Clinical Trial Results:
An Open-label, Multicenter Phase 1a/2a Trial Investigating the Safety, Tolerability and Antitumor Activity of Multiple Doses of Sym015, a Monoclonal Antibody Mixture Targeting MET, in Patients with Advanced Solid Tumor Malignancies
Summary
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EudraCT number |
2016-003912-11 |
Trial protocol |
DK ES |
Global end of trial date |
17 Dec 2020
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Results information
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Results version number |
v1(current) |
This version publication date |
16 Jul 2022
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First version publication date |
16 Jul 2022
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Other versions |
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Summary report(s) |
CSR Synopsis and Conclusions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
Sym015-01
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT02648724 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Symphogen A/S
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Sponsor organisation address |
Pederstrupvej 93, Ballerup, Denmark,
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Public contact |
Ulla H Hansen, Symphogen A/S, +45 45265050, uhh@symphogen.com
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Scientific contact |
Ulla H Hansen, Symphogen A/S, +45 45265050, uhh@symphogen.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
07 Jun 2021
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
17 Dec 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
17 Dec 2020
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To evaluate the antitumor activity of Sym015 when administered at the Q2W RP2D to patients with MET-amplified, KRAS WT solid tumor malignancies without available therapeutic options.
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Protection of trial subjects |
After EOT, patients continued to be followed for safety until 1 month (30+7 days) after the last dose of Sym015, when the 1-Month Follow-up (1M FUP) Visit was completed.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
01 Mar 2017
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Denmark: 2
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Country: Number of subjects enrolled |
Spain: 11
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Country: Number of subjects enrolled |
United States: 29
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Country: Number of subjects enrolled |
Korea, Republic of: 14
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Country: Number of subjects enrolled |
Taiwan: 1
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Worldwide total number of subjects |
57
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EEA total number of subjects |
13
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
34
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From 65 to 84 years |
15
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85 years and over |
8
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Recruitment
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Recruitment details |
- | |||||||||||||||||||||||||||||||||
Pre-assignment
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Screening details |
Screening assessment (D-14 to D-1) included demographics, medical history, tumour history, physical examination, urinalysis, disease assessment as mutation status, extent of disease, prior anti-cancer treatment, etc. | |||||||||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||||||||||||||
Allocation method |
Non-randomised - controlled
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Blinding used |
Not blinded | |||||||||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Part 1: Dose-Escalation | |||||||||||||||||||||||||||||||||
Arm description |
Sym015 was tested in four dose titration cohorts. A substitute or an additional dose level could potentially be evaluated. | |||||||||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Sym015
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Sym015 solution administered as IV infusion at dose levels of 6 mg/kg, 12 mg/kg, 18 mg/kg or 24 mg/kg
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Arm title
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Part 2: Dose-Expansion | |||||||||||||||||||||||||||||||||
Arm description |
Comprises 3 Cohorts: - Basket Cohort [n=25]: Patients with KRAS proto-oncogene wild-type (KRAS WT) advanced solid tumor malignancies with MET-amplification received Sym015 at the recommended Phase 2 dose. Included in this group was a subset of patients who received prior therapy with a MET-targeting tyrosine kinase inhibitor (TKI). - NSCLC MET- Amplified Cohort [n=8]: Patients with advanced NSCLC with MET-amplification were to receive Sym015 at the RP2D. Patients may have received prior therapy with METtargeting and/or EGFR-targeting agents. - NSCLC METex14del Cohort [n=12]: Patients with advanced NSCLC with METex14del were to receive Sym015 at the RP2D. Tumors need not be MET-amplified, and patients may have received prior therapy with MET-targeting and/or EGFR-targeting agents. | |||||||||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Sym015
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Sym015 solution administered as IV infusion
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Baseline characteristics reporting groups
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Reporting group title |
Part 1: Dose-Escalation
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Reporting group description |
