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    Summary
    EudraCT Number:2018-003866-14
    Sponsor's Protocol Code Number:APX005M-002
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-01-18
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2018-003866-14
    A.3Full title of the trial
    A Study to Evaluate the Safety and Efficacy of the CD40 Agonistic Antibody APX005M Administered in Combination with Nivolumab in Subjects with Non-small Cell Lung Cancer and Subjects with Metastatic Melanoma
    Estudio para evaluar la seguridad y la eficacia del anticuerpo agonista anti-CD40 APX005M, administrado en combinación con nivolumab, en pacientes con carcinoma pulmonar no microcítico y pacientes con melanoma metastásico
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study to Evaluate the Safety and Efficacy of the CD40 Agonistic Antibody APX005M Administered in Combination with Nivolumab in Subjects with Non-small Cell Lung Cancer and Subjects with Metastatic Melanoma
    Estudio para evaluar la seguridad y la eficacia del anticuerpo agonista anti-CD40 APX005M, administrado en combinación con nivolumab, en pacientes con carcinoma pulmonar no microcítico y pacientes con melanoma metastásico
    A.4.1Sponsor's protocol code numberAPX005M-002
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorApexigen, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportApexigen, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPivotal S.L.
    B.5.2Functional name of contact pointMedical Monitor
    B.5.3 Address:
    B.5.3.1Street AddressGolbelas 19, la Florida
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28023
    B.5.3.4CountrySpain
    B.5.4Telephone number0034917081250
    B.5.5Fax number0034917081301
    B.5.6E-mailsonia.macia@pivotal.es
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.2Product code APX005M
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPX005M
    D.3.9.1CAS number NA
    D.3.9.2Current sponsor codeAPX005M
    D.3.9.3Other descriptive nameAPX005M
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name OPDIVO 10 mg/mL concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameNivolumab
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNnivolumab
    D.3.9.1CAS number 946414-94-4
    D.3.9.2Current sponsor codenivolumab
    D.3.9.3Other descriptive nameNIVOLUMAB
    D.3.9.4EV Substance CodeSUB122750
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Non-small Cell Lung Cancer and Metastatic Melanoma
    Cancer de Pulmón no microcítico y Melanoma metastásico
    E.1.1.1Medical condition in easily understood language
    Lung cancer and advanced skin cancer derived from melanocytes.
    Cancer de Pulmón no microcítico y Cancer de Piel derivado de Melanocitos
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10029514
    E.1.2Term Non-small cell lung cancer NOS
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027481
    E.1.2Term Metastatic melanoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase 1b:
    •Determine the MTD and the RP2D of APX005M when given in combination with nivolumab
    Phase 2:
    •Evaluate the ORR by RECIST 1.1 in each cohort/group
    Fase Ib:
    •Determinar la dosis máxima tolerable (DMT) y la dosis recomendada de fase II de APX005M cuando se administra en combinación con nivolumab
    Fase II:
    •Evaluar la tasa de respuesta objetiva ) según los criterios RECIST 1.1 en cada cohorte/grupo
    E.2.2Secondary objectives of the trial
    •Evaluate safety of the APX005M and nivolumab combination
    •Evaluate the 6-month progression-free survival (PFS) rate (PFSR) in each cohort/group
    •Evaluate the DOR and median PFS in each cohort/group by RECIST 1.1
    •Determine the immune PDn of the APX005M and nivolumab combination
    •Determine the PK of APX005M
    •Assess incidence of APX005M ADA
    •Identify blood and/or tumor biomarkers that correlate with efficacy and/or resistance
    •Evaluate the ORR by immune related RECIST (iRECIST) in each cohort/group
    •Evaluate DOR and median PFS in each cohort/group by iRECIST
    •Evaluar la seguridad de la combinación de APX005M y nivolumab
    •Evaluar la tasa de supervivencia sin progresión (SSP) a 6 meses (TSSP) en cada cohorte/grupo
    •Evaluar la duración de la respuesta (DR) y la mediana de SSP en cada cohorte/grupo de acuerdo con los criterios RECIST 1.1
    •Determinar la FD en el sistema inmunitario de la combinación de APX005M y nivolumab
    •Determinar la FC de APX005M
    •Evaluar la incidencia de anticuerpos contra el fármaco (ACF) dirigidos a APX005M
    •Identificar biomarcadores tumorales y/o en sangre que muestren correlaciones con la eficacia y/o la resistencia
    •Evaluar la TRO según los criterios RECIST relacionados con la inmunidad (iRECIST) en cada cohorte/grupo
    •Evaluar la DR y la mediana de SSP en cada cohorte/grupo según los iRECIST
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Phase Specific Criteria
    Phase 1b: Subjects that meet eligibility criteria for Phase 2 Cohorts 1 or 2 and all of the general eligibility criteria
    Phase 2 Cohort 1 (inNSCLC): Histologically or cytologically confirmed, immunotherapy naïve, metastatic or locally advanced non-small cell lung cancer not amenable to curative treatment. Subjects may be treatment naïve or could have received one prior platinum-based chemotherapy for non-small cell lung cancer for any indication (adjuvant, part of combined modality therapy or for metastatic disease) within the past 3 years. Subjects with no or unknown activating mutation (e.g., EGFR, ALK, ROS) are eligible for this study. Subjects with a documented activating mutation (e.g., EGFR, ALK, ROS) amenable to tyrosine kinase inhibitor therapy, must also have received the appropriate therapy and progressed.
