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    Summary
    EudraCT Number:2018-003866-14
    Sponsor's Protocol Code Number:APX005M-002
    National Competent Authority:France - ANSM
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-06-19
    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 ConcernedFrance - ANSM
    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
    Étude visant à évaluer la sécurité et l’efficacité de l’APX005M, un anticorps agoniste du CD40, administré en association avec le nivolumab chez des patients présentant un cancer bronchique non à petites cellules ou un mélanome métastatique
    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
    Étude visant à évaluer la sécurité et l’efficacité de l’APX005M, un anticorps agoniste du CD40, administré en association avec le nivolumab chez des patients présentant un cancer bronchique non à petites cellules ou un mélanome métastatique
    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 bronchique non à petites cellules ET mélanome métastatique
    E.1.1.1Medical condition in easily understood language
    Lung cancer and advanced skin cancer derived from melanocytes.
    cancer bronchique non à petites cellules ET mélanome métastatique
    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
    3.1. Objectif principal
    Phase Ib :
    • Déterminer la dose maximale tolérée (DMT) et la dose recommandée pour la phase II (DRP2) d’APX005M administré en association avec le nivolumab.
    Phase II :
    • Évaluer le taux de réponse globale (TRG) selon les critères RECIST 1.1 dans chaque cohorte/groupe.
    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
    3.2. Objectifs secondaires
    • Évaluer la sécurité de l’association d’APX005M et de nivolumab.
    • Évaluer le taux de survie sans progression (SSP) à 6 mois dans chaque cohorte/groupe.
    • Évaluer la durée de la réponse (DR) et la SSP médiane dans chaque cohorte/groupe selon les critères RECIST 1.1.
    3.3. Objectifs exploratoires
    • Déterminer la pharmacodynamique (PD) immunitaire de l’association d’APX005M et de nivolumab.
    • Déterminer la pharmacocinétique (PK) de l’APX005M.
    • Évaluer l’incidence d’anticorps anti-médicament (AAM) dirigés contre l’APX005M.
    • Identifier les biomarqueurs sanguins et/ou tumoraux qui sont corrélés à l’efficacité et/ou à la résistance.
    • Évaluer le TRG selon les critères RECIST spécifiques aux immunothérapies (iRECIST) dans chaque cohorte/groupe.
    • Évaluer la DR et la SSP médiane dans chaque cohorte/groupe selon les critères 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.
    1. Patients acceptant et capables de donner leur consentement éclairé écrit pour cette étude.
    2. Hommes et femmes âgés de 18 ans et plus au moment du consentement.
    3. Lésion mesurable selon les critères RECIST 1.1.
    4. Indice de performance ECOG de 0 ou 1.
    5. Résolution de toutes les toxicités du traitement antérieur à un grade ≤ 1, à l’exception de l’alopécie et des neuropathies et anomalies des paramètres biologiques de grade 2 (les critères ci-dessous s’appliquent). En cas de chirurgie lourde ou de radiothérapie à une dose > 30 Gy, les patients doivent avoir récupéré des toxicités et/ou des complications de l’intervention.
    6. Fonctions organiques adéquates au cours des 14 jours précédant la première administration du médicament expérimental :
    a. leucocytes ≥ 2 x 109/L en l’absence de soutien par facteur de croissance ;
    b. PNN ≥ 1 x 109/L en l’absence de soutien par facteur de croissance ;
    c. plaquettes ≥ 100 x 109/L ;
    d. hémoglobine ≥ 8 g/dL ;
    e. créatininémie ≤ 1,5 mg/dL ET clairance de la créatinine ≥ 60 mL/min (calculée selon la formule du laboratoire local ou mesurée) ;
    f. ASAT et ALAT ≤ 2,5 x LSN ;
    g. bilirubine totale ≤ 1,5 x LSN ou bilirubine directe ≤ LSN chez les patients ayant un taux de bilirubine totale > 1,5 x LSN ;
    h. INR ou TP ≤ 1,5 x LSN, sauf si le patient reçoit un traitement anticoagulant dans la mesure où le TP ou le TCA est dans l’intervalle thérapeutique attendu avec l’utilisation d’anticoagulants ;
    i. TCA ≤ 1,5x LSN, sauf si le patient reçoit un traitement anticoagulant dans la mesure où le TP ou TCA est dans l’intervalle thérapeutique attendu avec l’utilisation d’anticoagulants.
