E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with metastatic or unresectable, recurrent HNSCC who have not yet been treated for their advanced disease |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10007050 |
E.1.2 | Term | Cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10041823 |
E.1.2 | Term | Squamous cell carcinoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10007284 |
E.1.2 | Term | Carcinoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10060121 |
E.1.2 | Term | Squamous cell carcinoma of head and neck |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067821 |
E.1.2 | Term | Head and neck cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 22.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10082179 |
E.1.2 | Term | Squamous cell carcinoma of head and neck metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the effect of ALX148 plus pembrolizumab on 12-month overall survival (OS) rate and objective response rate (ORR) in patients with metastatic or with unresectable, recurrent HNSCC that is PD-L1 positive (CPS ≥1) and who have not yet been treated for their advanced disease. |
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E.2.2 | Secondary objectives of the trial |
• To assess secondary measures of efficacy for ALX148 administered in combination with pembrolizumab and for pembrolizumab alone. • To assess the safety and tolerability of ALX148 administered in combination with pembrolizumab and for pembrolizumab alone (including for patients in the safety lead-in cohort).
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patients with metastatic or unresectable, recurrent head and neck squamous cell carcinoma (HNSCC) that is PD-L1 positive (defined as CPS > 1 by an FDA-approved test utilizing the 22C3 antibody and by any required locally approved test) and who have not received prior systemic therapy for their advanced disease. • Patients cannot have received prior systemic therapy for the treatment of metastatic or recurrent disease. • Patients can have received prior systemic therapy for the treatment of locoregionally advanced disease if it was completed more than 6 months prior to signing informed consent. 2. Patients must have at least one measurable lesion as defined by RECIST version 1.1. Lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions. 3. Adequate bone marrow function (obtained within 10 days of first planned dose), including: a. Absolute Neutrophil Count (ANC) ≥1,500/mm3 (≥1.5 x 109/L); b. Platelets ≥100,000/mm3 (≥100 x 109/L); c. Hemoglobin ≥9 g/dL (≥90 g/L) - must be met without packed red blood cell (pRBC) transfusion within the prior 2 weeks. Participants can be on stable doses of erythropoietin (≥ approximately 3 months) 4. Adequate renal function (obtained within 10 days of first planned dose), including: a. Estimated creatinine clearance (using Cockroft-Gault equation) ≥ 30 mL/min. 5. Adequate liver function (obtained within 10 days of first planned dose), including: a. Total serum bilirubin ≤1.5 x ULN (≤3.0 x ULN if the patient has documented Gilbert syndrome); b. Aspartate and Alanine transaminase (AST and ALT) ≤2.5 x ULN; ≤5.0 x ULN if there is liver involvement secondary to tumor. 6. Age ≥18 years, except in regions in which the minimum age for subject participation is >18 years. 7. INR or PT and PTT <1.5X ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants. 8. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) must be 0 or 1. 9. Participants with oropharyngeal carcinoma must have available results from testing of human papillomavirus (HPV) (p16) status. 10. Participants must have recovered from all AEs due to previous therapies, procedures, and surgeries to baseline or ≤Grade 1 per NCI CTCAE v. 5.0 except for AEs not constituting a safety risk by Investigator judgment (e.g. alopecia). Participants with ≤Grade 2 neuropathy may be eligible. 11. Available core or incisional biopsy sample prior to study entry that has been taken after the most recent therapy for HNSCC taken from either an unresectable recurrent lesion or a metastatic lesion for central confirmation of PD-L1 CPS and evaluation of other biomarkers. Fine needle aspirates are not acceptable. 12. Serum pregnancy test (for females of childbearing potential) negative at screening. 13. Male and female patients of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 120 days after the last dose of assigned treatment. A patient is of childbearing potential if, in the opinion of the Investigator, he/she is biologically capable of having children and is sexually active. 14. Evidence of a personally signed and dated informed consent document, from a patient with the capacity to consent for themselves or from a legal representative, indicating that the patient or legal representative has been informed of all pertinent aspects of the study before any study specific activity is performed. 15. Patients who are willing and able to comply with scheduled visits, treatment plans, laboratory tests, and other procedures. |
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E.4 | Principal exclusion criteria |
