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    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
    EudraCT number
    2016-003912-11
    Trial protocol
    DK   ES  
    Global end of trial date
    17 Dec 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    16 Jul 2022
    First version publication date
    16 Jul 2022
    Other versions
    Summary report(s)
    CSR Synopsis and Conclusions

    Trial information

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    Trial identification
    Sponsor protocol code
    Sym015-01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02648724
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Symphogen A/S
    Sponsor organisation address
    Pederstrupvej 93, Ballerup, Denmark,
    Public contact
    Ulla H Hansen, Symphogen A/S, +45 45265050, uhh@symphogen.com
    Scientific contact
    Ulla H Hansen, Symphogen A/S, +45 45265050, uhh@symphogen.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
    07 Jun 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    17 Dec 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    17 Dec 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    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.
    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.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Mar 2017
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Denmark: 2
    Country: Number of subjects enrolled
    Spain: 11
    Country: Number of subjects enrolled
    United States: 29
    Country: Number of subjects enrolled
    Korea, Republic of: 14
    Country: Number of subjects enrolled
    Taiwan: 1
    Worldwide total number of subjects
    57
    EEA total number of subjects
    13
    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)
    34
    From 65 to 84 years
    15
    85 years and over
    8

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    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
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    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
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    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

    Arm title
    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
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Sym015 solution administered as IV infusion

    Number of subjects in period 1
    Part 1: Dose-Escalation Part 2: Dose-Expansion
    Started
    12
    45
    Completed
    0
    0
    Not completed
    12
    45
         Consent withdrawn by subject
    2
    1
         Physician decision
    -
    2
         Death
    -
    3
         Unknown
    1
    -
         Transferred to named patient program
    -
    1
         Progressive disease
    9
    37
         Protocol deviation
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Part 1: Dose-Escalation
    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
    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.

    Reporting group values
    Part 1: Dose-Escalation Part 2: Dose-Expansion Total
    Number of subjects
    12 45 57
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    6 28 34
        From 65-84 years
    6 9 15
        85 years and over
    0 8 8
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.1 ( 11.10 ) 61.4 ( 12 ) -
    Gender categorical
    Units: Subjects
        Female
    7 18 25
        Male
    5 27 32
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    2 2 4
        Not Hispanic or Latino
    10 43 53
    Race (NIH/OMB)
    Units: Subjects
        Asian
    0 17 17
        Black or African American
    1 1 2
        White
    10 25 35
        Unknown or Not Reported
    1 1 2
        More than one race
    0 1 1
    ECOG-PS
    ECOG-PS is the Eastern Cooperative Oncology Group performance status. It describes patient functioning level on a 5 graded scale; 0 indicates the highest level of functioning and 5 the lowest
    Units: Subjects
        zero (0)
    4 7 11
        one (1)
    8 36 44
        two (2)
    0 2 2
    Site of primary tumour
    Units: Subjects
        Breast
    1 1 2
        Colon
    3 2 5
        Genitourinary
    2 3 5
        Hepatic (including gallbladder)
    0 1 1
        Liver
    0 3 3
        Neck
    1 0 1
        Other locally advanced sites
    1 4 5
        Other metastatics sites
    2 1 3
        Pancreas
    1 0 1
        Respiratory
    0 19 19
        Skin/soft tissue
    1 0 1
        Gastrointestinal
    0 11 11
    Histopathologic diagnosis
    Units: Subjects
        Adenocarcinoma
    7 40 47
        Misisng
    5 5 10
    Anatmoic based cancer type
    Units: Subjects
        Adenocarcinoma of Parotid Gland
    1 0 1
        Adenocarcinoma of Thymus
    1 0 1
        BRCA (breast cancer gene)
    1 1 2
        CRC (colorectal cancer)
    3 3 6
        Cholangiocarcinoma
    1 0 1
        GC (gastric cancer)
    0 13 13
        GU (genitourinary cancer)
    2 3 5
        HCC (hepatocellular carcinoma)
    0 2 2
        HCC-MIXED
    0 1 1
        HCC-Neuroendocrine
    0 1 1
        Lung-Neurocrine
    0 1 1
        NSCLC (non-small-cell lung carcinoma)
    0 18 18
        NSCLC-Sq type
    0 2 2
        Nasopharyngeal carcinoma
    1 0 1
        Pancreatic cancer
    1 0 1
        SCC (squamous cell carcinoma) of skin/soft tissue
    1 0 1
    Previous debulking surgery
    Units: Subjects
        Yes
    3 10 13
        No
    9 35 44
    Number of sites with metastasis
    Units: Subjects
        zero (0)
    0 0 0
        one (1)
    2 10 12
        two (2)
    1 12 13
        three (3)
    4 13 17
        more than 3
    5 10 15
    Body weight
    Units: kg
        arithmetic mean (standard deviation)
    75.9 ( 16.56 ) 67.2 ( 12.65 ) -

