Adenocarcinoma of Lung, Mesothelioma, Pancreatic Neoplasms
Conditions
Keywords
Immune Therapy, Immunotoxin, T-Cell Depletion, Mesothelioma
Brief summary
Background: * Malignant mesothelioma is a form of cancer that develops on the protective lining that covers the body's internal organs. It most often occurs on the lining of the lungs and chest wall or the lining of the abdomen. There is no known cure for malignant mesothelioma, so researchers are searching for new ways to treat it. * Mesothelin is a protein that is found in mesothelioma and other types of cancer cells. An experimental cancer drug called SS1P is designed to attack cells that have mesothelin while leaving healthy cells alone. Researchers want to test how effective SS1P is when it is given with pentostatin and cyclophosphamide. These drugs help suppress the immune system and may make the SS1P more effective. Objectives: \- To study the effectiveness of SS1P plus two drugs that suppress the immune system to treat malignant mesothelioma. Eligibility: \- Individuals at least 18 years of age who have malignant mesothelioma in the chest or abdomen. Design: * Participants will be screened with a physical exam, medical history, and blood tests. They will also have imaging studies. * The first treatment cycle will last 30 days. Up to three 21-day cycles of treatment will follow. * In the first cycle, participants will have pentostatin on days 1, 5, and 9. They will have cyclophosphamide on days 1 through 12. They will have SS1P on days 10, 12, and 14. * On the next three cycles, participants will have pentostatin on day 1.They will have cyclophosphamide on days 1 through 4. They will have SS1P on days 2, 4, and 6. * Participants will have frequent blood tests and other studies. They will receive all four cycles of treatment as long as there are no severe side effects. * Participants will have regular followup visits as directed by the study doctors.
Detailed description
BACKGROUND: Mesothelin is a cell surface glycoprotein present on normal mesothelial cells that is highly expressed in many human cancers including mesothelioma, lung and pancreatic adenocarcinoma. SS1 (dsFv) PE38 is a recombinant anti-mesothelin immunotoxin that has undergone phase I testing and has been evaluated in combination with pemetrexed and cisplatin for treatment of malignant pleural mesothelioma. SS1 (dsFv)PE38 is highly immunogenic and the majority of patients develop antibodies to it at end of one cycle. Pre-clinical studies demonstrate that SS1(dsFv)PE38 may be administered multiple times in combination with an immune-depleting regimen consisting of pentostatin and cyclophosphamide. OBJECTIVES: Mesothelioma Pilot Objective -To assess the safety, tolerability, and feasibility of a conditioning regimen of pentostatin and cyclophosphamide in combination with SS1(dsFv)PE38 -To monitor antibody formation to SS1(dsFv)PE38 and to assess the impact of the conditioning regimen on the formation of these antibodies Mesothelioma Positive Cancers Dose De-escalation Pilot Objective -To determine the safety profile and recommended phase 2 dose of SS1P (dsFv)PE38 in drug lot FIL129J01 using dosing regimen A in patients with mesothelioma, lung and pancreatic adenocarcinoma Phase 2 and Lung and Pancreatic Adenocarcinoma Expansion Pilot Objective -To evaluate objective tumor response in subjects with pleural mesothelioma, peritoneal mesothelioma, lung and pancreatic adenocarcinoma using Regimen A ELIGIBILITY: * Patients with one of the following histologically confirmed malignancies: * malignant pleural or peritoneal mesothelioma with epithelial or biphasic tumors having less than a 50% sarcomatoid component who have previously been treated on at least one platinum-containing chemotherapy regimen with progressive disease documented prior to study entry * advanced (Stage IIIB/IV) lung adenocarcinoma who have had at least one prior chemotherapy for advanced disease. Patients who received an approved targeted therapy as first-line treatment should have also received chemotherapy prior to study entry. * recurrent, locally advanced unresectable or metastatic adenocarcinoma of the pancreas. * Measurable disease by modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria