A study in metastatic breast cancer patients receiving eftilagimod alpha or placebo in combination with a standard chemotherapy (paclitaxel)

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Immutep

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Neoplasms [C04]

Trial duration

5 May 2023 → ongoing

Decision date (initial)

2024-06-25

Transition trial

Yes

Low-intervention

No

Rare-disease indication

No

Vulnerable population

Yes

Funding sources

Immutep S.A.S.

External identifiers

EU CT number

2024-511023-34-00

EudraCT number

2022-003323-17

ClinicalTrials.gov

NCT05747794

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Therapy, Pharmacokinetic, Efficacy, Safety, Pharmacodynamic, Dose response

DOSE OPTIMIZATION LEAD-IN:
-To evaluate the safety and tolerability of 90 mg efti combined with paclitaxel, compared to 30 mg.
-To define the optimal biological dose (OBD) of efti in combination with weekly paclitaxel for Phase 3 part of the trial.

PHASE 3:
-To demonstrate that OS is superior in patients treated with efti combined with weekly paclitaxel compared to weekly paclitaxel plus placebo.

Secondary objectives 1

1. DOSE OPTIMIZATION LEAD-IN -To evaluate antitumor activity Objective response rate (ORR) by RECIST 1.1; Progression free survival (PFS) and OS of 30 and 90 mg efti in combination with weekly paclitaxel; -To describe changes from baseline in health-related quality of life (QoL) assessments in patients treated with 30 and 90 mg efti in combination with weekly paclitaxel; -To characterize pharmacokinetic profile of efti at 30 and 90 mg. PHASE 3 -To evaluate PFS, based on RECIST, v1.1 in patients treated with efti combined with weekly paclitaxel compared to weekly paclitaxel plus placebo; -To evaluate ORR based on RECIST v1.1 in patients treated with efti combined with weekly paclitaxel compared to weekly paclitaxel plus placebo; -To examine safety and tolerability of efti in combination with weekly paclitaxel compared to weekly paclitaxel plus placebo.

Conditions and MedDRA coding

HER2-neg/low metastatic breast cancer

Regulatory references

Scientific advice from competent authorities

European Medicines Agency

EMA paediatric investigation plan (PIP)