    7. Les femmes en âge de procréer doivent avoir un test sérique de grossesse négatif au cours des 7 jours précédant la première administration du médicament expérimental et un test urinaire de grossesse négatif dans les 3 jours précédant la première administration du médicament expérimental, ou un test sérique de grossesse négatif dans les 3 jours précédant la première administration du médicament expérimental.
    8. Les femmes en âge de procréer doivent accepter de suivre les instructions concernant les méthodes de contraception pendant toute la durée du traitement à l’étude et pendant 5 mois après la dernière administration du médicament expérimental. Les hommes sexuellement actifs ayant une partenaire en âge de procréer doivent accepter de suivre les instructions concernant les méthodes de contraception pendant toute la durée du traitement à l’étude et pendant 7 mois après la dernière administration du médicament expérimental.
    9. Échantillon de tissu tumoral frais ou archivé disponible pour l’analyse de PD-L1 et d’autres biomarqueurs.
    10. Chez les patients ayant donné leur consentement, les biopsies tumorales réalisées lors de l’inclusion dans l’étude et avant le premier bilan tumoral planifié, tumeur primitive ou métastatique pouvant être biopsiée sans risque. Au moins 24 patients (6 patients dans chaque cohorte/groupe) doivent accepter le prélèvement d’échantillons de tissu frais par microbiopsie
    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.Exposition antérieure à tt agent immunomodulateur (ex anti-CD40, inhibiteurs de CTLA-4, PD 1/PD-L1, IDO), à l’exc de ce qui suit :
    a.Pr la cohorte 2 (mélanome non résécable ou métastatique) :
    i.ts les patients doivent avoir présenté une progression de la maladie confirmée pdtle TTT par un inhibiteur de PD-1/PD-L1 ;
    ii.les patients peuvent avoir reçu un TTT par 1 inhibiteur de CTLA-4 ss réserve qu’ils n’aient pas présenté de progression de la maladie pdtle TTT et que ce TTT ait été arrêté au-3 mois avant la 1èreADM dumed exp.
    b.Pour la cohorte 3 (CBNPC métastatique ou localement avancé) :
    i.ts les patients doivent avoir présenté une progression de la maladie pdtle TTT par un inhibiteur de PD-1/PD-L1.
    1.2E cancer (tumeur solide ou hémopathie maligne) au crs des 3 années préc, à l’exc de :
    a.carcinome cutané basocellulaire ou spinocellulaire traité de façon adéquate;ou
    b.cancer du col utérin in situ ;ou
    c.cancer de la prostate avec score de Gleason < 6 et taux de PSA (antigène spécifique de la prostate) indétectable pdt12 mois ;ou
    d.carcinome canalaire in situ avec résection chirurgicale complète (c’est-à-dire marges négatives) ;ou
    e.cancer médullaire ou papillaire de la thyroïde traité.
    2.Présence d’infection cliniquement grave active (grade ≥ 2 des critères NCI-CTCAE v4.03) au crs des 14 jours precdt la 1ère ADM du med exp.
    3.Corticothérapie systémique ou TTT par d’autres méd immunosuppresseurs systémiques au crs des 28 jours prcdt la 1èreADM dumed exp (à l’exc des corticoïdes inhalés);l’ADM de doses physiologiques de corticoïdes peutêtre autorisée après consultation du moniteur médical d’Apexigen.
    4.Chirurgie lourde au crs des 4 semaines précédant la 1èreADM du med exp.
    5.TTT concomitant par tt agent anticancéreux à l’exception d’une hormonothérapie et d’une radiothérapie palliative si elles sont cliniquement indiquées, sauf avec l’accord du monit méd.
    6.ATCDs d’allogreffe de moelle osseuse.
    7.Diabète ou hypertension non contrôlés.
    8.Maladie auto-immune active connue ou suspectée.Les patients présentant un diabète de type I, une hyperthyroïdie ne nécessitant qu’un TTT substitutif, des dermatoses (telles que vitiligo ou psoriasis ou alopécie) ne nécessitant pas de TTT systémique ou des affections qui ne devraient pas récidiver en l’absence d’un facteur déclenchant externe peuvent être inclus.
    9.ATCDs de pneumopathie (non infectieuse) ayant nécessité une corticothérapie ou pneumopathie en crs.
    10.ATCDs de pneumopathie interstitielle.
    11.ATCD de toxicité d’un TTT antérieur par un inhibiteur de PD-1/PD-L1 engageant le pronostic vital chez les patients présentant un mélanome métastatique, à l’exception des toxicités peu susceptibles de survenir à nouveau avec les mesures correctives habituelles (par exemple TTT hormonal substitutif après une crise surrénalienne).
