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    Clinical Trial Results:
    A Phase 1/2 Study of FPA008, an anti-CSF1 Receptor Antibody, in Patients with Pigmented Villonodular Synovitis (PVNS)/Diffuse Type Tenosynovial Giant Cell Tumor (dt-TGCT)

    Summary
    EudraCT number
    2015-000547-17
    Trial protocol
    NL   FR   PL  
    Global end of trial date
    30 Dec 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    02 Jun 2022
    First version publication date
    02 Jun 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    FPA008-002
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02471716
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Five Prime Therapeutics, Inc.
    Sponsor organisation address
    111 Oyster Point Boulevard, South San Francisco, CA, United States, 94080
    Public contact
    IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
    Scientific contact
    IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Dec 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Dec 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Phase 1: To determine the recommended dose (RD) of cabiralizumab in patients with PVNS/dt-TGCT. Phase 2: To estimate the objective response rate (ORR) of cabiralizumab in patients with PVNS/dt-TGCT
    Protection of trial subjects
    This study was performed in accordance with Good Clinical Practice (GCP) guidelines of the International Conference on Harmonization (ICH) and the Declaration of Helsinki (1989) and in compliance with local legal requirements. Before the start of the study, the study protocol and/or other relevant documents were approved by the Institutional Review Board/Independent Ethics Committee (IRB/IEC) and Regulatory Authorities, in accordance with local legal requirements. The Sponsor, Sponsor’s agents, and Investigator ensured that all ethical and legal requirements were met before the first patient was enrolled in the study. Written informed consent was obtained from each subject before any study procedures were undertaken.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    09 Jul 2015
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    1 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 29
    Country: Number of subjects enrolled
    Korea, Republic of: 1
    Country: Number of subjects enrolled
    Netherlands: 9
    Country: Number of subjects enrolled
    Poland: 3
    Country: Number of subjects enrolled
    United Kingdom: 1
    Country: Number of subjects enrolled
    France: 23
    Worldwide total number of subjects
    66
    EEA total number of subjects
    35
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    62
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This was a Phase 1/2 study in adults with pigmented villonodular synovitis (PVNS)/diffuse type-tenosynovial giant cell tumor (dt-TGCT). Phase 1 was a dose escalation, open-label, safety, tolerability, and pharmacokinetic (PK) study of cabiralizumab. Phase 2 was a dose expansion, open-label, efficacy study of cabiralizumab.

    Pre-assignment
    Screening details
    In Phase 1 participants were enrolled sequentially into successive dose cohorts based on assessment of dose-limiting toxicities, overall safety, and tolerability after the last patient enrolled in each cohort completed the first treatment cycle. In Phase 2, participants were enrolled at the recommended dose established during Phase 1.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg
    Arm description
    Dose escalation cohort dose level 1: 1 mg/kg cabiralizumab intravenously (IV) every 2 weeks for up to 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    Cabiralizumab
    Investigational medicinal product code
    FPA008
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cabiralizumab administered by IV infusion over approximately 30 minutes every 2 weeks.

    Arm title
    Phase 1: Cabiralizumab Dose Escalation 2 mg/kg
    Arm description
    Dose escalation cohort dose level 2: 2 mg/kg cabiralizumab IV every 2 weeks for up to 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    Cabiralizumab
    Investigational medicinal product code
    FPA008
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cabiralizumab administered by IV infusion over approximately 30 minutes every 2 weeks.

    Arm title
    Phase 1: Cabiralizumab Dose Escalation 4 mg/kg
    Arm description
    Dose escalation cohort dose level 3: 4 mg/kg cabiralizumab IV every 2 weeks for up to 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    Cabiralizumab
    Investigational medicinal product code
    FPA008
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cabiralizumab administered by IV infusion over approximately 30 minutes every 2 weeks.

