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Phase II Study of KW2871 Combined With High Dose Interferon-α2b in Patients With Metastatic Melanoma

Phase II Study of the Anti-Ganglioside GD3 Mouse/Human Chimeric Antibody KW2871 Combined With High Dose Interferon-α2b in Patients With Metastatic Melanoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00679289
Enrollment
36
Registered
2008-05-16
Start date
2008-03-28
Completion date
2014-02-03
Last updated
2022-10-12

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Cutaneous Melanoma, Metastatic Melanoma

Keywords

KW2871, Ecromeximab, Anti-ganglioside, Antibody, Interferon alpha, Metastatic melanoma

Brief summary

This was a Phase 2, open-label study of KW2871 (ecromeximab) in combination with high-dose interferon-α2b (HDI) in patients with metastatic melanoma. The primary objectives of this study were to assess progression-free survival (PFS) and safety. The secondary objectives were to assess the objective response rate, KW2871 pharmacokinetics (PK), and other exploratory immunology as indicated (e.g., development of human anti-chimeric antibodies \[HACA\], activity of antibody-dependent cell-mediated cytotoxicity \[ADCC\] and complement-dependent cytotoxicity \[CDC\] in peripheral blood, number and functional state of tumor-infiltrating immune cells and expression of GD3 in immune and tumor cells of tumor biopsies, and markers of interferon \[IFN\] response/resistance and markers of resistance to ADCC/CDC in peripheral blood mononuclear cells \[PBMCs\]).

Detailed description

Eligible patients were sequentially enrolled into dose-escalating cohorts to receive KW2871 intravenously (IV) once every 2 weeks starting on Day 3 of Week 1 at the following doses: 5 mg/m\^2 in Cohort 1, 10 mg/m\^2 in Cohort 2, and 20 mg/m\^2 in Cohort 3. HDI was administered concurrently at a dose of 20 million units (MU)/m\^2 IV once daily (QD) for 5 consecutive days per week for 4 weeks (induction phase), followed by 10 MU/m\^2 administered subcutaneously (SC) 3 times per week (maintenance phase). Patients received KW2871 and HDI combination therapy until disease progression requiring treatment intervention that would have interfered with the interpretation of the study results. Initially, 3 patients were enrolled within a cohort and evaluated for dose-limiting toxicity (DLT) and regimen-limiting toxicity (RLT) for the first 8 weeks of study treatment. If 1 of 3 patients experienced an RLT, the cohort was expanded to 6 patients. Escalation to the next higher dose cohort proceeded if the RLT rate was \<33% (0/3 or 1/6 patients) in a given cohort. The combination treatment was considered safe if ≤ 20% patients experienced RLT. DLT was defined as any adverse event (AE) that required reduction of the HDI dose or discontinuation of KW2871. RLT was defined as an HDI-related DLT that required more than 2 dose reductions of HDI during the induction phase or the first 4 weeks of the maintenance phase, or any KW2871- or regimen-related DLT.

Interventions

DRUGHDI

20 MU/m\^2 IV QD for 5 days/week for 4 weeks, then 10 MU/m\^2 SC 3 days/week until disease progression

DRUGKW2871

5 mg/m\^2 IV every 2 weeks until disease progression

Sponsors

University of Pittsburgh
CollaboratorOTHER
University of Chicago
CollaboratorOTHER
Life Science Pharmaceuticals
CollaboratorUNKNOWN
Ludwig Institute for Cancer Research
Lead SponsorOTHER

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Intervention model description

Dose-escalation cohorts

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

1. Age ≥ 18 years of age. 2. Histologically proven metastatic cutaneous, mucosal, or unknown primary melanoma. 3. Measurable disease using Response Evaluation Criteria in Solid Tumors (RECIST). 4. Ambulatory (Eastern Cooperative Oncology Group \[ECOG\] performance status 0 or 1) or expected survival ≥ 4 months. 5. Within the last 2 weeks prior to study day 1, the following laboratory parameters within the ranges specified: * Hemoglobin: ≥ 9 g/dL * Platelets: ≥ 100 x 10\^9/L * Neutrophils: ≥ 1.5 x 10\^9/L * International normalized ratio: ≤ 2.0 (≤ 3.0 if on warfarin therapy) * Serum creatinine: ≤ 1.5 x upper limit of normal (ULN) * Serum total bilirubin: ≤ 1.5 x ULN * Aspartate aminotransferase/alanine aminotransferase: ≤ 2.5 x ULN 6. Able and willing to give valid written informed consent.