    End points

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    End points reporting groups
    Reporting group title
    Part 1: Dose-Escalation
    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
    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
    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).

    Subject analysis set title
    Part 2: Patients in NSCLC MET-Amplified Cohort
    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.

    Subject analysis set title
    Part 2: Patients in NSCLC METex14Del Cohorot
    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.

    Subject analysis set title
    Part 1: 6 mg/kg
    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

    Subject analysis set title
    Part 1: 12 mg/kg
    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

    Subject analysis set title
    Part 1: 18 mg/kg
    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

    Subject analysis set title
    Part 1: 24 mg/kg
    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

    Subject analysis set title
    Part 2: Basket Cohort, with prior MET-targeting TKI therapy
    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.

    Subject analysis set title
    Part 2: Basket Cohort, without prior MET-targeting TKI therapy
    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.

    Primary: Primary Endpoint - Part 1

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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.
    End point type
    Primary
    End point timeframe
    Cycle 1, the initial 28-day period of Q2W dosing
    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
    End point values
    Part 1: Dose-Escalation
    Number of subjects analysed
    12
    Units: Number of DLTs
    0
    No statistical analyses for this end point

    Primary: Primary Endpoint - Part 2

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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
    End point type
    Primary
    End point timeframe
    24 months
    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
    End point values
    Part 2: Basket Cohort Part 2: Patients in NSCLC MET-Amplified Cohort Part 2: Patients in NSCLC METex14Del Cohorot
    Number of subjects analysed
    25
    8
    12
    Units: Documented, Confirmed Objective Response
    0
    2
    3
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1

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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).
    End point type
    Secondary
    End point timeframe
    12 Months
    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
    End point values
    Part 1: Dose-Escalation
    Number of subjects analysed
    0 [5]
    Units: mg/kg
        number (not applicable)
    Notes
    [5] - It was not possible to determine this endpoint as no DLTs were observed.
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (immunogenicity)

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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
    End point type
    Secondary
    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)
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    3
    3
    3
    3
    Units: Count of participants
        Cycle 1 - day 1 (not done)
    0
    0
    0
    0
        Cycle 1 - day 1 (negative)
    3
    3
    3
    3
        Cycle 1 - day 1 (patient withdrawn)
    0
    0
    0
    0
        Cycle 3 - day 1 (not done)
    0
    0
    0
    0
        Cycle 3 - day 1 (negative)
    1
    0
    2
    0
        Cycle 3 - day 1 (patient withdrawn)
    2
    3
    1
    3
        End of treatment (not done)
    0
    0
    0
    1
        End of treatment (negative)
    3
    2
    1
    2
        End of treatment (patient withdrawn)
    0
    1
    2
    0
        1-month follow-up (not done)
    0
    1
    0
    0
        1-month follow-up (negative)
    2
    1
    0
    2
        1-month follow-up (patient withdrawn)
    1
    1
    3
    1
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (immunogenicity)