    Phase 2 Cohort 2 (PD1-MM): Subjects with histologically or cytologically confirmed unresectable or metastatic melanoma that had confirmed progressive disease during treatment with anti-PD-1/PD-L1 therapy. Subjects with BRAF wild type or unknown status must have received only anti-PD-1/PD-L1 therapy. Subjects with BRAF activating mutation could have also received a BRAF inhibitor and/or MEK inhibitor regimen prior to anti-PD-1/PD-L1 therapy. Subjects with ocular melanoma are excluded.
    Phase 2 Cohort 3 (PD1-NSCLC): Subjects with histologically or cytologically confirmed, metastatic or locally advanced NSCLC not amenable to curative treatment. Subjects must have disease progression on an immediately preceding PD-1/PD-L1 containing regimen. Subjects could have received no more than one platinum containing regimen, or if subjects have a documented activating mutation (e.g. EGFR, ALK, ROS) amenable to tyrosine kinase inhibitor therapy, must also have received the appropriate therapy and progressed before the PD-1/PD-L1 containing regimen. Based on response to previous PD-1/PD-L1 containing regimen, subjects will be enrolled in one of the following groups:
    •Group A: Subjects with best response of progressive disease or with stable disease < 16 weeks
    •Group B: Subjects with tumor response or with stable disease ≥ 16 weeks
    General Inclusion Criteria:
    1.Subjects willing and able to provide written informed consent for this study
    2.Male or female ≥18 years old at time of consent
    3.Measurable disease by RECIST 1.1
    4.ECOG performance status of 0 or 1
    5.Resolution of prior treatment-related toxicities to Grade 1, with the exception of alopecia, Grade 2 neuropathy and laboratory abnormalities (parameters below apply). If subject received major surgery or radiation therapy of > 30 Gy, they must have recovered from the toxicity and/or complications from the intervention
    6.Adequate organ function within 14 days of first dose of investigational product:
    a.WBC ≥2 x 109/L in absence of growth factor support
    b.ANC ≥1.0 x 109/L in absence of growth factor support
    c.Platelet count ≥100 x 109/L
    d.Hemoglobin ≥8 g/dL
    e.Serum creatinine ≤1.5 mg/dL AND creatinine clearance ≥60 mL/min (calculated [using the formula of local laboratory] or measured)
    f.AST and ALT ≤2.5 x ULN
    g.Total bilirubin ≤1.5 x ULN, or direct bilirubin ≤ULN for subjects with total bilirubin levels >1.5 x ULN
    h.INR or PT ≤1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
    i.aPTT ≤1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
    7.Women of childbearing potential must have a negative serum pregnancy test within the 7 days prior to first dose of investigational product and a negative urine pregnancy test within the 3 days prior to first dose of investigational product, or a negative serum pregnancy test within the 3 days prior to first dose of investigational product
    8.Women of childbearing potential must agree to follow instructions for method(s) of contraception for the duration of study treatment and 5 months after the last dose of investigational product. Males who are sexually active with WOCBP must agree to follow instructions for method(s) of contraception for the duration of study treatment and 7 months after the last dose of investigational product
    9.Available archived or fresh tumor tissue sample for PD-L1 and other biomarker analysis
    10.For subjects that consent to collection of tumor biopsies at study entry and before the first scheduled tumor assessment, primary or metastatic tumor that can be safely biopsied. A minimum of 24 subjects (6 subjects with each cohort/group) must consent to fresh core biopsies.