EMEA-002698-PIP01-19

Plan to share IPD

No

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 14

1. 1. Able to give written informed consent and to comply with the protocol. Note: signed and dated informed consent must be obtained prior to any protocol related procedure.
2. 2. Metastatic HR+ (estrogen receptor positive and/or progesterone receptor positive) or hormone receptor negative (HR-), and HER2- neg/low breast adenocarcinoma, histologically proven by biopsy last available tumor tissue (primary tumor and/or a metastasis; metastasis preferred).
3. 3. Patients with HR+ MBC who progressed on or after ≥1 line of endocrine based therapy and are indicated to receive paclitaxel chemotherapy for metastatic disease, in line with locally applicable treatment guidelines and local standard of care. Meeting any of below conditions: a. Primary endocrine resistance: recurrence/relapse ≤2 years after the start of adjuvant endocrine therapy for early breast cancer, or progression within 6 months of 1st line endocrine based therapy for metastatic breast cancer. b. Secondary endocrine resistance: recurrence/relapse >2 years after starting adjuvant endocrine based therapy, recurrence/relapse <12 months of finishing adjuvant endocrine based therapy or progression after >6 months of endocrine based therapy for metastatic breast cancer.
4. 4. Patients with TNBC who are indicated to receive paclitaxel chemotherapy without anti-PD-1/PD-L1 therapy in the 1st line setting for metastatic disease, in line with locally applicable treatment guidelines and local standard of care.
5. 5. Dose optimization lead-in: Female of age 18 years-of-age or older. Phase 3: Female or male of age 18 years-of-age or older.
6. 6. All patients of childbearing potential must have a negative highly sensitive pregnancy test at screening and agree to use a highly effective method for contraception according to the EU Clinical Trial Facilitation Group guidance from time of trial entry until at least 6 months after the last administration of the trial drug. The partners of patients with childbearing potential must also apply contraceptive methods. Patients who are either: a. Postmenopausal (≥60 years of age, or <60 years of age and amenorrhoeic for 12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression with follicle-stimulating hormone (FSH) above 40 U/L and estradiol below 30 ng/L; or if taking tamoxifen or toremifene, and age <60 years, then FSH and estradiol in the postmenopausal range), permanently sterilized (e.g., bilateral tubal occlusion, hysterectomy), b. Incapable of pregnancy are not considered to be of childbearing potential.
7. 7. Dose optimization lead-in only: evidence of measurable disease as defined by RECIST 1.1.
8. 8. ECOG performance status 0-1.
9. 9. Expected survival longer than three months.
10. 10. Resolution of toxicity of prior therapy to grade <2 (except for transaminases in the presence of liver metastases and for alopecia where grade 2 is allowed).
11. 11. Patients who are HBsAg positive are eligible if they have received HBV antiviral therapy for at least 4 weeks and have undetectable HBV viral load prior to randomization.
12. 12. Patients with a history of HCV infection are eligible if HCV viral load is undetectable at screening.
13. 13. HIV infected patients must be on antiretroviral therapy and have a well-controlled HIV infection/disease defined as: a. Patients on ART must have a CD4+ T-cell count >350 cells/mm3 at time of screening. b. Patients on ART must have achieved and maintained virologic suppression defined as confirmed HIV RNA level below 50 copies/mL or the lower limit of qualification (below the limit of detection) using the locally available assay at the time of screening and for at least 12 weeks prior to screening. c. Patients on ART must have been on a stable regimen, without changes in drugs or dose modification, for at least 4 weeks prior to cycle 1 day 1.
14. 14. Laboratory criteria: a. Total white cell count ≥3 x 10^9/L b. Platelet count ≥100 x 10^9/L c. Hemoglobin ≥9 g/dL or 5.58 mmol/L d. Absolute Neutrophil Count (ANC) ≥1.5 x 10^9/L e. Estimated glomerular filtration rate by CKD-EPI >30 mL/min f. Total bilirubin ≤20 μmol/L, except for familial cholemia (Gilbert's disease) g. Serum ASAT and ALAT ≤3 times ULN or ≤5 times ULN if liver metastases are present. Please refer to the protocol for the full inclusion criteria with notes.

Exclusion criteria 28

1. 1. Prior chemotherapy for metastatic breast adenocarcinoma.
2. 2. Patients with HR+ MBC who have received <1 line of ET based therapy in the metastatic setting.
3. 3. Patients with HR+ MBC who are not primary or secondary resistant to ET-based therapy and would be candidates to ET based therapy as per applicable treatment guidelines.
4. 4. TNBC patients who are candidates for PD-1/PD-L1 therapy in combination with chemotherapy.
5. 5. Disease-free interval of less than twelve months from the last dose of adjuvant chemotherapy.
6. 6. Prior high-dose chemotherapy requiring hematopoietic stem cell rescue.
7. 7. Inflammatory breast cancer at the time of screening.
8. 8. Any (investigational) agent given with intent to treat breast cancer within 4 weeks, while for endocrine therapy within 1 week and for treatment with CDK4/6 inhibitors within 5 times half-life (according to SPC) prior to first dose of trial treatment.
9. 9. Symptomatic known cerebral and/or leptomeningeal metastases.
10. 10. Women who are pregnant or lactating.
11. 11. Serious intercurrent infection treated with parenteral antibiotics within 4 weeks prior to first dose of trial treatment.
12. 12. QTcF >480 ms, family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or Torsade de Pointes (TdP).
13. 13. Uncontrolled electrolyte disorders of grade 2 or higher severity that may worsen the effects of a QTc-prolonging drug (e.g., hypocalcemia, hypokalemia, hypomagnesemia).
14. 14. Evidence of severe or uncontrolled cardiac disease within 6 months prior to first dose of trial treatment including: myocardial infarction, severe/unstable angina, ongoing cardiac dysrhythmias of NCI CTCAE version 5.0 Grade ≥2, atrial fibrillation, coronary/peripheral artery bypass graft, symptomatic congestive heart failure (NYHA III-IV), cerebrovascular accident including transient ischemic attack, ventricular arrhythmias requiring medication or symptomatic pulmonary embolism.
15. 15. Active acute or chronic infection (exceptions are defined in Incl. crit. #11-13).
16. 16. HIV-infected patients with a history of Kaposi sarcoma and/or Multicentric Castleman Disease.
17. 17. Active or past autoimmune disease requiring systemic immunosuppressive therapy in the past 2 years. Replacement therapy is allowed.
18. 18. Any condition requiring continuous systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 4 weeks prior to first dose of trial treatment. Inhaled or topical steroids and physiological replacement doses of up to 10 mg daily prednisone equivalent are permitted in the absence of active autoimmune disease.
19. 19. Life threatening illness unrelated to cancer.
20. 20. Previous malignancies within the last three years other than breast cancer, except successfully treated squamous cell carcinoma of the skin, superficial bladder cancer, in situ carcinoma of the cervix and tamoxifenrelated endometrial cancer definitively treated with hysterectomy.
21. 21. Patients with prior organ or stem cell transplantation.
22. 22. Live vaccine within 30 days of planned C1D1. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette–Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed.
23. 23. Patients treated with systemic immune stimulatory agents (excluding vaccines) within 6 weeks or five half-lives of the drug prior to first administration of trial treatment.
24. 24. History of severe allergic episodes and/ or Quincke's oedema.
25. 25. Known hypersensitivity to any of the components of the trial agents.
26. 26. Participation in another interventional clinical trial with last trial treatment given within 4 weeks prior to C1D1, with intent other than covered by Exclusion criterion #8.
27. 27. Any current disorder that would impede the patient's ability to provide informed consent or to comply with the protocol, or in the clinical judgement of the Investigator, the patient is unsuitable for participation in this trial for any reason.
28. 28. Persons with any kind of dependency on the Investigator or employed by the Sponsor or Investigator; persons held in an institution by legal or official order. Please refer to the protocol for the full exclusion criteria with notes.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 2