Sym015 was tested in four dose titration cohorts. A substitute or an additional dose level could potentially be evaluated. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Part 2: Dose-Expansion
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Reporting group description |
Comprises 3 Cohorts: - Basket Cohort [n=25]: Patients with KRAS proto-oncogene wild-type (KRAS WT) advanced solid tumor malignancies with MET-amplification received Sym015 at the recommended Phase 2 dose. Included in this group was a subset of patients who received prior therapy with a MET-targeting tyrosine kinase inhibitor (TKI). - NSCLC MET- Amplified Cohort [n=8]: Patients with advanced NSCLC with MET-amplification were to receive Sym015 at the RP2D. Patients may have received prior therapy with METtargeting and/or EGFR-targeting agents. - NSCLC METex14del Cohort [n=12]: Patients with advanced NSCLC with METex14del were to receive Sym015 at the RP2D. Tumors need not be MET-amplified, and patients may have received prior therapy with MET-targeting and/or EGFR-targeting agents. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Part 1: Dose-Escalation
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Reporting group description |
Sym015 was tested in four dose titration cohorts. A substitute or an additional dose level could potentially be evaluated. | ||
Reporting group title |
Part 2: Dose-Expansion
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Reporting group description |
Comprises 3 Cohorts: - Basket Cohort [n=25]: Patients with KRAS proto-oncogene wild-type (KRAS WT) advanced solid tumor malignancies with MET-amplification received Sym015 at the recommended Phase 2 dose. Included in this group was a subset of patients who received prior therapy with a MET-targeting tyrosine kinase inhibitor (TKI). - NSCLC MET- Amplified Cohort [n=8]: Patients with advanced NSCLC with MET-amplification were to receive Sym015 at the RP2D. Patients may have received prior therapy with METtargeting and/or EGFR-targeting agents. - NSCLC METex14del Cohort [n=12]: Patients with advanced NSCLC with METex14del were to receive Sym015 at the RP2D. Tumors need not be MET-amplified, and patients may have received prior therapy with MET-targeting and/or EGFR-targeting agents. | ||
Subject analysis set title |
Part 2: Basket Cohort
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Part 2: Basket Cohort - Patients with KRAS proto-oncogene wild-type (KRAS WT) advanced solid tumor malignancies with MET-amplification received Sym015 at the recommended Phase 2 dose. Included in this group was a subset of patients who received prior therapy with a MET-targeting tyrosine kinase inhibitor (TKI).
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Subject analysis set title |
Part 2: Patients in NSCLC MET-Amplified Cohort
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
NSCLC MET- Amplified Cohort: Patients with advanced NSCLC with MET-amplification were to receive Sym015 at the RP2D. Patients may have received prior therapy with METtargeting and/or EGFRtargeting agents.
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Subject analysis set title |
Part 2: Patients in NSCLC METex14Del Cohorot
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Part2: NSCLC METex14del Cohort: Patients with advanced NSCLC with METex14del were to receive Sym015 at the RP2D. Tumors need not be MET-amplified, and patients may have received prior therapy with MET-targeting and/or EGFR-targeting agents.
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Subject analysis set title |
Part 1: 6 mg/kg
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Cohort of subjects receiving a dose of 6 mg/kg of Sym015 administered by intravenous infusion Q2W. Q2W = every second week
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Subject analysis set title |
Part 1: 12 mg/kg
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Cohort of subjects receiving a dose of 12 mg/kg of Sym015 administered by intravenous infusion Q2W. Q2W = every second week
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Subject analysis set title |
Part 1: 18 mg/kg
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Cohort of subjects receiving a dose of 18 mg/kg of Sym015 administered by intravenous infusion Q2W. Q2W = every second week
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Subject analysis set title |
Part 1: 24 mg/kg
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Cohort of subjects receiving a dose of 24 mg/kg of Sym015 administered by intravenous infusion Q2W. Q2W = every second week
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Subject analysis set title |
Part 2: Basket Cohort, with prior MET-targeting TKI therapy
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Patients in Basket Cohort, with prior MET-targeting TKI therapy. MET = MET proto-oncogene tyrosine kinase, hepatocyte growth factor receptor. TKI = tyrosine kinase inhibitor.
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Subject analysis set title |
Part 2: Basket Cohort, without prior MET-targeting TKI therapy
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Patients in Basket Cohort, without prior MET-targeting TKI therapy. MET = MET proto-oncogene tyrosine kinase, hepatocyte growth factor receptor. TKI = tyrosine kinase inhibitor.
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End point title |
Primary Endpoint - Part 1 [1] [2] | ||||||
End point description |
Occurrence of DLTs During Cycle 1 of Sym015 Administration:
The primary objective of Part 1 was to assess the safety and tolerability of Sym015 on a Q2W schedule. This was assessed by evaluating the occurrence of dose-limiting toxicities (DLTs) during Cycle 1 of Sym015 administration. Q2W = every second week.