    Criterios específicos de cada fase
    Fase Ib: pacientes que cumplan los criterios de selección para las cohortes 1 o 2 de la fase II y todos los criterios de selección generales.

    Cohorte 1 de la fase II (CPNMsi): cáncer de pulmón no microcítico localmente avanzado o metastásico confirmado mediante estudio histológico o citológico, sin tratamiento previo con inmunoterapia y no susceptible de tratamiento curativo. Los pacientes pueden no haber recibido tratamiento previo, o haber recibido una pauta de quimioterapia previa con un derivado del platino para el cáncer de pulmón no microcítico en cualquier indicación (tratamiento adyuvante, como parte de una politerapia o para la enfermedad metastásica) en los últimos 3 años. Los pacientes sin mutaciones activadoras (p. ej., EGFR, ALK, ROS) conocidas son aptos para este estudio. Los pacientes con una mutación activadora (p. ej., EGFR, ALK, ROS) documentada que sea susceptible de tratamiento con inhibidores de la tirosina-cinasa también deben haber recibido el tratamiento pertinente y haber presentado progresión de la enfermedad.
    Cohorte 2 de la fase II (PD1-MM): pacientes con melanoma metastásico o irresecable confirmado mediante estudio histológico o citológico que presentaron progresión de la enfermedad confirmada durante el tratamiento anti-PD-1/PD-L1. Los pacientes con BRAF de genotipo natural o estado mutacional desconocido solo deben haber recibido tratamiento anti-PD-1/PD-L1. Los pacientes con mutaciones activadoras de BRAF también pueden haber recibido tratamiento con un inhibidor de BRAF y/o un inhibidor de MEK antes del tratamiento anti-PD-1/PD-L1. Los pacientes con melanoma ocular quedan excluidos.
    Cohorte 3 de la fase II (PD1-CPNM): pacientes con CPNM localmente avanzado o metastásico confirmado mediante estudio histológico o citológico no susceptible de tratamiento curativo. Los pacientes deben haber presentado progresión de la enfermedad con tratamiento anti-PD-1/PD-L1 inmediatamente precedente. Los pacientes pueden haber recibido no más de una pauta terapéutica con un derivado del platino, o si presentan una mutación activadora (p. ej., EGFR, ALK, ROS) documentada que sea susceptible de tratamiento con inhibidores de la tirosina-cinasa, también deben haber recibido el tratamiento pertinente y haber presentado progresión de la enfermedad antes del tratamiento anti-PD-/PD-L1. Sobre la base de la respuesta a la pauta terapéutica anti-PD-1/PD-L1 anterior, los pacientes se inscribirán en uno de los siguientes grupos:
    •Grupo A: pacientes con mejor respuesta de progresión de la enfermedad o con enfermedad estable durante un período <16 semanas.
    •Grupo B: pacientes con respuesta tumoral o con enfermedad estable durante un período ≥16 semanas.
    Criterios de inclusión generales:
    1.Voluntad y capacidad para dar el consentimiento informado por escrito para este estudio
    2.Hombre o mujer de edad ≥18 años en el momento del consentimiento
    3.Enfermedad medible conforme a los criterios RECIST 1.1
    4.Estado funcional ECOG de 0 o 1
    5.Resolución de las reacciones adversas relacionadas con el tratamiento anterior hasta el grado 1, salvo alopecia, neuropatía de grado 2 y anomalías analíticas (se aplican los parámetros a continuación). Si al paciente se le ha practicado una intervención de cirugía mayor o se le ha administrado radioterapia >30 Gy, debe estar recuperado de la toxicidad y/o las complicaciones de la intervención
    6.Función orgánica adecuada en los 14 días previos a la administración de la primera dosis del producto en investigación.