    Arm title
    Phase 2: Cabiralizumab Dose Expansion Cohort 2A
    Arm description
    Dose Expansion Cohort: participants were treated with 4 mg/kg cabiralizumab IV every 2 weeks in 28-day cycles for up to 12 doses.
    Arm type
    Experimental

    Investigational medicinal product name
    Cabiralizumab
    Investigational medicinal product code
    FPA008
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cabiralizumab administered by IV infusion over approximately 30 minutes every 2 weeks.

    Arm title
    Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Arm description
    Dose Expansion Cohort: participants were treated with 4 mg/kg cabiralizumab IV on Cycle 1 Day 1 and Cycle 1 Day 15 then every 4 weeks thereafter for up to 12 months.
    Arm type
    Experimental

    Investigational medicinal product name
    Cabiralizumab
    Investigational medicinal product code
    FPA008
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cabiralizumab administered by IV infusion over approximately 30 minutes every 4 weeks.

    Number of subjects in period 1
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Started
    3
    3
    3
    33
    24
    Completed
    3
    2
    3
    18
    8
    Not completed
    0
    1
    0
    15
    16
         Study terminiated by sponsor
    -
    -
    -
    1
    -
         Consent withdrawn by subject
    -
    1
    -
    2
    5
         Death
    -
    -
    -
    1
    -
         Other
    -
    -
    -
    8
    9
         Lost to follow-up
    -
    -
    -
    3
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg
    Reporting group description
    Dose escalation cohort dose level 1: 1 mg/kg cabiralizumab intravenously (IV) every 2 weeks for up to 24 weeks.

    Reporting group title
    Phase 1: Cabiralizumab Dose Escalation 2 mg/kg
    Reporting group description
    Dose escalation cohort dose level 2: 2 mg/kg cabiralizumab IV every 2 weeks for up to 24 weeks.

    Reporting group title
    Phase 1: Cabiralizumab Dose Escalation 4 mg/kg
    Reporting group description
    Dose escalation cohort dose level 3: 4 mg/kg cabiralizumab IV every 2 weeks for up to 24 weeks.

    Reporting group title
    Phase 2: Cabiralizumab Dose Expansion Cohort 2A
    Reporting group description
    Dose Expansion Cohort: participants were treated with 4 mg/kg cabiralizumab IV every 2 weeks in 28-day cycles for up to 12 doses.

    Reporting group title
    Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Reporting group description
    Dose Expansion Cohort: participants were treated with 4 mg/kg cabiralizumab IV on Cycle 1 Day 1 and Cycle 1 Day 15 then every 4 weeks thereafter for up to 12 months.

    Reporting group values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B Total
    Number of subjects
    3 3 3 33 24 66
    Age categorical
    Units: Subjects
        < 65 years
    3 2 3 32 22 62
        ≥ 65 years
    0 1 0 1 2 4
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    37.7 ( 11.24 ) 40.7 ( 23.07 ) 41.7 ( 7.51 ) 38.0 ( 12.77 ) 44.1 ( 15.32 ) -
    Gender categorical
    Units: Subjects
        Female
    3 3 1 23 10 40
        Male
    0 0 2 10 14 26
    Race
    Units: Subjects
        American India/Alaska Native
    0 0 0 0 0 0
        Black
    0 0 0 0 2 2
        Native Hawaiian/Pacific Islander
    0 0 0 0 0 0
        White
    3 2 2 9 9 25
        Asian
    0 1 0 5 1 7
        Other
    0 0 0 19 8 27
        Unknown
    0 0 1 0 4 5

    End points

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    End points reporting groups
    Reporting group title
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg
    Reporting group description
    Dose escalation cohort dose level 1: 1 mg/kg cabiralizumab intravenously (IV) every 2 weeks for up to 24 weeks.

    Reporting group title
    Phase 1: Cabiralizumab Dose Escalation 2 mg/kg
    Reporting group description
    Dose escalation cohort dose level 2: 2 mg/kg cabiralizumab IV every 2 weeks for up to 24 weeks.

    Reporting group title
    Phase 1: Cabiralizumab Dose Escalation 4 mg/kg
    Reporting group description
    Dose escalation cohort dose level 3: 4 mg/kg cabiralizumab IV every 2 weeks for up to 24 weeks.

