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NCT06172478PHASE2Recruiting

A Study of HER3-DXd in Subjects With Locally Advanced or Metastatic Solid Tumors

Daiichi Sankyo

Start Date

2/26/2024

Completion Date

10/10/2028

Summary

This is a proof-of-concept study designed to investigate HER3-DXd monotherapy in locally advanced unresectable or metastatic solid tumors. The study is enrolling cohorts of participants with melanoma \[cutaneous/acral\], squamous cell carcinomas of the head and neck (SCCHN), HER2-negative gastric cancer ovarian carcinoma, cervical cancer, endometrial cancer, bladder cancer, esophageal carcinoma, pancreatic carcinoma, prostate cancer, second-line gastric cancer, lung cancer, and breast cancer.

Detailed Description

This study is designed to assess the safety and efficacy of HER3-DXd monotherapy in subjects with refractory locally advanced unresectable or metastatic solid tumors who have been previously treated with ≥1 prior line of systemic anticancer therapy. The primary objective of the study is to assess the efficacy of HER3-DXd monotherapy for each type of indicated locally advanced unresectable or metastatic tumor. Secondary objectives include the assessment of safety and tolerability, efficacy, and pharmacokinetics of HER3-DXd monotherapy for each type of indicated locally advanced unresectable or metastatic tumor. HER3 protein expression in tumor tissue and its relationship with HER3-DXd efficacy will also be evaluated.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria Participants must meet all of the following criteria to be eligible for enrollment into the study: 1. Sign and date the informed consent form prior to the start of any study-specific qualification procedures. A separate tissue screening consent will be obtained from all subjects to meet the baseline tumor tissue requirement. 2. Participants aged ≥18 years (follow local regulatory requirements if the legal age of consent for study participation is \>18 years old). 3. Has locally advanced unresectable or metastatic disease (not curable by surgery or radiation) as follows: Cutaneous (acral and non-acral) melanoma 1. Histologically or cytologically confirmed cutaneous (acral or non-acral) melanoma 2. Disease progression while on or after having received treatment with ≥1 prior line of anti-programmed cell death protein (PD-1) or anti-programmed death-ligand 1 (PD-L1) based therapy (previous use of other immune checkpoint inhibitors \[ICIs\] \[ie, anti-CTLA4, anti- LAG-3\] is acceptable). Prior anti-PD-(L)1 therapy in the adjuvant setting is allowed if there is recurrence within 12 weeks of the last dose. If the participant had BRAFm melanoma, they must have had disease progression on BRAF/MEK inhibitor therapy as well. Squamous cell carcinomas of the head and neck 3. Squamous cell carcinoma of the head and neck (with a primary location of oral cavity,oropharynx, larynx, hypopharynx) that is human papillomavirus (HPV) positive or negative (as determined by local standard). Excludes tumor location in the nasopharynx, nasal cavity, paranasal sinuses, and unknown primary locations. 4. Disease progression after having received treatment with ≥1 and \<3 prior lines of systemic therapy in the unresectable recurrent or metastatic setting. Must have had disease progression on anti-PD-(L)1 (either as monotherapy or in combination with chemotherapy or other therapies). Must also have had disease progression on a platinum-based chemotherapy (PBC) regimen either in the recurrent or metastatic setting or in the locally advanced setting with curative intent. Gastric or GEJ adenocarcinoma 5. Tumor tissue must be confirmed as negative for HER2 expression (immunohistochemistry \[IHC\] 0/1+ or IHC 2+/in situ hybridization negative) as classified by American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines and determined prior to enrollment by assessment in a local laboratory that is Clinical Laboratory Improvement Amendments certified (US sites) or accredited based on specific country regulations. 