Exclusion criteria

1. Other malignancy within 3 years prior to study entry for which the patient received active treatment, except for treated melanoma or non-melanoma skin cancer, cervical cancer, and breast carcinoma in situ. 2. Mental impairment that may have compromised the ability to give informed consent and comply with the study requirements. 3. Participation in any other clinical trial involving chemotherapy, radiotherapy, or other immunotherapy within 4 weeks prior to study enrollment. 4. Prior exposure to anti-GD3 antibodies. 5. Pregnancy or breastfeeding. 6. Women of childbearing potential who refused or were unable to use effective means of contraception. 7. Active autoimmune or other disorders that required systemic treatment with immunomodulatory or immunosuppressant medications (i.e., corticosteroids, cyclophosphamide, methotrexate, other biologics). Corticosteroids at substitution doses were allowed. 8. Metastatic brain disease was allowed provided that appropriate treatment had been administered (surgery or irradiation) and 2-month follow-up by brain magnetic resonance imaging (MRI) showed disease control (stability or regression). 9. Autoimmune-related hypothyroidism and vitiligo-like depigmentation were allowed provided the patient was medically stable with treatment (thyroid-hormone replacement or observation). 10. Serious medical illness, such as cardiovascular disease (uncontrolled congestive heart failure or hypertension, active ischemic disease of the heart \[angina\], recent \[\<3 months\] myocardial infarction, severe cardiac arrhythmia), bleeding disorders, obstructive or restrictive pulmonary diseases, active systemic infections requiring antibiotics, serious intercurrent illness requiring hospitalization, inflammatory bowel disorders, or significant psychiatric disease, which in the opinion of the principal investigator would have prevented adequate informed consent or rendered study treatment unsafe or contraindicated. 11. Patients with clinical suspicion of human immunodeficiency virus (HIV) or hepatitis underwent the following viral tests: patients with HIV must have had negative antibodies; patients with hepatitis B virus must have had negative antigens; patients with hepatitis C virus must have had a negative test for serum antibodies. If any of the tests were positive, patients were excluded from the study.

Design outcomes

Primary

MeasureTime frameDescription
Median Progression-free Survival (PFS) With 95% Confidence IntervalsFrom baseline through up to 17 months post-baselinePFS was calculated from the date of the first infusion to the date of documented progression or death, whichever occurred first. PFS analyses were performed using Kaplan-Meier methods for all patients combined and for patients in Cohort 3. Based on published results from Phase 3 randomized clinical trials in patients with metastatic melanoma at the time of study initiation, 2.5 months was estimated as a conservative (i.e., somewhat high) external standard of median PFS. The intent of this study was to improve this standard by ≥ 70% to a median PFS of ≥ 4.3 months for patients treated with KW2871 combined with HDI. If the therapeutic target of 4.3 months for median PFS represented the true underlying treatment effect of KW2871 plus HDI, then 23 patients would provide 80% power to detect a statistically significant improvement (α = 0.05; 1-sided test) over the 2.5-month external standard.
Number of Patients With Treatment-emergent Adverse Events (TEAEs)From baseline through up to 17 months post-baselineToxicity was graded in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3.0, as Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (life-threatening), or Grade 5 (fatal). TEAEs were reported based on clinical laboratory tests, physical examinations, and vital signs from pre-treatment through the study period. Causal relationship of each TEAE to study treatment was evaluated by the investigator separately for HDI and KW2871. Regimen-limiting toxicity was defined as an HDI-related dose-limiting toxicity (DLT) that required more than 2 dose reductions of HDI during the induction phase or the first 4 weeks of the maintenance phase, or any KW2871- or regimen-related DLT.

Secondary

MeasureTime frameDescription
Number of Patients With Best Overall Tumor ResponseFrom baseline through up to 17 months post-baselineTumor responses were evaluated using whole body computed tomography and categorized according to the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.0) at Screening, on Days 29, 57, 85, 115, 143, 171, 227, 283, 339, and at the End of Study Visit. Patients who were treated beyond 49 weeks were to undergo clinical and radiologic assessments per the standard of care. Per RECIST, target lesions are categorized as follows: Complete Response (CR): Disappearance of all target lesions \[no evidence of disease\]; Partial Response (PR): ≥ 30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD): ≥ 20% increase in the sum of the longest diameter of target lesions; Stable Disease (SD): small changes that do not meet above criteria.
Number of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871From baseline through up to 17 months post-baselineBlood samples were collected for the analysis of HACA at baseline, on Days 29, 115, 143, 171, 199, 227, 255, 283, 311, 339, and at the End of Study visit. Measurement of HACA development in plasma was performed with a BIAcore 2000 biosensor (Biacore AB, Uppsala, Sweden), using the BDF TM015 method. HACA positivity was defined as an increase in binding evident in the test channel but not in the control channel, with positivity assigned for values exceeding a uniform test threshold.
Maximum KW2871 Antibody Levels in Plasma Following the First InfusionAt Baseline and Study Day 3Blood samples for pharmacokinetic (PK) measurements were collected at baseline and before and 30 minutes after the initial KW2871 infusion on Day 3. The KW2871 antibody protein in patient serum was measured using an enzyme-linked immunosorbent assay (ELISA). The lower limit of quantitation was determined to be 100 ng/mL.