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End point type |
Primary
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End point timeframe |
Cycle 1, the initial 28-day period of Q2W dosing
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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: There are no statistical analyses provided, as there were no occurrences recorded. [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: There were no statistical analyses for this endpoint |
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No statistical analyses for this end point |
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End point title |
Primary Endpoint - Part 2 [3] | ||||||||||||
End point description |
Documented, Confirmed Objective Response (OR):
The primary objective of Part 2 was to evaluate the antitumor activity of Sym015 when administered at the Q2W RP2D to patients in the different cohorts. Documented OR was defined as a partial response [PR] or complete response [CR], as assessed by the Response Evaluation Criteria in Solid Tumours (RECIST) v1.1 at any time during trial participation by Investigator assessment.
Q2W - every second week; RP2D = recommended phase 2 dose
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End point type |
Primary
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End point timeframe |
24 months
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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: There were no statistical analyses for this endpoint |
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 1 [4] | ||||||||
End point description |
Determine a Q2W RP2D of Sym015
Determination based on an evaluation of the patient data for DLTs from Part1. (Q2W = every second week, RP2D = recommended phase 2 dose).
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End point type |
Secondary
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End point timeframe |
12 Months
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Notes [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: There were no statistical analyses for this endpoint |
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Notes [5] - It was not possible to determine this endpoint as no DLTs were observed. |
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 1 (immunogenicity) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
Immunogenicity of Sym015: Part 1
Serum sampling was done to assess the potential for anti-drug (ADA) formation
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End point type |
Secondary
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End point timeframe |
Cycle 1: Day (D) 1
Cycle 3, 5, 7: D1 (+-2)
End of treatment: at or by D10
Follow-up: 1 month after the last dose of study treatment (30+7D)
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 2 (immunogenicity) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
Immunogenicity of Sym015: Part 2
Serum sampling was done to assess the potential for anti-drug antibody (ADA) formation
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End point type |
Secondary
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End point timeframe |
Cycle 1: Day (D) 1
Cycle 2, 3, 5, 7: D1 (+-2)
End of treatment: At or by D10
Follow-up: 1 month after last does of study treatment (30+7D)
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 1 (AUC) | ||||||||||||||||||||
End point description |
Part 1: Area Under the Concentration-time Curve in a Dosing Interval (AUC) Following 1st Dose
Estimated using non-compartmental methods and actual time points following the first dose of Sym015.
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End point type |
Secondary
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End point timeframe |
From time zero to 48 hours after dosing. Samples taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 2 (AUC) [6] | ||||||||
End point description |
Part 2: Area Under the COncentration-time Curve in a Dosing Interval (AUC)
Estimated using non-compartmental methods and actual time points following the first dose of Sym015 for the whole basket cohort.
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End point type |
Secondary
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End point timeframe |
From time zero to 48 hours after doing. Sample taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
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Notes [6] - 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: There were no statistical analyses for this endpoint |
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 1 (Cmax) | ||||||||||||||||||||
End point description |
Part 1: C max
Maximum serum concentration was derived from observed data.
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End point type |
Secondary
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End point timeframe |
From time zero to 48 hours after dosing. Samples were taken pre-dosing and at 1, 2, 4, 8, 24, and 48 hours after the end of infusion.
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 2 (Cmax) [7] | ||||||||
End point description |
Part 2: C max
Maximum serum concentration was derived from observed data following the first dose of Sym015 for the full basket cohort.
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End point type |
Secondary
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End point timeframe |
From time zero to 48 hours after dosing. Samples were taken pre-dosing, and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
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Notes [7] - 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: There were no statistical analyses for this endpoint |
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 1 (Tmax) | ||||||||||||||||||||
End point description |
Part 1: Time to Reach Maximum Concentration (Tmax)
Time to reach maximum concentration (Tmax) was derived from observed data.
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End point type |
Secondary
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End point timeframe |
From time zero to 48 hours after dosing. Samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 2 (Tmax) [8] | ||||||||
End point description |
Part 2: Time to Reach Maximum Concentration (Tmax)
Time to reach maximum concentration (Tmax) was derived from observed data following the first dose of Sym015 for the full basket cohort.