    Reporting group title
    Phase 2: Cabiralizumab Dose Expansion Cohort 2A
    Reporting group description
    Dose Expansion Cohort: participants were treated with 4 mg/kg cabiralizumab IV every 2 weeks in 28-day cycles for up to 12 doses.

    Reporting group title
    Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Reporting group description
    Dose Expansion Cohort: participants were treated with 4 mg/kg cabiralizumab IV on Cycle 1 Day 1 and Cycle 1 Day 15 then every 4 weeks thereafter for up to 12 months.

    Primary: Phase 1: Number of Participants with Dose-limiting Toxicities (DLTs)

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    End point title
    Phase 1: Number of Participants with Dose-limiting Toxicities (DLTs) [1] [2]
    End point description
    DLTs are defined as any Grade ≥ 3 (per Common Terminology Criteria for Adverse Events [CTCAE] version 4.03) related adverse event that occur during Cycle 1 of treatment and assessed by the Investigator with concurrence by the Cohort Review Committee (CRC) as related to cabiralizumab with the following exceptions: • In the absence of clinical symptoms and other accompanying changes in bilirubin, serum elevations of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) ≤ 12 x upper limit of normal (ULN) were not considered a DLT and serum elevations of creatinine kinase (CK) and/or lactate dehydrogenase (LDH) ≤ 15 x ULN were not considered a DLT. • In the absence of clinical symptoms and other accompanying changes in bilirubin, serum elevations of AST and/or ALT > 12 x ULN and ≤ 20 x ULN that last for ≤ 7 days were not considered a DLT and serum elevations of CK and/or LDH > 15 x ULN and ≤ 20 x ULN that last for ≤ 7 days were not considered a DLT.
    End point type
    Primary
    End point timeframe
    Cycle 1, 28 days
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Statistical analyses were not planned or conducted.
    [2] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Dose-limiting toxicities (DLTs) were analyzed during Phase 1 only.
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg
    Number of subjects analysed
    3
    3
    3
    Units: participants
    0
    0
    0
    No statistical analyses for this end point

    Primary: Phase 2: Number of Participants with Confirmed Objective Response

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    End point title
    Phase 2: Number of Participants with Confirmed Objective Response [3] [4]
    End point description
    Objective response was defined as total number of participants with Investigator-assessed confirmed objective responses of either complete response (CR) or partial response (PR) per response evaluation criteria in solid tumors (RECIST) v1.1.
    End point type
    Primary
    End point timeframe
    24 weeks for Phase 2 dose expansion cohort 2A and 52 weeks for Phase 2 dose expansion cohort 2B.
    Notes
    [3] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Statistical analyses were not planned or conducted.
    [4] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Response was analyzed in Phase 2 only.
    End point values
    Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    32 [5]
    24 [6]
    Units: participants
    8
    8
    Notes
    [5] - Efficacy-Evaluable Population
    [6] - Efficacy-Evaluable Population
    No statistical analyses for this end point

    Secondary: Maximum Observed Serum Concentration (Cmax) Following First Dose of Cabiralizumab

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    End point title
    Maximum Observed Serum Concentration (Cmax) Following First Dose of Cabiralizumab
    End point description
    End point type
    Secondary
    End point timeframe
    Day 1 predose, 15 minutes after end of infusion, and 4, 24, and 168 hours after end of infusion.
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    3 [7]
    3 [8]
    3 [9]
    30 [10]
    24 [11]
    Units: μg/mL
        geometric mean (geometric coefficient of variation)
    22.494 ( 14.289 )
    52.056 ( 22.036 )
    91.218 ( 15.005 )
    91.801 ( 24.803 )
    86.995 ( 12.553 )
    Notes
    [7] - PK-Evaluable Population
    [8] - PK-Evaluable Population
    [9] - PK-Evaluable Population
    [10] - PK-Evaluable Population
    [11] - PK-Evaluable Population
    No statistical analyses for this end point