Countries

United States

Participant flow

Participants by arm

ArmCount
Cohort 1
KW2871: 5 mg/m\^2 IV every 2 weeks HDI: 20 MU/m\^2 IV QD for 5 days/week for 4 weeks, then 10 MU/m\^2 SC 3 days/week
6
Cohort 2
KW2871: 10 mg/m\^2 IV every 2 weeks HDI: 20 MU/m\^2 IV QD for 5 days/week for 4 weeks, then 10 MU/m\^2 SC 3 days/week
6
Cohort 3
KW2871: 20 mg/m\^2 IV every 2 weeks HDI: 20 MU/m\^2 IV QD for 5 days/week for 4 weeks, then 10 MU/m\^2 SC 3 days/week
24
Total36

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyAdverse Event003
Overall StudyPhysician Decision101
Overall StudyProgressive disease4518
Overall StudyWithdrawal by Subject011

Baseline characteristics

CharacteristicCohort 1Cohort 2Cohort 3Total
Age, Continuous55 years61 years54 years54 years
Body Mass Index24.4 kg/m^229.4 kg/m^226.3 kg/m^226.5 kg/m^2
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
6 Participants6 Participants24 Participants36 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
6 Participants6 Participants24 Participants36 Participants
Region of Enrollment
United States
6 Participants6 Participants24 Participants36 Participants
Sex: Female, Male
Female
2 Participants3 Participants13 Participants18 Participants
Sex: Female, Male
Male
4 Participants3 Participants11 Participants18 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
0 / 61 / 61 / 24
other
Total, other adverse events
6 / 66 / 624 / 24
serious
Total, serious adverse events
2 / 61 / 67 / 24

Outcome results

Primary

Median Progression-free Survival (PFS) With 95% Confidence Intervals

PFS was calculated from the date of the first infusion to the date of documented progression or death, whichever occurred first. PFS analyses were performed using Kaplan-Meier methods for all patients combined and for patients in Cohort 3. Based on published results from Phase 3 randomized clinical trials in patients with metastatic melanoma at the time of study initiation, 2.5 months was estimated as a conservative (i.e., somewhat high) external standard of median PFS. The intent of this study was to improve this standard by ≥ 70% to a median PFS of ≥ 4.3 months for patients treated with KW2871 combined with HDI. If the therapeutic target of 4.3 months for median PFS represented the true underlying treatment effect of KW2871 plus HDI, then 23 patients would provide 80% power to detect a statistically significant improvement (α = 0.05; 1-sided test) over the 2.5-month external standard.

Time frame: From baseline through up to 17 months post-baseline

Population: Patients who received initial treatment with HDI and at least 1 infusion of KW2871 and experienced a PFS event (progression or death).

ArmMeasureValue (MEDIAN)
Cohort 3Median Progression-free Survival (PFS) With 95% Confidence Intervals1.93 months
TotalMedian Progression-free Survival (PFS) With 95% Confidence Intervals2.53 months
Primary

Number of Patients With Treatment-emergent Adverse Events (TEAEs)

Toxicity was graded in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3.0, as Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (life-threatening), or Grade 5 (fatal). TEAEs were reported based on clinical laboratory tests, physical examinations, and vital signs from pre-treatment through the study period. Causal relationship of each TEAE to study treatment was evaluated by the investigator separately for HDI and KW2871. Regimen-limiting toxicity was defined as an HDI-related dose-limiting toxicity (DLT) that required more than 2 dose reductions of HDI during the induction phase or the first 4 weeks of the maintenance phase, or any KW2871- or regimen-related DLT.