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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
    End point type
    Secondary
    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)
    End point values
    Part 2: Basket Cohort Part 2: Patients in NSCLC MET-Amplified Cohort Part 2: Patients in NSCLC METex14Del Cohorot
    Number of subjects analysed
    24
    8
    12
    Units: Count of participants
        Cycle 1 - day 1 (not done)
    0
    0
    0
        Cycle 1 - day 1 (negative)
    25
    8
    12
        Cycle 1 - day 1 (positive)
    0
    0
    0
        Cycle 1 - day 1 (patient withdrawn)
    0
    0
    0
        Cycle 2 - day 1 (not done)
    1
    0
    0
        Cycle 2 - day 1 (negative)
    21
    8
    11
        Cycle 2 - day 1 (positive)
    0
    0
    0
        Cycle 2 - day 1 (patient withdrawn)
    3
    0
    1
        Cycle 3 - day 1 (not done)
    1
    1
    0
        Cycle 3 - day 1 (negative)
    8
    7
    8
        Cycle 3 - day 1 (positive)
    0
    0
    0
        Cycle 3 - day 1 (patient withdrawn)
    16
    0
    4
        Cycle 5 - day 1 (not done)
    0
    0
    1
        Cycle 5 - day 1 (negative)
    6
    6
    5
        Cycle 5 - day 1 (positive)
    0
    0
    0
        Cycle 5 - day 1 (patient withdrawn)
    19
    2
    6
        Cycle 7 - day 1 (not done)
    0
    1
    0
        Cycle 7 - day 1 (negative)
    2
    2
    5
        Cycle 7 - day 1 (positive)
    0
    0
    0
        Cycle 7 - day 1 (patient withdrawn)
    23
    5
    7
        End of treatment (not done)
    5
    0
    0
        End of treatment (negative)
    15
    7
    9
        End of treatment (positive)
    1
    0
    0
        End of treatment (patient withdrawn)
    4
    1
    3
        1-month follow up (not done)
    0
    1
    1
        1-month follow up (negative)
    10
    3
    5
        1-month follow up (positive)
    1
    0
    0
        1-month follow up (patient withdrawn)
    14
    4
    6
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (AUC)

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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.
    End point type
    Secondary
    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
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    3
    3
    3
    3
    Units: h * μg/mL
        median (full range (min-max))
    17900 (17100 to 24500)
    35700 (31600 to 42900)
    82500 (75200 to 86200)
    76800 (55200 to 86400)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (AUC)

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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.
    End point type
    Secondary
    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.
    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
    End point values
    Part 2: Dose-Expansion
    Number of subjects analysed
    12
    Units: h * μg/mL
        median (full range (min-max))
    60500 (19900 to 95200)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (Cmax)

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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.
    End point type
    Secondary
    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.
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    3
    3
    3
    3
    Units: μg/mL
        median (full range (min-max))
    146 (141 to 151)
    286 (275 to 323)
    563 (419 to 711)
    561 (379 to 726)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (Cmax)

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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.
    End point type
    Secondary
    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.
    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
    End point values
    Part 2: Dose-Expansion
    Number of subjects analysed
    45
    Units: μg/mL
        median (full range (min-max))
    495 (312 to 1170)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (Tmax)

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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.
    End point type
    Secondary
    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.
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    3
    3
    3
    3
    Units: hours
        median (full range (min-max))
    2.1 (2 to 5)
    1.1 (1 to 2)
    3.5 (3 to 4)
    3.0 (3 to 9)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (Tmax)

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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.
    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
    [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
    End point values
    Part 2: Dose-Expansion
    Number of subjects analysed
    45
    Units: hours
        median (full range (min-max))
    2.67 (1.42 to 44)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (Ctrough)

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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.
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    3
    3
    3
    3
    Units: μg/mL
        median (full range (min-max))
    23.1 (19.2 to 31.5)
    61.3 (56.1 to 65)
    130 (127 to 187)
    92.4 (91.3 to 151)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (Ctrough)

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    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
    End point values
    Part 2: Dose-Expansion
    Number of subjects analysed
    43
    Units: μg/mL
        median (full range (min-max))
    92.4 (24.1 to 429)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (T½)