    Secondary: Area Under the Serum Concentration-time Curve During the Dosing Interval (AUC0-tau) After First of Cabiralizumab

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    End point title
    Area Under the Serum Concentration-time Curve During the Dosing Interval (AUC0-tau) After First of Cabiralizumab
    End point description
    End point type
    Secondary
    End point timeframe
    Day 1 predose, 15 minutes after the end of infusion, and 4, 24, and 168 hours after the end of infusion.
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    3
    3
    3
    28
    23
    Units: μg*day/mL
        geometric mean (geometric coefficient of variation)
    102 ( 10.2 )
    283 ( 26.3 )
    593 ( 31.3 )
    660 ( 17.7 )
    593 ( 12.6 )
    No statistical analyses for this end point

    Secondary: Minimum Observed Serum Concentration (Cmin) Following First Dose of Cabiralizumab

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    End point title
    Minimum Observed Serum Concentration (Cmin) Following First Dose of Cabiralizumab
    End point description
    End point type
    Secondary
    End point timeframe
    Day 1 at 15 minutes after end of infusion, and 4, 24, and 168 hours after end of infusion.
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    3
    3
    3
    30
    24
    Units: μg/mL
        geometric mean (geometric coefficient of variation)
    2.18 ( 117 )
    7.26 ( 41.8 )
    21.2 ( 59.2 )
    23.9 ( 38.3 )
    22.6 ( 28.2 )
    No statistical analyses for this end point

    Secondary: Number of Participants with Adverse Events

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    End point title
    Number of Participants with Adverse Events
    End point description
    End point type
    Secondary
    End point timeframe
    From first dose of study drug up to 90 days after last dose; the median (min, max) duration of treatment in Phase 1 was 158 (15, 225) days and in Phase 2 was 127 (1, 365) days.
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    3
    3
    3
    33
    24
    Units: participants
    3
    3
    3
    33
    24
    No statistical analyses for this end point

    Secondary: Number of Participants with Clinical Laboratory Abnormalities

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    End point title
    Number of Participants with Clinical Laboratory Abnormalities
    End point description
    The number of participants with a clinical laboratory result that was outside the normal range at some time point during the study.
    End point type
    Secondary
    End point timeframe
    52 weeks
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    3
    3
    3
    33
    24
    Units: participants
    3
    3
    3
    33
    24
    No statistical analyses for this end point

    Secondary: Number of Participants with Electrocardiogram Abnormalities

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    End point title
    Number of Participants with Electrocardiogram Abnormalities
    End point description
    End point type
    Secondary
    End point timeframe
    ECG was performed post-dose on Day 15 for all cycles, and at the 30 days End of Treatment Follow-up Visit.
    End point values
    Phase 1: Cabiralizumab Dose Escalation 1 mg/kg Phase 1: Cabiralizumab Dose Escalation 2 mg/kg Phase 1: Cabiralizumab Dose Escalation 4 mg/kg Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    3
    3
    3
    33
    24
    Units: participants
    0
    0
    0
    0
    0
    No statistical analyses for this end point

    Secondary: Phase 2: Duration of Response

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    End point title
    Phase 2: Duration of Response [12]
    End point description
    Duration of response (DOR) was calculated as the time from the first documentation of confirmed objective response (CR or PR) per RECUST v 1.1 to the first objective documentation of progressive disease (PD) or to death due to any cause in the absence of documented PD. The Kaplan-Meier method was used to estimate DOR, and 2-sided 95% CI calculated based on the Brookmeyer and Crowley method. "99999" indicates values that could not be estimated.
    End point type
    Secondary
    End point timeframe
    Up to 14 months
    Notes
    [12] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Duration of response was analyzed for Phase 2 only.
    End point values
    Phase 2: Cabiralizumab Dose Expansion Cohort 2A Phase 2: Cabiralizumab Dose Expansion Cohort 2B
    Number of subjects analysed
    8 [13]
    8 [14]
    Units: months
        median (confidence interval 95%)
    4.4 (3.2 to 99999)
    99999 (11.5 to 99999)
    Notes
    [13] - Confirmed responders
    [14] - Confirmed responders
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose of study drug up to 90 days after last dose; the median (min, max) duration of treatment in Phase 1 was 158 (15, 225) days and in Phase 2 was 127 (1, 365) days.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.0
    Reporting groups
    Reporting group title
    Phase 1 2 mg/kg
    Reporting group description
    -