    7.Las mujeres con capacidad de concebir deben tener un resultado negativo en una prueba de embarazo en suero en los 7 días anteriores a la primera dosis y un resultado negativo en una prueba de embarazo en orina en los 3 días anteriores a la primera dosis del producto en investigación, o un resultado negativo en una prueba de embarazo en suero en los 3 días anteriores a la primera dosis del producto en investigación
    8.Las mujeres con capacidad de concebir deben aceptar seguir las instrucciones relativas a los métodos anticonceptivos durante el tratamiento del estudio y 5 meses después de la última dosis del producto en investigación. Los hombres que sean sexualmente activos con mujeres con capacidad de concebir deben aceptar seguir las instrucciones relativas a los métodos anticonceptivos durante el tratamiento del estudio y 7 meses después de la última dosis del producto en investigación
    9.Muestra de tejido tumoral disponible, ya sea reciente o de archivo, para el análisis de PD-L1 y otros biomarcadores
    10.En el caso de los pacientes que den su consentimiento para la obtención de biopsias tumorales en el momento de incorporarse al estudio y antes de la primera evaluación del tumor programada, tumor primario o metastásico que se pueda biopsiar de forma segura. Un mínimo de 24 pacientes (6 pacientes en cada cohorte/grupo) deben dar su consentimiento para la toma de biopsias con aguja gruesa.
    E.4Principal exclusion criteria
    General Exclusion Criteria:
    1.Previous exposure to any immunomodulatory agents (e.g., anti- CD40, CTLA-4, PD-1/ PD-L1, IDO inhibitors) with the following exceptions:
    a.For Cohort 2 (unresectable or metastatic melanoma):
    i. All subjects must have confirmed disease progression while on treatment with anti-PD-1/PD-L1 therapy
    ii.Subjects could have received anti-CTLA-4 therapy provided they did not have disease progression while on therapy and they discontinue treatment with anti-CTLA-4 therapy at least 3 months prior to first dose of investigational product
    b.For Cohort 3 (metastatic or locally advanced NSCLC):
    i.All subjects must have disease progression while on treatment with anti-PD-1/PD-L1 therapy
    2.Second malignancy (solid or hematologic) within the past 3 years except:
    a.Adequately treated basal cell or squamous cell skin cancer, or
    b.Carcinoma in situ of the cervix, or
    c.Prostate cancer Gleason score < 6 with undetectable prostate specific antigen (PSA) over 12 months, or
    d.Ductal breast carcinoma in situ with full surgical resection (i.e., negative margins), or
    e.Treated medullary or papillary thyroid cancer
    3.Active, known, clinically serious infections (≥ Grade 2 according to NCI-CTCAE v4.03) within the 14 days prior to first dose of investigational product
    4.Use of systemic corticosteroids or other systemic immunosuppressive drugs within the 28 days prior to first dose of investigational product (except inhaled corticosteroids); the use of physiologic doses of corticosteroids may be approved after consultation with the Apexigen Medical Monitor (or designee)
    5.Major surgery within 4 weeks of first dose of investigational product
    6.Concurrent treatment with any anti-cancer agent, except for hormonal therapy and palliative radiation as clinically indicated unless approved by the Medical Monitor
    7.History of allogeneic bone marrow transplantation
    8.Uncontrolled diabetes or hypertension
    9.Active, known or suspected autoimmune disease. Subjects with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
    10.History of (non-infectious) pneumonitis that required corticosteroids or current pneumonitis
    11.History of interstitial lung disease
    12.History of life-threatening toxicity related to prior anti-PD-1/PD-L1 treatment for subjects with metastatic melanoma except those that are unlikely to re-occur with standard countermeasures (e.g. hormone replacement after adrenal crisis)
    13.History of sensitivity or allergy to mAbs or IgG
    14.Congestive heart failure (New York Heart Association Class III to IV), symptomatic ischemia, conduction abnormalities uncontrolled by conventional intervention, or myocardial infarction within 6 months prior to the first dose of investigational product
    15.History of any thromboembolic event within 3 months prior to first dose of investigational product or an active coagulopathy
    16.Known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with untreated brain metastases ≤ 3mm that are asymptomatic, do not have significant edema, cause shift, require steroids or anti-seizure medications are eligible after discussion with the Medical Monitor. Lesions of any size in posterior fossa are excluded. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least 4 weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using corticosteroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability
    17.Known human immunodeficiency virus (HIV), hepatitis B or hepatitis C infection
    18.Has received a live-virus vaccination within 30 days of the first dose of investigational product. Seasonal flu vaccines that do not contain live virus are permitted
    19.Pregnant, breastfeeding, or unwilling to practice birth control during participation in the study
    20.Any clinically significant psychiatric, social, or medical condition that, in the opinion of the Investigator, could increase subject’s risk, interfere with protocol adherence, or affect a subject’s ability to give informed consent.
