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NeoplasmsPhase 1/2INTRUSTNCT03792724

Phase I-II Study of Intratumoral Urelumab Combined With Nivolumab in Patients With Solid Tumors

A Phase 1/2 study testing Urelumab + Nivolumab in people with Neoplasms, run by Clinica Universidad de Navarra, Universidad de Navarra at 2 sites in Spain.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Open label, phase I-II study to evaluate the safety and activity of intratumoral urelumab combined with systemic nivolumab in patients with advanced solid tumors. Serial tumor and blood samples will be obtained during the study to characterize the changes induced by treatment in the tumor microenvironment, as well as… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Neoplasms
What is being tested?
Urelumab + Nivolumab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
32 participants
Where
2 sitesSpain
Study dates
30 Jan 2019to 30 Jan 2023
Phase
Phase 1/2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Written informed consent.
  • Patients must be willing and able to comply with scheduled visits, treatment schedule, laboratory testing and other requirements of the study.
  • Patients must present the following tumor types:
  • For the phase I part, patients with any tumor type are eligible.
  • For the phase II part, two cohorts will be established:
  • Cohort A will include patients presenting tumor types with known sensitivity to Programmed cell death protein 1 (PD1)/ Programmed Death-ligand 1 (PDL1) blockade (e.g: melanoma, renal cancer, lung cancer, urothelial cancer, colorectal cancer presenting microsatellite instability (MSI), …). These patients must be naïve to PD1/PDL1 blockade.
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  • cohort B will include patients with PD1/PDL1 sensitive tumors that have progressed following previous PD1/PDL1 blockade (e.g: melanoma, NSCLC, renal cancer, bladder cancer ...). Additional treatments may be administered between prior PD1/PDL1 blockade and inclusion in the study, but if administered immediately before, a minimum wash-out period of four weeks must be observed between both treatments.
  • Patients must have received standard therapy, according to investigator´s criteria, or must be ineligible for standard therapy.
  • Patients must present at least one tumor lesion that is amenable to perform sequential intratumoral therapy and biopsies.
  • Measurable disease according to RECIST criteria. The measurable lesion(s) must be different than the lesion treated with intratumoral urelumab.
  • There is no limit on previous treatment lines, as long as the other inclusion criteria are met.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
  • Life expectancy >12 weeks.
  • Adequate organ function defined by:
  • Bone Marrow Reserve: white blood cells (WBC): >=2000/ mm3 absolute neutrophil count (ANC) >=1500x 109/L; platelet count >=100000/ mm3 100 x 109/L; hemoglobin >=9.0 g/dL).
  • Hepatic: bilirubin <1.5 times the upper limit of normality (ULN), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <3.0 x ULN (BR< 3 x ULN for patients with Gilbert´s Syndrome).
  • Renal: creatinine <1.5 x ULN or estimated creatinine clearance > 40 ml/min, using the Cokcroft-Gault formula.
  • Women of childbearing potential (WOCBP, i.e: fertile, following menarche and until becoming post-menopausal unless permanently sterile) must use a highly effective method to avoid pregnancy (i.e: combined estrogen and progestogen associated with inhibition of ovulation (oral, intravaginal or transdermal); progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable or implantable); intrauterine device; intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomised partner or sexual abstinence for 23 weeks (30 days plus the time required for nivolumab and urelumab to undergo five half-lives) after the last dose of investigational drug.
  • WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the start of treatment.
  • Men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 31 weeks after the last dose of investigational product. Women who are not of childbearing potential (ie, who are postmenopausal or surgically sterile as well as azoospermic men) do not require contraception.
  • Patients must be at least 18 years old.