    Reporting group title
    Phase 1 1 mg/kg
    Reporting group description
    -

    Reporting group title
    Phase 2 Cohort 2A
    Reporting group description
    -

    Reporting group title
    Phase 2 Cohort 2B
    Reporting group description
    -

    Reporting group title
    Phase 1 4 mg/kg
    Reporting group description
    -

    Serious adverse events
    Phase 1 2 mg/kg Phase 1 1 mg/kg Phase 2 Cohort 2A Phase 2 Cohort 2B Phase 1 4 mg/kg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    8 / 33 (24.24%)
    6 / 24 (25.00%)
    2 / 3 (66.67%)
         number of deaths (all causes)
    0
    0
    1
    0
    0
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Sarcoma
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    Congenital, familial and genetic disorders
    Twin reversed arterial perfusion sequence malformation
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Myocarditis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebellar infarction
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Migraine
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Influenza like illness
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Systemic inflammatory response syndrome
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain lower
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Diverticulum
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Menorrhagia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholelithiasis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Drug-induced liver injury
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    7 / 7
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Dermatitis exfoliative
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Skin atrophy
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Systemic lupus erythematosus
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Endocarditis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Intervertebral discitis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Lobar pneumonia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Streptococcal sepsis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Phase 1 2 mg/kg Phase 1 1 mg/kg Phase 2 Cohort 2A Phase 2 Cohort 2B Phase 1 4 mg/kg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    3 / 3 (100.00%)
    3 / 3 (100.00%)
    33 / 33 (100.00%)
    24 / 24 (100.00%)
    3 / 3 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumour pain
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    1
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    5
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    7 / 33 (21.21%)
    5 / 24 (20.83%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    7
    7
    0
    Face oedema
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    22 / 33 (66.67%)
    12 / 24 (50.00%)
    2 / 3 (66.67%)
         occurrences all number
    1
    0
    33
    21
    3
    Fatigue
         subjects affected / exposed
    1 / 3 (33.33%)
    2 / 3 (66.67%)
    11 / 33 (33.33%)
    8 / 24 (33.33%)
    3 / 3 (100.00%)
         occurrences all number
    1
    2
    17
    10
    6
    Localised oedema
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    1 / 33 (3.03%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    1
    1
    0
    Oedema
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    3
    0
    Oedema peripheral
         subjects affected / exposed
    1 / 3 (33.33%)
    2 / 3 (66.67%)
    19 / 33 (57.58%)
    8 / 24 (33.33%)
    2 / 3 (66.67%)
         occurrences all number
    1
    4
    36
    13
    4
    Pain
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Peripheral swelling
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    1
    3
    0
    Pyrexia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    5 / 33 (15.15%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    7
    1
    0
    Reproductive system and breast disorders
    Menstruation irregular
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Pelvic pain
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    2
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    1
    0
    Dysphonia
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    2
    0
    0
    Dyspnoea
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    4 / 33 (12.12%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    5
    2
    0
    Rhinorrhoea
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    2
    0
    Insomnia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    2
    0
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    6 / 33 (18.18%)
    0 / 24 (0.00%)
    2 / 3 (66.67%)
         occurrences all number
    0
    0
    9
    0
    3
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    10 / 33 (30.30%)
    3 / 24 (12.50%)
    2 / 3 (66.67%)
         occurrences all number
    0
    0
    14
    3
    6
    Blood alkaline phosphatase increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Blood bilirubin increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    0
    0
    Blood cholesterol increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    4 / 33 (12.12%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    4
    0
    0
    Blood creatine phosphokinase increased
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    21 / 33 (63.64%)