6. Disease progression after having received treatment with ≥2 prior lines of therapy that include PBC with or without anti-PD-1 therapy. Ovarian Carcinoma 7. Pathologically documented high-grade serous epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer. 8. Documented disease progression ≥4 weeks after the last dose of PBC and \<6 months of last dose of PBC in the advanced or metastatic setting. Prior use of folate reductase alpha targeting antibody-drug conjugate (ADC) (ie, mirvetuximab soravtansine) is allowed. Cervical Cancer 9. Pathologically or cytologically documented recurrent or persistent squamous, adenosquamous, or adenocarcinoma of the uterine cervix. 10. Disease progression after having received ≥1 line of systemic therapy in the recurrent or metastatic setting. This may include prior anti-PD-(L)1 treatment and/or tissue factor directed ADC (tisotumab vedotin \[TV\]) per regional standard of care. Endometrial Cancer 11. Pathologically or cytologically documented endometrial cancer (carcinoma of any histological sub-type or endometrial carcinosarcoma), irrespective of microsatellite instability (MSI) or mismatch repair (MMR) status. 12. Documented disease progression after having received ≥1 prior line of therapy (maximum of 3) PBC containing systemic treatment and an anti-PD(L)-1 therapy-containing regimen (combined or sequential) in the advanced/metastatic setting. Bladder Cancer 13. Pathologically or cytologically documented locally advanced/unresectable or metastatic urothelial carcinoma of the bladder, renal pelvis, ureter, or urethra. Histological variants are allowed if urothelial histology is predominant. Small cell/neuroendocrine tumors are not allowed even if mixed histology. 14. Relapsed or progressed after treatment with ≥1 prior line of therapy (maximum of 3) that contains anti-PD-(L)1 therapy in the perioperative or metastatic setting. At least 1 line of therapy must also contain one of the following treatment modalities: chemotherapy or enfortumab vedotin. Prior fibroblast growth factor receptor (FGFR)-inhibitor treatment for those who are eligible are allowed. * Required treatments can be given in combination or sequentially * Prior cisplatin-based therapy or PD-(L)1 inhibitor therapy given for the treatment of muscle invasive urothelial carcinoma is counted as 1 line of therapy * The same regimen administered twice in different disease settings will be counted as 1 line of prior therapy * Participants in the second-line setting who have previously received enfortumab vedotin and pembrolizumab in combination can be enrolled. Esophageal Carcinoma 15. Pathologically or cytologically documented esophageal squamous cell carcinoma. 16. Must have documented disease progression after having received 2 prior lines of therapy including previous PBC with or without an anti-PD-1 therapy-containing regimen (combined or sequential) in the advanced/metastatic setting. Pancreatic Carcinoma 17. Pathologically or cytologically documented unresectable or metastatic pancreatic adenocarcinoma. 18. Relapsed or disease progression after having received 1 prior line of systemic therapy in the locally advanced/metastatic setting. Prostate Cancer 19. Pathologically or cytologically documented unresectable locally advanced or metastatic castration-resistant prostate cancer (CRPC). 20. Adenocarcinoma of the prostate without neuroendocrine differentiation or small cell histology. 21. Surgically or medically castrated, with testosterone levels of \<50 ng/dL. 22. Documented objective progression as determined by radiographic progression for subjects with measurable disease after androgen deprivation. 23. Relapsed or disease progression after having received treatment with ≥1 of the following novel hormonal agents: abiraterone, enzalutamide, apalutamide, or darolutamide. 24. Relapsed or disease progression after having received ≥1 cytotoxic chemotherapy regimen that included a taxane. Gastric Cancer 2L 25. Must have had gastric or GEJ adenocarcinoma confirmed as negative for HER2 expression (IHC 0/1+ or IHC 2+/in situ hybridization negative) as classified by American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines and determined prior to enrollment by assessment in a local laboratory that is Clinical Laboratory Improvement Amendments certified (US sites) or accredited based on specific country regulations. 