for pleural mesothelioma or by RECIST criteria for peritoneal mesothelioma, lung adenocarcinoma and pancreatic adenocarcinoma * Adequate renal, hepatic and hematopoietic function * No major surgery, radiotherapy, chemotherapy or biologic therapy within 28 days of therapy DESIGN: -During the mesothelioma pilot phase of this study, the first eleven mesothelioma patients enrolled in this study received a conditioning regimen of pentostatin on days 1, 5 and 9 of the first cycle and day 1 of subsequent cycles in combination with cyclophosphamide on days 1 through 12 of the first cycle and days 1 through 4 of subsequent cycles (Regimen A) while the next 8 mesothelioma patients received conditioning regimen of pentostatin on days 1, 5, 9, 13 and 17 of the first cycle and day 1 and 5 of subsequent cycles in combination with cyclophosphamide on days 1 through 20 of the first cycle and days 1 through 8 of subsequent cycles (Regimen B). SS1P was administered every other day for six days (3 doses) beginning on the day after the last pentostatin dose in each cycle for both regimens. * In the mesothelin positive cancers dose de-escalation pilot study, a maximum of 12 patients with mesothelioma or lung or pancreatic adenocarcinoma will be enrolled in a 3+3 design to test up to 2 decreasing dose levels of SS1P administered in combination with cyclophosphamide and pentostatin on the Regimen A schedule for safety. * In the phase 2 mesothelioma and pancreatic and lung adenocarcinoma pilot expansion portions of the study, a two-stage Minimax phase II trial design will be used to enroll up to 16 evaluable subjects with pleural mesothelioma (cohort 1), up to 10 evaluable subjects with peritoneal mesothelioma (cohort 2), up to 10 patients with lung adenocarcinoma (cohort 3)and up to 10 evaluable subjects with pancreatic adenocarcinoma (cohort 4) who will receive treatment on Regimen A. * Treatment cycles will be repeated for up to four cycles if patients do not develop neutralizing antibodies, which will be assessed by a biological assay 14 and 20 days (+/- 2 days) following the first dose of SS1P in each cycle (corresponding to Days 24 and 30 of Cycle 1, and Days 16 and 22 of Cycles 2 through 4) * Toxicity will be assessed by the Cancer Therapy Evaluation Program (CTEP) Version 4.0 of Common Terminology Criteria in Adverse Events (CTCAE) * Tumor response assessments will be performed at the end of 2 cycles and at the end of treatment * Tumor biopsies will be performed before treatment, after 2 cycles, and after the last cycle or at follow-up.
Interventions
DRUGPentostatin
Regimen A: Cycle 1: 4 mg/m\^2 on days 1, 5 and 9 of 30 day cycle Cycles 2-4: 4 mg/m\^2 on day 1 of 21 day cycle Regimen B: Cycle 1: 4 mg/m\^2 or 2 mg/m\^2 on days 1, 5, 9, 13 and 17 of 38 day cycle Cycles 2-6: 4 mg/m\^2 on days 1 and 5 of 25 day cycle
DRUGCyclophosphamide
Regimen A:Cycle 1: 200 mg/day on days 1-12 of 30 day cycle Cycles 2-4: 200 mg/day on days 1-4 of 21 day cycle Regimen B:Cycle 1: 200 mg/day on days 1-20 of 38 day cycle Cycles 2-4: 200 mg/day on days 1-8 of 25 day cycle
BIOLOGICALSS1(dsFv)PE38 - lot 073I0809
Regimen A: Cycle 1: Cycle 1: 35mcg/kg days 10, 12 and 14 Cycles 2-4: Days 2, 4 and 6, for a maximum of six treatment cycles Regimen B: Cycle 1: 35mcg/kg days 18, 20 and 22 Cycles 2-4: (Days 6, 8 and 10), for a maximum of six treatment cycles
BIOLOGICALSS1(dsFv)PE38 - lot FIL129J01
Regimen A: Cycle 1: Cycle 1:35mcg/kg or 25 mcg/kg days 10, 12 and 14 Cycles 2-4: Days 2, 4 and 6, for a maximum of six treatment cycles
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* INCLUSION CRITERIA: Mesothelioma Cohorts (Cohorts 1 and 2 Only) * Subjects must have histologically confirmed epithelial or biphasic mesothelioma not amenable to potentially curative surgical resection. However, patients with biphasic tumors that have a less than or equal to 50% sarcomatoid component will be excluded. The diagnosis will be confirmed by the Laboratory of Pathology / Center for Cancer Research (CCR) / National Cancer Institute (NCI). * Patients must have had at least one prior chemotherapy regimen, with the Food and Drug Administration (FDA) approved regimen of a platinum-based therapy in combination