    16 / 24 (66.67%)
    3 / 3 (100.00%)
         occurrences all number
    1
    0
    49
    41
    10
    Blood lactate dehydrogenase increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    4 / 33 (12.12%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    5
    3
    0
    Weight increased
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    3
    3
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    3
    0
    Headache
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    7 / 33 (21.21%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    11
    3
    0
    Hypoaesthesia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    1
    0
    Neuropathy peripheral
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    0
    0
    Paraesthesia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    5 / 33 (15.15%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    5
    2
    0
    Sciatica
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    1
    0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    5
    0
    0
    Eye disorders
    Conjunctival hyperaemia
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    0
    1
    0
    Conjunctival oedema
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    Dry eye
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    3
    1
    1
    Eyelid oedema
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    6 / 33 (18.18%)
    7 / 24 (29.17%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    7
    9
    1
    Eyelid rash
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    1
    0
    Lacrimation increased
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    4 / 33 (12.12%)
    5 / 24 (20.83%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    4
    6
    1
    Periorbital oedema
         subjects affected / exposed
    2 / 3 (66.67%)
    2 / 3 (66.67%)
    20 / 33 (60.61%)
    13 / 24 (54.17%)
    2 / 3 (66.67%)
         occurrences all number
    2
    4
    42
    27
    6
    Photophobia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Scleritis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    0
    0
    Vision blurred
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    5 / 24 (20.83%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    5
    5
    0
    Gastrointestinal disorders
    Abdominal discomfort
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Abdominal pain
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    6
    0
    0
    Abdominal pain upper
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    2
    0
    Constipation
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    1 / 24 (4.17%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    1
    1
    1
    Diarrhoea
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    3 / 33 (9.09%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    4
    1
    0
    Lip oedema
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Nausea
         subjects affected / exposed
    0 / 3 (0.00%)
    2 / 3 (66.67%)
    5 / 33 (15.15%)
    3 / 24 (12.50%)
    1 / 3 (33.33%)
         occurrences all number
    0
    2
    5
    3
    2
    Salivary hypersecretion
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    Stomatitis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    1
    Vomiting
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    4 / 33 (12.12%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    4
    3
    0
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    0 / 3 (0.00%)
    2 / 3 (66.67%)
    0 / 33 (0.00%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    2
    0
    0
    0
    Dermatitis acneiform
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    7
    0
    0
    Dry skin
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    4 / 24 (16.67%)
    2 / 3 (66.67%)
         occurrences all number
    1
    0
    2
    4
    2
    Erythema
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    5 / 33 (15.15%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    8
    1
    0
    Pruritus
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    17 / 33 (51.52%)
    13 / 24 (54.17%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    41
    17
    0
    Pruritus generalised
         subjects affected / exposed
    1 / 3 (33.33%)
    1 / 3 (33.33%)
    5 / 33 (15.15%)
    1 / 24 (4.17%)
    1 / 3 (33.33%)
         occurrences all number
    1
    1
    8
    1
    1
    Rash
         subjects affected / exposed
    1 / 3 (33.33%)
    1 / 3 (33.33%)
    11 / 33 (33.33%)
    10 / 24 (41.67%)
    0 / 3 (0.00%)
         occurrences all number
    1
    2
    14
    18
    0
    Rash erythematous
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    7
    1
    0
    Rash generalised
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    4
    0
    Rash maculo-papular
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    8 / 33 (24.24%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    16
    2
    0
    Rash pruritic
         subjects affected / exposed
    0 / 3 (0.00%)
    1 / 3 (33.33%)
    5 / 33 (15.15%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    6
    7
    3
    0
    Skin atrophy
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    3
    0
    Skin disorder