Who cannot join

  • Any serious or uncontrolled medical disorder that, in the opinion of the investigator, may increase the risk associated with study participation or study drug administration, impair the ability of the subject to receive the planned therapy or interfere with the interpretation of study results. Special care should be taken with conditions affecting the liver.
  • Subjects with active, known or suspected autoimmune disease. Subjects with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
  • The treatment wash-out period for other previous therapies, including radiation therapy will be determined by the investigators, depending on resolution of associated toxicity. Limited-field palliative radiotherapy will not require a wash-out period. If PD1/PDL1 blockade is the previous therapy, a minimum wash-out period of four weeks must be observed between both treatments.
  • Patients should be excluded if they have a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
  • Active brain metastasis that may interfere with interpretation of results. Subjects with controlled metastasis will be allowed to enroll. Controlled brain metastases will be defined as no radiographic progression for at least 4 weeks following radiation and/or surgical treatment.
  • Pregnant or breastfeeding patients.
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  • Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS). Routine testing is not required.
  • Positive tests for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV RNA) indicating active or chronic infection. Subjects with positive hepatitis C antibody and negative quantitative hepatitis C by Polymerase chain reaction (PCR) are eligible. History of resolved hepatitis A virus infection is not an exclusion criteria.
  • History of allergy to study drug components or of severe hypersensitivity reactions to any monoclonal antibodies.
  • Prisoners or subjects who are involuntarily incarcerated or who are compulsorily detained for treatment of either a psychiatric or physical (eg, infectious disease) illness.
  • Concomitant or prior malignancy that, in the opinion of the investigator can interfere with the results of the study, in the opinion of the investigator.
  • Known drug or alcohol abuse.

Trial locations and contacts

2 sites in 1 country.

Jose L Perz Gracia, MD PhD contact

+34948255400

jlgracias@unav.es

Mercedes Egaña, MD PhD contact

Spain2 sites
  • Clinica Universidad de Navarra

    Madrid, 28022

    Eduardo Castañón, MD PhD

  • Clinica Universidad de Navarra

    Pamplona, Navarre, 31008

    Jose L Perez Gracia, MD PhD

Other trials in Spain

About this study

Open label, phase I-II study to evaluate the safety and activity of intratumoral urelumab combined with systemic nivolumab in patients with advanced solid tumors. Serial tumor and blood samples will be obtained during the study to characterize the changes induced by treatment in the tumor microenvironment, as well as predictive biomarkers of response.

Conditions
Neoplasms
Being tested
Urelumab + Nivolumab
Medical subject headings
Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Urelumab + NivolumabDrug

    Treatment with intratumoral urelumab after which Nivolumab will be given.

Study groups in NCT03792724
Study groupRoleWhat they receive
Cohort AExperimentalThree doses of intratumoral urelumab will be administered, every 4 weeks. after which Nivolumab will be given at a fixed dose of 240 mg for Cycle 2 and at a fixed dose of 480 mg every 4 weeks (Q4W) from Cycle 3 and beyond
Receives: Drug: Urelumab + Nivolumab
Cohort BExperimentalThree doses of intratumoral urelumab will be administered, every 4 weeks. after which Nivolumab will be given at a fixed dose of 240 mg for Cycle 2 and at a fixed dose of 480 mg Q4W from Cycle 3 and beyond
Receives: Drug: Urelumab + Nivolumab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of adverse events

    Number of adverse events

    Measured: 27 months

  2. Recommended dose of intratumoral urelumab

    mg of intratumoral urelumab

    Measured: 12 weeks

  3. Response rate

    Number of patients with partial response or complete response

    Measured: 27 months

Secondary outcomes (2)
  1. Overall survival (OS).

    Months until death

    Measured: 27 months

  2. Progression-free survival (PFS)

    Months until progression

    Measured: 27 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Jan 2019
  2. Study start30 Jan 2019 (estimated)
  3. Primary completion30 Jan 2023 (estimated)
  4. Study completion30 Jan 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1/2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
32 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03792724
Sponsor's protocol ID
INTRUST
Acronym
INTRUST
Status last verified
Nov 2018
First submitted
20 Dec 2018
Last updated
3 Jan 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Coley, W. B. Late results of the treatment of inoperable sarcoma by the mixed toxins of erysipelas and bacillus prodigiosus. Am J Med Sci. 131: 375-430, 1906

  • Coley WB. The Treatment of Inoperable Sarcoma by Bacterial Toxins (the Mixed Toxins of the Streptococcus erysipelas and the Bacillus prodigiosus). Proc R Soc Med. 1910;3(Surg Sect):1-48. doi: 10.1177/003591571000301601. No abstract available.

    PubMed 19974799
  • Han RF, Pan JG. Can intravesical bacillus Calmette-Guerin reduce recurrence in patients with superficial bladder cancer? A meta-analysis of randomized trials. Urology. 2006 Jun;67(6):1216-23. doi: 10.1016/j.urology.2005.12.014.

    PubMed 16765182
  • Janeway CA Jr. The immune system evolved to discriminate infectious nonself from noninfectious self. Immunol Today. 1992 Jan;13(1):11-6. doi: 10.1016/0167-5699(92)90198-G.