    1.Exposición previa a algún fármaco inmunomodulador , con las siguientes excepciones:
    a.En la cohorte 2 (melanoma metastásico o irresecable):
    i. Todos los pacientes deben haber presentado progresión de la enfermedad confirmada durante el tratamiento anti-PD-1/PD-L1
    ii.Los pacientes pueden haber recibido tratamiento anti-CTLA-4, siempre que no presentaran progresión de la enfermedad durante dicho tratamiento y que lo hayan suspendido al menos 3 meses antes de la primera dosis del producto en investigación
    b.En la cohorte 3 :
    i.Todos los pacientes deben haber presentado progresión de la enfermedad durante el tratamiento anti-PD-1/PD-L1
    2.Segunda neoplasia maligna en los 3 últimos años excepto:
    a.carcinoma basocelular o espinocelular debidamente tratado,
    b.carcinoma cervicouterino in situ,
    c.cáncer de próstata con puntuación de Gleason <6 y antígeno prostático específico (PSA) indetectable durante 12 meses,
    d.carcinoma ductal de la mama in situ con resección quirúrgica completa (es decir, márgenes negativos), o
    e.cáncer tiroideo medular o papilar tratado
    3.Infecciones conocidas, activas y clínicamente graves (grado ≥2 de acuerdo con los CTCAE del NCI, v4.03) en los 14 días anteriores a la primera dosis .
    4.Uso de corticoesteroides sistémicos u otros fármacos inmunosupresores sistémicos en los 28 días previos a la primera dosis (excepto corticoesteroides inhalados); el uso de dosis fisiológicas de corticoesteroides quizá esté aceptado, previa consulta con el supervisor médico de Apexigen (o delegado)
    5.Intervención de cirugía mayor en las 4 semanas previas a la primera dosis .
    6.Tratamiento concomitante con algún fármaco antineoplásico, salvo tratamiento hormonal y radioterapia paliativa según esté clínicamente indicado, a menos que lo apruebe el supervisor médico
    7.Antecedentes de alotrasplante de médula ósea
    8.Diabetes o hipertensión no controlada
    9.Enfermedad autoinmunitaria activa, conocida o presunta Se permite la inscripción de pacientes con diabetes mellitus tipo I, hipotiroidismo que solo requiera reposición hormonal, trastornos de la piel (como vitíligo, psoriasis o alopecia) que no requieran tratamiento sistémico, o afecciones que no se espera que recurran en ausencia de un desencadenante externo.
    10.Antecedentes de neumonitis (no infecciosa) que necesitó corticoesteroides o neumonitis en curso
    11.Antecedentes de enfermedad pulmonar intersticial
    12.Antecedentes de toxicidad potencialmente mortal relacionada con el tratamiento previo anti-PD-1/PD-L1 en los pacientes con melanoma metastásico, salvo en los que la reaparición sea poco probable aplicando medidas estándar para contrarrestarla (p. ej., reposición hormonal tras crisis suprarrenal)
    13.Antecedentes de sensibilidad o alergia a los anticuerpos monoclonales o las IgG
    14.Insuficiencia cardíaca congestiva , isquemia sintomática, anomalías de la conducción no controladas , o infarto de miocardio en los 6 meses anteriores a la primera dosis del producto en investigación
    15.Antecedentes de episodios tromboembólicos en los 3 meses anteriores a la primera dosis del producto en investigación o coagulopatía activa
    16.Presencia conocida de metástasis activas del sistema nervioso central (SNC) y/o meningitis carcinomatosa Los pacientes con metástasis cerebrales no tratadas ≤3 mm que sean asintomáticos, no tengan edema significativo, no presenten desplazamiento y no requieran corticoesteroides o anticonvulsivos son aptos, previa consulta con el supervisor médico. Los pacientes con lesiones de cualquier tamaño en la fosa craneal posterior quedan excluidos. Los pacientes con metástasis cerebrales tratadas previamente podrán participar siempre que estén estables (sin signos de progresión en las exploraciones por la imagen durante un mínimo de 4 semanas antes de la primera dosis del tratamiento del ensayo y con remisión de todo síntoma neurológico hasta el valor basal), no presenten indicios de metástasis cerebrales nuevas o en crecimiento y no hayan utilizado corticoesteroides durante un mínimo de 7 días antes del tratamiento del ensayo. Esta excepción no incluye a los pacientes con carcinomatosis meníngea, que quedarán excluidos independientemente de la estabilidad clínica
    17.Infección conocida por el virus de la inmunodeficiencia humana (VIH), el virus de la hepatitis B o el virus de la hepatitis C
    18.Recepción de una vacuna elaborada con microbios vivos en los 30 días previos a la primera dosis . Se permiten las vacunas contra la gripe estacional que no contengan el virus vivo
    19.Mujeres embarazadas, en período de lactancia, o que no estén dispuestas a utilizar métodos anticonceptivos durante su participación en el estudio
    20.Cualquier situación médica, social o psiquiátrica de importancia clínica que, en opinión del investigador, podría aumentar el riesgo para el paciente, interferir en el cumplimiento del protocolo o afectar a la capacidad del paciente para dar su consentimiento informado.