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    4 / 33 (12.12%)
    5 / 24 (20.83%)
    2 / 3 (66.67%)
         occurrences all number
    0
    0
    5
    6
    4
    Skin exfoliation
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 33 (0.00%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    3
    0
    Skin lesion
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    1
    0
    Urticaria
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    4
    0
    1
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    3 / 33 (9.09%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    5
    1
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    10 / 33 (30.30%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    17
    3
    0
    Arthritis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    1
    0
    Joint swelling
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    2 / 24 (8.33%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    3
    0
    Muscle spasms
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    1
    0
    Musculoskeletal pain
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    4
    0
    0
    Myalgia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    3 / 24 (12.50%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    2
    4
    1
    Infections and infestations
    Conjunctivitis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    3 / 24 (12.50%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    3
    0
    Ear infection
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Oral candidiasis
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    1
    0
    Urinary tract infection
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    1
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Hypercholesterolaemia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    7 / 33 (21.21%)
    1 / 24 (4.17%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    11
    1
    0
    Hyperglycaemia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    Hypoglycaemia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    4
    0
    0
    Hypokalaemia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    1
    0
    1
    Hypophosphataemia
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    2 / 33 (6.06%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    3
    0
    0
    Increased appetite
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    1 / 33 (3.03%)
    0 / 24 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Apr 2015
    Revisions included: •Eligibility criterion revised to clarify how patients would be characterized as having ‘inoperable tumors’ or ‘potentially resectable tumors’ that would result in unacceptable functional loss; determination by a qualified surgeon or multi-disciplinary tumor board to be documented in the CRF at screening. •Added requirement that patients in Phase 1 who developed a DLT during DLT assessment period be discontinued from study treatment. Patients with a DLT after Cycle 1 could continue on study treatment with appropriate dose modification, safety monitoring, and follow-up. •Disallowed intra-patient dose escalation. •Clarified that patients could re-escalate the dose following resolution of an AE, but recurrence of that AE would result in permanent dose reduction. •Clarified that patients who were no longer experiencing clinical benefit must be taken off study treatment. •Removal of drug holidays of 3 months to have planned Treatment Period of 6 cycles only. •To evaluate the duration of FPA008 effect after discontinuation of the treatment, a follow-Up Visit was added for patients who had not progressed at Treatment Completion/Early Termination and agreed to continue participation in the study. •The formatting for ALT, AST, and CPK elevation was revised to clarify that the rules for dose modification in Table 3 were not intended to address ALT, AST, and CK. •The protocol was revised to require a dose reduction by 25% for Grade 3 AEs following recovery to baseline or Grade 1 with the intent of enhancing the safety margin. •Addition of testing for anti-nuclear antibodies at Screening and Treatment Completion/Early Termination Visits to address FDA reviewer comments. •PK parameters of AUC0-last, observed Cmax, observed, Cmin (trough concentration) CL, and Vss were changed to AUC, Cmax, Cmin, CL Vss to generalize the PK parameter estimation. • Immunohistochemistry (IHC) testing for CD163, T cell markers, and Ki67 removed for consistency.
    29 Jun 2015
    Revisions included the following: • Retinal findings from the secondary endpoints were removed as it was not a secondary endpoint for this study. • Administrative changes for consistency throughout protocol. • Revision of End-of-Treatment Follow-Up Period for all patients, to follow all patients for at least 90 days following the last dose to assess safety while the antibody was cleared from the body. • Number of study centers updated to include an additional study site. • Addition of ‘prothrombin time’ and clarified reflex testing for CPK isoenzyme if CPK was elevated for clarification of the coagulation and clinical chemistry tests.
    09 Jun 2016