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End point type |
Secondary
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End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
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Notes [8] - 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: There were no statistical analyses for this endpoint |
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No statistical analyses for this end point |
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End point title |
Secondary Endpoint - Part 1 (Ctrough) | ||||||||||||||||||||
End point description |
Part 1: Trough Concentration (Ctrough)
Ctrough was derived from observed data.
|
||||||||||||||||||||
End point type |
Secondary
|
||||||||||||||||||||
End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
|
||||||||||||||||||||
|
|||||||||||||||||||||
No statistical analyses for this end point |
|
|||||||||
End point title |
Secondary Endpoint - Part 2 (Ctrough) [9] | ||||||||
End point description |
Part 2: Trough Concentration (Ctrough)
Ctrough was derived from observed data following the first dose of Sym015 for the whole basket cohort.
|
||||||||
End point type |
Secondary
|
||||||||
End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
|
||||||||
Notes [9] - 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: There were no statistical analyses for this endpoint |
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|
|||||||||
No statistical analyses for this end point |
|
|||||||||||||||||||||
End point title |
Secondary Endpoint - Part 1 (T½) | ||||||||||||||||||||
End point description |
Part 1: Elimination Half-life (T½)
Estimated using non-compartmental methods and actual time points.
|
||||||||||||||||||||
End point type |
Secondary
|
||||||||||||||||||||
End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
|
||||||||||||||||||||
|
|||||||||||||||||||||
No statistical analyses for this end point |
|
|||||||||
End point title |
Secondary Endpoint - Part 2 (T½) [10] | ||||||||
End point description |
Part 2: Elimination Half-life (T½)
Estimated using non-compartmental methods and actual time points following the first dose of Sym015 for the whole basket cohort.
|
||||||||
End point type |
Secondary
|
||||||||
End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
|
||||||||
Notes [10] - 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: There were no statistical analyses for this endpoint |
|||||||||
|
|||||||||
No statistical analyses for this end point |
|
|||||||||||||||||||||
End point title |
Secondary Endpoint - Part 1 (CL) | ||||||||||||||||||||
End point description |
Part 1: Clearance (CL)
Estimated using non-compartmental methods and actual time points.
|
||||||||||||||||||||
End point type |
Secondary
|
||||||||||||||||||||
End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
|
||||||||||||||||||||
|
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Notes [11] - None evaluated [12] - None evaluated |
|||||||||||||||||||||
No statistical analyses for this end point |
|
|||||||||
End point title |
Secondary Endpoint - Part 2 (CL) [13] | ||||||||
End point description |
Part 2: Clearance (CL)
Estimated using non-compartmental methods and actual time points following the first dose of Sym015 for the whole basket cohort.
|
||||||||
End point type |
Secondary
|
||||||||
End point timeframe |
From time zero to 48 hours after dosing. The samples were taken pre-dosing and at 1, 2, 4, 8, 24 and 48 hours after end of infusion.
|
||||||||
Notes [13] - 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: There were no statistical analyses for this endpoint |
|||||||||
|
|||||||||
No statistical analyses for this end point |
|
||||||||||
End point title |
Secondary Endpoint - Part 2 (additional preliminary evaluation of antitumour activity, assessed by OR) | |||||||||
End point description |
Part 2: Additional Preliminary Evaluation of the Antitumor Activity of Sym015 When Administered at the Q2W RP2D in a Subset of Patients. Assessed by OR
This applies to the subset of patients in the Basket Cohort who received prior therapy with a MET-targeting TKI. Documented OR (defined as PR or CR), assessed by RECIST v1.1 at any time during trial participation by Investigator assessment.
Objective Response (OR) is presented. Documented OR was defined as partial response [PR] or complete response [CR]) as assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 at any time during trial participation by Investigator assessment.
|
|||||||||
End point type |
Secondary
|
|||||||||
End point timeframe |
24 months
|
|||||||||
|
||||||||||
No statistical analyses for this end point |
|
||||||||||
End point title |
Secondary Endpoint - Part 2 (additional preliminary evaluation of antitumour activity, assessed by DCR | |||||||||
End point description |
Part 2: Additional Preliminary Evaluation of the Antitumor Activity of Sym015 When Administered at the Q2W RP2D in a Subset of Patients. Assessed by DCR.
This applies to the subset of patients in the Basket Cohort who received prior therapy with a MET-targeting TKI. Documented OR (defined as PR or CR), assessed by RECIST v1.1 at any time during trial participation by Investigator assessment.
Disease control rate (DCR) is presented. The DCR was defined as the percentage of patients who had BOR of confirmed CR or confirmed PR or SD (including unconfirmed CR/PR, provided 6 weeks minimum criteria for SD duration was met).