    E.5 End points
    E.5.1Primary end point(s)
    •Establish Maximum Tolerated Dose (Phase 1b)
    •Overall Response Rate (rate of Complete Response and Partial Response) by RECIST 1.1 in each cohort/group (Phase 2)
    •Establecer la DMT (fase Ib)
    •TRO (tasa de RC y RP) según los criterios RECIST 1.1 en cada cohorte/grupo (fase II)
    E.5.1.1Timepoint(s) of evaluation of this end point
    The Dose-Limiting Toxicity observation period for dose escalation is the 21 days following the first administration of APX005M and nivolumab (first 3-week cycle).
    Subjects will be evaluated for tumor response approximately every 8 weeks following the first dose of investigational product.
    DMT: 21 dias tras administracion de APX005M y nivolumab ( 3 primeros ciclos)
    Valoraciones tumorales cada 8 semanas tras primera dosis.
    E.5.2Secondary end point(s)
    •Incidence and severity of AEs and specific laboratory abnormalities graded according to NCI-CTCAE, v4.03
    •6-month Progression-Free Survival Rate by cohort/group (Phase 2)
    •Duration of Response (by RECIST 1.1) by cohort/group
    •Progression Free Survival (by RECIST 1.1) by cohort/group
    •PK parameters of APX005M, including Cmax, tmax, AUC 0-t, and AUC 0-~
    •Presence and titer of anti-APX005M antibodies
    •Association between potential PDn markers and PK of APX005M; association between potential predictive biomarkers and anti-tumor activity
    •Overall Response Rate (rate of Complete Response + Partial Response) by iRECIST in each cohort/group (Phase 2)
    •Duration of Response (by iRECIST) by cohort/group
    •Progression Free Survival (by iRECIST) by cohort/group
    •Incidencia e intensidad de los AA y anomalías analíticas específicas, clasificados de acuerdo con los CTCAE del NCI, v4.03
    •TSSP a 6 meses por cohorte/grupo (fase II)
    •DR (según los criterios RECIST 1.1) por cohorte/grupo
    •SSP (según los criterios RECIST 1.1) por cohorte/grupo
    Criterios de valoración exploratorios:
    •Parámetros FC de APX005M, como Cmáx, tmáx, AUC 0-t, and AUC 0-~
    •Presencia y título de anticuerpos anti-APX005M
    •Asociación entre posibles marcadores FD y la FC de APX005M; asociación entre posibles biomarcadores predictivos y la actividad antitumoral
    •TRO (tasa de RC + RP) de acuerdo con los criterios iRECIST en cada cohorte/grupo (fase II)
    •DR (según los criterios iRECIST) por cohorte/grupo
    •SSP (según los criterios iRECIST) por cohorte/grupo
    E.5.2.1Timepoint(s) of evaluation of this end point
    Safety and tolerability of the APX005M and nivolumab combination will be monitored on a regular basis and prior to each dose escalation.
    Subjects will be evaluated for tumor response approximately every 8 weeks following the first dose of investigational product.
    Seguridad y tolerabilidad de manera continua durante el estudio y antes de cada escalada de dosis.
    Valoraciones tumorales cada 8 semanas tras primera dosis.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    This is a phase 1b-2 study. Phase 1b is dose-escalation study. Phase 2 is dose-expansion study.
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned6
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Spain
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 100
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 74
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state174
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 174
    F.4.2.2In the whole clinical trial 174
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2019-02-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-02-01
    P. End of Trial
    P.End of Trial StatusOngoing
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