: May 8, 2023
• Study Completion: May 8, 2023
• Last Updated: June 1, 2023

Record last verified: 2023-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (5)