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    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.
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    3
    1
    1
    1
    Units: hours
        median (full range (min-max))
    179 (116 to 179)
    137 (137 to 137)
    193 (193 to 193)
    170 (170 to 170)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (T½)

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    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
    End point values
    Part 2: Dose-Expansion
    Number of subjects analysed
    26
    Units: hours
        median (full range (min-max))
    167 (87.1 to 217)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 1 (CL)

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    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.
    End point values
    Part 1: 6 mg/kg Part 1: 12 mg/kg Part 1: 18 mg/kg Part 1: 24 mg/kg
    Number of subjects analysed
    1
    1
    0 [11]
    0 [12]
    Units: mL/h
        median (full range (min-max))
    0.3 (0.3 to 0.3)
    0.2 (0.2 to 0.2)
    ( to )
    ( to )
    Notes
    [11] - None evaluated
    [12] - None evaluated
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (CL)

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    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
    End point values
    Part 2: Dose-Expansion
    Number of subjects analysed
    10
    Units: mL/h
        median (full range (min-max))
    0.327 (0.187 to 0.525)
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (additional preliminary evaluation of antitumour activity, assessed by OR)

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    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
    End point values
    Part 2: Basket Cohort, with prior MET-targeting TKI therapy Part 2: Basket Cohort, without prior MET-targeting TKI therapy
    Number of subjects analysed
    5
    20
    Units: Count of participants
    0
    0
    No statistical analyses for this end point

    Secondary: Secondary Endpoint - Part 2 (additional preliminary evaluation of antitumour activity, assessed by DCR

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    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
    End point values
    Part 2: Basket Cohort, with prior MET-targeting TKI therapy Part 2: Basket Cohort, without prior MET-targeting TKI therapy
    Number of subjects analysed
    5
    20
    Units: Count of participants
    2
    8
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    24 months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Part 1: Dose-escalation
    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
    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.