Time frame: From baseline through up to 17 months post-baseline

Population: Patients who received initial treatment with HDI and at least 1 infusion of KW2871.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE6 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 1/20 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 35 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 41 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 50 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any HDI-related TEAE6 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any KW2871-related TEAE4 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any SAE2 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of HDI+KW28710 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of HDI only0 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of KW2871 only0 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Regimen-limiting toxicity0 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Regimen-limiting toxicity0 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE6 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any KW2871-related TEAE5 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of HDI+KW28711 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 1/21 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any HDI-related TEAE6 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of KW2871 only0 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 32 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any SAE1 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 51 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 42 Participants
TotalNumber of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of HDI only0 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 41 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 51 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of HDI only1 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any HDI-related TEAE24 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any KW2871-related TEAE7 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any SAE7 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of KW2871 only1 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE24 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 1/22 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Any TEAE leading to withdrawal of HDI+KW28713 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Maximum TEAE Severity Grade 320 Participants
Cohort 3Number of Patients With Treatment-emergent Adverse Events (TEAEs)Regimen-limiting toxicity2 Participants
Secondary

Maximum KW2871 Antibody Levels in Plasma Following the First Infusion

Blood samples for pharmacokinetic (PK) measurements were collected at baseline and before and 30 minutes after the initial KW2871 infusion on Day 3. The KW2871 antibody protein in patient serum was measured using an enzyme-linked immunosorbent assay (ELISA). The lower limit of quantitation was determined to be 100 ng/mL.

Time frame: At Baseline and Study Day 3

Population: Patients who received initial treatment with HDI and at least 1 infusion of KW2871 and had at least 1 plasma sample evaluated for KW2871 antibody levels.

ArmMeasureValue (MEAN)Dispersion
Cohort 3Maximum KW2871 Antibody Levels in Plasma Following the First Infusion3.22 µg/mLStandard Deviation 3.02
TotalMaximum KW2871 Antibody Levels in Plasma Following the First Infusion5.17 µg/mLStandard Deviation 5.07
Cohort 3Maximum KW2871 Antibody Levels in Plasma Following the First Infusion9.18 µg/mLStandard Deviation 4.26
Secondary

Number of Patients With Best Overall Tumor Response

Tumor responses were evaluated using whole body computed tomography and categorized according to the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.0) at Screening, on Days 29, 57, 85, 115, 143, 171, 227, 283, 339, and at the End of Study Visit. Patients who were treated beyond 49 weeks were to undergo clinical and radiologic assessments per the standard of care. Per RECIST, target lesions are categorized as follows: Complete Response (CR): Disappearance of all target lesions \[no evidence of disease\]; Partial Response (PR): ≥ 30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD): ≥ 20% increase in the sum of the longest diameter of target lesions; Stable Disease (SD): small changes that do not meet above criteria.

Time frame: From baseline through up to 17 months post-baseline

Population: Patients who received initial treatment with HDI and at least 1 infusion of KW2871.

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Cohort 3Number of Patients With Best Overall Tumor ResponseCR0 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponsePD0 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponseSD5 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponsePR1 Participants
TotalNumber of Patients With Best Overall Tumor ResponseSD5 Participants
TotalNumber of Patients With Best Overall Tumor ResponsePR0 Participants
TotalNumber of Patients With Best Overall Tumor ResponsePD1 Participants
TotalNumber of Patients With Best Overall Tumor ResponseCR0 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponsePD7 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponseCR1 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponsePR0 Participants
Cohort 3Number of Patients With Best Overall Tumor ResponseSD16 Participants
Secondary

Number of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871

Blood samples were collected for the analysis of HACA at baseline, on Days 29, 115, 143, 171, 199, 227, 255, 283, 311, 339, and at the End of Study visit. Measurement of HACA development in plasma was performed with a BIAcore 2000 biosensor (Biacore AB, Uppsala, Sweden), using the BDF TM015 method. HACA positivity was defined as an increase in binding evident in the test channel but not in the control channel, with positivity assigned for values exceeding a uniform test threshold.

Time frame: From baseline through up to 17 months post-baseline

Population: Patients who received initial treatment with HDI and at least 1 infusion of KW2871 and had at least 1 post-baseline plasma sample evaluated for HACA.

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Cohort 3Number of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871Baseline negative, post-baseline negative5 Participants
Cohort 3Number of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871Baseline negative, post-baseline positive1 Participants
TotalNumber of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871Baseline negative, post-baseline negative6 Participants
TotalNumber of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871Baseline negative, post-baseline positive0 Participants
Cohort 3Number of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871Baseline negative, post-baseline negative16 Participants
Cohort 3Number of Patients With Human Antichimeric Antibody (HACA) Reactivity To KW2871Baseline negative, post-baseline positive0 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026