BOR = Best Overall Response. CR = Complete Response. PR = Partial Response. SD = Stable Disease.
|
|||||||||
End point type |
Secondary
|
|||||||||
End point timeframe |
24 Months
|
|||||||||
|
||||||||||
No statistical analyses for this end point |
|
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Adverse events information
|
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Timeframe for reporting adverse events |
24 months
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
23.1
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Reporting groups
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Reporting group title |
Part 1: Dose-escalation
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Reporting group description |
Sym015 was tested in four dose titration cohorts. A substitute or an additional dose level could potentially be evaluated. Sym015: Sym015 is a mixture of two monoclonal antibodies which specifically bind to non-overlapping epitopes in the extracellular domain of MET. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Part 2: Dose-Expansion
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Reporting group description |
Basket Cohort: Patients with KRAS proto-oncogene wild-type (KRAS WT) advanced solid tumor malignancies with MET-amplification received Sym015 at the recommended Phase 2 dose. Included in this group was a subset of patients who received prior therapy with a MET-targeting tyrosine kinase inhibitor (TKI). Sym015: Sym015 is a mixture of two monoclonal antibodies which specifically bind to non-overlapping epitopes in the extracellular domain of MET. NSCLC MET-Amplified Cohort: Patients with advanced NSCLC with MET-amplification were to receive Sym015 at the RP2D. Patients may have received prior therapy with METtargeting and/or EGFR-targeting agents. NSCLC METex14del Cohort: Patients with advanced NSCLC with METex14del were to receive Sym015 at the RP2D. Tumors need not be MET-amplified, and patients may have received prior therapy with MET-targeting and/or EGFR-targeting agents. mutation. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
|||
Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
||
17 Feb 2016 |
Summary of significant changes included the following:
1. Part 1 of the study was modified to make premedication mandatory prior to each dose of Sym015. Part 2 of the study was modified to make premedication mandatory prior to each dose of Sym015 during Cycle 1.
2. Definition of dose-limiting toxicities was modified.
3. Protocol was modified to discontinue therapy for all patients who met Hy’s Law criteria that could not be explained by factors not related to Sym015.
4. Additional criteria included for dose reduction due to toxicity.
5. Allowed GnRH analogues in patients with prostate cancer.
|
||
22 Feb 2016 |
Summary of significant changes included the following:
1. Part 1 of the study was modified to make KRAS mutation testing mandatory to include only patients with KRAS WT solid tumor malignancies.
|
||
02 May 2016 |
Summary of significant changes included the following:
1. Inclusion criteria No. 6 was modified to require KRAS mutation testing according to institutional standards in order to utilize the various testing platforms that were available at the participating study sites.
2. Part 1 of the study was modified to include a tumor biopsy during screening for assessment of KRAS mutational status, if necessary, for eligibility assessment.
3. Part 2 of the study was modified to include an ADA sample time point at C2/D1.
4. It was clarified that AEs/SAEs were reported from signing of informed consent for participation in the study. Furthermore, it was clarified that patients who signed informed consent and were subsequently considered to be screening failures were followed for AEs/SAEs until it was determined that they were not to be participating in the study.
5. Reporting requirements for safety data to Sponsor or designee were explained.
6. It was made clear that the sample size considerations were based on a 2-stage design, not a 2-stage Minmax design
|
||
04 Nov 2016 |
Summary of significant changes included the following:
1. The overall study design was modified by moving the Q3W Cohort from Part 1 to Part 2 to ensure patients with MET-amplification were treated in this Cohort and thereby introducing a Q2W Basket Cohort as well as a Q3W Basket Cohort in Part 2.
2. Study objectives, study endpoints and patient numbers were updated according to the change in overall study design.
3. 6-12 patients were allowed to be included in the Q3W Basket Cohort.
4. The selection of the Q2W RP2D was confirmed as 18 mg/kg loading dose infused over 1.5 hours on C1/D1 followed by Q2W maintenance doses of 12 mg/kg infused over 1 hour beginning on C1/D15.
5. The select inclusion criterion was modified.
6. The select exclusion criterion was modified and/or deleted.
7. It was clarified that a study site may choose to pre-screen patients utilizing archival tumor tissue to confirm MET-amplification status and/or KRAS mutational status before entering patients into screening for the treatment portion of the study.