1. DOSE OPTIMIZATION LEAD-IN • Frequency, severity, and duration of adverse events (AEs). • Clinically relevant abnormalities in vital signs, physical examinations, 12-lead ECGs, and safety laboratory assessments. • Occurrence of dose-limiting toxicities (DLTs). • Determination of the OBD.
2. PHASE 3 • Overall survival (OS) is defined as the time from randomization to death from any cause.

Secondary endpoints 9

1. DOSE OPTIMIZATION LEAD-IN • Objective response rate (ORR) according to RECIST 1.1 by investigator assessment defined as the proportion of patients who have best overall response (BOR) of CR or PR.
2. • Progression free survival (PFS) per RECIST 1.1, defined as the timefrom the date of first treatment to documented disease progression or death from any cause as assessed by the investigator assessment based on RECIST 1.1. Censuring rules as per FDA guideline. .
3. • Overall survival (OS) is defined as the time from the date of first treatment to death from any cause. Patients who are lost to follow-up and those who are alive at the date of data cut-off will be censored at the last date the patient was last known alive, or date of data cut-off, whichever occurs first.
4. • Changes from baseline in quality of life (QOL) as assessed by EORTC QLQ-C30 over the course of the trial.
5. • Plasma concentration time profile and derived PK parameters of efti at 30 and 90 mg (dose optimization lead-in only) dose levels.
6. • Progression free survival (PFS) per RECIST 1.1, defined as the time from randomization to documented disease progression or death from any cause as assessed by the investigator assessment based on RECIST 1.1. Censuring rules as per FDA guideline.
7. • Objective response rate (ORR) according to RECIST 1.1 by investigator assessment defined as the proportion of patients who have best overall response (BOR) of CR or PR.
8. • Frequency, severity, and duration of adverse events (AEs)
9. • Clinically relevant abnormalities in vital signs, physical examinations, 12-lead ECGs, and safety laboratory assessments.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 2

Placebo 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Immutep

Sponsor organisation

Immutep

Address

Batiment 7 Le Pythagore Route De L Orme Route Departementale, 128 Parc Des Algorithmes 128 Parc Des Algorithmes

City

St Aubin

Postcode

91190

Country

France

Scientific contact point

Organisation

Immutep

Contact name

Clinical Trial Enquiries

Public contact point

Organisation

Immutep

Contact name

Clinical Trial Enquiries

Third parties 6

Locations

2 EU/EEA countries · 14 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 21 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

8 submissions — initial application plus substantial / non-substantial modifications