with pemetrexed being preferred unless there was a specific contraindication for an individual patient. There is no limit to the number of prior chemotherapy regimens received. * Total Bilirubin less than or equal to 1.5 X institutional upper limit of normal (ULN) INCLUSION CRITERIA: Lung Adenocarcinoma Cohort (Cohort 3) Only * Subjects must have histologically confirmed advanced (Stage IIIB/IV) lung adenocarcinoma. The diagnosis will be confirmed by the Laboratory of Pathology/CCR/NCI. * Patients must have had at least one prior therapy for advanced disease \[platinum containing chemotherapy or one of the approved targeted therapies (an approved estimated glomerular filtration rate (EGFR) tyrosine kinase inhibitor (TKI) for EGFR mutant tumors or crizotinib and ceritinib for ALK translocated tumors)\]. There is no limit to the number of prior chemotherapy regimens received. * Mesothelin expression in at least 5% of cells as assessed in archival tumor tissue samples, determined by the immunohistochemistry (IHC) assay performed at Laboratory of Pathology / CCR / NCI. Archival samples must be available for eligibility. * Total Bilirubin less than or equal to 1.5 X institutional upper limit of normal (ULN) INCLUSION CRITERIA: Pancreatic Cancer Cohort (Cohort 4) Only * Subjects with recurrent, locally advanced unresectable or metastatic adenocarcinoma of the pancreas. The diagnosis will be confirmed by the Laboratory of Pathology/CCR/NCI. * Patients must have had at least one prior chemotherapy for advanced disease. There is no limit to the number of prior chemotherapy regimens received. * Total Bilirubin less than or equal to 2 X institutional upper limit of normal (ULN) INCLUSION CRITERIA: All Subjects * Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as \>20 mm with conventional techniques or as \>10 mm with spiral CT scan. See Section 11 for the evaluation of measurable disease. * Patients must not have had major surgery, radiation therapy, chemotherapy, biologic therapy (including any investigational agents), or hormonal therapy (other than replacement), within 4 weeks prior to entering the study and must have evidence of stable or progressive disease to be eligible. * Age greater than or equal to 18 years. Since the study diseases are extremely rare in children they are excluded from this study. * Performance status (Eastern Cooperative Oncology Group (ECOG)) less than or equal to 1 * Patients must have adequate organ and marrow function (as defined below). * leukocytes less than or equal to 3,000/mm\^3 * absolute neutrophil count less than or equal to 1,500/mm\^3 * hemoglobin less than or equal to 9 g/dL * platelets less than or equal to 90,000/ mm\^3 * total bilirubin See guidelines for individual cohorts in sections 3.1.1.3, 3.1.2.4 and 3.1.3.3 * Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase (SGOT))/alanine aminotransferase (ALT)(serum glutamic-pyruvic transaminase (SGPT)) less than or equal to 3 X institutional upper limit of normal (ULN) (5x if liver function test (LFT) elevations due to liver metastases) * creatinine less than or equal to 1.5 X institutional ULN OR --creatinine clearance greater than or equal to 45 mL/min/1.73 m\^2 for patients with creatinine levels above institutional normal, obtained through calculated or measured Creatinine Clearance Patients may be transfused to obtain a hemoglobin of less than or equal to 9 g/Dl. * The effects of SS1(dsFv)PE38, pentostatin, and cyclophosphamide on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (barrier method of birth control; abstinence) for the duration of study therapy and for 3 months after the last dose of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. While hormonal methods of birth control are effective, we ask that female patients who are participating in the study cease hormonal forms of birth control, as these methods of birth control (birth control pills, injections, or implants) may affect the study drug. Patients must be off hormonal forms of birth control for at least 4 weeks prior to initiating the study. * Ability to comply with intravenous administration schedule, and the ability to understand and the willingness to sign a written informed consent document.