26. Disease progression after having received treatment with only 1 prior line of systemic anti-cancer therapy that includes 5-FU-based chemotherapy with or without an anti-PD-1 therapy. For subjects whose tumors are claudin (CLDN) 18.2 positive, treatment with 5-FU based chemotherapy with CLDN18.2 directed therapy in the first-line setting is allowed. Non-small Cell Lung Cancer aa. Histologically or cytologically documented metastatic or locally advanced nonsquamous NSCLC not amenable to curative surgery or radiation bb. Documentation of absence of actionable driver mutation (ie, ALK rearrangement, BRAF V600E mutation, EGFR-activating mutations \[exon 19 deletion or L858R mutation\], EGFR exon 20 insertion mutation, HER2 mutation, KRAS G12C mutation, MET exon 14 skipping mutation, NTRK 1/2/3 gene fusion, RET rearrangement, or ROS1 rearrangement). New testing for these genomic alterations is not required for Screening. cc. Relapsed or disease progression after receiving only anti-PD-(L)1 and PBC (ie, platinum doublet) administered in combination or sequentially for metastatic disease. Breast Cancer dd. Pathologically documented breast cancer that is assessed as HER2 negative (IHC2+/ISH-, IHC1+, or IHC0 per ASCO/CAP guidelines), and HR positive (either ER and/or PgR positive \[ER or PgR ≥1%\] per ASCO/CAP guidelines). The HER2 and HR results must be from a tumor sample obtained in the metastatic setting. ee. Participant must have received one line of chemotherapy for mBC, but not more than one line and must have a clinically or radiologically documented evidence of tumor progression on or after CDK 4/6 inhibitor combined with endocrine therapy; previous treatments with phosphoinositide 3-kinase (PI3K) inhibitors, mammalian target of rapamycin (mTOR) inhibitors, protein kinase B (PKB) inhibitors also known as AKT-inhibitors and poly ADP ribose polymerase (PARP)-inhibitors are allowed. 4. Has ≥1 measurable lesion on CT or MRI as per RECIST v1.1 by investigator assessment. Prostate cancer participants with bone only disease may be eligible. 5. Provides a pretreatment tumor tissue sample that meets 1 of the following collection requirements: 1. Tumor biopsy from ≥1 lesion not previously irradiated and performed since progression with the most recent systemic cancer therapy regimen and prior to signature of the tissue ICF (ARCHIVAL PRETREATMENT sample). OR 2. Newly obtained pretreatment tumor biopsy from ≥1 lesion not previously irradiated and amenable to sampling, after signature of tissue ICF (FRESH PRETREATMENT sample) 6. Has Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1 at screening. Exclusion Criteria Participants who meet any of the following criteria will be disqualified from entering the study: 1. Has HER2-positive gastric cancer as classified by ASCO-CAP guidelines and determined prior to enrollment by assessment in a local laboratory that is Clinical Laboratory Improvement Amendments certified (US sites) or accredited based on specific country regulations. 2. Has nasopharyngeal cancer. 3. Has mucosal or uveal melanoma. 4. Has a history of (non-infectious) interstitial lung disease (ILD), that required corticosteroids, has current ILD/pneumonitis, or suspected ILD/pneumonitis cannot be ruled out by imaging at screening. 5. Has clinically severe respiratory compromise (based on the investigator's assessment) resulting from intercurrent pulmonary illnesses 6. Is receiving chronic systemic corticosteroids dosed at \>10 mg prednisone daily or equivalent anti-inflammatory activity or any form of immunosuppressive therapy prior to Cycle 1 Day 1. Participants who require use of bronchodilators, inhaled or topical steroids, or local steroid injections may be included in the study. 7. Had prior treatment with an anti-HER3 antibody and/or antibody-drug conjugate (ADC) that consists of an exatecan derivative that is a topoisomerase I inhibitor (eg, trastuzumab deruxtecan). 8. Has history of other active malignancy within 3 years prior to Cycle 1 Day 1, except the following: 1. Adequately treated nonmelanoma skin cancer 2. Adequately treated intraepithelial carcinoma of the cervix 3. Any other curatively treated in situ disease 9. Has any evidence of severe or uncontrolled diseases (eg, active bleeding diatheses, active serious infection) psychiatric illness/social situations, geographical factors, substance abuse, or other factors that, in the investigator's opinion, make it high risk for the subject to participate in the study or that would jeopardize compliance with the protocol 10. Has previously received topoisomerase-1 inhibitors (e.g., irinotecan) treatment in the advanced or metastatic disease setting.