8. The infusion time of Sym015 was modified to 1.5 hour (+10 minutes) for doses ≥ 18 mg/kg
9. Preference was made clear for the eligibility assessment for MET-amplification be done using tissue from a tumor biopsy.
10. Skin biopsies were removed from Part 2 of the study.
11. Dose-delay criteria 4 was updated.
12. One of the dose-limiting toxicities (2) was clarified.
13. Dose-reduction criteria 2 and 5 was updated in accordance with dose-limiting toxicity criteria.
14. Overall survival (OS) status was updated in the continued follow-up after the 1M FUP Visit and adjusted the follow-up schedule to be every 2 months.
15. It was updated that PD was not to be captured as an AEs unless the nature of the PD was different than expected.
16. Timelines for reporting of SAE Follow-up information was updated.
17. It was updated that the sample size determination to be based on a Simon’s Optimal 2-stage design. |
||
11 May 2017 |
Summary of significant changes included the following:
1. Inclusion criterion #5 was modified to clarify that patients must have had recurrent and/or PD and were without other therapeutic options.
2. Inclusion criterion #7 was revised to allow local assessment of KRAS-mutation and MET-amplification based on a peripheral blood sample (liquid biopsy).
3. Inclusion and exclusion criteria were modified to allow a subset of patients pretreated with a MET-targeting TKI.
4. It was specified that patients included based on MET-amplification from a liquid biopsy were withdrawn if subsequent analysis of a tumor biopsy did not meet eligibility criteria, and the patients did not have clinical benefit from therapy. Such patients were replaced.
5. The option for investigators was added to include an H2 antagonist and/or acetaminophen premedication, where indicated.
6. Prohibited medication section was modified to allow steroid therapy as prophylaxis for contrast reactions.
7. Other minor updates and clarifications were included.
|
||
20 Nov 2017 |
Summary of significant changes included the following:
1. The overall study design was modified by removing Q3W dosing with Sym015, which was not to be evaluated, and a separate Cohort of KRAS WT, advanced NSCLC patients with METEx14 mutation was added.
2. Secondary study objectives were updated according to the change in overall study design.
3. The summary of clinical findings was updated based on the 7 MET-amplified patients that had been enrolled in the ongoing Part 2 Basket Cohort at the time of the amendment.
4. Inclusion and exclusion criteria were modified to allow enrolment of patients with NSCLC and other malignancies with METEx14 mutation, and who had been pre-treated with MET-targeting TKI.
5. Exclusion criteria was modified to specify time required between prior antineoplastic agent and C1/D1, and prior immunosuppressive or systemic hormonal therapy.
6. Prohibited medication was modified to specify when the use of steroid therapy was considered not allowed.
7. The order of collection of tumor biopsy and biomarker blood sample was specified if collected at the same time point.
8. Other minor updates and clarifications were included
|
||
07 Dec 2018 |
Summary of significant changes included the following:
1. Effective with this protocol amendment, accrual to the Basket Cohort was suspended. Emerging literature allowed for the identification of specific tumor types that were more likely to respond to Sym015 treatment (e.g., NSCLC). With this change, a new Cohort of NSCLC MET-amplified patients had been added to Part 2 of the study design, for a total of three Cohorts.
2. With the suspension of the Basket Cohort, NSCLC MET-amplified patients entered to the Basket Cohort were counted toward the NSCLC MET-Amplified Cohort; NSCLC METEx14Del patients entered to the Basket Cohort were counted toward the NSCLC METEx14Del Cohort; patients with both were counted as MET-Amplified.
3. Updated clinical experience information had been added to the scientific background.
4. According to the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines for testing of HER2 amplification, MET amplification was defined as positive with a MET/CEP7 ratio of > 2.2 (occasionally 2.0). Symphogen had opted to change the cut-off to > 3.0 based on emerging data that suggest higher degrees of MET-amplification were associated with higher degree of response.
5. It was specified that concomitant therapy with bisphosphonates and denosumab were allowed during the dosing portion of the study.
6. It was clarified that after the screening assessments, targeted physical examination may have been performed as indicated.
7. The number of PK time points was reduced for patients entered to the NSCLC Cohorts.
8. The mandatory post-dosing tumor biopsy scheduled to be performed at the EOC2 or upon disease progression was made optional.
9. It was clarified that all analyses were related to and used only in connection with the data collected in the present study as well as future development of Sym015.
|
||
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 |