Exclusion criteria
(All Subjects) * Patients with symptomatic brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. However, patients who have had treatment for their brain metastases and whose brain metastatic disease status has remained stable for at least 4-6 weeks without steroids may be enrolled at the discretion of the principal investigator. * Uncontrolled medical illness including, but not limited to, ongoing or uncontrolled, symptomatic congestive heart failure (American Heart Association (AHA) Class II or worse), uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. * Human immunodeficiency virus (HIV) positive patients will be excluded due to a theoretical concern that the degree of immune suppression associated with the treatment may result in progression of HIV infection. * Patients with Hepatitis B and C will be excluded. * Serum neutralization antibody assay shows greater than or equal to 75% neutralization of the SS1 (dsFv) PE38 activity at 200 ng/ml. * Patients may not be receiving any other investigational agents. * History of another invasive malignancy in the last two years. Adequately treated noninvasive, non-melanoma skin cancers as well as in situ carcinoma of the cervix will be allowed. * Prior treatment with drugs of the immunotoxin class. * Patients with tumor amenable to potentially curative therapy as assessed by the investigator. * Pregnant women are excluded from this study because SS1(dsFv)PE38, pentostatin, and cyclophosphamide have the potential for teratogenic or abortifacient effects. The agents in the trial may also potentially be secreted in milk and therefore breastfeeding women should be excluded. Because of the potential of teratogenic or abortifacient effects women of childbearing potential and men must agree to use adequate contraception (barrier methods) before, during the study and for a period of 3 months after the last dose of the investigational agent. * History of allergic reactions attributed to compounds of similar chemical or biologic composition to SS1(dsFv)PE38. INCLUSION CRITERIA: WOMEN AND MINORITIES -Both men and women and members of all races and ethnic groups are eligible for this trial. Every effort will be made to recruit women and minorities in this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recommended Phase 2 Dose (RP2D) in Drug Lot FIL129J01 | Days 1, 3, and 5 of a 21 day cycle | Should any 2 patients within the first 3 to 6 patients experience treatment limiting toxicity requiring cessation of treatment prior to the conclusion of the first cycle, the maximum tolerated dose will have been exceeded and patients will be enrolled to the next lower dose. |
| Response Assessment | 52 months and 4 days | Response was assessed by the European Organization for Research and Treatment of Cancer (EORTC) modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Complete response (CR) is complete disappearance of all target lesions. Partial response (PR) is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions. Progressive disease (PD) disease is at least a 20% increase in the sum of the LD of target lesions. Stable disease (SD) is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started. |
| Count of Participants With SS1P Antibody Formation | On last day of last dosing cycle, end of cycle 1 (day 30) | Development of antibodies following treatment with SS1P. The goal was to delay development of antibodies to SS1P so a patient could get a second cycle of therapy with SS1P. |
| Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | Date treatment consent signed to date off study, approximately 64 months and 26 days | Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | 36 months | The Kaplan-Meier was used to determine the probability of overall survival from on-study date until death or last follow-up (calculated from the date of study entry until the date of analysis). |
| Progression-free Survival | 36 months | Defined as the time interval from the start of treatment to documented evidence of disease progression. Progressive disease is assessed by the European Organization for Research and Treatment of Cancer (EORTC) modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and is at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum on study LD (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5mm. (Note: the appearance of one or more new lesions is also considered progression). |
| Duration of Response | up to 2.5 years | DOR is assessed by the European Organization for Research and Treatment of Cancer (EORTC) modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria and is measured from the time measurement criteria is met for complete response or partial response (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started). Complete response is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to\<10mm. partial response is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. Progressive disease is at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum on study LD (this includes the baseline sum if that is the smallest on study). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Count of Participants SS1P Cycles Received Following Onstudy | Cycles 1-6, up to 180 days | Here are the number of participants who had SS1P cycles during cycle 1-6. |
Countries
United States
Participant flow
Pre-assignment details
55 participants were enrolled. No data was collected for 10/55 participants who were screened for neutralizing antibodies and were positive, thus not enrolled into a Group /Arm, nor treated. 45/55 participants were treated on this study.