    PubMed 1739426
  • Matzinger P. Friendly and dangerous signals: is the tissue in control? Nat Immunol. 2007 Jan;8(1):11-3. doi: 10.1038/ni0107-11.

    PubMed 17179963
  • Hammerich L, Binder A, Brody JD. In situ vaccination: Cancer immunotherapy both personalized and off-the-shelf. Mol Oncol. 2015 Dec;9(10):1966-81. doi: 10.1016/j.molonc.2015.10.016. Epub 2015 Nov 10.

    PubMed 26632446
  • Marabelle A, Kohrt H, Caux C, Levy R. Intratumoral immunization: a new paradigm for cancer therapy. Clin Cancer Res. 2014 Apr 1;20(7):1747-56. doi: 10.1158/1078-0432.CCR-13-2116.

    PubMed 24691639
  • Kaminski JM, Shinohara E, Summers JB, Niermann KJ, Morimoto A, Brousal J. The controversial abscopal effect. Cancer Treat Rev. 2005 May;31(3):159-72. doi: 10.1016/j.ctrv.2005.03.004.

    PubMed 15923088
  • Steinman RM. Decisions about dendritic cells: past, present, and future. Annu Rev Immunol. 2012;30:1-22. doi: 10.1146/annurev-immunol-100311-102839. Epub 2011 Nov 17.

    PubMed 22136168
  • Joffre OP, Segura E, Savina A, Amigorena S. Cross-presentation by dendritic cells. Nat Rev Immunol. 2012 Jul 13;12(8):557-69. doi: 10.1038/nri3254.

    PubMed 22790179
  • Inaba K, Turley S, Yamaide F, Iyoda T, Mahnke K, Inaba M, Pack M, Subklewe M, Sauter B, Sheff D, Albert M, Bhardwaj N, Mellman I, Steinman RM. Efficient presentation of phagocytosed cellular fragments on the major histocompatibility complex class II products of dendritic cells. J Exp Med. 1998 Dec 7;188(11):2163-73. doi: 10.1084/jem.188.11.2163.

    PubMed 9841929
  • Broz ML, Binnewies M, Boldajipour B, Nelson AE, Pollack JL, Erle DJ, Barczak A, Rosenblum MD, Daud A, Barber DL, Amigorena S, Van't Veer LJ, Sperling AI, Wolf DM, Krummel MF. Dissecting the tumor myeloid compartment reveals rare activating antigen-presenting cells critical for T cell immunity. Cancer Cell. 2014 Nov 10;26(5):638-52. doi: 10.1016/j.ccell.2014.09.007. Epub 2014 Oct 16.

    PubMed 25446897
  • Hildner K, Edelson BT, Purtha WE, Diamond M, Matsushita H, Kohyama M, Calderon B, Schraml BU, Unanue ER, Diamond MS, Schreiber RD, Murphy TL, Murphy KM. Batf3 deficiency reveals a critical role for CD8alpha+ dendritic cells in cytotoxic T cell immunity. Science. 2008 Nov 14;322(5904):1097-100. doi: 10.1126/science.1164206.

    PubMed 19008445
  • Schraml BU, Reis e Sousa C. Defining dendritic cells. Curr Opin Immunol. 2015 Feb;32:13-20. doi: 10.1016/j.coi.2014.11.001. Epub 2014 Dec 3.

    PubMed 25553392
  • Poulin LF, Salio M, Griessinger E, Anjos-Afonso F, Craciun L, Chen JL, Keller AM, Joffre O, Zelenay S, Nye E, Le Moine A, Faure F, Donckier V, Sancho D, Cerundolo V, Bonnet D, Reis e Sousa C. Characterization of human DNGR-1+ BDCA3+ leukocytes as putative equivalents of mouse CD8alpha+ dendritic cells. J Exp Med. 2010 Jun 7;207(6):1261-71. doi: 10.1084/jem.20092618. Epub 2010 May 17.

    PubMed 20479117

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Urelumab + Nivolumab in people with Neoplasms, run by Clinica Universidad de Navarra, Universidad de Navarra at 2 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 21 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 3 Jan 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Jose L Perz Gracia, MD PhD (+34948255400, jlgracias@unav.es), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of adverse events (time frame: 27 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03792724, which also lists 142 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jan 2019.

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