    Serious adverse events
    Part 1: Dose-escalation Part 2: Dose-Expansion
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 12 (25.00%)
    18 / 45 (40.00%)
         number of deaths (all causes)
    0
    3
         number of deaths resulting from adverse events
    0
    0
    Vascular disorders
    Peripheral ischaemia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Generalised oedema
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intra-abdominal fluid collection
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rectal haemorrhage
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestinal perforation
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatitis
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    0 / 12 (0.00%)
    2 / 45 (4.44%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Bone pain
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Bacteraemia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bone abscess
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pelvic abscess
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 12 (0.00%)
    2 / 45 (4.44%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypoalbuminaemia
         subjects affected / exposed
    0 / 12 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Part 1: Dose-escalation Part 2: Dose-Expansion
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    11 / 12 (91.67%)
    43 / 45 (95.56%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumour pain
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 45 (0.00%)
         occurrences all number
    2
    0
    Vascular disorders
    Flushing
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Hypertension
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 12 (0.00%)
    4 / 45 (8.89%)
         occurrences all number
    0
    4
    Early satiety
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Facial pain
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Fatigue
         subjects affected / exposed
    4 / 12 (33.33%)
    10 / 45 (22.22%)
         occurrences all number
    4
    11
    Feeling abnormal
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Pain
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Pyrexia
         subjects affected / exposed
    0 / 12 (0.00%)
    7 / 45 (15.56%)
         occurrences all number
    0
    11
    Reproductive system and breast disorders
    Pelvic discomfort
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 12 (8.33%)
    8 / 45 (17.78%)
         occurrences all number
    1
    11
    Dyspnoea
         subjects affected / exposed
    1 / 12 (8.33%)
    4 / 45 (8.89%)
         occurrences all number
    1
    5
    Oropharyngeal pain
         subjects affected / exposed
    1 / 12 (8.33%)
    2 / 45 (4.44%)
         occurrences all number
    1
    2
    Pleural effusion
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Respiratory tract congestion
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 45 (2.22%)
         occurrences all number
    1
    1
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 12 (0.00%)
    3 / 45 (6.67%)
         occurrences all number
    0
    3
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 12 (0.00%)
    5 / 45 (11.11%)
         occurrences all number
    0
    5
    Blood creatine phosphokinase increased
         subjects affected / exposed
    0 / 12 (0.00%)
    4 / 45 (8.89%)
         occurrences all number
    0
    4
    Neutrophil count decreased
         subjects affected / exposed
    0 / 12 (0.00%)
    4 / 45 (8.89%)
         occurrences all number
    0
    5
    Weight decreased
         subjects affected / exposed
    1 / 12 (8.33%)
    2 / 45 (4.44%)
         occurrences all number
    1
    3
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 45 (0.00%)
         occurrences all number
    2
    0
    Nervous system disorders
    Cognitive disorder
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Dizziness
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 45 (2.22%)
         occurrences all number
    1
    1
    Dysgeusia
         subjects affected / exposed
    0 / 12 (0.00%)
    3 / 45 (6.67%)
         occurrences all number
    0
    3
    Headache
         subjects affected / exposed
    1 / 12 (8.33%)
    3 / 45 (6.67%)
         occurrences all number
    1
    3
    Somnolence
         subjects affected / exposed
    2 / 12 (16.67%)
    2 / 45 (4.44%)
         occurrences all number
    2
    2
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 12 (0.00%)
    8 / 45 (17.78%)
         occurrences all number
    0
    13
    Ear and labyrinth disorders
    Ear discomfort
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Ear haemorrhage
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Ear pain
         subjects affected / exposed
    2 / 12 (16.67%)
    0 / 45 (0.00%)
         occurrences all number
    2
    0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 12 (0.00%)
    7 / 45 (15.56%)
         occurrences all number
    0
    8
    Ascites
         subjects affected / exposed
    1 / 12 (8.33%)
    1 / 45 (2.22%)
         occurrences all number
    1
    1
    Constipation
         subjects affected / exposed
    2 / 12 (16.67%)
    9 / 45 (20.00%)
         occurrences all number
    2
    9
    Diarrhoea
         subjects affected / exposed
    1 / 12 (8.33%)
    4 / 45 (8.89%)
         occurrences all number
    2
    4
    Dyspepsia
         subjects affected / exposed
    1 / 12 (8.33%)
    5 / 45 (11.11%)
         occurrences all number
    2
    6
    Nausea
         subjects affected / exposed
    1 / 12 (8.33%)
    10 / 45 (22.22%)
         occurrences all number
    1
    10
    Presbyoesophagus
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Salivary gland enlargement
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Vomiting
         subjects affected / exposed
    2 / 12 (16.67%)
    4 / 45 (8.89%)
         occurrences all number
    3
    4
    Oedema peripheral
         subjects affected / exposed
    2 / 12 (16.67%)
    10 / 45 (22.22%)
         occurrences all number
    4
    18
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    0 / 12 (0.00%)
    3 / 45 (6.67%)
         occurrences all number
    0
    4
    Renal and urinary disorders
    Urinary incontinence
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    0 / 12 (0.00%)
    6 / 45 (13.33%)
         occurrences all number
    0
    6
    Infections and infestations
    Cystitis
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 12 (0.00%)
    3 / 45 (6.67%)
         occurrences all number
    0
    3
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    3 / 12 (25.00%)
    9 / 45 (20.00%)
         occurrences all number
    3
    10
    Dehydration
         subjects affected / exposed
    1 / 12 (8.33%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    Hypoalbuminaemia
         subjects affected / exposed
    2 / 12 (16.67%)
    6 / 45 (13.33%)
         occurrences all number
    2
    10
    Hypokalaemia
         subjects affected / exposed
    3 / 12 (25.00%)
    1 / 45 (2.22%)
         occurrences all number
    3
    4
    Hypomagnesaemia
         subjects affected / exposed
    3 / 12 (25.00%)
    1 / 45 (2.22%)
         occurrences all number
    3
    1
    Hyponatraemia
         subjects affected / exposed
    0 / 12 (0.00%)
    4 / 45 (8.89%)
         occurrences all number
    0
    6

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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
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