Participants by arm
| Arm | Count |
|---|---|
| Mesothelioma Pilot Phase Regimen A Drug: Pentostatin Regimen A: Cycle 1: 4 mg/m\^2 on days 1, 5 and 9 of 30 day cycle Cycles 2-4: 4 mg/m\^2 on day 1 of 21 day cycle
Other Names:
• Nipent Drug: Cyclophosphamide Regimen A:Cycle 1: 200 mg/day on days 1-12 of 30 day cycle Cycles 2-4: 200 mg/day on days 1-4 of 21 day cycle
Other Names:
• Cytoxan Drug: SS1 (dsFv)PE38 Regimen A: Cycle 1: 35 mcg/kg days 10, 12, and 14. Cycles 2-4: Days 2, 4, and 6, for a maximum of six treatment cycles. | 11 |
| Mesothelioma Pilot Phase Regimen B Drug: Pentostatin Regimen B: Cycle 1: 4 mg/m\^2 or 2 mg/m\^2 on days 1, 5, 9, 13 and 17 of 38 day cycle Cycles 2-6: 4 mg/m\^2 on days 1 and 5 of 25 day cycle Regimen B: Cycle 1: 4 mg/m\^2 on days 1, 5, 9, 13 and 17 of 38 day cycle Cycles 2-6: 4 mg/m\^2 on days 1 and 5 of 25 day cycle
Other Names:
• Nipent Drug: Cyclophosphamide Regimen B:Cycle 1: 200 mg/day on days 1-20 of 38 day cycle Cycles 2-4: 200 mg/day on days 1-8 of 25 day cycle
Other Names:
• Cytoxan Drug: SS1 (dsFv)PE38 Regimen B: Cycle 1: 35mcg/kg days 18, 20, and 22. Cycles 2-4: (Days 6, 8, and 10), for a maximum of six treatment cycles. | 8 |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase Drug: Pentostatin Regimen A: Cycle 1: 4 mg/m\^2 on days 1, 5 and 9 of 30 day cycle Cycles 2-4: 4 mg/m\^2 on day 1 of 21 day cycle
Other Names:
• Nipent Drug: Cyclophosphamide Regimen A:Cycle 1: 200 mg/day on days 1-12 of 30 day cycle Cycles 2-4: 200 mg/day on days 1-4 of 21 day cycle
Other Names:
• Cytoxan Drug: SS1(dsFv)PE38 Regimen A: Cycle 1: 35 mcg/kg or 25 mcg/kg days 10, 12 and 14. Cycles 2-4: Days 2, 4, and 6, for a maximum of six treatment cycles. | 7 |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase Drug: Pentostatin Regimen A: Cycle 1: 4 mg/m\^2 on days 1, 5 and 9 of 30 day cycle Cycles 2-4: 4 mg/m\^2 on day 1 of 21 day cycle
Other Names:
• Nipent Drug: Cyclophosphamide Regimen A:Cycle 1: 200 mg/day on days 1-12 of 30 day cycle Cycles 2-4: 200 mg/day on days 1-4 of 21 day cycle
Other Names:
• Cytoxan Drug: SS1(dsFv)PE38 Regimen A: Cycle 1: 35 mcg/kg or 25 mcg/kg days 10, 12 and 14. Cycles 2-4: Days 2, 4, and 6, for a maximum of six treatment cycles. | 15 |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A Drug: Pentostatin Regimen A: Cycle 1: 4 mg/m\^2 on days 1, 5 and 9 of 30 day cycle Cycles 2-4: 4 mg/m\^2 on day 1 of 21 day cycle
Other Names:
• Nipent Drug: Cyclophosphamide Regimen A:Cycle 1: 200 mg/day on days 1-12 of 30 day cycle Cycles 2-4: 200 mg/day on days 1-4 of 21 day cycle
Other Names:
• Cytoxan Drug: SS1(dsFv)PE38 Regimen A: Cycle 1: 35 mcg/kg or 25 mcg/kg days 10, 12 and 14. Cycles 2-4: Days 2, 4, and 6, for a maximum of six treatment cycles. | 4 |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A Drug: Pentostatin Regimen A: Cycle 1: 4 mg/m\^2 on days 1, 5 and 9 of 30 day cycle Cycles 2-4: 4 mg/m\^2 on day 1 of 21 day cycle
Other Names:
• Nipent Drug: Cyclophosphamide Regimen A:Cycle 1: 200 mg/day on days 1-12 of 30 day cycle Cycles 2-4: 200 mg/day on days 1-4 of 21 day cycle
Other Names:
• Cytoxan Drug: SS1(dsFv)PE38 Regimen A: Cycle 1: 35 mcg/kg or 25 mcg/kg days 10, 12 and 14. Cycles 2-4: Days 2, 4, and 6, for a maximum of six treatment cycles. | 0 |
| Total | 45 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 | FG006 |
|---|---|---|---|---|---|---|---|---|
| Dose De-escalation of Regimen A | Adverse Event | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| Dose De-escalation of Regimen A | Deveoped antibodies | 0 | 0 | 0 | 0 | 3 | 0 | 0 |
| Dose De-escalation of Regimen A | Progressive disease | 0 | 0 | 0 | 0 | 2 | 0 | 0 |