Interventions

DRUG

HER3-DXd

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Conditions

Advanced Solid TumorMelanomaHead and Neck CancerGastric CancerOvarian CarcinomaCervical CancerEndometrial CancerBladder CancerEsophageal CancerPancreatic CarcinomaProstate CancerNon-small Cell Lung Cancer (NSCLC)Lung CancerBreast Cancer

Locations

City of Hope

Duarte, California 91010

United States

Yale Cancer Center

New Haven, Connecticut 06510

United States

AdventHealth Medical Group Oncology Research at Celebration

Kissimmee, Florida 34747

United States

University of Illinois Cancer Center

Chicago, Illinois 60612

United States

Johns Hopkins University

Baltimore, Maryland 21205

United States

Health Partners Frauenshuh Cancer Center

Saint Louis Park, Minnesota 55426

United States

Health Partners Cancer Center at Regions Hospital

Saint Paul, Minnesota 55101

United States

Washington University, School of Medicine

St Louis, Missouri 63110

United States

Roswell Park Cancer Institute IDS

Buffalo, New York 14203

United States

Memorial Sloan Kettering Hospital

New York, New York 10065

United States

SCRI Oncology Partners

Nashville, Tennessee 37203

United States

The University of Texas MD Anderson Cancer Center

Houston, Texas 77030

United States

Fred Hutchinson Cancer Center

Seattle, Washington 98109

United States

Chris O'Brien Lifehouse

Camperdown, 2050

Australia

Icon Cancer Centre Chermside

Chermside, 4032

Australia

Monash Medical Centre Clayton

Clayton, 3168

Australia

Icon Cancer Centre Hobart

Hobart, 7000

Australia

Icon Cancer Centre Townsville

Hyde Park, 4812

Australia

Cliniques Universitaires Saint-Luc

Brussels,

Belgium

UZA

Edegem, 2650

Belgium

Universitair Ziekenhuis Gent

Ghent, 9000

Belgium

Universitair Ziekenhuis Brussel

Jette,

Belgium

UZ Leuven

Leuven, 3000

Belgium

Cross Cancer Institute

Edmonton, Alberta T6G 1Z2

Canada

Sunnybrook Research Institute

Toronto, M4N 3M5

Canada

Princess Margaret Cancer Centre

Toronto, M5G2M9

Canada

BC Cancer - Vancouver

Vancouver, V5Z4E6

Canada

West China Hospital, Sichuan University

Chengdu, 610098

China

Sun Yat-sen University Cancer Center

Guangzhou, 510060

China

Chu Bordeaux

Bordeaux, 33000

France

Centre Georges Franăois Leclerc

Dijon, 21079

France

Hopital Claude Huriez - Chu Lille

Lille, 59000

France

Centre Léon Bérard

Lyon, 69008

France

Hăpital de La Timone

Marseille, 13005

France

Chu Nantes - Hătel Dieu

Nantes, 44093

France

Institut Claudius Regaud

Toulouse, 31100

France

ICL - Alexis Vautrin

Vandœuvre-lès-Nancy, 54500

France

Institut Gustave Roussy

Villejuif, 94805

France

Krankenhaus Nordwest GmbH

Frankfurt, 60488

Germany

Bacs-Kiskun Varmegyei Oktatokorhaz

Kecskemét, 6000

Hungary

Humanitas Gavazzeni

Bergamo, 24125

Italy

IRCCS Ospedale Policlinico San Martino

Genova, 16132

Italy

AOU Federico II - Oncologia Clinica

Naples, 80131

Italy

Centro Ricerche Cliniche di Verona s.r.l.

Verona, 37134

Italy

Saitama Medical University International Medical Center

Hidaka, 350-1298

Japan

National Cancer Center Hospital East

Kashiwa-shi, 277-8577

Japan

NHO Shikoku Cancer Center

Matsuyama, 791-0245

Japan

Shizuoka Cancer Center

Nagaizumi-cho, 411-8777

Japan

Aichi Cancer Center Hospital

Nagoya, 464-8681

Japan

Kindai University Hospital

Osakasayama-shi, 589-8511

Japan

National Cancer Center Hospital

Tokyo, 104-0045

Japan

Cancer Institute Hospital of JFCR

Tokyo, 135-8550

Japan

Yokohama City University Medical Center

Yokohama, 232-0024

Japan

Amsterdam UMC locatie Vumc

Amsterdam, 1081 HV

Netherlands

Universitair Medisch Centrum Groningen

Groningen, 9713 GZ

Netherlands

Leids Universitair Medisch Centrum

Leiden, 2333 ZG

Netherlands

Maastricht University Medical Center

Maastricht, 6229 HX

Netherlands

Radboud University Medical Center

Nijmegen, 6525 GA

Netherlands

Akershus universitetssykehus

Lørenskog, 1478

Norway

Haukeland universitetssjukehus

Lørenskog, 1478

Norway

Oslo Universitetssykehus HF, Radiumhospitalet

Oslo, 0379

Norway

Cha Bundang Medical Center, Cha University

Seongnam, 13496

South Korea

Seoul National University Bundang Hospital

Seongnam, 13620

South Korea

Seoul National University Hospital

Seoul, 03080

South Korea

Severance Hospital, Yonsei University Health System

Seoul, 03722

South Korea

Asan Medical Center

Seoul, 05505

South Korea

Samsung Medical Center

Seoul, 06351

South Korea

Hospital Universitari Vall D'Hebron

Barcelona, 08035

Spain

Hospital Clinic de Barcelona

Barcelona, 08036

Spain

Hospital de La Santa Creu I Sant Pau

Barcelona, 08041

Spain

Hospital General Universitario Gregorio Marañon

Madrid, 28009

Spain

Hospital Universitario Ramon Y Cajal

Madrid, 28034

Spain

Hospital Universitario 12 de Octubre

Madrid, 28041

Spain

HOSPITAL REGIONAL UNIVERSITARIO de MALAGA AVDA.

Málaga, 29010

Spain

Hospital Universitario Virgen Macarena

Seville, 41009

Spain

Hospital Clinico Universitario de Valencia

Valencia, 46010

Spain

Kaohsiung Chang Gung Memorial Hospital

Kaohsiung City, 833

Taiwan

National Cheng Kung University Hospital

Tainan, 704

Taiwan

National Taiwan University Hospital

Taipei, 100225

Taiwan

Taipei Veterans General Hospital

Taipei, 11217

Taiwan

Chang Gung Memorial Hospital

Taoyuan, 333

Taiwan

University Hospital Coventry

Coventry, CV2 2DX

United Kingdom

Barts Hospital

London, EC1A 7BE

United Kingdom

Royal Free Hospital

London, NW3 2QG

United Kingdom

Nottingham City Hospital Campus

Nottingham, NG5 1PB

United Kingdom