    Revisions included the following: • Included latest available safety and pharmacology data from studies with FPA008. • Added risk/benefit language regarding elevation of serum enzymes. • Added “selected serum markers” that could have relevance in PVNS to exploratory PD evaluation. • Added Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numerical Pain Rating Scale (NPRS) as additional measurements of functional outcome. • Added language to allow exploration of alternative dose levels beyond those defined in the protocol after the RD was declared. • Added language to allow modification of RD in Phase 2. • Added Re-treatment Cohort to allow for collection and further exploration of safety, efficacy, PK, and PD in patients who had previously received treatment and completed the 90 day EOT Follow-Up Period. • Updated the eligibility criteria to allow re-treatment of patients who had received FPA008 at lower doses than the RD and to exclude patients with metastatic disease. • Added assessment of synovium by in situ hybridization (ISH) to evaluate samples for the presence of CSF1, CSF1R, and CD68 (macrophage marker). • Added PET scans as an evaluation procedure to provide further information on clinical assessment of disease. • Updated study schema to reflect addition of re-treatment cohort. • Added language for the modification of DLT criteria so as to provide background and rationale related to the elevation of AST, ALT, CK, and LDH. • Updated the number of study centers participating in the study to 11. • Updated dose modification guidelines in the event of ALT, AST, CPK and LDH elevations. • Removed language regarding timing of assessment of health outcomes. • Added language regarding removal of patients who become pregnant and timing of ECOG evaluation. • Added window for collection of vital signs. • Updated language regarding analysis of data. • Updated approximate enrollment numbers for Phase 2. • Updated 95% CI boundaries.
    24 Aug 2016
    Revisions included the following: • Protocol updated to include Baseline, Cycle Day 15 patient reported outcomes (PROs) and change in PRO timing to prior to infusion (not after) for typo correction and to align with schedule of assessments. • Additional PET scan at Cycle 3 Day 1 (± 7days) for subgroup of 10 patients who underwent PET scan to account for the fact that change in SUV by PET might be observed earlier than changes in tumor volume by MRI. • Dose modification criterion for AST, ALT, Total Bilirubin level updated to allow patients who had moderate elevation of liver test abnormalities which resolved within 28 days to resume dosing of FPA008 at either full dose (4 mg) or one dose level lower (2 mg) after discussion with medical monitor. • Dose modification criterion for CPK and LDH updated to allow patients who had moderate elevation of CPK abnormalities which resolved within 28 days to resume dosing of FPA008 at either full dose (4 mg) or one dose level lower (2 mg) after discussion with medical monitor. • Protocol was updated to remove PRO and clinical outcomes of EQ-5D-5L, Numeric Pain Rating Scale, and Western Ontario McMasters University Osteoarthritis Index. Protocol was updated to add the Brief Pain Inventory and a Joint Stiffness Numeric Rating Scale as the chosen PROs were more specific to PVNS and/or were less burdensome to patients. • Minor updates for clarifications and for consistency throughout the protocol.
    01 Sep 2017
    Revisions included: • FPA008 replaced with cabiralizumab throughout and product description updated. • Included information regarding serum enzyme elevation seen across cabiralizumab studies. • Addition of study objective to determine the change in analgesic medication use while receiving cabiralizumab. • Clarified that the primary endpoint for Phase 2 was Investigator-assessed, not centrally reviewed. • Exploratory endpoints updated to include ORR by tumor volume score, add language indicating that Ogilvie-Harris was only to be assessed for patients in Cohort 2A, add EQ-5D-5L, Global Impression Scales, PVNS-SSAF, PROMISE_PF, and range of motion measurement. • Phase 2 was updated to include Cohort 2B with 4-week dosing regimen. • Re-treatment Cohort was deleted as patients were to be included as part of the original Phase 2, not as a separate cohort. • Addition of language stating AE and SAE to be collected through 90 days post-treatment or when another PNVS treatment was initiated. • Addition of Ogilvie-Harris, Brief Pain Inventory, and Joint Stiffness Numeric Rating Scale, and the timing of these assessment for patients in Cohort 2A. Clarified that PET were no longer required for patients on study as the number of patients required with PET scan had been met • Study schema separated into 2 phases and Phase 2 schema updated to include Cohort 2B. • Updated total number of patients to account for Cohort 2B. • Two new inclusion criteria added to reflect the addition of evaluation of pain measurement. • Exclusion criteria updated to allow prior antibody-treated and prior small molecule-treated patients with an appropriate washout; to allow consideration for other ingredient to which patients were intolerable; to allow to allow additional options for TB testing; to add CPK exclusion, add anti-nuclear antibody (ANA) exclusion and exclude patients with autoimmune disease. • Dose modification criteria updated. • Tumor response parameters were updated.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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