| Pilot Phase & Phase 2 | Adverse Event | 0 | 1 | 0 | 1 | 0 | 2 | 0 |
| Pilot Phase & Phase 2 | Changed treatment, too early to assess | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| Pilot Phase & Phase 2 | Complicating disease/intercurr. illness | 0 | 2 | 0 | 0 | 0 | 0 | 0 |
| Pilot Phase & Phase 2 | Death on study | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
| Pilot Phase & Phase 2 | Developed antibodies | 7 | 2 | 3 | 8 | 0 | 0 | 0 |
| Pilot Phase & Phase 2 | Physician Decision | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
| Pilot Phase & Phase 2 | Progressive disease | 1 | 2 | 2 | 3 | 0 | 2 | 0 |
| Pilot Phase & Phase 2 | Refused further treatment | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
| Pilot Phase & Phase 2 | Treatment delay >3 weeks | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
Baseline characteristics
| Characteristic | Mesothelioma Pilot Phase Regimen A | Mesothelioma Pilot Phase Regimen B | Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Total |
|---|---|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 2 Participants | 1 Participants | 1 Participants | 8 Participants | 0 Participants | 0 Participants | 12 Participants |
| Age, Categorical Between 18 and 65 years | 9 Participants | 7 Participants | 6 Participants | 7 Participants | 4 Participants | 0 Participants | 33 Participants |
| Age, Continuous | 55.27 years STANDARD_DEVIATION 7.68 | 60.55 years STANDARD_DEVIATION 16.41 | 49.91 years STANDARD_DEVIATION 16.32 | 64.21 years STANDARD_DEVIATION 7.65 | 52.53 years STANDARD_DEVIATION 6.77 | — | 56.49 years STANDARD_DEVIATION 10.97 |
| Count of Participants with a Peritoneum and Pleural Tumor Site Pancreatic | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 4 Participants | — | 4 Participants |
| Count of Participants with a Peritoneum and Pleural Tumor Site Peritoneum | 2 Participants | 1 Participants | 7 Participants | 0 Participants | 0 Participants | — | 10 Participants |
| Count of Participants with a Peritoneum and Pleural Tumor Site Pleural | 9 Participants | 7 Participants | 0 Participants | 15 Participants | 0 Participants | — | 31 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | — | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 11 Participants | 8 Participants | 7 Participants | 14 Participants | 4 Participants | — | 44 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | — | 2 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | — | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | — | 0 Participants |
| Race (NIH/OMB) White | 10 Participants | 8 Participants | 6 Participants | 14 Participants | 4 Participants | — | 42 Participants |
| Region of Enrollment United States | 11 Participants | 8 Participants | 7 Participants | 15 Participants | 4 Participants | — | 45 Participants |
| Sex: Female, Male Female | 4 Participants | 2 Participants | 2 Participants | 5 Participants | 1 Participants | — | 14 Participants |
| Sex: Female, Male Male | 7 Participants | 6 Participants | 5 Participants | 10 Participants | 3 Participants | — | 31 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk |
|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 5 / 11 | 8 / 8 | 3 / 7 | 9 / 15 | 1 / 8 | 1 / 4 | 0 / 0 |
| other Total, other adverse events | 11 / 11 | 8 / 8 | 7 / 7 | 15 / 15 | 8 / 8 | 4 / 4 | 0 / 0 |
| serious Total, serious adverse events | 6 / 11 | 8 / 8 | 3 / 7 | 9 / 15 | 1 / 8 | 1 / 4 | 0 / 0 |
Outcome results
Primary
Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide
Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.