    12.ATCDs de sensibilité ou d’allergie aux anticorps monoclonaux ou aux IgG.
    13.Insuffisance cardiaque congestive (classe III à IV de la NYHA), ischémie symptomatique, anomalies de la conduction non contrôlées par une intervention conventionnelle ou infarctus du myocarde au crs des 6 mois précédant la 1èreADM du med exp.
    14.ATCDs d’évt thromboembolique au crs des 3 mois précédant la 1èreADM du med exp ou présence d’une coagulopathie.
    15.Présence de métastases du système nerveux central (SNC) actives et/ou d’une méningite carcinomateuse. Les patients présentant des métastases cérébrales non traitées ≤ 3 mm asymptomatiques, sans œdème significatif, qui ne provoquent pas de déplacement des structures environnantes et ne nécessitent pas l’utilisation de corticoïdes ou de médicaments antiépileptiques sont éligibles après discussion avec le moniteur médical.Les lésions de tte taille dans la fosse postérieure sont un critère de non-inclusion.Les patients présentant des métastases cérébrales préalablement traitées peuvent être éligible à l’étude sous réserve qu’ils soient stables après le TTT (ss signes de progression à l’imagerie pdt au - 4 semaines avant la 1ère ADM du TTT expérimental et avec régression de tous les symptômes neurologiques au stade initial), que l’imagerie ne montre pas de métastases cérébrales nouvelles ou en progression et qu’ils n’aient pas reçu de corticoïdes pdt au - 7 jours avant l’ADM du TTT expérimental. Cette exception ne s’applique pas à la méningite carcinomateuse qui est un critère de non-inclusion, quelle que soit la stabilité clinique.
    16.Infection connue par VIH), VHB VHC
    17.ADM d’un vaccin à virus vivant au crs des 30 jours précédant la 1èreADM du med exp. Les vaccins contre la grippe saisonnière qui ne contiennent pas de virus vivant sont autorisés.
    18.Grossesse, allaitement ou refus d’utiliser une contraception pdtla participation à l’étude.
    19.Tte affection psychiatrique ou médicale ou situation sociale qui selon l’investigateur, pourrait augmenter le risque pour le patient, interférer avec le respect du protocole ou altérer la capacité du patient à donner son consentement éclairé.
    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)
    • Détermination de la dose maximale tolérée (DMT).
    • TRG (taux de RC + RP) selon les critères RECIST 1.1 dans chaque cohorte/groupe (phase 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.
    TDL est de 21 jours après la première administration d’APX005M et de nivolumab (premier cycle de 3 semaines)
    La réponse tumorale sera évaluée toutes les 8 semaines environ après la première administration du médicament expérimental
    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, AUC0-t, and AUC0-~
    • 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
    Critères d’évaluation secondaires
    • Incidence et sévérité d’EI et d’anomalies des paramètres biologiques cotés selon les critères NCI-CTCAE v4.03.
    • Taux de SSP à 6 mois par cohorte/groupe (phase II).
    • DR (selon les critères RECIST 1.1) par cohorte/groupe.
    • SSP (selon les critères RECIST 1.1) par cohorte/groupe.
    1.2. Critères exploratoires
    • Paramètres PK de l’APX005M, incluant Cmax, tmax, ASC0-t et ASC0-
    • Présence et titres d’anticorps anti-APX005M.
    • Corrélation entre les marqueurs PD potentiels et la PK de l’APX005M ; corrélation entre les biomarqueurs prédictifs potentiels et l’activité antitumorale.
    • TRG (taux de RC + RP) selon les critères iRECIST dans chaque cohorte/groupe (phase II).
    • DR (selon les critères iRECIST) dans chaque cohorte/groupe.
    • SSP (selon les critères iRECIST) dans chaque cohorte/groupe.
    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.
    La sécurité et la tolérance de l’association d’APX005M et de nivolumab seront surveillées par les représentants d’Apexigen et par les investigateurs de façon régulière et avant chaque escalade de dose.
    La réponse tumorale sera évaluée toutes les 8 semaines environ après la première administration du médicament expérimental
    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 concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA12
    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
    dernière visite du dernier patient
    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 months11
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months10
    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 state14
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 56
    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 Decision2019-08-14
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-09-06
    P. End of Trial
    P.End of Trial StatusOngoing
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