1. Patients with disease suitable for local therapy with curative intent. 2. Patients with progressive disease within 6 months of completion of curatively intended systemic therapy for the treatment of locoregionally advanced HNSCC. 3. Patients with nasopharyngeal carcinoma (NPC). 4. Patients with known symptomatic CNS metastases or leptomeningeal disease requiring steroids. Patients with previously diagnosed brain metastases are eligible if they have completed their treatment and have recovered from the acute effects of radiation therapy or surgery prior to study entry, have discontinued corticosteroid treatment for these metastases and are clinically stable off anticonvulsants for at least 4 weeks and are neurologically stable before enrollment. 5. Has a history of (non-infectious) pneumonitis / interstitial lung disease that required steroids or has current pneumonitis / interstitial lung disease. 6. Prior radiotherapy within 2 weeks of start of study treatment. Note: Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (defined as ≤2 weeks of radiotherapy) to non-CNS disease. 7. Prior treatment with any anti-CD47 or anti-SIRPα agent. 8. Prior treatment with a PD-1 or PD-L1, or anti PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T cell receptor (e.g., CTLA-4, OX-40, CD137). 9. Has a diagnosis of immunodeficiency (with the exception of hypogammaglobulinemia) or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug. 10. Has an active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed. 11. History of autoimmune hemolytic anemia, autoimmune thrombocytopenia, or hemolytic transfusion reaction. 12. Patients with intolerance to or who have had a severe allergic or anaphylactic reaction to antibodies or infused therapeutic proteins or patients who have had a severe allergic or anaphylactic reaction to any of the substances included in the study drugs (including but not limited to excipients, which are listed in the ALX148 IB in Section 4.4 “Formulation of the Dosage Form to be Used”). 13. Any experimental antibodies or live vaccines in the last 30 days prior to the first dose of study drug. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster, yellow fever, rabies, Bacillus Calmette–Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed. 14. Patients with active, uncontrolled, clinically significant bacterial, fungal, or viral infection, including hepatitis B (HBV), hepatitis C (HCV), known infection with SARS-CoV-2, known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) related illness. 15. Has an active infection requiring systemic therapy. 16. Has had an allogeneic tissue/solid organ transplant. 17. Any of the following in the previous 6 months: myocardial infarction, unstable angina, coronary/peripheral artery bypass graft, NYHA Class II or greater congestive heart failure, cerebrovascular accident, or transient ischemic attack, deep venous thrombosis, arterial thrombosis, symptomatic pulmonary embolism, or any other significant thromboembolism. Any major surgery within 28 days prior to enrollment. 18. Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment. Note: Participants who have entered the follow-up phase of an investigational study may participate as long as it has been at least 4 weeks after the last dose of the previous investigational agent. 19. Diagnosis of any other malignancy within the last 3 years prior to enrollment except for adequately treated non-melanomatous skin cancer, or carcinoma in situ (e.g., breast carcinoma in situ, cervical cancer in situ, prostate carcinoma in situ) that have undergone potentially curative therapy. |
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E.5 End points |
E.5.1 | Primary end point(s) |
• 12-month overall survival (OS) rate of ALX148 plus pembrolizumab. • Objective response rate of ALX148 plus pembrolizumab (ORR; CR or PR using the Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary endpoint of the study is the objective response rate (ORR) at any time (ORR: CR or PR using the Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1 for solid tumors). The analysis population for the primary analysis will be the ITT population. An additional analysis will be done, using the evaluable population. |
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E.5.2 | Secondary end point(s) |
• Disease control rate (DCR), duration of response (DOR), time to tumor progression (TTP). • Progression-free survival (PFS), and overall survival (OS). • Adverse Events as characterized by type, frequency, severity (as graded by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v. 5.0), timing, seriousness, and relationship to study therapy. • Laboratory abnormalities as characterized by type, frequency, severity (as graded by NCI CTCAE v. 5.0) and timing. • Pharmacokinetic parameters of ALX148 such as Cmax, Tmax, AUC, CL, and t1/2 as data permit. • Immunogenicity; Human serum ADA (i.e., anti-ALX148 antibody) samples will be analyzed for the presence or absence of anti-ALX148 antibodies. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Secondary endpoints will be analyzed primarily in the ALX+pembrolizumab treatment arm. The comparisons with the pembrolizumab treatment arm will be performed as exploratory analyses. Adverse events, ECGs, blood pressure, pulse rate, cardiac monitoring, and safety laboratory data will be reviewed and summarized on an ongoing basis during the study to evaluate the safety of patients. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Tolerability; Immunogenicity |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 14 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Canada |
Korea, Republic of |
Singapore |
United States |
Netherlands |
Spain |
Belgium |
United Kingdom |
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E.8.7 | Trial 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
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EoT in a Member State of the EU is defined as the time at which it is deemed that sufficient patients have been recruited and completed the study as stated in the regulatory application and EC application in the Member State. Poor recruitment (recruiting less than the anticipated number in the CTA) by a Member State is not a reason for premature termination but is considered a normal conclusion to the study in that Member State. EoT in all participating countries is defined as LSLV. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 1 |
E.8.9.1 | In the Member State concerned days | 18 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 1 |
E.8.9.2 | In all countries concerned by the trial days | 18 |