Time frame: Date treatment consent signed to date off study, approximately 64 months and 26 days
Population: No pts. were enrolled in the Phase 2 Lung Adenocarcinoma Pilot group.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | 11 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | 8 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | 7 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | 15 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | 4 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0) Who Were Administered SS1P and Pentostatin or Cyclophosphamide | 0 Participants |
Primary
Count of Participants With SS1P Antibody Formation
Development of antibodies following treatment with SS1P. The goal was to delay development of antibodies to SS1P so a patient could get a second cycle of therapy with SS1P.
Time frame: On last day of last dosing cycle, end of cycle 1 (day 30)
Population: No pts. were enrolled in the Phase 2 Lung Adenocarcinoma Pilot group.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Count of Participants With SS1P Antibody Formation | 6 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants With SS1P Antibody Formation | 2 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants With SS1P Antibody Formation | 3 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants With SS1P Antibody Formation | 7 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants With SS1P Antibody Formation | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants With SS1P Antibody Formation | 0 Participants |
Primary
Recommended Phase 2 Dose (RP2D) in Drug Lot FIL129J01
Should any 2 patients within the first 3 to 6 patients experience treatment limiting toxicity requiring cessation of treatment prior to the conclusion of the first cycle, the maximum tolerated dose will have been exceeded and patients will be enrolled to the next lower dose.
Time frame: Days 1, 3, and 5 of a 21 day cycle
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Recommended Phase 2 Dose (RP2D) in Drug Lot FIL129J01 | 25 mcg/kg/dose |
Primary
Response Assessment
Response was assessed by the European Organization for Research and Treatment of Cancer (EORTC) modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Complete response (CR) is complete disappearance of all target lesions. Partial response (PR) is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions. Progressive disease (PD) disease is at least a 20% increase in the sum of the LD of target lesions. Stable disease (SD) is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
Time frame: 52 months and 4 days
Population: No pts. were enrolled in the Phase 2 Lung Adenocarcinoma Pilot group.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Response Assessment | Complete Response | 0 Participants |
| Mesothelioma Pilot Phase Regimen A | Response Assessment | Partial Response | 2 Participants |
| Mesothelioma Pilot Phase Regimen A | Response Assessment | Stable Disease | 5 Participants |
| Mesothelioma Pilot Phase Regimen A | Response Assessment | Progressive Disease | 3 Participants |
| Mesothelioma Pilot Phase Regimen | Response Assessment | Complete Response | 0 Participants |
| Mesothelioma Pilot Phase Regimen | Response Assessment | Progressive Disease | 1 Participants |
| Mesothelioma Pilot Phase Regimen | Response Assessment | Partial Response | 0 Participants |
| Mesothelioma Pilot Phase Regimen | Response Assessment | Stable Disease | 6 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Response Assessment | Progressive Disease | 1 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Response Assessment | Partial Response | 0 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Response Assessment | Stable Disease | 6 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Response Assessment | Complete Response | 0 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Response Assessment | Complete Response | 0 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Response Assessment | Partial Response | 0 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Response Assessment | Progressive Disease | 3 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Response Assessment | Stable Disease | 6 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Response Assessment | Progressive Disease | 2 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Response Assessment | Stable Disease | 1 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Response Assessment | Partial Response | 0 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Response Assessment | Complete Response | 0 Participants |
Secondary
Duration of Response
DOR is assessed by the European Organization for Research and Treatment of Cancer (EORTC) modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria and is measured from the time measurement criteria is met for complete response or partial response (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started). Complete response is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to\<10mm. partial response is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. Progressive disease is at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum on study LD (this includes the baseline sum if that is the smallest on study).
Time frame: up to 2.5 years
Population: In months; the only 3 responders were in group one, thus arm/groups 2-7 are not shown here.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Duration of Response | 16.3 Months |
Secondary
Overall Survival
The Kaplan-Meier was used to determine the probability of overall survival from on-study date until death or last follow-up (calculated from the date of study entry until the date of analysis).
Time frame: 36 months
Population: No pts. were enrolled in the Phase 2 Lung Adenocarcinoma Pilot group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Overall Survival | 8.9 Months |
| Mesothelioma Pilot Phase Regimen | Overall Survival | 11.2 Months |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Overall Survival | 29.3 Months |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Overall Survival | 4.2 Months |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Overall Survival | 9.3 Months |
Secondary
Progression-free Survival
Defined as the time interval from the start of treatment to documented evidence of disease progression. Progressive disease is assessed by the European Organization for Research and Treatment of Cancer (EORTC) modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and is at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum on study LD (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5mm. (Note: the appearance of one or more new lesions is also considered progression).
Time frame: 36 months
Population: No pts. were enrolled in the Phase 2 Lung Adenocarcinoma Pilot group.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Progression-free Survival | 11.8 Months |
| Mesothelioma Pilot Phase Regimen | Progression-free Survival | 8.8 Months |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Progression-free Survival | 8.9 Months |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Progression-free Survival | 3.9 Months |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Progression-free Survival | 4.4 Months |
Other Pre-specified
Count of Participants SS1P Cycles Received Following Onstudy
Here are the number of participants who had SS1P cycles during cycle 1-6.
Time frame: Cycles 1-6, up to 180 days
Population: No pts. were enrolled in the Phase 2 Lung Adenocarcinoma Pilot group.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Mesothelioma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 1 Cycle | 1 Participants |
| Mesothelioma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 2 Cycles | 8 Participants |
| Mesothelioma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 3 Cycles | 0 Participants |
| Mesothelioma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 4 Cycles | 1 Participants |
| Mesothelioma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 5 Cycles | 0 Participants |
| Mesothelioma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 6 Cycles | 1 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 2 Cycles | 0 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 4 Cycles | 1 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 6 Cycles | 0 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 1 Cycle | 3 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 3 Cycles | 3 Participants |
| Mesothelioma Pilot Phase Regimen | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 5 Cycles | 1 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 6 Cycles | 0 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 5 Cycles | 0 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 4 Cycles | 3 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 3 Cycles | 0 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 1 Cycle | 0 Participants |
| Phase 2 Peritoneal Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 2 Cycles | 4 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 4 Cycles | 0 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 2 Cycles | 8 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 3 Cycles | 1 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 6 Cycles | 0 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 5 Cycles | 1 Participants |
| Phase 2 Pleural Mesothelioma Pilot Expansion Phase | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 1 Cycle | 5 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 1 Cycle | 2 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 5 Cycles | 0 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 2 Cycles | 1 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 3 Cycles | 1 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 4 Cycles | 0 Participants |
| Phase 2 Pancreatic Adenocarcinoma Pilot Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 6 Cycles | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 4 Cycles | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 3 Cycles | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 5 Cycles | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 6 Cycles | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 2 Cycles | 0 Participants |
| Phase 2 Lung Adenocarcinoma Pilot Expansion Phase Regimen A | Count of Participants SS1P Cycles Received Following Onstudy | SS1P 1 Cycle | 0 Participants |